bluuebunny/crossref_metadata_2025_split huggingface dataset:
Four Fishermen, Orson Welles, and the Making of the Brazilian Northeast*
Authors: Campbell Courtney J 
Published: November 2016

Abstract
In 1942 Orson Welles traveled to Brazil to film a movie about four Brazilian fishermen who had protested their labor conditions by traveling nearly 2,500 kilometers for sixty-one days from the city of Fortaleza to Rio de Janeiro on a rustic sail-raft called a jangada. Their voyage pressured Brazil’s so-called New State (Estado Novo) to recognize the fishermen’s trade as an official profession within the state’s expanding social programs and centralized labor laws. Through an analysis of the fishermen, their voyage, Orson Welles’ visit, and Brazil’s Northeast, this article examines the role of the region in both imagining and moving beyond the nation in the twentieth century. It presents press accounts, intellectual essays, music, images, film, and the Diï¿½rio dos jangadeiros – a scrapbook of sorts in which supporters from all social classes left messages for the fishermen at each port. While structurally, the fishermen’s protest pulled the most rustic element of this newly defined region into the modern legal apparatus of a centralized state, symbolically, the fishermen’s journey generated an archetypal figure that provided a way to talk about the Northeast in terms of its rusticity, developing both racialized and folkloric characteristics of its people and uniting the semi-arid backlands and the humid, tropical coast. The fishermen of the Northeast were transformed from brave labor organizers into non-threatening folkloric figures through a process of memory, narration, and forgetting. Examining the fishermen’s story as a regionally-defining moment that transcended national boundaries provides a significant case study of how, by the mid-twentieth century, the nation came to be understood as a series of interrelated regions, with one region serving as both national scapegoat and root of authentic culture.
Spinal Cord Stimulation for Refractory Angina Pectoris
Authors: Pan Xiaoxiao , Bao Hongguang , Si Yanna , Xu Chenjie , Chen Hao , Gao Xianzhong , Xie Xinyi , Xu Yajie , Sun Fan , Zeng Lingqing 
Published: November 2016

Objectives:
Paresthesia-free stimulation such as high frequency and burst have been demonstrated as effective therapies for neuropathic pain. The aim of this meta-analysis was to evaluate the efficacy and safety of conventional spinal cord stimulation (SCS) in the treatment of refractory angina pectoris (RAP).

Materials and Methods:
Relevant randomized controlled trials that investigated SCS for patients with RAP were comprehensively searched in Medline, Pubmed, Embase, and Cochrane Library. Five meta-analyses were performed examining the changes in Canadian Cardiovascular Society classes, exercise time, Visual Analog Scale (VAS) scores of pain, Seattle Angina Questionnaire, and nitroglycerin use in RAP patients after SCS therapy. We analyzed standardized mean differences (MD) and 95% confidence intervals (CIs) for each outcome by Review Manager 5.0 and STATA 12.0.

Results:
A total of 12 randomized controlled trials involving 476 RAP patients were identified. A trend of reduction in the angina frequency (MD=−9.03, 95% CI, −15.70 to −2.36) and nitroglycerin consumption (MD=−0.64, 95% CI, −0.84 to −0.45) could be observed in the SCS group. Compared with the control group, SCS showed benefit on increasing exercise time (MD=0.49, 95% CI, 0.13-0.85) and treatment satisfaction (MD=6.87, 95% CI, 2.07-11.66) with decreased VAS scores of pain (MD=−0.50, 95% CI, −0.81 to −0.20) and disease perception (MD=−8.34, 95% CI, −14.45 to −2.23). However, the result did not reach the significance level in terms of physical limitation (95% CI, −8.75 to 3.38; P=0.39) or angina stability (95% CI, −7.55 to 3.67; P=0.50).

