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Background Zygomaticomaxillary complex (ZMC) and zygomatic arch (ZA) fractures are common injuries resulting from facial trauma and frequently require surgical management (Huang et al., Craniomaxillofac Trauma Reconstr 8(4):271-6, 2015). A substantial number of post-operative functional and cosmetic complications can arise from the surgical management of these fractures. These include scarring, inadequate facial profile restoration, facial asymmetries and diplopia (Ellis et al. J Oral Maxillofac Surg 54(4):386-400, 1996; Yang et al. Oral Maxillofac Surg Clin North Am 23(1):31-45, 2011; Kloss et al. Int J Oral Maxillofac Surg 40(1):33-7, 2011). Intuitively, most of these aforementioned complications arise as a result of inadequate fracture reduction; however, current standard practice is to assess reduction post-operatively through plain radiographs or computed tomography (CT) scans. The role of intra-operative CT scanning to assess the reduction of ZMC/ZA fractures and the potential impact on complications, has thus far not been established. Methods This is a prospective randomised controlled trial currently being undertaken at the Royal Brisbane and Women’s Hospital. All patients who require operative management of their ZMC or ZA fractures are offered enrollment in the trial. The patients are randomised into two groups: interventional (intra-operative CT) and control (no intra-operative CT). All patients in each group will have post-operative radiographs taken. From these radiographs, the reduction of the ZMC and/or ZA fracture is graded by a blinded assessor. Patients will be reviewed in clinic at 1 week and 6 weeks post-surgery. During these consultations, all patients will be assessed for scarring, diplopia, facial profile restoration and need for revision surgery. Discussion Many complications associated with surgical management of ZMC and ZA fractures involve poor aesthetic results as a direct consequence of inadequate fracture reduction. Inadequate fracture reduction is predictable given that small incisions are used and only limited visualisation of the fractures is possible during the procedure. This is due to a desire to limit scarring and reduce the risk of damage to vital structures in an aesthetically sensitive region of the body. It follows that an intraoperative adjunctive tool such as a CT scan, which can assist in visualisation of the fractures and the subsequent reduction, could potentially improve reduction and reduce complications. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12616000693426. Registered on 26 May 2016. Electronic supplementary material The online version of this article (10.1186/s13063-019-3625-8) contains supplementary material, which is available to authorized users.

Complications related to lateral pterygoid muscle (LPM) botulinum toxin A (BtA) injection for recurrent temporomandibular joint dislocation are uncommon. No cases of velopharyngeal dysfunction (VPD) following LPM BtA injection have been reported to date. This report details the perioperative and follow-up findings for a patient developing VPD following LPM BtA injection.

The purpose of this study was to evaluate the effect of formulation and processing changes on the dissolution and bioavailability of propranolol hydrochloride tablets. Directly compressed blends of 6 kg (20,000 units) were prepared by mixing in a 16-qt V blender and tablets were compressed on an instrumented Manesty D3B tablet press. A half-factorial (2(5-1), Resolution V) design was used to study the following variables: filler ratio (lactose/dicalcium phosphate), sodium starch glycolate level, magnesium stearate level, lubricant blend time, and compression force. The levels and ranges of the excipients and processing changes studied represented level 2 or greater changes as indicated by the Scale-up and Post Approval Changes (SUPAC-IR) Guidance. Changes in filler ratio, disintegrant level, and compression force were significant in affecting percent drug released (Q) in 5 min (Q5) and Q10. However, changes in magnesium stearate level and lubricant blend time did not influence Q5 and Q10. Hardness was found to be affected by changes in all of the variables studied. Some interaction effects between the variables studied were also found to be significant. To examine the impact of formulation and processing variables on in vivo absorption, three batches were selected for a bioavailability study based on their dissolution profiles. Thirteen subjects received four propranolol treatments (slow-, medium-, and fast-dissolving formulations and Inderal 80 mg) separated by 1 week washout according to a randomized crossover design. The formulations were found to be bioequivalent with respect to the log Cmax and log AUC0-infinity. The results of this study suggest that (i) bioavailability/bioequivalency studies may not be necessary for propranolol and perhaps other class 1 drugs after level 2 type changes, and (ii) in vitro dissolution tests may be used to show bioequivalence of propranolol formulations with processing or formulation changes within the specified level 2 ranges examined.

