bluuebunny/crossref_metadata_2025 huggingface dataset:
Intergenerational Shared Sites
Authors: Ruggiano Nicole
Published: July 2011

Few studies have examined older adults’ behavior and attitudes within the context of intergenerational shared site (IGSS) environments, where children and older adults receive services at the same facility and typically share space and resources on an ongoing basis. This natural study examined the behaviors of older adults participating in two senior center programs that were co-located with child care facilities. Data collection involved participant observation and in-depth interviews with staff members at each IGSS. The data were systematically coded and analyzed for themes. Although positive informal intergenerational interactions occurred at both centers, many older adults demonstrated negative behaviors and attitudes when their programs shared space and/or relinquished resources to children’s programs. Implications for research and practice are provided.
Trigger factors for familial hemiplegic migraine
Authors: Hansen Jakob Møller , Hauge Anne Werner , Ashina Messoud , Olesen Jes
Published: July 2011

Objective: The aim was to identify and describe migraine trigger factors in patients with familial hemiplegic migraine (FHM) from a population-based sample.

Methods: 127 FHM patients were sent a questionnaire listing 16 trigger factors. Distinction was made between attacks of hemiplegic migraine (HM) and migraine with aura (MA) or without aura (MO) within each patient.

Results: The response rate was 59% (75/127) of whom 57 (76%) had current HM attacks. Sixty-three per cent (47/75) reported at least one factor triggering HM, and 36% (27/75) reported at least one factor that often or always caused HM. Twenty per cent (15/75) reported only HM, whereas FHM in combinations with MA and MO were reported by 80% (60/75). Stress (with attacks either following or during the stress), bright light, intense emotional influences and sleeping too much or too little were the trigger factors mentioned by most.

Conclusion: Many FHM patients report trigger factors and one-third reported at least one trigger factor often or always triggering FHM. The typical triggers are the same as for MA. Patients should be educated to avoid these factors. The role of trigger factors in the onset of new or first attacks of FHM remains unknown.
Process planning for corner machining based on a looping tool path strategy
Authors: Banerjee A , Feng H-Y , Bordatchev E V
Published: July 2011

A corner is an elemental machining feature for internal pockets that is difficult to plan and execute. During machining of a corner, there is continuous variation in radial depth of cut and frequent changes in magnitude as well as direction of the feed rate. These result in inconsistent machining leading to machine tool jerk, excessive cutting force, and poor surface finish. In this paper, an integrated process planning approach for optimal corner machining has been proposed that combines the tool path generation and machining parameter selection tasks. As a first step a looping tool path strategy was implemented to progressively remove material in multiple loops in order to keep the radial depth under a permissible limit. The tool path consists of G1 continuous biarc and arc spline segments which allow a constant feed rate to be held over the entire tool path. The geometries of the corner and cutting tool and the kinematics of the machine tool structure were considered in the calculation of the allowable constant feed rate. In the next step, the machining time was minimized by iteratively adjusting the feed per tooth value under cutting force constraints. The constraint ensured that the tool deflection was always under a tolerance limit. The resulting tool paths for different test cases indicated the ability of the tool path generation strategy to minimize the number of loops. A comparison of the results on machining times based on initial and optimal feed values and their corresponding tool path lengths indicated the potential for the improvement in productivity of corner machining. The proposed integrated approach that combines both geometric and machining parameters can generate more optimal process plans than approaches that consider these parameters separately.
An accurate double-superposition global–local theory for vibration and bending analyses of cylindrical composite and sandwich shells subjected to thermo-mechanical loads
Authors: Shariyat M
Published: July 2011

Based on the idea of double superposition, an accurate high-order global–local theoryis proposed for bending and vibration analysis of cylindrical shells subjected to thermo-mechanical loads, for the first time. The theory has many novelties, among them: (1) less computational time due to the use of the global–local technique and matrix formulations; (2) satisfaction of the complete kinematic and transverse stress continuity conditions at the layer interfaces under thermo-mechanical loads; (3) consideration of the transverse flexibility; (4) release of Love–Timoshenko assumption; and (5) capability of investigating the local phenomena. Various comparative examples are included to validate the theory and to examine its accuracy and efficiency.
Flutter prediction in turbomachinery with energy method
Authors: Zhang X W , Wang Y R , Xu K N
Published: July 2011

The study described in this article is the application of energy method for the prediction of flutter boundary and the effects of some parameters on aeroelastic stability in turbomachinery. The unsteady flow with multi-layer moving grid technique for blade oscillation was undergone for aerodynamic work with the blade passage being discretized using a background fixed H-grid and a body-fitted O-grid moving with the blade. Also, with the assumption of equivalent viscous damping, aerodynamic modal damping ratio was defined based on energy method. The numerical method, with mode shapes and nodal diameter numbers considered, was applied for a transonic compressor rotor stage for which measured flutter boundary on characteristic map was available. It was found that the calculated flutter boundary in the first bending blade mode agreed well with the measured one. Furthermore, it was concluded that the mode shapes and inter-blade phase angle were key parameters on aeroelasticity in turbomachinery and that the flutter instability was mainly induced by the co-action of shock wave and separated flow.
Evaluating the ability of posterior elements to support new instrumentation for spinal fusion
Authors: Singh D A , Ginsberg H J , Whyne C M
Published: July 2011

