bluuebunny/crossref_metadata_2025 huggingface dataset:
A report on physiotherapy services for children and young people
Authors: Davies Jo , Miller Michael
Published: September 2011

Introduction

There is a recognised difference in the centralised children's services compared with the more localised adult services for those with neuromuscular diseases. At the young people's unit at Martin House transition is a difficult time with uncertainties about the availability and working practices of physiotherapy services for adults.

With funding from the DH as part of the £30million the physiotherapy services in Yorkshire and Humber were reviewed.

Method

Contacts were made from a number of sources, starting with known children's services and an email questionnaire was sent. There was a small circulation of questions to users of the service.

Results

There was excellent completion circulated after contact had been established by the researcher.

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The paediatric service in the region is well coordinated with close links with respective neuromuscular teams.

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The challenge of identifying the different adult services highlighted the possible difficulties faced by people with a neuromuscular condition.

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There is variety in the provision and accessibility of adult services offered around the region.

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There is a limited review/monitoring service in place for adults with only 42% of teams offering this.

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54% of adult teams are unable to provide on-going physiotherapy. They are usually goal- orientated and based on self-management which isn't always appropriate in a progressive deteriorating condition.

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The lack of access to specialist physiotherapy in adult services is a problem for both community and hospice physiotherapists and patients.

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Provision of Hydrotherapy is an on-going issue.

Recommendations

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Consideration of a review/monitoring service for adults is needed.

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Consideration of a transition service is needed.

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There is a need to provide more access to specialist neuromuscular physiotherapists in adult services.

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A maintained and accessible database of adult services for these patients should be made available to assist referrers.
Breathing space: a flexible group programme for people with shortness of breath
Authors: Stuart Demelza , Wosahlo Penny
Published: September 2011

Introduction

Breathlessness is a common symptom experienced by patients with advanced conditions which greatly impacts on wellbeing. The nature of patients' breathlessness often prevents them from being able to access support representing an unmet need for this population.

Breathing Space is a non-pharmacological support programme for breathless patients with an advanced medical condition.

The programme is a multi-disciplinary initiative with collaboration between the Hospice and local community services.

Aims

To empower patients through:

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Understanding why they are breathless

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Awareness of practical strategies to self manage breathlessness

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Living life to the fullest alongside breathlessness

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Providing support for patients and carers not able to access existing services.

Methods

A unique model was developed with a focus on maximising accessibility for the breathless patient. A series of stand alone modules encompass breathing control techniques, education and coping strategies to equip the patient with a set of skills to self manage their breathlessness even if they attend just once.

Breathing space

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9 drop in modules (Boothet al, 2006)

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Carers welcome and encouraged to attend

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Transport and lunch provided free of charge

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Advocacy service available.

Results

The results from the MYCaW outcome measure, attendance and user feedback will be collated and presented.

Discussion

While managing breathlessness is well established in palliative care, there is limited evidence to support the effectiveness of these interventions. Breathing Space offers a refreshing approach to this challenging symptom within a flexible group framework. Robust evaluation will contribute to the evidence base for non-pharmacological interventions for palliative breathlessness.

Through collaboration between hospice and community professionals, Breathing Space allows for sharing of practice and expertise.

Conclusion

Breathing Space supports patients with advanced breathlessness to improve their wellbeing.
Using a holistic assessment tool in a multi-professional motor neuron disease clinic
Authors: Wright Heather , Bruni Carla , Quinn Sharon
Published: September 2011

Background

Patients who are diagnosed with MND begin a journey of change which affects the individual for the rest of their life. In South West Essex a monthly clinic has been set up enabling the patient and their carers to access a wide range of health professionals. The authors use a modified personal assessment tool as a structured way to discuss concerns.

Method

Patients are asked to complete the tool in the waiting area with the assistance of their carer if needed. There are four parts of the tool: the distress thermometer (rates ‘total’ distress from 0 to 10), a list of problems which can be ticked, problems are then ranked (1–4) and finally, an action plan is agreed. The tool was given to all patients attending the clinic between November 2010 and April 2011.

