bluuebunny/crossref_metadata_2025_split huggingface dataset:
Juridische status van een ethische code: waar plaats je zo’n code in de hiërarchie van de continentale normen?
Authors: de Becker Alexander 
Published: November 2014

Legal status of a code of conduct for officials: where to place it in the hierarchy of rules in continental countries?
The article aims to compare the current legal status of codes of conduct (if any) in five different EU-countries. Its starting point is the recent legal initiative in the Netherlands to abolish the existing status for officials and to replace it with contracts of employment. The parliamentary initiators indicate ethical elements as crucial for the employment relation in the public sector. Does this imply that a code of conduct has to be established? The article first focuses on the historical evolution of codes of conduct in different EU-Member States. Within the UK, integrity has always been considered a key stone of the civil service. However, it took until the nineties until a code of conduct was set out. The spread out of the importance of integrity for civil servants has spread out later in continental Europe. The impact of the theory of New Public Management, through the OECD, was therefore crucial. Consequently, Belgium and Germany developed codes of conduct while France and the Netherlands paid more attention to weight of ethical behavior in the public sector. Currently, it stays beyond any doubt that the codes of conduct in the UK have got a binding legal value. This value has not yet been achieved by the Belgian and the German codes. The article defends the point of view that a binding code in the Netherlands can be a useful tool.
Verder op weg naar een professie voor de beleidsambtenaar?
Authors: Wilmink Hans 
Published: November 2014

On the way to a professional status for the civil servant?
A profession can be defined as a group of workers with shared knowledge, skills and quality standards. To maintain its professional status, the professional community needs to be relatively autonomous. However, while performing their tasks, many pressures jeopardize the professional worker’s autonomous position. Here, the professional community can make a difference. Subordination to the political principal characterizes the position of the civil servant. What margin of professional independence do political leaders allow their civil servants? Recent academic empirical reports in the Netherlands show conflicting outcomes. This essay describes how civil servants from a Dutch ministry deal with their professional standards and argues that, in the process of professionalization, more clarity is required with regard to how autonomy and independence for civil servants are safeguarded. This is especially relevant in a contemporary context where new ways to account for the professional behavior of civil servants need to be sought.
Leiderschap is wat je teweegbrengt bij anderen
Authors: Kwakkelstein Tobias , Jansen Thijs 
Published: November 2014

Interview with professor of public administration Paul ’t Hart
This is an interview with professor of public administration Paul ’t Hart, following the success of his Dutch essay ‘Civil Servant 3.0’. In the interview, ’t Hart addresses new demands on civil servants, challenges for leadership and the need to learn from international best practices in public sector reform.
Van eerste overheid naar eerst de burger, maar hoe?
Authors: Kleistra Yvonne , Walraven Guido 
Published: November 2014

Citizens first instead of government first, but how? Review of the report ‘Citizens first instead of government first. On social advice that challenges local government’ by the Denktank VNG
The first report (2013) by the Association of Netherlands Municipalities think tank deals with the question of how local governments can improve their own performance regarding the current trend of social initiatives in which citizens organize themselves to tackle problems in their neighborhoods. Kleistra and Walraven discuss the method, content and findings of the report. They question the widely used citizen perspective that is adopted by the think tank as a starting point for further research on the topic; its uncritical stance with regard to the highly debated issue of citizen participation; the limited research effort that underpins its overall findings and conclusions; and in particular its unequivocal call for large scale municipal experimenting and improvising without further elaborating on the key question of ‘how to proceed’ for the benefit of municipal policymakers. This brings them to the conclusion that the report itself generates highly relevant questions, but that these questions should be addressed more effectively than has so far been the case, by connecting in-depth empirical research on municipal performance with regard to citizens initiatives to the large body of scientific knowledge on citizen participation.
Recorregut de recerca geològica i mineralògica per la subcomarca del Lluçanès (comarca d´Osona): des d´Alboquers a Olost, Albars, Prats de Lluçanès i a Santa Maria de Merlés
Authors: Mata Perelló Josep Maria , Sanz Balagué Joaquim 
Published: November 2014