Posterior spinal plating devices have recently made a re-emergence as both stand-alone devices and for use in conjunction with anterior fusion. Yet, the structural integrity of the posterior elements to support loads throughout the spine and the impact of plating on posterior element strength has not been well characterized. This study aims to quantify the mechanical strength of the posterior elements (spinous processes/laminae) throughout the spine and to determine the effect of attaching posterior element plating systems on their ultimate load to failure. Vertebral levels from six cadaveric spines were grouped in pairs to account for varying geometries and sizes of the human posterior elements (a total of 59 levels in 5 groups). One sample from each pair was tested in its native state, and the complementary vertebra was tested via posterior plating. Posterior element plating caused moderate reductions in posterior element failure strength (15–24 per cent) throughout the cervical, thoracic, and lumbar spine. Bone mineral density of the posterior elements had the most significant impact on ultimate load to failure (a decrease of 0.1g/cm3, yields a 189 N reduction in). The modest structural impact of posterior element plating motivates continued investigation into potential use of less invasive plating devices for posterior spinal fusion.
Surveillance using serological and molecular methods for the detection of infectious agents in captive Brazilian neotropic and exotic felids
Authors: Filoni Claudia , Catão-Dias José Luiz , Cattori Valentino , Willi Barbara , Meli Marina L. , Corrêa Sandra Helena Ramiro , Marques Mara Cristina , Adania Cristina Harumi , Silva Jean Carlos Ramos , Marvulo Maria Fernanda Vianna , Neto José Soares Ferreira , Durigon Edison Luiz , de Carvalho Vania Maria , Coutinho Selene Dall’Acqua , Lutz Hans , Hofmann-Lehmann Regina
Published: July 2011

The aim of the current study was to investigate the exposure of captive wild felids to various infectious pathogens using serological and molecular methods. One hundred and fifty-nine neotropic felids and 51 exotic felids from 28 captive settings in Brazil were tested. While antibodies against Feline parvovirus and Feline coronavirus (FCoV), Feline calicivirus and Bartonella spp. were frequently detected by serologic tests, antibodies against Felid herpesvirus 1 or infection with hemotropic mycoplasmas were less prevalent. Serologic evidence of exposure to Ehrlichia spp., Feline immunodeficiency virus, and Feline leukemia virus (FeLV) was detected rarely, and infections with FeLV, Ehrlichia spp., and Cytauxzoon spp. were found infrequently. The detected Bartonella sequence was molecularly similar to B. koehlerae and B. henselae; for Cytauxzoon, the sequence resembled those from domestic cats. No Anaplasma phagocytophilum and Theileria spp. infections were detected. The positive test results varied significantly among different facilities and species. Additionally, FCoV seropositivity was more prevalent in captivity than in free-ranging populations. Results suggest that testing is appropriate prior to relocation of felids.
EU Disability Policy and Implications of EU Accession for Disability Rights in Education and Employment in Bulgaria, Romania, Croatia, and the Former Yugoslav Republic of Macedonia
Authors: Phillips Sarah D.
Published: July 2011

The effects of EU candidacy and accession on disability rights in education and employment are examined in two new member and two candidate countries. The development of EU disability policy is also discussed, especially as EU policy impacts reforms in Romania, Bulgaria, Croatia, and the Former Yugoslav Republic of Macedonia. Analysis is based on the existing literature and personal communication with scholars and activists in the countries of inquiry. Although considerable progress has been made in antidiscrimination legislation in the four countries, a lack of political will and inadequate financing means that real on-the-ground progress in advancing disability rights is limited. The article concludes with recommendations for how the EU and its administrative bodies and members of disability communities in the four countries can better advance disability rights in education and employment as part of the accession process.
Medical tourism facilitators: Patterns of service differentiation
Authors: Gan Lydia L. , Frederick James R.
Published: July 2011

This article studies the nature of differentiation in the market for medical tourism facilitators in the USA. Medical tourism facilitators in the USA resemble a monopolistically competitive industry. They choose to differentiate their services in several ways, including by the scope of countries and hospitals which they use, the scope of the treatments in which they specialize, the extent of involvement of medical professionals in the company, and the kinds of ancillary services they offer. The authors perform an exploratory study of the differentiation among 46 such firms. Using principal-components analysis, they detect three components: an emphasis on providing a broad selection of destinations, an emphasis on physician’s concerns, and an emphasis on the travel aspects of medical tourism. Cluster analysis separates the firms’ profiles into six types.
Social identities facilitate and encapsulate action-relevant constructs
Authors: Thomas Emma F. , Mavor Kenneth I. , McGarty Craig
Published: July 2011

Three studies explore the recently elaborated social identity model of collective action (SIMCA) and an alternative, the encapsulated model of social identity in collective action (EMSICA). These models both afford a central role to the function of social identities in promoting collective action, through affective reactions to injustice and group efficacy, but in different ways. Combined analyses of three samples ( N = 305) using multigroup structural equation modelling showed that both SIMCA and EMSICA fit the data well but that the path from group efficacy to action was of small size. Results showed that social identity processes can both facilitate and encapsulate other action-relevant constructs, and highlight the importance of considering multiple causal pathways to action.
Technical Adequacy of Early Numeracy Curriculum-Based Progress Monitoring Measures for Kindergarten and First-Grade Students
Authors: Hampton David D. , Lembke Erica S. , Lee Young-Sun , Pappas Sandra , Chiong Cynthia , Ginsburg Herbert P.
Published: July 2011