Results

20 patients attended clinic over the 6 month period. 15 assessment tools were completed. 7/15 completed the distress thermometer (DT) with an average score of 5 (range 0–9). 3 patients completed a subsequent thermometer assessment. One score decreased from 9 to 8 and the other 2 scores increased (3–7 and 3–5). Numerous unmet needs were highlighted including: Worry, fear or anxiety 4/15, anger or frustration 4/15, breathing difficulties 4/15, and mobility issues 5/15. Examples of comments included worrying about “lack of independence” and “who will look after my dog”.

Discussion

By using this tool we have allowed patients to identify unmet needs. Often the highlighted needs were not issues we would have explored previously as routine. The tool has been useful in initiating conversation around emotional issues. Another important outcome has been prompting onward referrals.

Conclusion

The use of this tool has been successful in assessing unmet needs in a MND clinic.
Developing e-learning in a hospice setting: benefits, challenges and outcomes
Authors: Foster Sue
Published: September 2011

Aim

To establish a virtual learning environment (Moodle) within Hospice

Background

On line teaching and learning is making a significant impact on education. In recent years the use of e-learning has increased rapidly, enriching the teaching and learning experiences for many, due in part to the convenient and flexible nature of this delivery option. Following a successful outcome to a business case submitted to senior management, a project was undertaken within the hospice education department to establish a VLE using ‘Moodle’. It was hoped the outcome of this initiative would have a significant impact on the costs, resources and time taken to provide mandatory training and to maximise opportunities for continuous professional development. To achieve this the project team worked with key partners from each directorate to ensure the VLE met the needs of all its users.

Method

The pilot for the e-learning project consisted of four mandatory training sessions, Vulnerable Adults and Child Protection, Infection Control, COSHH and Fire Safety, with 10 participants for each. Guidelines were developed and training was facilitated prior to undertaking the pilot. At the end of each session participants were asked to complete an on line evaluation and on completion of the pilot project, focus groups were held to capture their thoughts and experiences.

Findings

Both challenges and rewards were part of the experience. Most of the challenges seemed to be a consequence of the lack of face-to-face interaction in the on line environment, lack of IT skills and feelings of isolation. The flexibility of e-learning offered a solution to many of the challenges inherent in providing education and training within the healthcare setting. Advantages included a learner-centric, easily accessible, cost effective and measurable means of providing staff training and educational opportunities.
Carers support
Authors: Attiwell Teena , Forster Liz
Published: September 2011

In the last few years there has been a weath of research and literature identifying the importance of supporting Carers. The End of Life Care Strategy(2008) identified four key principles in supporting Carers.

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1) Carers need to be involved in decision making with the recognition they have their own needs

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2) Need information about the likely progress of the person's condition and information about services available

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3) Practical and emotional support both during the person's life and after bereavement

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4) Carers to have their own needs assessed and reviewed.

Aims of the new service

To provide psychological support, information and advice to Carers; to provide an opportunity to share experiences with one another; to offer Complementary Therapies.

The Service

This takes place fortnightly on a Tuesday evening. A personal invitation and information leaflet about the service is sent to every Carer of the Day Hospice patients.

Venue

Day Hospice

Resources

The service is run by two qualified nurses, two complementary therapists and a volunteer. The hospice receives a grant to fund this.

How the need was identified

The need was identified through our patients and carers feedback via a survey conducted in 2009. We also wanted to implement this as part of what the ‘End of Life Strategy means for patients and carers (2008) to support carers.

Evaluation

Carers are requested to complete a questionnaire after 6 months. This has shown that the service is useful and provide valuable support to the carers.

Proposals for the future

Developing a bereavement support group for carers, currently the carer is contacted 6 weeks after bereavement to be offered counselling – we have identified ‘group’ bereavement support may be more beneficial as they have met together as carers and formed friendships, so meeting post bereavement could be further support to them.
‘I don’t have to explain myself': using open groups to mobilise peer support in palliative care
Authors: Cullen Anne , Nolan Steve , Sandford Mo
Published: September 2011

Model

Over the last 2 years members of a hospice social work, bereavement and chaplaincy service have piloted the use of semi-structured, facilitated open groups for day hospice patients, carers and bereavement service users. The approach is based on slow-open homogeneous group work model.

Rationale

The approach developed initially as an operational response to the needs of a number of Carers' Group users who were inappropriately returning to the group after the death of the person they had cared for. Team members observed that those who returned were seeking a continuing connection with the hospice and staff that had provided a safe, ‘holding’ environment. In addition, staff identified that any support group would need to be user-led, inclusive and flexible.

