bluuebunny/crossref_metadata_2025_split huggingface dataset:
From Complicity to Impunity
Authors: Rubenstein Leonard S. 
Published: September 2017

Abstract
As the “enhanced interrogation” program of the US Central Intelligence Agency (CIA) at secret detention facilities developed, health professionals came to play a gradually increasing role in accommodating, facilitating, and finally, rationalizing torture. Ultimately, they contributed substantially to a redefinition that, although contrary to the United Nations Convention Against Torture, was adopted by the US Department of Justice and focused on whether interrogation methods were “safe,” by which was meant not resulting in death or permanent physical injury. This role evolved in stages: CIA health professionals accommodated the use of torture by their role in keeping it “safe”; participated directly in the infliction of torture; imposed purported “limitations” on enhanced methods consistent with the “safety” definition; and by 2005, provided the foundation for US Department of Justice legal opinions purporting to justify the use of methods of torture. In doing so, they rationalized their complicity in and culpability for torture.
Seasonal Variation in Slipped Capital Femoral Epiphysis: New Findings Using a National Children’s Hospital Database
Authors: Loder Randall T. , Schneble Chris A. 
Published: September 2017

Background:
Slipped capital femoral epiphysis (SCFE) demonstrates seasonal variation in certain latitudes but not others. Is such variation influenced by temperature differences, sunlight exposure and subsequent vitamin D production, or other climate variables? It was the purpose of this study to further investigate the seasonal variation in month of presentation for SCFE.

Methods:
Data for this study originated from the Pediatric Hospital Information System for all children with a diagnosis of SCFE from January 1, 2004 through December 31, 2014. From this database the patient’s sex, ethnicity, hospital location, and month of presentation was determined. Only those patients treated primarily for SCFE were included. Geographic and climate data [latitude, average annual temperature, precipitation, climate type (Köppen-Geiger and Liss), horticultural plant zone hardiness, and sunlight exposure] for each of the 49 Pediatric Hospital Information System hospitals was determined. Seasonal variation was analyzed using cosinor analysis. A P<0.05 was considered statistically significant.

Results:
There were 10,350 cases of SCFE with an overall peak presentation in mid August. For those living at a latitude of >35-degree N there was single peak, a less prominent double peak for those 31- to 35-degree N, and no variation for those <31-degree N. As the average annual temperature increased there was less seasonal variability. Humid, temperate and cold winter climates demonstrated seasonal variation, whereas other climate types did not. Those living in areas having <2500 hours of sunlight per year demonstrated seasonal variation. Further, areas having a photovoltaic solar production potential <5.0 kWh/m2/d also demonstrated seasonal variation.

Conclusions:
We discovered new seasonal variation findings regarding SCFE. These are a double peak pattern for those between 31- and 35-degree N latitude; less variability as the average annual temperature increases; and sunlight exposure correlates with seasonal variability. Potential explanations are a rachitic state due to seasonal variation in vitamin D production, and seasonal variation in physeal growth and strength. These new findings will require further investigation.

Level of Evidence:
Level III.
Efficacy and Tolerability of IncobotulinumtoxinA for Treating Glabellar Frown Lines in Korean Adults: A Postmarketing Observational Study
Authors: Park Je-Young , Sung Nak-Kwan , Pitt Jonathan M. 
Published: September 2017

BACKGROUND
IncobotulinumtoxinA is safe and effective in Caucasian adults. Its effects have been less documented in Asian adults.

OBJECTIVE
To describe the efficacy and tolerability of incobotulinumtoxinA for treating glabellar frown lines (GFLs) in South Korean adults.

METHODS
South Korean adults aged 18 to 65 years with moderate-to-severe GFLs received a single dose of 10 to 28 U incobotulinumtoxinA during routine clinical practice. After 30 ± 14 days, investigators assessed the efficacy using the Global Aesthetic Improvement Scale and rated tolerability using a 4-point scale.

RESULTS
Six hundred seventy-three subjects were enrolled, of which 528 completed the study according to protocol. Glabellar frown lines improved in 98.7% (521/528) of subjects, with 30.8% of cases rated as “very much improved” and 47.4% as “much improved.” The extent of improvement was unaffected by sex, age, and weight but was greater when the time between GFL identification and treatment was <6 months (p < .001) and when concomitant aesthetic nondrug treatments were used (p < .001). For 94% of subjects, tolerability was good or very good. All reported adverse events were transient and mild or moderate in severity.