Itinerari realitzat el 27 d’abril de 2013. En aquesta ocasió, el recorregut de d’itinerari discorrerà, en la seva totalitat per la Depressió Geològica de l´Ebre (i més concretament, ho farà pel seu sector corresponent a la seva Depressió Central). Tot i així, d’itinerari passarà per les proximitats d’alguns indrets més o menys replegats de l´esmentada depressió, tot i que en general aquests plecs no tenen gran desenvolupament. Malgrat això, cal fer esment del Sinclinal d´Olost, Cap a ponent, trobarem també l´Anticlinal de Puig – reig i el Sinclinal de Gironella, entre altres elements Així, des del seu inici a la petita d´Alboquers (del municipi de Sant Bertomeu del Grau, al Lluçanès osonenc) fins a la seva fi, pels voltants de la localitat de santa Maria de Merlès, igualment situada a la subcomarca del Lluçanès (però en aquest cas dintre del Berguedà), totes les aturades del recorregut de d’itinerari, es trobaran ubicades dintre d’aquesta unitat geològica anteriorment esmentada. Per d’altra banda, i com ja s’entreveu al títol, el recorregut de d’itinerari discorrerà per íntegrament per la subcomarca del Lluçanès, iniciant-se als sectors osonencs, per a finalitzar als situats dintre de l´actual comarca del Berguedà.
Bio-Conjugated Polycaprolactone Membranes: A Novel Wound Dressing
Authors: Cai Elijah Zhengyang , Teo Erin Yiling , Jing Lim , Koh Yun Pei , Qian Tan Si , Wen Feng , Lee James Wai Kit , Hing Eileen Chor Hoong , Yap Yan Lin , Lee Hanjing , Lee Chuen Neng , Teoh Swee-Hin , Lim Jane , Lim Thiam Chye 
Published: November 2014

Background The combination of polycaprolactone and hyaluronic acid creates an ideal environment for wound healing. Hyaluronic acid maintains a moist wound environment and accelerates the in-growth of granulation tissue. Polycaprolactone has excellent mechanical strength, limits inflammation and is biocompatible. This study evaluates the safety and efficacy of bio-conjugated polycaprolactone membranes (BPM) as a wound dressing.
Methods 16 New Zealand white rabbits were sedated and local anaesthesia was administered. Two 3.0×3.0 cm full-thickness wounds were created on the dorsum of each rabbit, between the lowest rib and the pelvic bone. The wounds were dressed with either BPM (n=12) or Mepitel (n=12) (control), a polyamide-silicon wound dressing. These were evaluated macroscopically on the 7th, 14th, 21st, and 28th postoperative days for granulation, re-epithelialization, infection, and wound size, and histologically for epidermal and dermal regeneration.
Results Both groups showed a comparable extent of granulation and re-epithelialization. No signs of infection were observed. There was no significant difference (P>0.05) in wound size between the two groups. BPM (n=6): 8.33 cm2, 4.90 cm2, 3.12 cm2, 1.84 cm2; Mepitel (n=6): 10.29 cm2, 5.53 cm2, 3.63 cm2, 2.02 cm2; at the 7th, 14th, 21st, and 28th postoperative days. The extents of epidermal and dermal regeneration were comparable between the two groups.
Conclusions BPM is comparable to Mepitel as a safe and efficacious wound dressing.
Expression of Nuclear Factor Erythroid 2 Protein in Malignant Cutaneous Tumors
Authors: Choi Chang Yong , Kim Jin Young , Wee Seo Yeong , Lee Jang Hyun , Nam Doo Hyun , Kim Chul Han , Cho Moon Kyun , Lee Yoon Jin , Nam Hae Seon , Lee Sang Han , Cho Sung Woo 
Published: November 2014