The evident success of this responsive model of semi-structured, facilitated open group work lent itself to other groups of varying size, and the model has been used with several initiatives, including weekly day hospice patient groups and monthly family bereavement groups, which attract 25–30 children and adults.

Feedback

Evaluations by participants of all the groups indicate that this approach is well attuned to the needs of palliative care services users. A further unanticipated benefit is that the model provides the opportunity for skill sharing within the multi-disciplinary team, including salaried staff and volunteers.

Focus of presentation

This presentation, based on a rigorous service evaluation, outlines the development of the model as a response to user needs; it describes the principles on which the model has been established; and it critically appraises the strengths and weaknesses of the model through user feedback and staff reflections.
A review of lymphoedema service provision in adult hospices in the UK and Ireland
Authors: Birch Kathy , Knibb Wendy
Published: September 2011

Introduction

This study scoped lymphoedema services in adult hospices in the UK and Ireland. It was undertaken to benchmark and inform development of a local hospice lymphoedema service and was completed as part of an MSc in Advanced Practice.

Aims

The study investigated hospice demographics, lymphoedema services including budget provision, treatments used, staffing levels and qualifications. A secondary aim explored the use of Manual Lymphatic Drainage (MLD) with the palliative population.

Methods

The study was undertaken in November and December 2010. It adopted a quantitative approach using a postal questionnaire sent to 195 adult hospices, with in-patient units, in the UK and Ireland. This represented the whole population. Data were analysed using SPSS, with open-ended questions grouped and themed.

Results

A response rate of 65% revealed that 61.4% of respondents provided some level of lymphoedema service. Where services existed, 69.2% of hospices had staff employed solely to treat lymphoedema, 66.7% had ring-fenced budgets for lymphoedema care with 67.3% treating lymphoedema patients from outside the palliative population. Nurses and physiotherapists were the main professional groups involved in lymphoedema management.

MLD was employed as a treatment strategy for palliative patients in 75.6% of hospices. It was used holistically, often in an adapted form, with both physical and psychological benefit.

Discussion

Wide geographical variations exist with a cluster of fully developed services in the Midlands. It appears that different models of care are evolving in Wales and Northern Ireland in response to recent national guidance.

Conclusions

There is potential inequity of service provision due to geographical variations. Further research is needed to plot the trend of hospice lymphoedema services, explore the impact of new models of care and give further consideration to the use of MLD with palliative patients.
Implementing triage in a busy hospice team
Authors: Knighy Andrew
Published: September 2011

The number of referrals to the Princess Alice Community Team continue to rise and, while it is apparent that the percentage of referrals for patients with non-malignant disease has not increased, the complexity of many referrals and the chronicity of cancer means that patients are referred for longer term care.

The Community Team has been responsive but the need to see a patient as urgently as the referrer perceives has placed undue stress on the Clinical Nurse Specialists (CNS). The referral process was uncontrolled.

We therefore employed a triage nurse to:

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Assess all referrals for appropriateness and urgency

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Gather information about new patients before they are formally assessed

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Respond quickly to urgent referrals

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Speak to patients and carers, introduce the service and gain a sense of their needs

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Assess non-urgent referrals, managing initial new patient needs through liaison with the primary care professionals

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Assign patients to other departments, for example, therapists or day hospice if primary request is for this intervention

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Keep a telephone only contact patient caseload

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Record and audit new referrals and outcome of triage process

The post has been a great success. An additional post has been made.

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CNSs have not felt burdened by new referrals arriving with little information. The triage nurse can obtain copies of clinic letters, imaging reports discharge summaries etc.

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Patients have felt welcomed and their cares listened to, an introduction to the service has been undertaken. They have been reassured.

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Some patients have been ‘referred back’ to the referrer or GP as not appropriate or, more commonly, have been held on the triage caseload until a time that requires a CNS visit.

Stats on patterns of referral, outcomes and ‘refer backs’ will be provided as well as a discussion on future developments.
Palliative care social work – the leadership art of the chameleon
Authors: Cullen Anne
Published: September 2011

Focus of the study

The study was informed by a literature review that identified similarities between the characteristic values and skills of social workers and some recent descriptions of close ‘charismatic’ or ‘transformational’ leadership, especially an account of the role of the leader as ‘servant and partner’.

