bluuebunny/crossref_metadata_2025_split huggingface dataset:
Soft-tissue defects after spinal instrumentation in 5 children: risk factors, management strategies, and outcomes
Authors: Sayama Christina , Vadivelu Sudhakar , Livingston Andrew , Ho Allen , Izaddoost Shayan A. , Briceño Valentina , Luerssen Thomas G. , Jea Andrew 
Published: September 2014

Object
Wound-related complications following complex posterior spine procedures in children may result in the need for serial debridements and may place spinal instrumentation at risk. In this study, the authors review their experience with the management of soft-tissue defects from spinal instrumentation in 5 high-risk pediatric patients. The use of various rotational and transpositional flaps in the management of these complicated cases is discussed, as well as their outcomes.

Methods
The authors retrospectively reviewed the medical records of 5 patients who returned to the Neuro-Spine service at Texas Children's Hospital for erosion of spinal instrumentation through the skin between September 1, 2007, and October 31, 2012. Patient demographics and clinical and operative data were recorded.

Results
Risk factors such as young age (1 case), poor nutritional status (1 case), multiple previous surgeries (3 cases), severe neurological deficits (2 cases), and history of radiation therapy for malignancy (2 cases) were noted in the 5 patients. The paraspinous flap (4 cases) was the mainstay of the treatment. Follow-up ranged from 7.5 to 17.5 months (mean 11 ± 4.2 months). One of the patients required more than 1 procedure for revision of the wound. Cultures were positive in 2 of the 5 cases. Spinal instrumentation was removed in 3 of the 5 cases; however, in all 3 of the cases there was evidence of delayed instability that developed after the removal of spinal instrumentation.

Conclusions
The use of local tissue flaps is safe and efficacious for treatment of posterior wound complications due to spinal instrumentation in children. Removal of spinal instrumentation should be avoided due to the development of delayed instability. Highly vascularized tissue is used to speed healing, clear bacteria, and eliminate dead space, obviating the need to remove contaminated spinal instrumentation.
Intrathecal morphine analgesia after cervical and thoracic spinal cord tumor surgery
Authors: Poblete Beate , Konrad Christoph , Kothbauer Karl F. 
Published: September 2014

Object
The aim of this study was to provide evidence for the effect of intrathecal morphine application after spinal cord tumor resection.

Methods
Twenty patients participated in a prospective open proof-of-concept study. During dural closure, morphine (7 μg/kg) was injected into the subarachnoid space. All patients were monitored in an intensive care setting postoperatively. Pain, additional opioids given, and vital parameters were recorded.

Results
Six patients received a mean morphine dose of 365 μg between C-3 and C-7 and 14 patients received a mean dose of 436 μg between T-2 and T-12. In the cervical and thoracic groups, the mean Numeric Rating Scale score was highest upon intensive care unit admission (1.2 and 2.5, respectively) and declined at 12 hours (0.5 and 0.8, respectively). Minimal extra morphine was required. Minor side effects occurred without consequence.

Conclusions
Intrathecal morphine for postoperative analgesia after resection of cervical and thoracic spinal cord tumors is effective and safe. These preliminary results require confirmation by larger comparative studies and further clinical experience.
Liberté d'expression sur les réseaux sociaux
Authors: Weiss Marie-Andrée 
Published: September 2014

[Délit de presse] La liberté d’expression est un principe essentiel mais qu’il a fallu border par des garde-fous. Alors que cette liberté est perçue différemment, même dans des régions comme l’Amérique du Nord et l’Europe économiquement et politiquement proches, comment le contrôle des abus est-il exercé sur les réseaux sociaux ?
Transformer les risques en opportunités : le pouvoir de l'information
Authors: Junghans Pascal 
Published: September 2014

Les professionnels de l’information font face à un bouleversement global de leur domaine d’action avec l’arrivée d’une économie fondée sur la « data ». Ce changement impacte très profondément le volet « risques » de la profession. Nous consacrons ce dossier à un état des lieux du risque informationnel dans sa diversité, puisqu’il touche aussi bien le droit que les ressources humaines. Nous verrons également comment différentes professions, très consommatrices d’informations, développent des stratégies de sécurité adaptées. Enfin, nous présenterons les solutions mises en place par les professionnels de l’information.
Le narcissisme, la pulsion et l'objet
Authors: Roussillon René 
Published: September 2014