Ten patients with multiple sclerosis (MS) were enrolled in a preliminary trial of the potassium channel blocker, 3,4-diaminopyridine, to evaluate drug toxicity and pharmacokinetics. The patients were treated with oral 3,4-diaminopyridine, first with increasing single doses up to 100 mg and then with divided dosage for up to 3 weeks. Paresthesias were reported by all patients and abdominal pain was dose limiting in 6 patients. 3,4-Diaminopyridine levels and half-life varied widely from patient to patient. Cerebrospinal fluid levels of 3,4-diaminopyridine were about 10% of those in serum. Neither seizures nor epileptiform changes on electroencephalographic examination occurred. Small reversible improvements in specific neurological deficits were seen on examination in all patients and reversible improvement in visual evoked response latencies were found in 2 patients. These results suggest that further study of 3,4-diaminopyridine in patients with MS is warranted.

P synchronous pacing has long been identified as advantageous for patients with atrioveniricular conduction defects and intact sinus node function. Prior endocavitury systems have been infrequently employed, because of unreliable P wave sensing from standard ring electrodes in the atrium or the requirement for a second atriaJ sensing lead. A single endocardial lead employing a unipolar ventricular stimulating electrode and an orthogonal P wave sensing design was developed and tested in 22 patients undergoing electrophysiologic study or pacemaker implantation. Thirteen centimeters from the stimulating tip of a standard permanent pacing lead, three or four electrodes with a surface area of one millimeter squared, equidistant from the tip, were placed circumferentially about the catheter. With the catheter tip normally placed in the right ventricular apex, atrial sensing eJectrodes were positioned in the mid-high lateral right atrium, adjacent to, but not affixed to, the right atrial wall. Bipolar orthogonal leads X and Y were obtained. In 22 patients, during sinus rhythm, atrial electrogram voltages in the X axis of 2.47 plus or minus 1.6 millivolts and 2.32 plus or minus 1.6 millivolts in the Y axis were recorded. QRS voltages of 0.078 millivolts and 0.073 millivolts, respectively, allowed dramatic ability to discriminate P from QRS complexes (P/QRS equals 32/1). There was no change in QRS voltages recorded during spontaneous premature ventricular contractions, bipolar or unipolar ventricular pacing. A single catheter designed for P synchronous pacing empJoying circumferentially placed atrial sensing electrodes has demonstrated unique atrial sensing voltages with excellent QRS signal rejection. (PACE, Vol. 4, November-December, 1981)

N-Ethylmaleimide has been found suitable for the determination of mercapto groups in proteins. Its application to ovalbumin, β-lactoglobulin, and bovine serum albumin has given results in accordance with those of other analytical methods. The first two proteins must be denatured, and different denaturants vary in their action. Since the reactivity of mercapto groups in proteins is determined by many factors, more than one reagent and a single set of conditions should in general be used.

Interference by salicylic acid was noted in a high pressure liquid chromatographic assay of theophylline in serum. The acid eluted very close to theophylline in a mobile phase consisting of 0.01 M acetate buffer, pH 4.0, containing 28% methanol on a C-18 reverse-phase column. The two peaks could be resolved by switching to a mobile phase containing 18% methanol, 1.6% acetonitrile, and 1.6% acetic acid in water. However, in this mobile phase traces of the extracting solvent, ethyl acetate, caused a sharpening of the theophylline peak leading to spuriously high results. The problem was overcome by using chloroform to extract the theophylline from serum.