The purpose of this study was to examine six early numeracy measures used to monitor the mathematics progress of kindergarten and first-grade students. Seventy-one kindergarten students and 75 first-grade students were administered the measures each week. Delayed-alternate form reliability was adequate for instructional decision making on some measures, and low reliability was reported for quantity discrimination, as well as for the next number and number facts measures. Concurrent criterion validity coefficients comparing the measures with student performance on the Woodcock-Johnson Tests of Achievement–Third Edition (WJ III) resulted in weaker coefficients as compared to previous studies that have compared similar measures with the WJ III. Hierarchical linear modeling was used at each grade level to ascertain the ability of the six measures to model weekly growth trajectories over 13 weeks. All measures produced growth rates that were significant across time, for both kindergarten and first grade, with linear growth observed for all measures.
Do perimenopausal and menopausal symptoms affect the marital relationship?
Authors: Caico Carol
Published: July 2011

This study investigated whether women’s perimenopausal/menopausal symptoms had negative effects on marital or long-term relationships, an aspect underrepresented in the literature. A questionnaire distributed to 110 convenience-sampled women, ages 45-60 years and prescreened for inclusion by private practitioners or the author’s colleagues, yielded a 60% return. Symptoms correlated positively with participants’ feelings about the relationship and sexual intimacy with their partner (.353–.783, p = 0.01, and 272–.371, p = 0.05, respectively). Divorced women did not experience the same loss of sexual desire or feel anger or resentment toward their partners as did married women. Clinicians should ask women about perimenopausal/menopausal symptoms, loss of libido, and the marital relationship during annual visits. Education related to this period of life may provide a better understanding to women and the partner may be included in education, as many men do not understand the changes associated with perimenopause and menopause.
Mediating sovereignty: a comparative latent semantic analysis of US newspapers and conflicts in Kosovo and South Ossetia
Authors: Dittmer Jason , Parr David A
Published: July 2011

This article addresses the role of news media in mediating and legitimating sovereignty claims within the nation-state system. Given the performativity of sovereignty claims, the speech acts of political actors require mediation in order to achieve their intent. This mediation occurs through formal channels but requires dissemination via popular media to permeate the public consciousness. Journalistic practices play a key role in the degree to which sovereignty claims are narrated. The authors compare the ways in which US newspapers legitimated (or undermined) sovereignty claims by Kosovo and South Ossetia during their respective conflicts. Their research uses latent semantic analysis to reveal narrative emplotments of various actors in each conflict. The results indicate that, despite the potential to be narrated in similar ways, the Kosovo conflict was narrated as a humanitarian intervention, while the Russian intervention in South Ossetia was narrated as an imperialist intervention linked to larger geopolitical competition.
Initial therapy of mantle cell lymphoma
Authors: Inwards David J. , Witzig Thomas E.
Published: July 2011

Mantle cell lymphoma is a well-recognized distinct clinicopathologic subtype of B-cell non-Hodgkin lymphoma. The current World Health Organization (WHO) classification subdivides this entity into aggressive and other variants. The disease has a predilection for older males, and patients typically present at an advanced stage with frequent splenomegaly and extranodal involvement including bone marrow, peripheral blood, gastrointestinal, and occasional central nervous system involvement. Early studies of therapy outcomes in this disease revealed that while response rates where high, relapse was expected after a limited period of time. Prolonged survival was uncommon, with initial median survival rates typically in the 3–4-year range. Those with a high proliferative rate, blastoid morphology, and selected clinical features were recognized as having a worse prognosis. Therapeutic approaches have diverged into aggressive therapies with high response rates and promising progression free survival rates, which may be applied to younger healthy patients, and less aggressive approaches. Aggressive therapies include intensive chemotherapy alone or chemotherapy followed by autologous stem cell transplant, which has been shown to be most effective when applied in first remission. Whether these more intense therapies result in improved survival as compared with less aggressive therapies is not well established. Allogeneic transplant has also been investigated, although high treatment-related mortality and the risk of chronic graft versus host disease and the relatively advanced age of this patient population have tempered enthusiasm for this approach. A number of less aggressive therapies have been shown to produce promising results. Consolidation and maintenance strategies are an active area of investigation. A number of newer agents have shown promising activity in relapsed disease, and are being investigated in the front-line setting. Overall survival rates are improving in this disease, with current studies suggesting a median survival of 5 or more years.
Errorless and errorful learning modulated by transcranial direct current stimulation
Authors: Hammer Anke , Mohammadi Bahram , Schmicker Marlen , Saliger Sina , Münte Thomas F
Published: July 2011

Background

Errorless learning is advantageous over trial and error learning (errorful learning) as errors are avoided during learning resulting in increased memory performance. Errorful learning challenges the executive control system of memory processes as the erroneous items compete with the correct items during retrieval. The left dorsolateral prefrontal cortex (DLPFC) is a core region involved in this executive control system. Transcranial direct current stimulation (tDCS) can modify the excitability of underlying brain functioning.