Discussion:
The current meta-analysis suggested that SCS was a potential alternative in the treatment of PAP patients. Further investigation for finding the appropriate intensity of stimulation is required before this treatment should be widely recommended and applied.
Pathogenesis and immunotherapy in cutaneous psoriasis: what can rheumatologists learn?
Authors: Alexander Helen , Nestle Frank O. 
Published: November 2016

Purpose of reviewThis review presents our current understanding of the pathogenesis and treatment of psoriasis with a particular focus on recent areas of research and emerging concepts.Recent findingsPsoriasis arises in genetically predisposed individuals who have an abnormal innate and adaptive immune response to environmental factors. Recent studies have identified novel genetic, epigenetic and immunological factors that play a role in the disease pathogenesis. There is emerging evidence for the role of the skin microbiome in psoriasis. Studies have shown reduced diversity and altered composition of the skin microbiota in psoriasis.SummaryRecent advances in our understanding of the complex immunopathogenesis of psoriasis have led to the identification of crucial cytokines and cell signalling pathways that are targeted by a range of immunotherapies.
Bundled Payments for Care Improvement: Lessons Learned in the First Year
Authors: Althausen Peter L. , Mead Lisa 
Published: November 2016

Summary:
The Bundled Payments for Care Improvement (BPCI) initiative is the latest cost-saving program developed by the Center for Medicare and Medicaid Innovation. This model is intended to create a system for higher quality and more coordinated care at a lower cost to Medicare. It is currently an optional program for physician groups, hospitals and post-acute care providers to benefit financially from improved care models and cost containment measures. Under the initiative, organizations enter into payment arrangements that include financial and performance accountability for episodes of care. Under this initiative, there are certain fraud and abuse waivers in place that allow gainsharing among BPCI organizations and approved providers so long as certain requirements are met. Our practice entered this initiative for total joint arthroplasty episodes of care as well as the hip and femur fracture episode of care. The first year experience demonstrated that a significant learning curve is required. Keys for success include appropriate patient selection for elective surgery, implant pricing control, adherence to preoperative and postoperative protocols, diligent postcare care management, and appropriate choice of metrics to maximize gainsharing potential. Ultimately, the BPCI program has been a successful venture, saving our hospitals over $1.6 million in 2015. In the process, this provided an additional revenue stream for our physicians while decreasing the overall cost of care.
Comanagement and Gainsharing Opportunities for Independent Physicians
Authors: McBride Chris , Althausen Peter L. 
Published: November 2016

Summary:
Gainsharing and comanagament programs are both successful means of achieving physician buy-in for all cost containment programs in Orthopaedic Trauma. Under comanagement agreements, physicians are reimbursed for their time and intellectual efforts in program and algorithm creation. The cost is minimal for the hospital in return for the millions of dollars in savings they achieve. Gainsharing models can incentivize physicians to quickly adopt cost-effective implant choices, care plans, and program development. Hospital systems keep the majority of the profits, patients, and insurance carriers benefit from the cost savings and physicians receive remuneration for their efforts. Careful attention must be paid to the legal issues surrounding the Federal Anti-Kickback Statute, the Civil Monetary Penalty Law, and the Physician Self-Referral Law when setting up these agreements. The keys to success for these programs are the presence of a physician champion, economic transparency for both physicians and hospitals, accurate data collection, and adequate economic incentive for physicians to drive change in practice patterns.
Surgeon Attitudes Regarding the Use of Generic Implants: An OTA Survey Study
Authors: Walker Justin A. , Althausen Peter L. 
Published: November 2016

Objectives:
To determine the role of generic orthopaedic trauma implants in the current orthopaedic trauma market, as perceived by OTA members, and investigate potential hurdles to the use of generic implants and other cost-containment measures.

Design:
Survey study.

Setting:
Not applicable.

Participants:
All active OTA members with valid e-mail addresses were invited to participate.

Intervention:
Participants completed a brief online survey with questions regarding participation in cost-containment and incentive programs, industry relationships, generic implant use, and the role of surgeons in cost containment.

Main Outcome Measures:
Survey data.

Results:
Participation in cost-containment programs (comanagement agreements, bundled payment for care improvement, and gainsharing) was found to be very low among participants (17%, 36.5%, 17%, respectively). Industry sales representatives were present in a majority of participants' cases (76.9%) the majority of time, but relatively a few surgeons (21.2%) felt their presence was necessary. Most surgeons were aware of the availability of generic implants (72.6%), but a few had adopted the use of such implants (25.5%), despite 50/52 (96.2%) prescribing generic drugs and 45/52 (86.5%) using generic products in their own households.

Conclusions:
Most participants agreed that generic orthopaedic implants have a role in cost containment, but a few have adopted these implants. The presence of sales representatives does not seem to be necessary for most surgeons, and minimizing or eliminating their presence may result in substantial savings for health care institutions. Increased education and the use of financial incentive programs may encourage improved surgeon participation in cost containment and adoption of generic implants and may help reduce health care spending.