Methodology

The method adopted was to undertake a qualitative study of palliative care social work in a hospice in the south of England. Specialist palliative care social work was selected as a likely source of examples of social work practice ‘at its best.’ The main fieldwork activities undertaken were semi-structured interviews with social workers and other members of the hospice's multi-disciplinary team, followed by a final workshop session.

Findings

The study showed that social work practice in this setting was driven by an attitude of profound respect and sustained availability, which included a commitment to ‘being with’ people in circumstances of intractable suffering. Specific mechanisms were identified through which social workers used professional skills such as adaptive communication, sensitive risk management, systemic thinking and improvisation, to enable service users to identify and express their priority needs, to mobilise their own distinctive abilities and strengths, and to optimise their use of informal support networks. By making these insights accessible to the multi-disciplinary team, social workers promoted the ability of service users to function as effective co-experts within the distributed leadership dynamic of the multi-disciplinary team.

Presentation

The presentation provides a detailed analysis of the processes through which social workers supported service users to discover and exercise their own capacity to be ‘leaders in our own lives’; and how this contributes a to a more practical understanding of what is involved in ‘servant and partner’ leadership.
‘Made to fit’: filling critical gaps with a hospice at home service
Authors: Baldry Catherine , Jack Barbara , Groves Karen , Gaunt Kathryn , Sephton Janice , Whelan Alison
Published: September 2011

Background

Promoting the choice to die at home is central to UK policies and strategies. Nationally, various models of Hospice at Home service support this choice. Locally a service was developed to fill gaps in, and work together with, existing community services providing a bespoke Hospice at Home Service outreaching from the hospice hub.

Method

Retrospective cohort study and stakeholder evaluation during a 1 year pilot study in the North West of England. Data (demographic and service intervention) was collected on 201 service recipients. 55 Healthcare Professionals; (General Practitioners, District Nurses, Community Specialist Palliative Care Nurses and Hospital Discharge Coordinator) participated in semi-structured interviews, focus groups and electronic open end questionnaires.

Results

In the first year, 201 received the service. 184 (92%) had cancer, 36% aged over 80 years. 57 (28%) lived alone. 181 (90%) recipients died. 73% (132) died at home (72% (120) with cancer), 6% (29) in the hospice, 12 (6.5%) care home, 1 (0.5%) in an ambulance on their way home, 7 (4%) hospital. 51 patients lived alone, 69% (35) died at home. Healthcare Professionals reported the impact of the different elements of the service (accompanied transfer home; multiprofessional (including doctors) crisis intervention team and a flexible sitting service) as being instrumental in helping patients to remain at home. The additional service supplements existing services, enables a speedier discharge home and supports carers to enable them to continue coping. It is of interest that in the second year a 73% home death rate has been maintained.

Conclusions

This novel bespoke service provides different elements of a Hospice at Home service, a tailor made package to meet individual and local area needs. This service appears to be having a major impact on place of death and is enabling patients to die in their place of choice
Music to soothe the soul
Authors: Edmondson Kate , Garlick Dawn , Wright Vicki
Published: September 2011

Background

A talented composer and musician when admitted to a hospice many miles from home, missed the spiritual comfort provided by his own music collection stored on his ipod. Hospice CD ‘s were not to his taste! When he died his partner was distressed and guilt ridden because she had not been able to access his music for him. She decided to raise money to provide ipods for all inpatients to use and enjoy.

Aims

To provide each inpatient with an extra source of comfort and relaxation to suit their own individual taste.

Method

Enough money was raised to buy 14 ipods and docking stations, 12 month supply of disposable headphones and a laptop for downloading the music.

An eclectic range of music of all genres was downloaded, including music composed and recorded by the patient and partner.

One auxiliary nurse volunteered to take responsibility for downloading music that had special meaning for individual patients as requested.

Results

Comments from patients and families that have used the ipods are collected, also the types of music requested, comments- have indicated that the ipods provide a positive experience for patients and families with a wide range of musical tastes.

Staff comments were collected through an online survey.

Raising staff awareness of the benefits to patients of listening to music of their own individual choice rather than that selected by nursing staff from a central CD player, radio, piano or organ has prompted another auxiliary nurse to survey Day Therapy patients and find out what their music preferences are.