CONCLUSION
IncobotulinumtoxinA was well tolerated and effective for treating moderate-to-severe GFLs in Korean adults irrespective of age, sex, or weight.
Effect of the Salary Model on Sustainability of a Professional Practice Environment
Authors: Hickey Rosa G. , Buchko Barbara L. , Coe Paula F. , Woods Anne B. 
Published: September 2017

OBJECTIVE
This replication study examined differences in RN perception of the professional practice environment (PPE) between salary- and hourly-wage compensation models over time.

BACKGROUND
A previous study demonstrated that nurses in a salary-wage model had a significantly higher perception of the PPE compared with their peers receiving hourly wages.

METHODS
A descriptive, comparative design was used to examine the Revised Professional Practice Environment (RPPE) scale of nurses in the same units surveyed in the previous study 2 years later.

RESULTS
Mean scores on the RPPE continued to be significantly lower for hourly-wage RNs compared with the RNs in the salary-wage model.

CONCLUSIONS
Nurses in an hourly-wage unit have significantly lower perceptions of the clinical practice environment than their peers in a salary-wage unit, indicating that professional practice perceptions in a salary-wage unit were sustained for a 2-year period and may provide a more effective PPE.
Four States, Four Projects, One Mission: Collectively Enhancing Mental and Behavioral Health Capacity Throughout the Gulf Coast
Authors: Langhinrichsen-Rohling Jennifer , Osofsky Howard , Osofsky Joy , Rohrer Glenn , Rehner Timothy 
Published: September 2017

Context:
The 2010 Deepwater Horizon oil spill triggered numerous concerns regarding the health and well-being of citizens within the already vulnerable Gulf Coast region. Four Mental and Behavioral Health Capacity Projects (MBHCPs) united to form the Quad-State MBHCP component of the Gulf Region Health Outreach Program (GRHOP). Their shared mission was to increase mental and behavioral health (MBH) capacity within coastal counties of Louisiana, Mississippi, Alabama, and the Florida Panhandle.

Objective:
To describe strategies used to collectively enhance the impact of the 4 state-specific MBHCPs and to share lessons learned from a multistate collaborative flexibly designed to meet a shared mission.

Materials and Procedures:
Archival materials were assessed. They included attendance sheets/notes from regularly scheduled group meetings, GRHOP quarterly and annual reports, and state-specific MBHCP logic models. Nationally available data on MBH services provided in project-relevant primary care sites were also examined.

Results:
Three strategies were found to be effective facilitators of collective success: (i) reciprocal participation in the backbone organization (GRHOP); (ii) creation and comparison of state-specific MBHCP logic models and activities; and (iii) cross-fertilization among the MBHCP state-specific logic models, a unified Quad-State, and the GRHOP-wide logic model to generate additional synergistic endeavors and measureable outcomes. Examples of region-wide MBHCP success, such as uptake in integrated health services in health care clinics across the jurisdiction of investment, are presented.

Conclusions:
Isolated approaches to complex issues are, at times, ineffective. The Collective Impact (CI) model, with an emphasis on coordination among existing organizations, stakeholders, and the public, can serve as a guidepost to facilitate sustainable change even when used in a modified form. Strategies discussed herein for maximizing the 5 prescribed CI conditions provide an important roadmap for how to interface among multidisciplinary projects seeking to address the same, large-scale public health problem.
Weight-Based Dosing for Once-Daily Enoxaparin Cannot Provide Adequate Anticoagulation for Venous Thromboembolism Prophylaxis
Authors: Pannucci Christopher J. , Hunt Madison M. , Fleming Kory I. , Prazak Ann Marie 
Published: September 2017

Background:
Surgeons commonly provide enoxaparin prophylaxis to high-risk patients to decrease venous thromboembolism risk. The authors’ prior work demonstrated that most patients receive inadequate venous thromboembolism prophylaxis, based on anti–factor Xa level, when enoxaparin 40 mg/day is provided and that peak anti–factor Xa level correlates with weight. This study models a weight-based strategy for daily enoxaparin prophylaxis and its impact on anti–factor Xa levels.

Methods:
The authors enrolled plastic surgery patients who received enoxaparin 40 mg/day and had anti–factor Xa levels drawn. The enoxaparin dose of 40 mg was converted to a milligram-per-kilogram dose for each patient. Stratified analysis examined the milligram-per-kilogram dose that produced low, in-range, and high anti–factor Xa levels to identify the appropriate milligram-per-kilogram dose to optimize venous thromboembolism prevention and bleeding events.