Results

In a single blinded tDCS study one group of young healthy participants received anodal and another group cathodal tDCS of the left DLPFC each compared to sham stimulation. Participants had to learn words in an errorless and an errorful manner using a word stem completion paradigm. The results showed that errorless compared to errorful learning had a profound effect on the memory performance in terms of quality. Anodal stimulation of the left DLPFC did not modulate the memory performance following errorless or errorful learning. By contrast, cathodal stimulation hampered memory performance after errorful learning compared to sham, whereas there was no modulation after errorless learning.

Conclusions

Concluding, the study further supports the advantages of errorless learning over errorful learning. Moreover, cathodal stimulation of the left DLPFC hampered memory performance following the conflict-inducing errorful learning as compared to no modulation after errorless learning emphasizing the importance of the left DLPFC in executive control of memory.
Management of pain induced by exercise and mobilization during physical therapy programs: views of patients and care providers
Authors: Alami Sophie , Desjeux Dominique , Lefèvre-Colau Marie Martine , Boisgard Anne Sophie , Boccard Eric , Rannou François , Poiraudeau Serge
Published: July 2011

Background

The expectations of patients for managing pain induced by exercise and mobilization (PIEM) have seldom been investigated. We identified the views of patients and care providers regarding pain management induced by exercise and mobilization during physical therapy programs.

Methods

We performed a qualitative study based on semi-structured interviews with a stratified sample of 12 patients (7 women) and 14 care providers (6 women): 4 general practitioners [GPs], 1 rheumatologist, 1 physical medicine physician, 1 geriatrician, 2 orthopedic surgeons, and 5 physical therapists.

Results

Patients and care providers have differing views on PIEM in the overall management of the state of disease. Patients' descriptions of PIEM were polymorphic, and they experienced it as decreased health-related quality of life. The impact of PIEM was complex, and patient views were sometimes ambivalent, ranging from denial of symptoms to discontinuation of therapy. Care providers agreed that PIEM is generally not integrated in management strategies. Care providers more often emphasized the positive and less often the negative dimensions of PIEM than did patients. However, the consequences of PIEM cited included worsened patient clinical condition, fears about physical therapy, rejection of the physical therapist and refusal of care. PIEM follow-up is not optimal and is characterized by poor transmission of information. Patients expected education on how better to prevent stress and anxiety generated by pain, education on mobilization, and adaptations of physical therapy programs according to pain intensity.

Conclusion

PIEM management could be optimized by alerting care providers to the situation, improving communication among care providers, and providing education to patients and care providers.
Site-specific modification of ED-B-targeting antibody using intein-fusion technology
Authors: Möhlmann Sina , Bringmann Peter , Greven Simone , Harrenga Axel
Published: July 2011

Background

A promising new approach in cancer therapy is the use of tumor specific antibodies coupled to cytotoxic agents. Currently these immunoconjugates are prepared by rather unspecific coupling chemistries, resulting in heterogeneous products. As the drug load is a key parameter for the antitumor activity, site-specific strategies are desired. Expressed protein ligation (EPL) and protein trans-splicing (PTS) are methods for the specific C-terminal modification of a target protein. Both include the expression as an intein fusion protein, followed by the exchange of the intein for a functionalized moiety.

Results

A full-length IgG specific for fibronectin ED-B was expressed as fusion protein with an intein (Mxe GyrA or Npu DnaE) attached to each heavy chain. In vitro protocols were established to site-specifically modify the antibodies in high yields by EPL or PTS, respectively. Although reducing conditions had to be employed during the process, the integrity or affinity of the antibody was not affected. The protocols were used to prepare immunoconjugates containing two biotin molecules per antibody, attached to the C-termini of the heavy chains.

Conclusion

Full-length antibodies can be efficiently and site-specifically modified at the C-termini of their heavy chains by intein-fusion technologies. The described protocols can be used to prepare immunoconjugates of high homogeneity and with a defined drug load of two. The attachment to the C-termini is expected to retain the affinity and effector functions of the antibodies.
Association of laboratory parameters with viral factors in patients with hepatitis C
Authors: Ijaz Bushra , Ahmad Waqar , Javed Fouzia T , Gull Sana , Sarwar Muhammad T , Kausar Humera , Asad Sultan , Jahan Shah , Khaliq Saba , Shahid Imran , Sumrin Aleena , Hassan Sajida
Published: July 2011

Background and Aims

HCV infection may lead to hepatic fibrosis. In this study, we tried to determine whether there is any correlation of HCV genotypes and viral load to the clinical parameters such as ALT, AST, ALP, bilirubin, Hb level, patient's age and gender; and then correlated this association with disease progression in liver biopsy samples.

Methods

In cross-sectional and observational study, 6048 serum HCV RNA positive patients were chosen. The study consists of 53 months from March 2006 to September 2010. Patients were divided into three cohorts to validate our data. Statistical analysis and correlation of lab parameters with viral factors was determined by using SPSS version 16.

Results

The most prevalent genotype was 3 (70.9%) followed by 1 (13.3%) and 4 (7.4%), collectively. During Univariate analysis, in all cohorts; serum bilirubin, ALP, ALT and AAR showed significant correlation with genotypes, however multivariate analysis showed that all genotypes except 4a have no association with host biochemical markers. Disease progression was also independent of all genotypes. Serum ALP, ALT, bilirubin and viremea levels were significantly elevated in patients with genotype 4a. Viral load showed negative association with serum bilirubin (r = -0.112, P = 0.000) and ALP levels (r = -0.098, P = 0.000). We observed positive correlation of ALP and bilirubin levels, while negative associations of viral load with HCV liver disease progression.