This poster describes the background to this service, comments from patients and families, and the results of the two surveys.
Perioperative safety of Hydrosoft coils
Authors: Waldau Ben , Turk Aquilla S , Yashar Parham , Khaldi Ahmad , Turner Raymond D , Chaudry M Imran , Siddiqui Adnan H , Levy Elad I , Hoh Brian L , Mocco J
Published: September 2011

Objective

Hydrosoft coils were developed to serve as finishing coils to prevent aneurysmal recurrence at the neck. Initial animal studies were encouraging since some studies showed endothelial healing across the neck without recurrence over time. However, theoretical concerns exist regarding the potential threat to parent vessels as the Hydrosoft coils at the neck expand, as well as whether such coils can be adequately supple to safely serve as a true finishing coil. A retrospective review of the initial clinical experience utilizing Hydrosoft coils from three high-volume centers was performed.

Methods

Each center was asked to report angiographic (aneurysmal location, aneurysmal maximal size, neck size, incidence of intraprocedural parent vessel thrombosis, coil herniation, aneurysmal rupture as well as Raymond scale and percent occlusion after coiling) and clinical (rupture status, Hunt and Hess grade, incidence of stroke, hemorrhage, vasospasm and hydrocephalus) data on consecutive patients who underwent placement of Hydrosoft coils.

Results

A total of 141 patients were enrolled. Embolization achieved a Raymond Scale score of I (complete obliteration) in 79 aneurysms (56%), II (residual neck) in 40 aneurysms (28%) and III (residual dome) in 21 aneurysms (15%); in one case the Hydrosoft coil could not be placed. Procedural morbidity and mortality were 2.1% and 1.4%, respectively. No complications were definitively attributed to the use of Hydrosoft coils. There were three cases (2.1%) of parent vessel thrombosis, two of which resolved after intraprocedural administration of thrombolytic agents and did not lead to neurological sequelae. The incidences of intraprocedural or periprocedural aneurysmal rupture (2.1%), cerebral hemorrhage (3.5%), stroke (4.9%), vasospasm (26.2%) or hydrocephalus (31.1%) were comparable to contemporary literature.

Conclusion

The use of Hydrosoft coils appears to be safe and does not lead to higher complication rates than are currently accepted in the literature. Further prospective studies are required to determine whether the use of Hydrosoft coils results in a lower incidence of aneurysmal recurrence.
A partial articulated acanthodian from the Silurian of New Brunswick, Canada
Authors: Burrow Carole J.
Published: September 2011

Vertebrates preserved in calcareous concretions collected from Silurian marginal-marine deposits near Nerepis, southern New Brunswick include agnathan thelodonts, a heterostracan, and possibly an anaspid, as well as spines and scales from an acanthodian (the only jawed fish remains). Several incomplete specimens of acanthodians, all determined as the same taxon Nerepisacanthus denisoni nov. gen. et sp., are described based on material identified in several museum collections. The fish-bearing nodules are from the Silurian Cunningham Creek Formation, which has been dated from ?late Llandovery (Telychian) – Ludlow (Ludlovian). The new species is only the second undisputed pre-Devonian acanthodian taxon known from articulated, although incomplete, specimens. N. denisoni has robust flank scales with a smooth crown bearing short subparallel ridges along the anterior edge, plus flatter scales with a crown formed of elongate, curved, areal-growth ridges, anterior to the pectoral region. The anterior dorsal fin spine is long, slightly curved and bears up to seven smooth longitudinal ridges of varying width on each side. The perichondrally ossified scapula is thin-walled and probably has a U-shaped cross section. “Dentition” cones and small denticles are preserved in the branchial or pharyngeal region. Although elements indisputably identifiable as dentigerous jaw bones were not found in the specimens, N. denisoni appears most closely related to the Early Devonian ischnacanthiform Acritolepis and is tentatively assigned to the family Acritolepidae Valiukevičius and Burrow.
Climacograptus pungensRuedemann, 1904 and the definition of the Darriwilian (Ordovician) graptolite genusArchiclimacograptusMitchell, 1987
Authors: Maletz Jörg
Published: September 2011