Results:
Among 94 patients, weight-based dosing ranged from 0.28 to 0.94 mg/kg once daily. For peak and trough anti–factor Xa levels, there was nearly complete overlap for milligram-per-kilogram dosing that produced low versus in-range anti–factor Xa levels. For peak anti–factor Xa, there was nearly complete overlap for milligram-per-kilogram dosing that produced in-range versus high anti–factor Xa levels. Mean milligram-per-kilogram dose was not significantly different between patients who did or did not have postoperative venous thromboembolism (0.41 mg/kg versus 0.52 mg/kg; p = 0.085) or clinically relevant bleeding (0.48 mg/kg versus 0.51 mg/kg; p = 0.73).

Conclusions:
Alterations in enoxaparin dose magnitude based on patient weight cannot allow a high proportion of patients to achieve appropriate anti–factor Xa levels when once-daily enoxaparin prophylaxis is provided. Future research should examine the impact of increased enoxaparin dose frequency on anti–factor Xa levels, venous thromboembolism events, and bleeding.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Transparency in Functional Rhinoplasty: Benefits of Routine Prospective Outcome Measurements in a Tertiary Referral Center
Authors: Datema Frank R. , van Zijl Floris V. W. J. , van der Poel Egge F. , Baatenburg de Jong Robert J. , Lohuis Peter J. F. M. 
Published: September 2017

Background:
Patients, governments, health care providers, and insurance companies are increasingly interested in medical performance. Transparent outcome reporting requires a thorough methodologic design, dedicated prospective data collection process, and preferably no interference with the efficacy of daily practice. The primary aim of this article is to describe how these bottlenecks are tackled with an automated prospective rhinoplasty outcome routine. The secondary aim is to motivate others by describing practical benefits encountered during implementation.

Methods:
Since April 2014, 269 consecutive patients referred for functional-aesthetic (revision) rhinoplasty were included. The Nasal Obstruction Symptom Evaluation scale, the Utrecht Questionnaire, and visual analogue scales were offered to all patients before primary consultation and follow-up to translate the subjective burden of nasal problems and change herein following surgery, into data. These data were exported for real-time automated outcome analysis supported by graphic output through a customized Web-based dashboard.

Results:
One hundred seventy-one patients proved eligible for rhinoplasty, of which 121 had sufficient follow-up. The dashboard provides an overview of demographic characteristics of different populations, reasons why rhinoplasties were not performed, and real-time short- and long-term change in functional and aesthetic outcome in both primary and revision cases. Practical benefits of the instruments used are presented and discussed.

Conclusions:
Routine prospective outcome monitoring provides an evidence-based response to the increasing demand for transparency in health care. The dashboard proved valuable during patient counseling, patient selection, and management of expectations and has the potential to compare rhinoplasty results between surgeons and institutions, provided that the populations share similar characteristics.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Three-Dimensional Printing: A Novel Approach to the Creation of Obturator Prostheses Following Palatal Resection for Malignant Palate Tumors
Authors: Bartellas Michael , Tibbo Jamie , Angel Doug , Rideout Arthur , Gillis Joshua 
Published: September 2017

Background:
A subgroup of patients who have an oronasal fistula live in areas that have limited access to oral prosthetics. For these individuals, a temporary prosthesis, such as a palatal obturator, may be necessary in order to speak, eat, and breath properly. The creation of an obturator, which requires a highly trained prosthodontist, can take time and can be expensive. Through the current proof-of-concept study, there is an attempt to create a patient-specific palatal obturator through use of free and publicly available software, and a low-cost desktop 3-dimensional printer. The ascribed study may provide a means to increase global access to oral prosthetics if suitable biomaterials are developed.

Methods:
Computerized tomography data were acquired from a patient who had an oronasal fistula. Through use of free software, these data were converted into a 3-dimensional image. The image was manipulated in order to isolate the patient's maxilla and was subsequently printed. The palatal obturator models were designed, and reformed, in correspondence with the maxilla model design. A final suitable obturator was determined and printed with 2 differing materials in order to better simulate a patient obturator.

Results:
Creating a suitable palatal obturator for the specified patient model was possible with a low-cost printer and free software.