L’auteur cherche à mesurer les effets de l’introduction du narcissisme et du moi sur la métapsychologie. Parmi tous ceux qui s’offrent alors à la réflexion il choisit de centrer son analyse sur trois thèmes : les effets sur la théorie de la pulsion et la question de l’introjection pulsionnelle dans le moi, la place de l’objet en regard du moi à partir de la question clinique de la mélancolie, enfin les conjonctures « narcissiques » qui conduisent aux formes extrêmes de l’anti-socialité.
Corps, adolescence et psychose
Authors: Lombardi Riccardo , Pola Marisa 
Published: September 2014

Sont abordés dans ce travail quelques aspects de l’évolution clinique d’un adolescent de 17 ans souffrant d’une crise psychotique, traité dans le cadre d’une cure psychanalytique à raison de 4 séances par semaine. Dans le contexte d’un arrêt du développement à l’adolescence, une explosion psychotique peut fournir une opportunité de relancer le processus de maturation. La psychose de l’adolescent est ici abordée à la lumière de la théorie du changement catastrophique de Bion – théorie selon laquelle la relation contenant/contenu prend un aspect explosif –, et de l’hypothèse de la relation corps/esprit avancée par Ferrari et Matte Blanco. Les auteurs soulignent le rôle de la négation du corps et des changements corporels qui jouent un rôle central dans la genèse du conflit psychotique de l’adolescence, et montrent comment la relation analytique peut offrir les conditions de rêverie déterminantes pour promouvoir la reconnaissance du corps, des sensations corporelles et des affects, en tant que pré-conditions de l’activation d’un système mental autonome.
Référence et coréférence du pronom indéfini on
Authors: Landragin Frédéric , Tanguy Noalig 
Published: September 2014

Le pronom indéfini on a une référence floue : il permet aussi bien une lecture inclusive qu’exclusive, personnelle que non-personnelle. Lorsqu’il désigne un groupe de référents, les limites de ce groupe sont souvent floues, on incarnant ainsi la forme de référence qui correspond le mieux à la notion de groupe flou , notion retenue dans notre projet pour rendre compte de certains référents pluriels. Après quelques rappels sur la syntaxe et la sémantique de on , nous présentons une étude de ses propriétés référentielles, en interrogeant, d’une part, sa propension à vraiment référer et, d’autre part, sa participation plus ou moins forte aux chaînes de référence. Nous proposons de distinguer plusieurs degrés de coréférence, afin de rendre compte de ce phénomène de référence floue lors de la délimitation et de la modélisation des chaînes de référence d’un texte.
L' « atelier du monde » peut-il evoluer ? Le cheminement des entreprises chinoises de l'emergence a l'innovation
Authors: Wei Zhao , Arvanitis Rigas 
Published: September 2014

Si la Chine a connu une rapide croissance dans les 25 dernières années, en partie due aux politiques proactives du gouvernement qui a su exploiter l’avantage de faible coût de la main-d’œuvre, cela a permis de créer un environnement économique dans lequel les entreprises sont dépendantes des technologies fournies par leurs clients étrangers, sous une variété de formes de « Joint-Ventures », sous-contratation, production OEM, etc. La croissance future dépendra de l’amélioration technologique qui devrait s’appuyer plus sur la capacité propre des entreprises que sur les politiques industrielles. Cependant, développer une base technologique nationale endogène constitue un véritable défi pour l’industrie chinoise que nous détaillons dans ces pages. Classification JEL : O30, O14, O38, O53, O10.
Creativity, growth, and nudge: the case of Shanghai
Authors: Jin Pan , Munier Francis 
Published: September 2014

Depuis la réforme de l’année 1978, la performance économique de la Chine a été remarquable. Néanmoins, un nouveau tournant apparaît et certaines questions se posent. Le taux de croissance de la Chine peut-il continuer à ce rythme ? La Chine doit-elle abandonner son modèle historique fondé sur de faibles coûts de main-d’œuvre ou plutôt s’orienter vers la créativité ? Est-ce la bonne voie pour maintenir à la fois la croissance quantitative et améliorer la qualité de vie des citoyens ? Le but de notre article est de montrer que le passage du « Made in China » à « Created in China » conduit à une prise de conscience croissante de l’importance de la créativité comme un vecteur de progrès et de croissance économique. Nous définissons les caractéristiques fondamentales de Shanghai comme une ville créative, en essayant de montrer si Shanghai est fondée sur une forme de double voie. Nous précisons l’idiosyncrasie de la culture chinoise comme un avantage naturel pour la créativité et nous explorons le potentiel de la mise en œuvre d’une politique dite « nudge policy ».
Les combattants de Pavie. Octobre 1524 - 24 février 1525
Authors: Le Gall Jean-Marie 
Published: September 2014