Background Reactive oxygen species (ROS) damages cell molecules, and modifies cell signaling. The nuclear factor E2-related factor (Nrf2) is a critical transcription regulator, which protects cells against oxidative damage. Nrf2 expression is increased in a large number of cancers. However, little information has been reported regarding the expression of Nrf2 in skin cancers. Hence, we explored the expression of Nrf2 protein in skin cancers.
Methods The Nrf2 protein expression in 24 specimens, including 6 malignant melanomas (MM), 6 squamous cell carcinomas (SCC), 6 basal cell carcinomas (BCC), and 6 normal skin tissues, was evaluated by western blotting. Immunohistochemical staining was performed. The expression of Kelch-like ECH-associated protein 1 (Keap1), the key regulator of Nrf2, was also analyzed by western blotting.
Results Small interfering RNA transfection to the melanoma cell line G361 confirmed that an approximately 66 kDa band was the true Nrf2 band. The western blot revealed that the Nrf2 protein was definitely expressed in normal skin tissues, but the Nrf2 expression was decreased in MM, SCC, and BCC. Immunohistochemical examination showed that expression of Nrf2 was decreased in all skin cancer tissues compared to the normal skin tissues. Keap1 was not expressed in all malignant skin tumors and normal skin tissues by western blot.
Conclusions ROS was increased in various types of cancers which proteins were highly expressed or underexpressed. This study demonstrated that the expression of Nrf2 protein was down-regulated in human malignant skin tumors. We suggest that decreased expression of Nrf2 is related to skin cancers.
Applicability and Safety of in Vitro Skin Expansion Using a Skin Bioreactor: A Clinical Trial
Authors: Jeong Cheol , Chung Ho Yun , Lim Hyun Ju , Lee Jeong Woo , Choi Kang Young , Yang Jung Dug , Cho Byung Chae , Lim Jeong Ok , Yoo James J , Lee Sang Jin , Atala Anthony J 
Published: November 2014

Background Tissue expansion is an effective and valuable technique for the reconstruction of large skin lesions and scars. This study aimed to evaluate the applicability and safety of a newly designed skin expanding bioreactor system for maximizing the graft area and minimizing the donor site area.
Methods A computer-controlled biaxial skin bioreactor system was used to expand skin in two directions while the culture media was changed daily. The aim was to achieve an expansion speed that enabled the skin to reach twice its original area in two weeks or less. Skin expansion and subsequent grafting were performed for 10 patients, and each patient was followed for 6 months postoperatively for clinical evaluation. Scar evaluation was performed through visual assessment and by using photos.
Results The average skin expansion rate was 10.54%±6.25%; take rate, 88.89%±11.39%; and contraction rate, 4.2%±2.28% after 6 months. Evaluation of the donor and recipient sites by medical specialists resulted in an average score of 3.5 (out of a potential maximum of 5) at 3 months, and 3.9 at 6 months. The average score for patient satisfaction of the donor site was 6.2 (out of a potential maximum of 10), and an average score of 5.2 was noted for the recipient site. Histological examination performed before and after the skin expansion revealed an increase in porosity of the dermal layer.
Conclusions This study confirmed the safety and applicability of the in vitro skin bioreactor, and further studies are needed to develop methods for increasing the skin expansion rate.
Subbrow Approach as a Minimally Invasive Reduction Technique in the Management of Frontal Sinus Fractures
Authors: Lee Yewon , Choi Hyun Gon , Shin Dong Hyeok , Uhm Ki Il , Kim Soon Heum , Kim Cheol Keun , Jo Dong In 
Published: November 2014

Background Frontal sinus fractures, particularly anterior sinus fractures, are relatively common facial fractures. Many agree on the general principles of frontal fracture management; however, the optimal methods of reduction are still controversial. In this article, we suggest a simple reduction method using a subbrow incision as a treatment for isolated anterior sinus fractures.
Methods Between March 2011 and March 2014, 13 patients with isolated frontal sinus fractures were treated by open reduction and internal fixation through a subbrow incision. The subbrow incision line was designed to be precisely at the lower margin of the brow in order to obtain an inconspicuous scar. A periosteal incision was made at 3 mm above the superior orbital rim. The fracture site of the frontal bone was reduced, and bone fixation was performed using an absorbable plate and screws.
Results Contour deformities were completely restored in all patients, and all patients were satisfied with the results. Scars were barely visible in the long-term follow-up. No complications related to the procedure, such as infection, uncontrolled sinus bleeding, hematoma, paresthesia, mucocele, or posterior wall and brain injury were observed.
Conclusions The subbrow approach allowed for an accurate reduction and internal fixation of the fractures in the anterior table of the frontal sinus by providing a direct visualization of the fracture. Considering the surgical success of the reduction and the rigid fixation, patient satisfaction, and aesthetic problems, this transcutaneous approach through a subbrow incision is concluded to be superior to the other reduction techniques used in the case of an anterior table frontal sinus fracture.
The Superficial Inferior Epigastric Artery Flap and its Relevant Vascular Anatomy in Korean Women
Authors: Kim Byung Jun , Choi Jun Ho , Kim Tae Hoon , Jin Ung Sik , Minn Kyung Won , Chang Hak 
Published: November 2014