Conclusions:
With further development in biomaterials, it may be possible to design and create an oral prosthesis through use of low-cost 3-dimensional printing technology and freeware. This can empower individuals to attain good healthcare, even if they live in rural, developing, or underserviced areas.
Reconstruction of an Alar Defect With a Fusiform Nasolabial Turnover Flap With a Proximal, Superiorly Tapered Apex
Authors: El Habr Constantin , Vinelli Gian , Tinklepaugh Adam , Ciocon David 
Published: September 2017

Abstract
The nasolabial turnover flap was first described by Spear et al in 1987 for the coverage of full thickness defects of the lateral ala. It offered a single-stage repair that recreated the internal nasal lining, the external nasal valve, and the rounded contour of the ala without requiring a cartilage graft. A frequently encountered problem with the execution of Spear's original design is elevation of the ipsilateral commissure of the adjacent lip due to its broad proximal pedicle. Here, the authors describe a fusiform-type design with a proximal, superiorly tapered apex that relies on anteriorly coursing perforators from the underlying angular artery. The authors also review the inherent advantages and disadvantages of the flap itself and the unique situation where there is a skin cancer adjacent to the donor site.
A Study on the Effects of the Use of Propofol in Experimental Model Inferior Epigastric Island Flap on Ischemia-Reperfusion Injury
Authors: Eroglu Tuncay , Bozkurt Mehmet , Kapi Emin , Selcuk Caferi Tayyar , Kuvat Samet Vasfi , Tufek Adnan , Isik Fatma Birgul , Bozarslan Beri Hocaoglu , Firat Ugur , Satici Omer 
Published: September 2017

Abstract
Problems concerning vascular blood flow are the most frequently encountered ones after flap applications. The flap tissue starts to develop ischemia in patients with a vascular blood flow insufficiency. And reperfusion starts in those patients in whom the ischemia is temporary, triggering an ischemia-reperfusion injury depending on the duration of the ischemia. The aim of this study was to evaluate the effect of propofol, which is an anesthetic agent known to have an antioxidant effect and a free radical scavenging feature on the ischemia-reperfusion injury created on an experimental epigastric island flap.
Thirty Sprague–Dawley rats were used in the study. The rats were divided into 3 groups of 10 rats each. Inferior epigastric artery-based abdominal flaps were prepared in all the groups. In group 1 (sham), the flap was elevated but no ischemia was applied. In groups 2 (control) and 3 (propofol), the flap was exposed to ischemia for 2 hours after it was elevated. All the rats were sacrificed and biochemical and histopathological assessments were made on the tissue samples taken on the 14th day. As a result of a comparison between the groups, the flap viability rates and the superoxide dismutase, total antioxidant capacity, and catalase values were found to be significantly higher (P < 0.001) in the propofol group while the malondialdehyde and total oxidative stress values were lower (P < 0.001). Based on the data obtained from the present study, the use of propofol was observed to have a protective effect against ischemia-reperfusion injuries in flap surgeries.
Efficiency and Duration of Orthodontic/Orthognathic Surgery Treatment
Authors: Dehghani Mahboobe , Fazeli Faryal , Sattarzadeh Ali Payam 
Published: September 2017

Introduction:
To investigate the combined orthodontic-orthognathic treatment times at an academic hospital in the UK and to consider the level of occlusal change in delivering this treatment by the way of comparing peer assessment rating (PAR) scores pre- and post-treatment.

Methods:
It was a retrospective longitudinal study of orthognathic patients between 2010 and 2013 who had completed orthognathic treatment. Analysis of records of 50 patients was carried out. Age, gender malocclusion, and skeletal pattern, extraction/nonextraction of teeth, duration of active orthodontic treatment, number of appointments, transfer of patients between orthodontists mid-treatment, and PAR scores pre and post-treatment were recorded for each patient.

Results:
The skeletal pattern was III in 70% of and II in 28% of patients. Mean duration of active orthodontic treatment was 27.9 months. Age, gender, malocclusion, and skeletal pattern did not seem to affect treatment times. Extraction of teeth and transfer of operators increased treatment times. The mean PAR reduction was 89% with the PAR efficiency factor (reduction in PAR scores divided by duration of treatment in months) of 1.61. Younger patients, those with class III malocclusions and patients starting with higher PAR scores, achieved greater PAR reductions. Gender, number of appointments, extractions, transfer of operators, and total duration of treatment were not shown to affect the PAR % reduction.