The genus Archiclimacograptus represents one of the earliest taxa of axonophoran graptolites with geniculate thecae, but its current status and evolutionary relationships are difficult to access even after a number of cladistic analyses have been executed. Archiclimacograptus? pungens (Ruedemann), a poorly known little species from the lower Darriwilian of eastern North America is interpreted as a possible member of the genus. The species belongs to a group of axonophorans with highly asymmetrical proximal end and pattern C astogeny, characterized by the lack of an apertural spine on th12, ranging from the Levisograptus dentatus Biozone (Darriwilian) to the Nemagraptus gracilis Biozone (Sandbian). Specimens are common in North America and the Argentinian Precordillera, but have not been reported from any Atlantic Faunal Realm localities. The distribution of the group indicates a restriction to the Pacific Faunal Realm, providing the earliest indication of a developing biogeographic differentiation of axonophoran graptolites after their origin in the oceanic biofacies during the Upper Dapingian to lower Darriwilian time interval. Archiclimacograptus? ambiguus is described as a new species.
MAGNETIZED ROTATING NEUTRON STARS SIMULATED BY GENERAL-RELATIVISTIC POLYTROPIC MODELS: THE NUMERICAL TREATMENT
Authors: GEROYANNIS V. S. , KATELOUZOS A. G. , VALVI F. N.
Published: September 2011

We compute general-relativistic polytropic models of magnetized rotating neutron stars, assuming that magnetic field and rotation can be treated as decoupled perturbations acting on the nondistorted configuration. Concerning the magnetic field, we develop and apply a numerical method for solving the relativistic Grad–Shafranov equation as a nonhomogeneous Sturm–Liouville problem with nonstandard boundary conditions. We present significant geometrical and physical characteristics of six models, four of which are models of maximum mass. We find negative ellipticities owing to a magnetic field with both toroidal and poloidal components; thus the corresponding configurations have prolate shape. We also compute models of magnetized rotating neutron stars with almost spherical shape due to the counterbalancing of the rotational effect (tending to yield oblate configurations) and the magnetic effect (tending in turn to derive prolate configurations). In this work such models are simply called "equalizers." We emphasize on numerical results related to magnetars, i.e. ultramagnetized neutron stars with relatively long rotation periods.
MODELING THE PERFORMANCE OF DIRECT NUMERICAL SIMULATION ON PARALLEL SYSTEMS
Authors: KERBYSON DARREN J. , BARKER KEVIN J.
Published: September 2011

Direct Numerical Simulation (DNS) is an important application area that is expected to use large fractions of future large-scale simulations. In this work we develop, validate and use a performance model of the combustion code, DNS3D, to explore achieved performance on current parallel systems. The performance model is developed from a thorough analysis of the application. Its key computation characteristics are coupled with the performance characteristics of the system using an parameterized analytical model. The model is validated on three parallel systems: a muti-core AMD Opteron based system with an Infiniband fat-tree network, an IBM Power5+ system with an HPS fat-tree network, and an IBM Power7 system with a direct connect network. The performance model is shown to achieve high prediction accuracy on all three systems. We illustrate how the model can be used to explore impact of changes in either the system or the application. It is used to both analyze the achieved performance on these systems as well as to explore the possible benefits of further optimizing DNS3D's main computational kernel of one-dimensional FFTs, or in possibly overlapping communication with computation.
PARSSSE: AN ADAPTIVE PARALLEL STATE SPACE SEARCH ENGINE
Authors: SUN YANHUA , ZHENG GENGBIN , JETLEY PRITISH , KALE LAXMIKANT V.
Published: September 2011

State space search problems abound in the artificial intelligence, planning and optimization literature. Solving such problems is generally NP-hard, so that a brute-force approach to state space search must be employed. Given the exponential amount of work that state space search problems entail, it is desirable to solve them on large parallel machines with significant computational power. In this paper, we analyze the parallel performance of several classes of state space search applications. In particular, we focus on the issues of grain size, the prioritized execution of tasks and the balancing of load among processors in the system. We demonstrate the corresponding techniques that are used to scale such applications to large scale. Moreover, we tackle the problem of programmer productivity by incorporating these techniques into a general search engine framework designed to solve a broad class of state space search problems. We demonstrate the efficiency and scalability of our design using three example applications, and present scaling results up to 32,768 processors.
HYBRID-PARALLEL SPARSE MATRIX-VECTOR MULTIPLICATION WITH EXPLICIT COMMUNICATION OVERLAP ON CURRENT MULTICORE-BASED SYSTEMS
Authors: SCHUBERT GERALD , FEHSKE HOLGER , HAGER GEORG , WELLEIN GERHARD
Published: September 2011