Background Lower abdominal soft tissue transfer is the standard procedure for breast reconstruction. However, abdominal wall weakness and herniation commonly occur postoperatively at the donor site. To reduce the morbidities of the donor site, the superficial inferior epigastric artery (SIEA) flap was introduced, but inconsistent anatomy of the SIEA has reduced its utility. In the present study, the anatomy of the superficial inferior epigastric vessels in Korean women was determined with regards to breast reconstructive surgery.
Methods The vascular anatomies of the SIEA and superficial inferior epigastric vein (SIEV) were evaluated on 32 breast cancer patients receiving free transverse rectus abdominis musculocutaneous flap reconstruction after mastectomy. The existence, pulsation, location, external diameter, and depth of the SIEA and SIEV were measured at the lower abdominal incision level.
Results SIEA and SIEV were present in 48/64 (75.00%) and 63/64 (98.44%) hemi-abdomens, respectively. Pulsation of the SIEA was found in 44/48 (91.67%) cases. The mean locations of SIEA and SIEV were +5.79 (±12.87) mm, and -8.14 (±15.24) mm from the midpoint between the anterior superior iliac spine and symphysis pubis, respectively. The mean external diameters of SIEA and SIEV were 1.20 (±0.39) mm and 1.37 (±0.33) mm, and they were found at a mean depth of 9.75 (±2.67) mm and 8.33 (±2.65) mm, respectively.
Conclusions The SIEA was absent in 25% of Korean women and had a relatively small caliber. Therefore, careful preoperative assessment of the lower abdominal vasculature is required to achieve successful breast reconstruction using SIEA flaps.
Distally Based Sural Artery Adipofascial Flap based on a Single Sural Nerve Branch: Anatomy and Clinical Applications
Authors: Mok Wan Loong James , Por Yong Chen , Tan Bien Keem 
Published: November 2014

Background The distally based sural artery flap is a reliable, local reconstructive option for small soft tissue defects of the distal third of the leg. The purpose of this study is to describe an adipofascial flap based on a single sural nerve branch without sacrificing the entire sural nerve, thereby preserving sensibility of the lateral foot.
Methods The posterior aspect of the lower limb was dissected in 15 cadaveric limbs. Four patients with soft tissue defects over the tendo-achilles and ankle underwent reconstruction using the adipofascial flap, which incorporated the distal peroneal perforator, short saphenous vein, and a single branch of the sural nerve.
Results From the anatomical study, the distal peroneal perforator was situated at an average of 6.2 cm (2.5-12 cm) from the distal tip of the lateral malleolus. The medial and lateral sural nerve branches ran subfascially and pierced the muscle fascia 16 cm (14-19 cm) proximal to the lateral malleolus to enter the subcutaneous plane. They merged 1-2 cm distal to the subcutaneous entry point to form the common sural nerve at a mean distance of 14.5 cm (11.5-18 cm) proximal to the lateral malleolus. This merging point determined the pivot point of the flap. In the clinical cases, all patients reported near complete recovery of sensation over the lateral foot six months after surgery. All donor sites healed well with a full range of motion over the foot and ankle.
Conclusions The distally based sural artery adipofascial flap allowed for minimal sensory loss, a good range of motion, an aesthetically acceptable outcome and can be performed by a single surgeon in under 2 hours.
Periareolar Augmentation Mastopexy with Interlocking Gore-Tex Suture, Retrospective Review of 50 Consecutive Patients
Authors: Franco Johnny , Kelly Emma , Kelly Michael 
Published: November 2014