Conclusions:
Combined orthodontic-orthognathic treatment has been effective in treating patients with severe skeletal discrepancies. Transfer of operators and extractions protracted treatment times. Younger patients and those with class III malocclusions achieved higher PAR % reduction.
Establishing a Rodent Model of Ventricular Fibrillation Cardiac Arrest With Graded Histologic and Neurologic Damage With Different Cardiac Arrest Durations
Authors: Ettl Florian , Magnet Ingrid A.M. , Weihs Wolfgang , Warenits Alexandra-Maria , Grassmann Daniel , Wagner Michael , Teubenbacher Ursula , Högler Sandra , Sterz Fritz , Janata Andreas 
Published: September 2017

ABSTRACT

Purpose:
The aim of the study was to establish a ventricular fibrillation (VF) cardiac arrest (CA) resuscitation model with consistent neurologic and neuropathologic damage as potential therapeutic target.

Methods:
Prospectively randomized groups of experiments in two phases. In phase 1 four groups of male Sprague–Dawley rats (n = 5) were resuscitated after 6 min VFCA with 2 and 6 min basic life support durations (BLS) with and without adrenaline. In phase 2 the most promising group regarding return of spontaneous circulation (ROSC) and survival was compared with a group of 8 min CA. Resuscitability, neurologic deficit scores (NDS), and overall performance category (OPC) were assessed daily; histolopathology of the hippocampal CA1 region [hematoxylin and eosin- (viable neurons), Fluoro-Jade- (dying neurons), and Iba-1 immunostaining (microglial activation–semiquantitative)] on day 14.

Results:
Two minutes BLS and with adrenaline as most promising group of phase 1 compared with an 8 min group in phase 2 exhibited ROSC in 8 (80%) vs. 9 (82%) animals and survivors till day 14 in 7 (88%) (all OPC 1, NDS 0 ± 0) vs. 6 (67%) (5 OPC 1, 1 OPC 2, NDS 0.83 ± 2.4) animals. OPC and NDS were only significantly different at day 1 (OPC: P = 0.035; NDS: P = 0.003). Histopathologic results between groups were not significantly different; however, a smaller variance of extent of lesions was found in the 8 min group. Both CA durations caused graded neurologic, overall, such as histopathologic damage.

Conclusions:
This dynamic global ischemia model offers the possibility to evaluate further cognitive and novel neuroprotective therapy testing after CA.
Host's Endogenous Caveolin-1 Expression is Downregulated in the Lung During Sepsis to Promote Cytoprotection
Authors: Kataki Agapi , Karagiannidis Ioannis , Memos Nikolaos , Koniaris Efthymios , Antonakis Pantelis , Papalois Apostolos , Zografos George C. , Konstadoulakis Manoussos M. 
Published: September 2017

ABSTRACT
The present study focuses on the profile of “endogeneous” caveolin-1 protein in septic lung (CLP model).
Caveolin-1, CD25, pP38, pAkt, and 14-3-3b protein expression profiles were studied using flow cytometry and immunohistochemistry 6, 12, 24, 36, and 48 h after sepsis induction. Cell viability was determined by 7-AAD staining and fibrosis by Masson trichrome stain. The effect of protein C zymogen concentrate (PC) on caveolin-1 expression was also investigated given that PC, once dissociated from caveolin-1, elicits a PAR-1-mediated protective signaling by forming a complex with endothelial protein C receptor (EPCR).
CLP treatment increased lung inflammation and cell apoptosis. Fibrosis was apparent in vessels and alveoli. Caveolin-1+ cells presented reduced protein expression, especially 12 h post-CLP (P = 0.002). Immunohistochemistry revealed caveolin-1 positive expression mainly in regions with strong inflammatory reaction. Early induction of pP38+ cell population (P = 0.014) and gradual increase of CD25+ cells were also observed. Alternations in 14-3-3b expression related to apoptosis were apparent and accompanied by increased AKT phosphorylation activity late during sepsis progression.
After PC administration, cell apoptosis was reduced (P = 0.004) and both the percentile and expression intensity of caveolin-1 positive cells were compromised (P = 0.009 and P = 0.027, respectively). 14-3-3b, CD25, and pP38 protein expression were decreased (P = 0.014, P = 0.004, and P = 0.007, respectively), whereas pAkt expression was induced (P = 0.032).
The observed decline of endogenous caveolin-1 protein expression during sepsis implies its involvement in host's cytoprotective reaction either directly, by controlling caveolae population to decrease bacterial burden, or indirectly via regulating 14-3-3b-dependent apoptosis and EPCR-PAR-1-dependent protective signaling.