Cet article analyse l’expérience combattante des soldats qui participèrent au siège et à la bataille de Pavie entre octobre 1524 et février 1525. Les ressorts et les souffrances des combattants ainsi que les formes du combat sont examinés. Pour les mercenaires, allemands ou suisses, l’argent des paies et la perspective du butin sont un ressort essentiel ; la pénurie d’argent, cruciale chez les impériaux expose l’armée impériale à l’indiscipline, la rapine et la désertion. Toutefois, partagés dans les deux armées, ces mercenaires ont aussi le sens de la réputation de leur nation. Ils entendent rester fidèles à ceux qui les paient et envers qui ils sont engagés. Chez ceux qui ne sont pas mercenaires, et qui font la guerre à crédit, le service du Roi, la fidélité aux capitaines, le patriotisme chez les Espagnols, la fidélité à l’Empereur plus que la défense de liberté de la ville pour ses habitants mobilisent. Les combats prennent la forme des assauts meurtriers, puis d’un siège qui est émaillé d’escarmouches pour l’honneur, mais aussi par désir de trouver des vivres, de faire du butin, de prendre des prisonniers pour obtenir informations et rançons, et pour essayer de percer la ligne d’encerclement. Cependant, la bataille de Pavie ne fut pas une escarmouche qui dégénéra mais un affrontement voulu par les Impériaux, moins pour secourir Pavie que pour éviter la dispersion d’une armée impériale sous l’effet du manque d’argent. La bataille, traumatique vient mettre fin à la souffrance endurée pendant quatre mois, moins par manque de vivres ou par maladie que par le froid, le manque de bois et de vin, par l’épuisement physique provoqué par les chantiers du siège, enfin par l’épuisement psychologique résultant des bombardements, des harcèlements quotidiens et de l’attente. Cette lecture de l’expérience des soldats, faite à partir des rapports d’espion ou par les lettres contemporaines des événements, modifie la lecture rétrospective et réductrice de la bataille de Pavie comme défaite de la chevalerie.
The value of preoperative ultrasound guided fine-needle aspiration cytology of radiologically suspicious axillary lymph nodes in breast cancer
Authors: Sauer Torill , Kåresen Rolf 
Published: September 2014

Background:
Preoperative ultrasound (US) and eventually US-guided fine-needle aspiration cytology (FNAC) of suspicious axillary lymph nodes (ALN) is a standard procedure in the work-up of suspicious breast lesions. Preoperative US FNAC may prevent sentinel node biopsy (SNB) procedure in 24-30% of patients with early stage breast carcinoma. The aim of this study was to evaluate the institutional results of this preoperative diagnostic procedure.

Materials and Methods:
A total of 182 cases of preoperative FNAC of suspicious ALN where retrieved from the pathology files. The results were compared with the final histology and staging. False negative (FN) FNAC cases were reviewed and possibly missed metastatic cases (2) were immunostained with the epithelial marker AE1/AE3.

Results:
There were no false positives, whereas 16 cases were FN. In all but one case the FN's represented sampling error. Half of the 16 FN cases in this series were macrometastases.

Discussion:
About 83% of the preoperatively aspirated cases were N+, indicating that a radiologically suspicious ALN has a very high risk of being metastatic. Preoperative US guided FNAC from radiologically suspicious ALN is highly efficient in detecting metastases. Depending on national guidelines, a preoperative, positive ALN FNAC might help to stratify the patients as to SNB and/or ALN dissection.
Diabetes and gonadal disorders
Authors: Chen Min , Dou Jingtao 
Published: September 2014