Conclusion

Disease progression seems independent of the genotypes. Relationship between ALP and bilirubin with viral load may be an attractive marker to guess disease progression in patients with hepatitis C.
Single-step autoantibody profiling in antiphospholipid syndrome using a multi-line dot assay
Authors: Egerer Karl , Roggenbuck Dirk , Büttner Thomas , Lehmann Barbara , Kohn Annushka , von Landenberg Philipp , Hiemann Rico , Feist Eugen , Burmester Gerd-Rüdiger , Dörner Thomas
Published: July 2011

Introduction

Diagnosis of antiphospholipid syndrome (APS) still remains a laboratory challenge due to the great diversity of antiphospholipid antibodies (aPL) and their significance regarding APS-diagnostic criteria.

Methods

A multi-line dot assay (MLDA) employing phosphatidylserine (PS), phosphatidylinositol (PI), cardiolipin (CL), and beta2-glycoprotein I (β2 GPI) was used to detect aPL, immunoglobulin G (IgG) and immunoglobulin M (IgM) in 85 APS patients, 65 disease controls, and 79 blood donors. For comparison, anti-CL and anti-β2 GPI IgG and IgM were detected by enzyme-linked immunosorbent assay (ELISA).

Results

The level of agreement of both methods was good for anti-CL IgG, moderate for anti-CL IgM, very good for anti-β2 GPI IgG, and moderate for anti-β2 GPI IgM (kappa = 0.641, 0.507, 0.803 and 0.506, respectively). The frequency of observed discrepancies for anti-CL IgG (1.75%), anti-CL IgM (3.93%), anti-β2 GPI IgG (1.75%), and anti-β2 GPI IgM (0.87%) was low (McNemar test, P < 0.05, not-significant, respectively). Sensitivity, specificity, positive (+LR) and negative (-LR) likelihood ratios for at least one positive aPL antibody assessed by ELISA were 58.8%, 95.8%, 14.1, and 0.4, respectively, and for at least three positive aPl IgM and/or one positive aPL IgG by MLDA were 67.1%, 96.5%, 19.3, and 0.3, respectively. The frequency of IgM to PI, PS and CL, and combination of three or more aPL IgM detected by MLDA was significantly higher in APS patients with cerebral transient ischemia (P < 0.05, respectively).

Conclusions

The novel MLDA is a readily available, single-step, sensitive diagnostic tool for the multiplex detection of aPL antibodies in APS and a potential alternative for single aPL antibody testing by ELISA.
Atypical clinical presentation of a subset of patients with anti-RNA polymerase III - non-scleroderma cases associated with dominant RNA polymerase I reactivity and nucleolar staining
Authors: Ceribelli Angela , Krzyszczak Malgorzata E , Li Yi , Ross Steven J , Chan Jason YF , Chan Edward KL , Burlingame Rufus W , Webb Tyler T , Bubb Michael R , Sobel Eric S , Reeves Westley H , Satoh Minoru
Published: July 2011

Introduction

Anti-RNA polymerase III (RNAP III) antibodies are highly specific markers of scleroderma (systemic sclerosis, SSc) and associated with a rapidly progressing subset of SSc. The clinical presentation of anti-RNAP III positive patients, onset of Raynaud's phenomenon (RP) and SSc in unselected patients in a rheumatology clinic were evaluated.

Methods

Autoantibodies in sera from 1,966 unselected patients (including 434 systemic lupus erythematosus (SLE), 119 SSc, 85 polymyositis/dermatomyositis (PM/DM)) in a rheumatology clinic were screened by radioimmunoprecipitation. Anti-RNAP III positive sera were also tested by immunofluorescence antinuclear antibodies and anti-RNAP III ELISA. Medical records of anti-RNAP III positive patients were reviewed.

Results

Among 21 anti-RNAP III positive patients, 16 met the American College of Rheumatology (ACR) SSc criteria at the initial visit but 5 did not; diagnoses were vasculitis, early polyarthritis, renal failure with RP, interstitial lung disease, and Sjögren's syndrome. The first two patients developed rapidly progressive diffuse SSc. An additional case presented with diffuse scleroderma without RP and RP developed two years later. Anti-RNAP III antibodies in these 6 cases of atypical clinical presentation were compared with those in 15 cases of typical (SSc with RP) cases. Anti-RNAP III levels by ELISA were lower in the former group (P = 0.04 by Mann-Whitney test) and 3 of 6 were negative versus only 1 of 15 negative in the latter (P < 0.05 by Fisher's exact test). Three cases of non-SSc anti-RNAP III positive patients had predominant reactivity with RNAP I with weak RNAP III reactivity and had a strong nucleolar staining. Three anti-RNAP III patients, who did not have RP at the initial visit, developed RP months later. Scleroderma developed prior to RP in 5 out of 16 (31%) in the anti-RNAP III group, but this was rare in patients with other autoantibodies. The interval between the onset of RP to scleroderma was short in anti-RNAP III positive patients.