Level of Evidence:
Level 4. See Instructions for Authors for a complete description of levels of evidence.
The multifaceted roles of inflammasome proteins in cancer
Authors: Petrilli Virginie 
Published: November 2016

Purpose of review
Inflammasomes are major actors of the innate immune system, through their regulation of inflammatory caspases and maturation of IL-1β and IL-18. These multiprotein complexes have been shown to play major roles in inflammatory and metabolic diseases and have more recently been implicated in tumor development and dissemination. In this review, we address these recent findings, focusing particularly on colorectal cancer (CRC) initiation and tumor dissemination.

Recent findings
Based mostly on loss-of-function experiments in mouse models, paradoxical results were obtained as both protumoral and antitumoral activities were reported. Moreover, several studies report major inflammasome-independent functions for some of these innate receptor proteins such as absent in melanoma 2, nod-like receptor family pyrin containing 3 (NLRP3) or nod-like receptor family CARD containing 4 (NLRC4), functions exerted in epithelial cells as well as in immune cells.

Summary
The current review summarizes recent findings on the implication of inflammasomes and of absent in melanoma 2, NLRC4 and NLRP3 inflammasome-independent functions in cancer development and dissemination. Although contradictory in certain aspects, these studies highlight a lack of understanding of their mechanistic functions and regulations in cancer and the need for further investigations.
Prevalence of Multifocal Primary Hyperhidrosis and Symptom Severity Over Time: Results of a Targeted Survey
Authors: Glaser Dee Anna , Ballard Angela M. , Hunt Niquette L. , Pieretti Lisa J. , Pariser David M. 
Published: November 2016

BACKGROUND
There is a paucity of data on the prevalence of multifocal primary hyperhidrosis and changes in hyperhidrosis severity over time.

OBJECTIVE
The goal of this study was to better understand multifocal primary hyperhidrosis, prevalence and distribution of hyperhidrosis by focal site, age of onset of symptoms by focal area, and change in hyperhidrosis severity over time and with seasons.

MATERIALS AND METHODS
The International Hyperhidrosis Society, through an unrestricted research grant from Revance Therapeutics, conducted an online survey of registered visitors to its Web site. Participants identified as having “excessive sweating” and opted to participate in the survey (23 questions) after an e-mail invitation.

RESULTS
The survey data illustrate that multifocal primary hyperhidrosis is more common than previously believed and that multifocal hyperhidrosis is more common than singular focal hyperhidrosis (81% of patients reported 3 or more focal hyperhidrotic sites). The data also show that sweating symptom severity does not improve with age but stays the same or gets worse and is “bothersome” throughout the year.

CONCLUSION
Recognition of the chronic and multifocal nature of primary hyperhidrosis is useful for treating hyperhidrosis patients long term and illustrates a need for treatments or treatment combinations that are effective for multiple body areas.
Effects of Linagliptin on Vessel Wall Healing in the Rat Model of Arterial Injury Under Normal and Diabetic Conditions
Authors: Eriksson Linnea , Röhl Samuel , Saxelin Robert , Lengquist Mariette , Kronqvist Malin , Caidahl Kenneth , Östenson Claes-Göran , Razuvaev Anton 
Published: November 2016

Abstract:
Diabetic patients suffer an increased risk of restenosis and late stent thrombosis after angioplasty, complications which are related to a defective reendothelialization. Dipeptidyl peptidase-4 inhibitors have been suggested to exert a direct effect on endothelial and smooth muscle cells (SMCs). Therefore, the objective was to study if the dipeptidyl peptidase-4 inhibitor linagliptin could influence vascular repair and accelerate reendothelialization after arterial injury in healthy and diabetic animals. Diabetic Goto-Kakizaki and healthy Wistar rats were subjected to arterial injury and treated with linagliptin or vehicle. Vessel wall healing was monitored noninvasively using ultrasound, and on sacrifice, with Evans blue staining and immunohistochemistry. The effect of linagliptin on SMCs was also studied in vitro. We found that linagliptin reduced the proliferation and dedifferentiation of SMCs in vitro, and modulated the inflammatory response in the SMCs after arterial injury in vivo. However, these effects of linagliptin did not affect the neointima formation or the reendothelialization under normal and diabetic conditions. Although linagliptin did not influence vessel wall healing, it seems to possess a desirable antiproliferative influence on SMCs in vitro and an antiinflammatory effect in vivo. These pharmacological properties might carry a potential significance for favorable outcome after vascular interventions in diabetic patients.
Is vulvovaginal atrophy due to a lack of both estrogens and androgens?
Authors: Labrie Fernand , Martel Céline , Pelletier Georges 
Published: November 2016