Evaluation influence is a reconceptualization of evaluation use that reflects the broad and diffuse impacts an evaluation can have on social programs and policies. This way of thinking about impact provides an opportunity to investigate how and why evaluations influence social programs and policy. Twenty participants (practitioners and managers) from two child protection programs evaluated in the previous 24 months were interviewed about the influence of these evaluations, which was complemented with the collection of internal documents about changes to the programs. A qualitative case study analysis of evaluation influence was conducted using the interviews and documents to investigate the influence of two evaluations at different stages in the dissemination process. The participants identified that the evaluations appeared to have significant high-level policy level influence; however, limited examples of influence on practices in the programs were identified. There was some suggestion that the evaluations had increased practitioner interest in working with and participating in program evaluations. The findings suggest the importance of developmental evaluation approaches and practitioner engagement in evaluation to improve the influence and adoption of new knowledge from the evaluation of social programs. Refereed/Peer-reviewed

To improve the holistic response to child sexual abuse in Perth, Western Australia, a group consisting of government and community support agencies developed a new co-located approach that combined support services with investigations, called the Multi-agency Investigation & Support Team (MIST). The model was comparable to the prominent Children’s Advocacy Centre approach, with adaptations for Australian conditions. This study evaluated the fidelity with which this new program was delivered and examined whether it resulted in improved criminal justice, child protection, and service outcomes compared to existing practice. Drawing on service data linked across participating agencies the study found MIST was delivered with reasonable fidelity to its planned procedure, but with some challenges for delivery of the program due to the relative workload for staff in the MIST condition. The service demonstrated high levels of caregiver satisfaction with the response and high rates of children’s engagement with therapy. A quasi-experimental comparison between MIST (n = 126) and Practice as Usual (n = 276) found MIST was significantly faster throughout the criminal justice and child protection processes, but the conditions did not differ in the rate of arrest or child protection actions. While embedding support services within the investigation process may not have a dramatic influence on criminal justice and child protection outcomes, the high rates of uptake of therapeutic services and parental satisfaction suggest other benefits that require future exploration. Refereed/Peer-reviewed

Cross-agency collaboration for responding to child abuse cases is critical for the safety and wellbeing of children. However, working effectively across organizational boundaries can be difficult, especially where there are considerable disciplinary differences. Accordingly, many jurisdictions have put in place policies and processes to support cross-agency collaboration across groups responding to severe child abuse. The aim of this scoping review was to highlight key factors that may influence the quality of cross-agency collaboration in severe child abuse cases. A systematic search comprising 57 empirical studies examining the facilitators and/or barriers to cross-agency collaboration in child abuse cases was undertaken identifying eleven factors. This review found the most commonly cited factor was the need to reconcile the different roles/mandates of workers with their roles in a cross-agency response. A clear cross-agency protocol that establishes agreed procedures was also a commonly cited factor, along with cross-agency training, and communication and information sharing practices. This scoping review highlighted the lack of high-quality evidence that could be used to assess the effectiveness of policies and processes to support cross-agency collaboration for child abuse cases, and targeted areas for future research to enhance the quality of evidence for this common type of program/intervention. Refereed/Peer-reviewed

Child Advocacy Centers (CAC) emphasize developing effective cross-agency collaborations between workers involved in serious abuse investigations to foster improvements in agency outcomes, and to minimize distress, confusion and uncertainty for children and families. This study examined the characteristics of CACs, whether models in practice match the predominant model presented in the research literature. Directors of CACs in the United States that were members of the National Children’s Alliance (NCA) mailing list (n = 361) completed an online survey in 2016. While some core characteristics were ubiquitous across CACs, the data suggests that different types of CACs exist defined by characteristics that are not prescribed under NCA principles, but which are arguably relevant to the quality of the response. From the results of a cluster analysis, the researchers propose a typology of CACs that reflects the development and integration of centers: (a) core CAC services (i.e. interviewing & cross-agency case review); (b) an aggregator of external services, and (c) a more centralized full-service CAC. Further research is needed to understand how these variations may impact practice and outcomes; this is particularly important considering many CACs do not match the full-service models most commonly examined in the research literature, which limits the degree to which these findings apply to CACs generally. This article proposes further research framed by the need to better understand how different parts of the response impact on outcomes for children and families affected by abuse. Refereed/Peer-reviewed