Conclusions

Anti-RNAP III antibodies are highly specific for SSc; however, a subset of anti-RNAP III positive patients do not present as typical SSc. The interval between RP and scleroderma in this group is short, and 31% of patients developed scleroderma prior to RP in this group. Anti-RNAP III positive patients may not present as typical SSc and detecting anti-RNAP III may have predictive value.
Adiposity and Hot Flashes in Midlife Women: A Modifying Role of Age
Authors: Thurston Rebecca C. , Santoro Nanette , Matthews Karen A.
Published: July 2011

Background:

The nature of the relationship between adiposity and hot flashes has been debated, but it has not been examined using physiological measures of hot flashes. We examined associations between body size/composition and physiologically assessed hot flashes among women with hot flashes.

Methods:

A subcohort of women in the Study of Women's Health Across the Nation (n = 52; 25 African-American and 27 non-Hispanic Caucasian; ages, 54 to 63 yr) who reported hot flashes, had their uterus and ovaries, and were not taking medications impacting hot flashes were recruited in 2008–2009. Women completed anthropometric measures [bioimpedance analysis of total percentage of body fat, body mass index (BMI), waist circumference], a blood draw (estradiol, SHBG, FSH, dehydroepiandrosterone sulfate), and 4 d of ambulatory sternal skin conductance monitoring with diary (physiological and reported hot flashes, respectively). Associations between anthropometrics and hot flashes were estimated with generalized estimating equations with covariates age, race, and anxiety.

Results:

Higher BMI (odds ratio, 0.97; 95% confidence interval, 0.94–0.99; P < 0.05) and waist circumference (odds ratio, 0.98; 95% confidence interval, 0.97–0.99; P < 0.01) were associated with fewer physiological hot flashes. Interactions by age (P < 0.05) indicated that inverse associations of body fat, BMI, and waist circumference with hot flashes were most apparent among the oldest women in the sample. Estradiol and SHBG reduced but did not eliminate age-related variations in relations between body size/composition and hot flashes.

Conclusion:

Higher adiposity was associated with fewer physiological hot flashes among older women with hot flashes. A modifying role of age must be considered in understanding the role of adiposity in hot flashes.
Vital Radiology – Learning from Our Mistakes to Improve Junior Doctors' Interpretation of Radiographs
Authors: Mullett Rebecca , Gough Edward , Prowse Simon , Jayan Radhakrishnan , Craghill Edward , Bowering Katherine , Taheri Azadeh , Curtis John
Published: July 2011

Following a Never Event in our Trust which involved misinterpretation of a radiograph by a junior doctor, we set out to reduce the risk of recurrence by creating Vital Radiology. Vital Radiology is a new scheme designed to teach junior doctors about important radiological diagnoses that, if missed at the bedside, can have devastating consequences for patients. Although in its infancy, the scheme is receiving positive feedback both from the participants and senior clinicians. Ultimately we aim to extend the scheme throughout our trust and beyond, with the intention to improve junior doctors' confidence in interpreting images and, more importantly, to reduce risk to patients.
Appendicitis in children and young people
Authors: Wheeler Robert A
Published: July 2011

The incidence of appendicitis has its peak between 12 and 18 years of age. It is one of the commonest, and familiar, emergency surgical conditions in this age group, but it appears to be difficult to diagnose, since it is one of the most frequent causes of litigation on the basis of ‘missed diagnosis’. This paper explores why appendicitis should pose such difficulties to clinicians.
Comparing the USA, UK and 17 Western countries’ efficiency and effectiveness in reducing mortality
Authors: Pritchard Colin , Wallace Mark S
Published: July 2011

Objectives

To test the hypothesis that the USA healthcare system was superior to the NHS and 17 other Western countries in reducing feasible mortality rates over the period 1979–2005.

Design

Economic inputs into healthcare, GDP health expenditure (GDPHE) were compared with clinical outputs, i.e. total ‘adult’ (15–74 years) and ‘older’ (55–74 years) mortality rates based upon three-year average mortality rates for 1979–81 vs. 2003–2005. A cost-effective ratio was calculated by dividing average GDPHE into reduced mortality rates over the period.

Setting

Nineteen Western countries’ mortality rates compared between 1979–2005.

Participants

Mortality of people by age and gender.

Main outcome measures

A cost-effective ratio to measure efficiency and effectiveness of healthcare systems in reducing mortality rates. Chi-square tested any differences between the USA, UK and other Western countries.

Results

Input: The USA had the highest current and average GDPHE; the UK was 10th highest but joint 16th overall, still below the Western countries’ average. Output: Every country's mortality rate fell substantially; but 15 countries reduced their mortality rates significantly more than the US, while UK ‘adult’ and ‘older’ mortality rates fell significantly more than 12 other countries. Cost-effectiveness: The USA GDPHE: mortality rate ratio was 1:205 for ‘adults’ and 1:515 for ‘older’ people, 16 Western countries having bigger ratios than the US; the UK had second greatest ratios at 1:593 and 1:1595, respectively. The UK ratios were >20% larger than 14 other countries.