We evaluate optimized parallel sparse matrix-vector operations for several representative application areas on widespread multicore-based cluster configurations. First the single-socket baseline performance is analyzed and modeled with respect to basic architectural properties of standard multicore chips. Beyond the single node, the performance of parallel sparse matrix-vector operations is often limited by communication overhead. Starting from the observation that nonblocking MPI is not able to hide communication cost using standard MPI implementations, we demonstrate that explicit overlap of communication and computation can be achieved by using a dedicated communication thread, which may run on a virtual core. Moreover we identify performance benefits of hybrid MPI/OpenMP programming due to improved load balancing even without explicit communication overlap. We compare performance results for pure MPI, the widely used "vector-like" hybrid programming strategies, and explicit overlap on a modern multicore-based cluster and a Cray XE6 system.
CONFIGURATION ASSIGNMENT OF THE POSITIVE-PARITY STRUCTURES IN 108Ag
Authors: LIU C. , WANG S. Y. , QI B. , SUN D. P. , XU C. J. , LIU L. , WANG B. , SHEN X. C. , QIN M. R. , CHEN H. , ZHU L. H. , WU X. G. , LI G. S. , HE C. Y. , ZHENG Y. , WANG L. L. , ZHANG B. , LIU G. Y. , WANG Y. W.
Published: September 2011

The high-spin states of 108 Ag have been studied by the in-beam γ spectroscopy with the reaction 104 Ru (7 Li ,3n)108 Ag at a beam energy of 33 MeV. The previously known positive-parity band structures have been extended up to higher spins. Their configurations are discussed based on alignments, band-crossing frequencies, and B(M1)/B(E2) ratios.
Effects of high-fat overfeeding on mitochondrial function, glucose and fat metabolism, and adipokine levels in low-birth-weight subjects
Authors: Brøns Charlotte , Jacobsen Stine , Hiscock Natalie , White Andrew , Nilsson Emma , Dunger David , Astrup Arne , Quistorff Bjørn , Vaag Allan
Published: September 2011

Low birth weight (LBW) is associated with an increased risk of insulin resistance and downregulation of oxidative phosphorylation (OXPHOS) genes when exposed to a metabolic challenge of high-fat overfeeding (HFO). To elaborate further on the differential effects of HFO in LBW subjects, we measured in vivo mitochondrial function, insulin secretion, hepatic glucose production, and plasma levels of key regulatory hormones before and after 5 days of HFO in 20 young LBW and 26 normal-birth-weight (NBW) men. The LBW subjects developed peripheral insulin resistance after HFO due to impaired endogenous glucose storage (9.42 ± 4.19 vs. 5.91 ± 4.42 mg·kg FFM−1·min−1, P = 0.01). Resting muscle phosphorcreatine and total ATP in muscle increased significantly after HFO in LBW subjects only, whereas additional measurements of mitochondrial function remained unaffected. Despite similar plasma FFA levels, LBW subjects displayed increased fat oxidation during insulin infusion compared with normal-birth-weight (NBW) subjects after HFO (0.37 ± 0.35 vs. 0.17 ± 0.33 mg·kg FFM−1·min−1, P = 0.02). In contrast to NBW subjects, the plasma leptin levels of LBW subjects did not increase, and the plasma gastric inhibitory polypeptide (GIP) as well as pancreatic polypeptide (PP) levels increased less in LBW compared with NBW subjects during HFO. In conclusion, HFO unmasks dissociation between insulin resistance and mitochondrial dysfunction in LBW subjects, suggesting that insulin resistance may be a cause, rather than an effect, of impaired muscle OXPHOS gene expression and mitochondrial dysfunction. Reduced increments in response to HFO of fasting plasma leptin, PP, and GIP levels may contribute to insulin resistance, lower satiety, and impaired insulin secretion in LBW subjects.
Is Blood Alcohol Level a Good Predictor for Injury Severity Outcomes in Motor Vehicle Crash Victims?
Authors: Mann Bikaramjit , Desapriya Ediriweera , Fujiwara Takeo , Pike Ian
Published: September 2011