Background Periareolar Augmentation Mastopexy is one of the most challenging operations in plastic surgery. Problems with scar quality, areolar widening, and distortion are frequent problems that interfere with a predictable result.
Methods A retrospective review was performed on fifty consecutive patients who underwent a periareolar augmentation mastopexy with the interlocking approach. Of the 50 patients, 30 had both preoperative and postoperative photographs and were the basis of the study.
Results The age of the patients ranged from 19 to 56 years with the average age being 39 years. The postoperative follow-up averaged 9.5 months and the implants averaged 316 mL. There were no deaths, pulmonary embolism, deep vein thrombosis, or infected implants. Four patients had complications following surgery for an overall complication rate of 13%. Two patients developed an infected Gore-Tex suture. Two of these complications were treated with revision surgery. Five patients required reoperation for an overall reoperative rate of 16% (one patient was converted to a full mastopexy).
Conclusions As a result of this retrospective study, we have found the interlocking approach to periareolar augmentation/mastopexy to be a safe and reliable operation.
Empirical Treatment of Highly Suspected Nontuberculous Mycobacteria Infections Following Aesthetic Procedures
Authors: Kim Hyung Rok , Yoon Eul Sik , Kim Deok Woo , Hwang Na Hyun , Shon Yoo Seok , Lee Byung Il , Park Seung-Ha 
Published: November 2014

Background Infection caused by nontuberculous mycobacteria (NTM) has been increasing. Awareness of this infection is crucial yet problematic. Delayed management may lead to destructive results. We empirically treated a series of patients with clinical suspicion of NTM infection prior to the identification of the pathogen.
Methods A total of 12 patients who developed surgical site infections between January 2011 and February 2014 were reviewed. Patients with a skin and subcutaneous infection resistant to standard management over two weeks, and previous history of aesthetic procedures within three months were regarded as highly suspected of having an NTM infection. A variety of diagnostic modalities were examined simultaneously, along with starting empirical treatment including a combination of clarithromycin and moxifloxacin, and surgical debridement.
Results All wounds healed completely within 4 weeks. The mean follow-up duration was 7.2 months, and none of the patients developed relapse. Specific NTM pathogens were identified in six patients. Eight patients showed caseating granuloma implying an NTM infection. One patient showed an uncommon Stenotrophomonas infection, which was successfully treated. Three patients had no evidence of a pathogen despite repeated microbial tests. Complications such as scarring, pigmentation, and disfigurement were common in all the patients.
Conclusions NTM should be considered in the differential diagnosis of an unusual skin and soft-tissue infection. We propose an empirical regimen of clarithromycin and moxifloxacin as an efficient treatment option for an NTM infection.
Comparison between Intramedullary Nailing and Percutaneous K-Wire Fixation for Fractures in the Distal Third of the Metacarpal Bone
Authors: Moon Sung Jun , Yang Jae-Won , Roh Si Young , Lee Dong Chul , Kim Jin Soo 
Published: November 2014

Background To compare clinical and radiographic outcomes between intramedullary nail fixation and percutaneous K-wire fixation for fractures in the distal third portion of the metacarpal bone.
Methods A single-institutional retrospective review identified 41 consecutive cases of metacarpal fractures between September 2009 and August 2013. Each of the cases met the inclusion criteria for closed, extra-articular fractures of the distal third of the metacarpal bone. The patients were divided by the method of fixation (intramedullary nailing or K-wire). Outcomes were compared for mean and median total active motion of the digit, radiographic parameters, and period until return to work. Complications and symptoms were determined by a questionnaire.
Results During the period under review, 41 patients met the inclusion criteria, and the fractures were managed with either intramedullary nailing (n=19) or percutaneous K-wire fixation (n=22). The mean and median total active range of motion and radiographic healing showed no statistically significant difference between the two groups. No union failures were observed in either group. The mean operation time was shorter by an average of 14 minutes for the percutaneous K-wire fixation group. However, the intramedullary nailing group returned to work earlier by an average of 2.3 weeks. Complications were reported only in the K-wire fixation group.
Conclusions Intramedullary nailing fixation is advisable for fractures in the distal third of the metacarpal bone. It provides early recovery of the range of motion, an earlier return to work, and lower complication rates, despite potentially requiring a wire removal procedure at the patient's request.