Abstract
Diabetes is closely related with the gonadal endocrine functions. On one hand, the abnormal glucose metabolism may affect functions of the hypothalamic-pituitary-gonadal axis, which in turn leads to sex hormone disorders and, subsequently, hypogonadism both in male and female patients; on the other hand, abnormal secretion of sex hormones is associated with the risk of diabetes. The common hypogonadism diseases, such as hypergonadotropic hypogonadism (Klinefelter syndrome, Tuner syndrome) and hypogonadotropic hypogonadism (Kallmann syndrome, Prader-Willi syndrome), can significantly increase the prevalence of abnormal glucose metabolism. The exact mechanism underlying the interaction between gonadal diseases and diabetes remains unclear, yet it may be associated with insulin resistance, obesity, abnormal chromosome and abnormal secretion of sex hormone. Clinically, individualized treatment with considerations to both gonadal diseases and abnormal glucose could be advisable.
Unsteady Flow Separation and High Performance of Airfoil with Local Flexible Structure at Low Reynolds Number
Authors: Lei Peng-Fei , Zhang Jia-Zhong , Kang Wei , Ren Sheng , Wang Le 
Published: September 2014

AbstractThe unsteady flow separation of airfoil with a local flexible structure (LFS) is studied numerically in Lagrangian frames in detail, in order to investigate the nature of its high aerodynamic performance. For such aeroelastic system, the characteristic-based split (CBS) scheme combined with arbitrary Lagrangian-Eulerian (ALE) framework is developed firstly for the numerical analysis of unsteady flow, and Galerkin method is used to approach the flexible structure. The local flexible skin of airfoil, which can lead to self-induced oscillations, is considered as unsteady perturbation to the flow. Then, the ensuing high aerodynamic performances and complex unsteady flow separation at low Reynolds number are studied by Lagrangian coherent structures (LCSs). The results show that the LFS has a significant influence on the unsteady flow separation, which is the key point for the lift enhancement. Specifically, the oscillations of the LFS can induce the generations of moving separation and vortex, which can enhance the kinetic energy transport from main flow to the boundary layer. The results could give a deep understand of the dynamics in unsteady flow separation and flow control for the flow over airfoil.
An Adaptive ANOVA-Based Data-Driven Stochastic Method for Elliptic PDEs with Random Coefficient
Authors: Zhang Zhiwen , Hu Xin , Hou Thomas Y. , Lin Guang , Yan Mike 
Published: September 2014

AbstractIn this paper, we present an adaptive, analysis of variance (ANOVA)-based data-driven stochastic method (ANOVA-DSM) to study the stochastic partial differential equations (SPDEs) in the multi-query setting. Our new method integrates the advantages of both the adaptive ANOVA decomposition technique and the data-driven stochastic method. To handle high-dimensional stochastic problems, we investigate the use of adaptive ANOVA decomposition in the stochastic space as an effective dimension-reduction technique. To improve the slow convergence of the generalized polynomial chaos (gPC) method or stochastic collocation (SC) method, we adopt the data-driven stochastic method (DSM) for speed up. An essential ingredient of the DSM is to construct a set of stochastic basis under which the stochastic solutions enjoy a compact representation for a broad range of forcing functions and/or boundary conditions.Our ANOVA-DSM consists of offline and online stages. In the offline stage, the original high-dimensional stochastic problem is decomposed into a series of low-dimensional stochastic subproblems, according to the ANOVA decomposition technique. Then, for each subproblem, a data-driven stochastic basis is computed using the Karhunen-Loève expansion (KLE) and a two-level preconditioning optimization approach. Multiple trial functions are used to enrich the stochastic basis and improve the accuracy. In the online stage, we solve each stochastic subproblem for any given forcing function by projecting the stochastic solution into the data-driven stochastic basis constructed offline. In our ANOVA-DSM framework, solving the original highdimensional stochastic problem is reduced to solving a series of ANOVA-decomposed stochastic subproblems using the DSM. An adaptive ANOVA strategy is also provided to further reduce the number of the stochastic subproblems and speed up our method. To demonstrate the accuracy and efficiency of our method, numerical examples are presented for one- and two-dimensional elliptic PDEs with random coefficients.
Transforming Ward Rounds Through Rounding-in-Flow
Authors: Calderon Alvin S. , Blackmore C. Craig , Williams Barbara L. , Chawla Kavita P. , Nelson-Peterson Dana L. , Ingraham Michael D. , Smith Donna L. , Kaplan Gary S. 
Published: September 2014

Abstract

Background
Traditional “batched” bedside clinical care rounds, where rounds for all patients precede clinical tasks, may delay clinical care and reduce resident work efficiency.

Innovation
Using Lean concepts, we developed a novel “Rounding-in-Flow” approach, with the patient care team completing all tasks for a single patient before initiating any tasks for the next patient. Outcome measures included timely patient discharge and intern work hours.