AbstractObjective:The aim of this study was to review the preclinical data showing the role of both estrogens and androgens in the physiology of the vagina, and, most likely, in vulvovaginal atrophy of menopause.Methods:Mass spectrometry-based assays (validated according to the FDA guidelines) for the measurement of sex steroids, their precursors, and metabolites were used. In addition to fixation of the vagina for morphological examination, histomorphometry, immunocytochemistry, immunofluorescence, and quantitative reverse transcription polymerase chain reaction were performed.Results:The vaginal epithelium of the animals receiving dehydroepiandrosterone (DHEA) was made of large multilayered columnar mucous cells showing distended cytoplasmic vacuoles representative of an androgenic effect. DHEA also stimulates collagen fiber compactness of the lamina propria (second layer)—an effect essentially due to an androgenic effect, whereas stimulation by DHEA of the muscularis in the third vaginal layer is approximately 70% due to the androgenic conversion of DHEA. Stimulation of the surface area of the nerve endings, on the contrary, is exclusively androgenic. Vaginal weight stimulation by DHEA is about 50% androgenic and 50% estrogenic.Conclusions:Practically all studies on the influence of steroid hormones in the vagina have focused on luminal epithelial cells. Since all estrogens and androgens in postmenopausal women are made intracellularly and derive from the conversion of circulating DHEA, it is of interest to observe from these preclinical data that DHEA exerts both estrogenic and androgenic activity in the three layers of the vagina, the stimulatory effect on nerve density being 100% androgenic. Taking vaginal weight as a global parameter, the stimulatory effect of DHEA in the rat vagina is about equally estrogenic and androgenic, thus illustrating the importance of androgens in vaginal morphology and function, and the likely importance of androgens in vulvovaginal atrophy of menopause.
Comparative effectiveness of electro-acupuncture versus gabapentin for sleep disturbances in breast cancer survivors with hot flashes: a randomized trial
Authors: Garland Sheila N. , Xie Sharon X. , Li Qing , Seluzicki Christina , Basal Coby , Mao Jun J. 
Published: November 2016

Abstract

Objective:
Sleep disturbance is a major consequence of hot flashes among breast cancer survivors. This study evaluated the effects of electro-acupuncture (EA) versus gabapentin (GP) for sleep disturbances among breast cancer survivors experiencing daily hot flashes.

Methods:
We analyzed data from a randomized controlled trial involving 58 breast cancer survivors experiencing bothersome hot flashes at least two times per day. Participants were randomly assigned to receive 8 weeks of EA or daily GP (total dose of 900 mg/d). The primary outcome was change in the total Pittsburgh Sleep Quality Index (PSQI) score between groups at week 8. Secondary outcomes include specific PSQI domains.

Results:
By the end of treatment at week 8, the mean reduction in PSQI total score was significantly greater in the EA group than the GP group (−2.6 vs −0.8, P = 0.044). The EA also had improved sleep latency (−0.5 vs 0.1, P = 0.041) and sleep efficiency (−0.6 vs 0.0, P = 0.05) compared with the GP group. By week 8, the EA group had improved sleep duration, less sleep disturbance, shorter sleep latency, decreased daytime dysfunction, improved sleep efficiency, and better sleep quality (P < 0.05 for all) compared with baseline, whereas the GP group improved in duration and sleep quality only (P < 0.05).

Conclusions:
Among women experiencing hot flashes, the effects of EA are comparable with GP for improving sleep quality, specifically in the areas of sleep latency and efficiency. Larger randomized controlled trials with longer follow-ups are needed to confirm this preliminary finding.
Complication Rates With Human Acellular Dermal Matrices: Retrospective Review of 211 Consecutive Breast Reconstructions
Authors: Schnarrs Robert H. , Carman Claire M. , Tobin Chase , Chase Serena A. , Rossmeier Kerri A. 
Published: November 2016

Background:
Human acellular dermal matrix (HADM) is commonly used to provide coverage and support for breast reconstruction. The primary purpose of this study was to evaluate the complication rates associated with breast reconstruction procedures when performed in conjunction with multiple types of HADM in a consecutive series.