Multi-Disciplinary teams (MDTs) have often been presented as the key to dealing with a number of intractable problems associated with responding to allegations of physical and sexual child abuse. While these approaches have proliferated internationally, researchers have complained of the lack of a specific evidence base identifying the processes and structures supporting multi-disciplinary work and how these contribute to high-level outcomes. This systematic search of the literature aims to synthesize the existing state of knowledge on the effectiveness of MDTs. This review found that overall there is reasonable evidence to support the idea that MDTs are effective in improving criminal justice and mental health responses compared to standard agency practices. The next step toward developing a viable evidence base to inform these types of approaches seems to be to more clearly identify the mechanisms associated with effective MDTs in order to better inform how they are planned and implemented. Refereed/Peer-reviewed

While awareness of institutional child sexual abuse has grown in recent years, there remains limited understanding of its occurrence and outcomes as a distinct form of abuse. Drawing on research commissioned by the Australian Royal Commission into Institutional Responses to Child Sexual Abuse, this article presents a rapid review of available evidence on the impacts of institutional abuse on victim/survivors. Literature searches identified 75 sources spanning international peer reviewed work and reports to Government that document or quantify the impacts of mostly historical child sexual abuse occurring in religious, educational, sporting and residential or out-of-home care settings. Consistent with child sexual abuse in other contexts, institutional child sexual abuse is found to be associated with numerous, pervasive and connected impacts upon the psychological, physical, social, educative and economic wellbeing of victims/survivors. Further, institutional child sexual abuse is associated with vicarious trauma at the individual, family and community level, and with impacts to the spiritual wellbeing of victims/survivors of abuse that occurs in religious settings. The identified literature suggests the trauma of institutional child sexual abuse may be exacerbated by the interplay of abuse dynamics in institutional settings, which may reduce or impede circumstances supporting disclosure, belief, support and protection from future harm. Acknowledging the limitations of the present study and the available evidence, this narrative synthesis provides insights into the complex impacts of institutional child sexual abuse. Refereed/Peer-reviewed

The Child Advocacy Center (CAC) model has been presented as the solution to many of the problems inherent in responses by authorities to child sexual abuse. The lack of referral to therapeutic services and support, procedurally flawed and potentially traumatic investigation practices, and conflict between the different statutory agencies involved are all thought to contribute to low conviction rates for abuse and poor outcomes for children. The CAC model aims to address these problems through a combination of multidisciplinary teams, joint investigations, and services, all provided in a single child friendly environment. Using a systematic search strategy, this research aimed to identify and review all studies that have evaluated the effectiveness of the approach as a whole, recognizing that a separate evidence base exists for parts of the approach (e.g., victim advocacy and therapeutic responses). The review found that while the criminal justice outcomes of the model have been well studied, there was a lack of research on the effect of the model on child and family outcomes. Although some modest outcomes were clear, the lack of empirical research, and over reliance on measuring program outputs, rather than outcomes, suggests that some clarification of the goals of the CAC model is needed. Refereed/Peer-reviewed

Background: The impact of an evaluation is an important consideration in designing and carrying out evaluations. Evaluation influence is a way of thinking about the effect that an evaluation can have in the broadest possible terms, which its proponents argue will lead to a systematic body of evidence about influential evaluation practices. Method: This literature review sets out to address three research questions: How have researchers defined evaluation influence; how is this reflected in the research; and what does the research suggest about the utility of evaluation influence as a conceptual framework. Drawing on studies that had cited one of the key evaluation influence articles and conducted original research on some aspect of influence this article reviewed the current state of the literature toward the goal of developing a body of evidence about how to practice influential evaluation. Results: Twenty-eight studies were found that have drawn on evaluation influence, which were categorized into (a) descriptive studies, (b) analytical studies, and (c) hypothesis testing. Conclusion: Despite the prominence of evaluation influence in the literature, there is slow progress toward a persuasive body of literature. Many of the studies reviewed offered vague and inconsistent definitions and have applied influence in an unspecified way in the research. It is hoped that this article will stimulate interest in the systematic study of influence mechanisms, leading to improvements in the potential for evaluation to affect positive social change.