Methods
We performed a retrospective cohort study with historic and contemporaneous control groups, with time series adjustment for underlying temporal trends at a single medical center. Primary outcomes were timely patient discharge orders and resident duty hours. Participants were 17 376 consecutive hospital inpatients between January 1, 2011, and June 30, 2012, and medical ward rounding teams of interns, residents, and attending hospitalists.

Results
Timely discharge orders, defined as written by 9:00 am, improved from 8.6% to 26.6% (OR, 1.55; 95% CI 1.17–2.06; P  =  .003). Time of actual patient discharge was unchanged. Resident duty hour violations, defined as less than 10 hours between clinical duties, decreased from 2.96 to 0.98 per intern per rotation (difference, 1.98; 95% CI 1.09–2.87; P &lt; .001). Average daily intern work hours decreased from 12.3 to 11.9 hours (difference, 0.4 hours; 95% CI 0.16–0.69; P  =  .002).

Conclusions
Compared with batched rounding, Lean Rounding-in-Flow using “1-piece flow” principles was associated with more discharge orders written before 9:00 am and fewer violations in the 10-hour break rule, with minimal changes to intern total work hours and actual patient discharge time.
Success of a Faculty Development Program for Teachers at the Mayo Clinic
Authors: Lee Staci M. , Lee Mark C. , Reed Darcy A. , Halvorsen Andrew J. , Berbari Elie F. , McDonald Furman S. , Beckman Thomas J. 
Published: September 2014

Abstract

Background
There has been limited research on the improvement of underperforming clinical teachers.

Objective
To determine whether a faculty development program could improve the evaluations of clinical teachers in an internal medicine residency program.

Methods
A total of 123 teachers completed faculty development at the Mayo Clinic from 2009 to 2012. The faculty enhancement and education development program (FEED) consists of 6 interactive, small group, 2-hour sessions taught by experienced Mayo Clinic faculty over 1 year. These sessions address the following competencies: asking questions, diagnosing learners, giving feedback, using teaching frameworks, recognizing learning styles, and providing clinical supervision. Resident-of-faculty Mayo teaching effectiveness (MTE) scores have previously demonstrated content, internal structure, and criterion validity. Teachers were grouped into the top 80% or the bottom 20%, according to baseline MTE scores. Mixed linear models were used to compare these groups regarding changes in MTE scores after completion of FEED. Results were adjusted for teacher age, sex, medical specialty, academic rank, and teaching awards.

Results
For all participants combined, the adjusted MTE scores (mean; standard error) improved from baseline (3.80; 0.04) to completion of FEED (3.93; 0.04; P &lt; .001). However, the bottom 20% had a significantly greater improvement in scores than the top 80% (score-change difference  =  0.166, P &lt; .001).

Conclusions
We describe a low-intensity faculty development intervention that benefited all clinical teachers, but was particularly effective for underperforming teachers in internal medicine. The approach may be suitable for adoption or adaptation in other graduate medical education programs.
A Faculty Development Program to Reduce Rater Error on Milestone-Based Assessments
Authors: Raj Jaya M. , Thorn Patti M. 
Published: September 2014

Abstract

Background
Rater errors, such as halo/reverse halo, range restriction, and leniency errors, are frequently cited as threats to the validity of resident assessment by faculty.

Objective
We studied whether participation in faculty development on the use of a new Milestone-based assessment tool reduced rater error for participants compared to individuals who did not participate.

Methods
We reviewed evaluations of resident Milestones completed by faculty at the end of rotations between July 2012 and June 2013. The 2 Milestones in each competency with the greatest number of ratings were selected for analysis.

Results
A total of 412 evaluations were analyzed, including 217 completed by faculty who participated in the development activity, and 240 completed by nonparticipant faculty. All evaluations that contained identical scores for all Milestones (16%) were completed by nonparticipant faculty (χ2  =  37.498, P &lt; .001). Faculty who had participated in development assigned a wider range of scores and lower minimum scores to residents, and provided the highest ratings for residents less frequently (P &lt; .001) than nonparticipants.

Conclusions
Faculty who participated in education about the Milestones demonstrated significantly less halo, range restriction, and leniency errors than faculty members who did not participate. These findings support a recommendation to develop a cadre of “core faculty” by training them in the use of Milestone assessment tools, and making them responsible for a significant portion of resident assessments.