Conclusions

In cost-effective terms, i.e. economic input versus clinical output, the USA healthcare system was one of the least cost-effective in reducing mortality rates whereas the UK was one of the most cost-effective over the period.
NMR structure of a 4 × 4 nucleotide RNA internal loop from an R2 retrotransposon: Identification of a three purine–purine sheared pair motif and comparison to MC-SYM predictions
Authors: Lerman Yelena V. , Kennedy Scott D. , Shankar Neelaabh , Parisien Marc , Major Francois , Turner Douglas H.
Published: July 2011

The NMR solution structure is reported of a duplex, 5′GUGAAGCCCGU/3′UCACAGGAGGC, containing a 4 × 4 nucleotide internal loop from an R2 retrotransposon RNA. The loop contains three sheared purine–purine pairs and reveals a structural element found in other RNAs, which we refer to as the 3RRs motif. Optical melting measurements of the thermodynamics of the duplex indicate that the internal loop is 1.6 kcal/mol more stable at 37°C than predicted. The results identify the 3RRs motif as a common structural element that can facilitate prediction of 3D structure. Known examples include internal loops having the pairings: 5′GAA/3′AGG, 5′GAG/3′AGG, 5′GAA/3′AAG, and 5′AAG/3′AGG. The structural information is compared with predictions made with the MC-Sym program.
Robust Software Partitioning with Multiple Instantiation
Authors: Spacey Simon A. , Wiesemann Wolfram , Kuhn Daniel , Luk Wayne
Published: July 2011

The purpose of software partitioning is to assign code segments of a given computer program to a range of execution locations such as general-purpose processors or specialist hardware components. These execution locations differ in speed, communication characteristics, and size. In particular, hardware components offering high speed tend to accommodate only few code segments. The goal of software partitioning is to find an assignment of code segments to execution locations that minimizes the overall program run time and respects the size constraints. In this paper we demonstrate that an additional speedup is obtained if we allow code segments to be instantiated on more than one location. We further show that the program run time not only depends on the execution frequency of the code segments but also on their execution order if there are multiply instantiated code segments. Unlike frequency information, however, sequence information is not available at the time when the software partition is selected. This motivates us to formulate the software-partitioning problem as a robust optimization problem with decision-dependent uncertainty. We transform this problem to a mixed-integer linear program of moderate size and report on promising numerical results.
A Simple but Usually Fast Branch-and-Bound Algorithm for the Capacitated Facility Location Problem
Authors: Görtz Simon , Klose Andreas
Published: July 2011

This paper presents a simple branch-and-bound method based on Lagrangean relaxation and subgradient optimization for solving large instances of the capacitated facility location problem (CFLP) to optimality. To guess a primal solution to the Lagrangean dual, we average solutions to the Lagrangean subproblem. Branching decisions are then based on this estimated (fractional) primal solution. Extensive numerical results reveal that the method is much faster and more robust than other state-of-the-art methods for solving the CFLP exactly.
Early Dynamic Change in High-Sensitivity Cardiac Troponin T in the Investigation of Acute Myocardial Infarction
Authors: Aldous Sally J , Richards A Mark , Cullen Louise , Than Martin P
Published: July 2011

BACKGROUND

The definition of acute myocardial infarction (AMI) requires a rise and/or fall in troponin with 1 or more results ≥99th percentile of the reference range. How much troponin must change has not been specified. We ascertained whether dynamic changes (δ) in high-sensitivity troponin T (hs-TnT) improved diagnostic and prognostic test performance in the emergency department.

METHODS

We recruited 939 patients with symptoms suggestive of acute coronary syndrome (without ST elevation). hs-cTnT was measured at 0 h and 2 h after presentation. End-points were admission diagnosis of AMI and 1-year adverse events (composite of death, AMI, revascularization).

RESULTS

Diagnostic specificity of 0–2-h hs-cTnT for AMI (incurred by 200 patients) improved from 79.8% (78.8%–80.5%) by using the 99th percentile alone to 94.2% (92.9%–95.4%) when we also included a δ ≥20%, but diagnostic sensitivity decreased from 94.5% (90.7%–96.9%) to 49.5% (44.6%–53.9%). With the inclusion of those patients with a δ ≥20% when 0–2-h hs-cTnT was <99th percentile, in addition to any with concentrations ≥99th percentile, diagnostic sensitivity increased to 97.5% (94.4%–98.9%). hs-cTnT ≥99th percentile predicted adverse events (incurred by 111 patients), adjusted hazard ratio 1.9 (1.2–2.8), whereas a δ ≥20% did not, hazard ratio 1.1 (0.7–1.7).

CONCLUSIONS

Diagnostic specificity of hs-cTnT improved with the use of a δ ≥20% in those patients with concentrations ≥99th percentile, but at a cost of a large reduction in sensitivity. Diagnostic sensitivity improved with the use of a δ ≥20% in patients with 0–2-h concentrations <99th percentile. Both approaches may be required for optimum rule-in and rule-out strategies, respectively. The δ criteria seem to be less useful for medium-term risk stratification.
Quality Error Rates in Point-of-Care Testing
Authors: O'Kane Maurice J , McManus Paul , McGowan Noel , Lynch PL Mark
Published: July 2011

BACKGROUND

Although a theoretical consideration suggests that point-of-care testing (POCT) might be uniquely vulnerable to error, little information is available on the quality error rate associated with POCT. Such information would help inform risk/benefit analyses when one considers the introduction of POCT.

METHODS

This study included 1 nonacute and 2 acute hospital sites. The 2 acute sites each had a 24-h central laboratory service. POCT was used for a range of tests, including blood gas/electrolytes, urine pregnancy testing, hemoglobin A1c (Hb A1c), blood glucose, blood ketones, screening for drugs of abuse, and urine dipstick testing. An established Quality Query reporting system was in place to log and investigate all quality errors associated with POCT. We reviewed reports logged over a 14-month period.