Methods:
After receiving institutional review board approval, medical records from a single surgeon were retrospectively reviewed for 126 consecutive patients (170 breasts and 211 procedures) who received a breast reconstruction or revision with implantation of HADM between 2012 and 2014. Patient demographics, surgical technique, and the complication profile of 4 major types of HADM were evaluated by procedure. Complication data were primarily evaluated for infection, seroma formation, necrosis, and other complications requiring additional surgery.

Results:
The total complication rate was 19.4%. The complication rates were not statistically different between all 4 types of HADM: Alloderm (n = 143); Alloderm RTU (n = 19); FlexHD (n = 18); hMatrix (n = 32) (P > 0.05). Smokers and large-breasted women (≥500 g) had a significantly higher complication rate than the rest of the population (P < 0.01 and P < 0.03, respectively). The complication rates associated with all other patient cohorts analyzed (age, body mass index, comorbid conditions, cancer diagnosis, prepectoral technique) showed no influence on complication rates (P > 0.05).

Conclusions:
In characteristically similar cohorts, there was no statistically significant difference in complication rates based on type of HADM; however, certain risk factors and anatomy should be considered before HADM-assisted breast reconstruction.
Epidermal Graft Accelerates the Healing of Acute Wound: A Self-controlled Case Report
Authors: Bystrzonowski Nicola , Hachach-Haram Nadine , Kanapathy Muholan , Richards Toby , Mosahebi Afshin 
Published: November 2016

Summary:
Wound care represents a significant socioeconomic burden, with over half of chronic wounds taking up to a year to heal. Measures to accelerate wound healing are beneficial to patients and also reduce the cost and burden of wound management. Epidermal grafting (EG) is an emerging option for autologous skin grafting in the outpatient setting to improve wound healing. Although several case series have previously reported good clinical outcome with EG, the healing rate in comparison to conservative wound management is not known. In this report, we compare the weekly healing rate of 2 separate wounds in the same patient, one treated with EG and the other with dressings. The treated wound showed accelerated healing, with the healing rate being the highest at the first 2 weeks after EG. The average healing time of the treated wound was 40% faster compared with the control wound. EG accelerates healing of acute wounds, potentially reducing the healthcare cost and surgical burden.
New-onset depression following stable, slow, and rapid rate of prescription opioid dose escalation
Authors: Salas Joanne , Scherrer Jeffrey F. , Schneider Frank David , Sullivan Mark D. , Bucholz Kathleen K. , Burroughs Thomas , Copeland Laurel A. , Ahmedani Brian K. , Lustman Patrick J. 
Published: November 2016

Abstract
Recent studies suggest that longer durations of opioid use, independent of maximum morphine equivalent dose (MED) achieved, is associated with increased risk of new-onset depression (NOD). Conversely, other studies, not accounting for duration, found that higher MED increased probability of depressive symptoms. To determine whether rate of MED increase is associated with NOD, a retrospective cohort analysis of Veterans Health Administration data (2000-2012) was conducted. Eligible patients were new, chronic (>90 days) opioid users, aged 18 to 80, and without depression diagnoses for 2 years before start of follow-up (n = 7051). Mixed regression models of MED across follow-up defined 4 rate of dose change categories: stable, decrease, slow increase, and rapid increase. Cox proportional hazard models assessed the relationship of rate of dose change and NOD, controlling for pain, duration of use, maximum MED, and other confounders using inverse probability of treatment-weighted propensity scores. Incidence rate for NOD was 14.1/1000PY (person-years) in stable rate, 13.0/1000PY in decreasing, 19.3/1000PY in slow increasing, and 27.5/1000PY in rapid increasing dose. Compared with stable rate, risk of NOD increased incrementally for slow (hazard ratio = 1.22; 95% confidence interval: 1.05-1.42) and rapid (hazard ratio = 1.58; 95% confidence interval: 1.30-1.93) rate of dose increase. Faster rates of MED escalation contribute to NOD, independent of maximum dose, pain, and total opioid duration. Dose escalation may be a proxy for loss of control or undetected abuse known to be associated with depression. Clinicians should avoid rapid dose increase when possible and discuss risk of depression with patients if dose increase is warranted for pain.