RESULTS

Over the reporting period, 225 Quality Query reports were logged against a total of 407 704 POCT tests. Almost two-thirds of reports were logged by clinical users, and the remainder by laboratory staff. The quality error rate ranged from 0% for blood ketone testing to 0.65% for Hb A1c testing. Two-thirds of quality errors occurred in the analytical phase of the testing process. These errors were all assessed as having no or minimal adverse impact on patient outcomes; however, the potential adverse impact was graded higher.

CONCLUSIONS

The quality error rate for POCT is variable and may be considerably higher than that reported previously for central laboratory testing.
Spectroscopic and Molecular Modeling Studies of the Inclusion Complex of TNBAB with β-cyclodextrin in Aqueous Solution
Authors: Yang Zhenyu , Gao Chunzhi , Wang Hongming , Gu Ningyu , Zhang Rongbin , Zhang Ning
Published: July 2011

In this investigation, a novel surfactant (N, N, N-trimethyl-4-(5-(octyloxy) naphthalene-1-yloxy) butan-1-aminium bromide, TNBAB) with a naphthalene chromophore moiety was designed and synthesized. The UV, fluorescence and 1H NMR measurements and molecular modeling have been carried out at 298.2 K for TNBAB + H2O, and TNBAB +
β-CD + H2O systems. The stoichoimetry, stability constant and potential energy surface for the inclusion complex of TNBAB and β-CD have been determined. The results of UV and fluorescence suggested that β-CD formed strong complex with TNBAB, the stoichoimetry was found to be almost 1:1, and the inclusion constants obtained are larger than 2.1×104 L mol-1. 1H NMR and molecular modeling studies indicated β-CD and TNBAB could form a two different inclusion complexes (Fig. 9), the two part of the aliphatic chain (one including partly naphthalene nucleus) were encapsulated in the cavity of the β-CD through hydrophobic interaction, respectively.
Design of a modified linear quadratic regulator for vibration control of suspension systems
Authors: Yildirim Ş. , Kalkat M. , Uzmay İ. , Husi G.
Published: July 2011

This paper is concerned with the construction of a prototype active vehicle suspension system for a one-wheel car model by using a modified Linear Quadric Regulator (LQR). The experimental system is approximately described by a non-linear system with two degrees of freedom subject to excitation from a road profile. The active control at the suspension location is designed by using feedback constant gain controller structure. The experimental results show that the active suspension system with LQR more improves the control performance than standard PID controller. On the other hand, the results improved that the modified LQR has superior performance for controlling suspension systems in real time.
On-site monitoring in a passive house
Authors: Csoknyai T. , Talamon A.
Published: July 2011

In the beginning of August 2009 a long-term monitoring started in a recently built passive house near Isaszeg. The first results were presented in the last year's conference. The present paper gives an overview about a whole-year data evaluation focusing on energy consumption. During the first year of building occupancy three types of heat suppliers and two types of heat exchangers in the ventilation systems were applied and monitored, thus different heating options could be compared.
Investigation of the flatness of rolled aluminium sheet
Authors: Pálinkás S. , Tóth J.
Published: July 2011

A lot of problems arise even recently concerning the control of flatness and profile of rolled strip in industrial circumstances. In the course of planning of the cold-rolling technology of geometrically true strip that is exempt of internal deformation stresses — i.e. flatness strip — it is necessary to take into consideration the elastic and thermal deformation of working rolls, the basic sheet-metal forming of rolls, the existing crown of basic material as well as the wearing of the rolls. A measurement method by which the shape of strip can exactly be measured is necessary for performing the control. In the present phase of my research work, a measurement device has been developed by means of which the given problem can be solved for the time being in experimental circumstances.
Dengue: clinical forms and risk groups in a high incidence city in the southeastern region of Brazil
Authors: Cardoso Ivana Macedo , Cabidelle Aline de Souza Areias , Borges Patrícia de Castro e Leão , Lang Carolina Ferreira , Calenti Fabrício Greco , Nogueira Larissa de Oliveira , Falqueto Aloisio , Cerutti Junior Crispim
Published: July 2011

INTRODUCTION: The article describes the epidemiologic profile of dengue cases in Vitória, the capital of Espírito Santo, Brazil, from 2000 to 2009, aimed at identifying risk groups regarding the incidence and severity of the disease. METHODS: Confirmed cases of dengue among city residents during ten years were classified as dengue fever, dengue hemorrhagic fever, dengue shock syndrome and dengue with complications, and analyzed according to sex, age, race-color and education. RESULTS: The proportion of dengue cases was highest among women aged 20 to 29 years-old and similar between whites and blacks. A gradual decrease occurred in the percentage of dengue cases in the population aged 15 years-old or more, in the historical series of 10 years, and a growing increase in individuals less than 15 years-old, showing statistical significance. The fatality rate ranged from zero to 0.3% for all forms of dengue and from 0.2% to 18.2% for severe forms. CONCLUSIONS: The profile of those affected by the disease in the municipality is similar to those affected in Brazil. The increasing number of cases in individuals under 15 years-old corroborates the results of recent studies in other Brazilian municipalities.