Experimental studies in animals suggest that alcohol may influence pathophysiologic response to injury mechanisms. However, biological evidence for the alcohol-injury severity relationship provides conflicting results. The purpose of our retrospective cross-sectional study in 2,323 people was to assess whether blood alcohol level (BAC) adversely influences injury severity in victims of motor vehicle collisions (MVCs). We found no difference in mortality OR 1.09 (0.73–1.62), or length of hospital stay, and a trend for lower ISS score was found in the high-alcohol group (P=0.052). Furthermore, the high-alcohol group demonstrated a lower adjusted rate of severe head injury OR 0.65 (0.48–0.87), chest injury OR 0.58 (0.42–0.80), and serious extremity injury OR 0.10 (0.01–0.76). The findings of our study do not demonstrate a dose-response relationship between alcohol consumption and injury severity in MVCs. This study implies that higher BAC may lead to less severe injuries, without impacting mortality or length of hospital stay, however, further research is required to elucidate the nature of this relationship.
MicroRNA Regulation of Cancer Stem Cells
Authors: Liu Can , Tang Dean G.
Published: September 2011

Cancer stem cells (CSC), or cancer cells with stem cell properties, have been reported in many human tumors and are thought to be responsible for tumor initiation, therapy resistance, progression, relapse, and metastasis. Despite their potential clinical importance, how CSCs are regulated at the molecular level is not well understood. MicroRNAs (miRNA), small noncoding RNAs that play critical roles in normal stem cell functions during development, have emerged as important regulators of CSCs as well. In this review, we summarize the current major findings of miRNA regulation of various CSCs and discuss our recent findings that miR-34a suppresses prostate CSCs and metastasis by directly repressing CD44. This recent progress has important implications for understanding how CSCs are intricately regulated by networks of miRNAs and for developing novel mechanism-based miRNA therapeutics that specifically target CSCs. Cancer Res; 71(18); 5950–4. ©2011 AACR.
DNA Damage Response and Growth Factor Signaling Pathways in Gliomagenesis and Therapeutic Resistance
Authors: Squatrito Massimo , Holland Eric C.
Published: September 2011

The dismal prognosis of glioblastoma multiforme (GBM) is mainly due to the poor response of GBM patients to any therapeutic modalities, which include ionizing radiation and DNA-alkylating agents. In the last few years, the important role of the DNA damage response (DDR) pathway in tumor formation and modulation of therapeutic response has been appreciated. Interestingly, several of the genetic alterations commonly found in GBMs (such as epidermal growth factor receptor amplification and PTEN inactivation) have also recently been shown to regulate the activity of the DNA repair machinery and, consequently, the response to DNA-damaging agents used routinely in the clinic. In this review, we focus on some of these findings that suggest that at least some of the pathways driving GBM formation could be directly responsible for the therapy resistance of this tumor type. Possible therapeutic approaches exist that may either overcome or take advantage of these GBM genetic alterations to improve the response of these tumors to DNA-damaging therapy. Cancer Res; 71(18); 5945–9. ©2011 AACR.
Oncogenic EGFR Signaling Activates an mTORC2–NF-κB Pathway That Promotes Chemotherapy Resistance
Authors: Tanaka Kazuhiro , Babic Ivan , Nathanson David , Akhavan David , Guo Deliang , Gini Beatrice , Dang Julie , Zhu Shaojun , Yang Huijun , De Jesus Jason , Amzajerdi Ali Nael , Zhang Yinan , Dibble Christian C. , Dan Hancai , Rinkenbaugh Amanda , Yong William H. , Vinters Harry V. , Gera Joseph F. , Cavenee Webster K. , Cloughesy Timothy F. , Manning Brendan D. , Baldwin Albert S. , Mischel Paul S.
Published: September 2011

Although it is known that mTOR complex 2 (mTORC2) functions upstream of Akt, the role of this protein kinase complex in cancer is not well understood. Through an integrated analysis of cell lines, in vivo models, and clinical samples, we demonstrate that mTORC2 is frequently activated in glioblastoma (GBM), the most common malignant primary brain tumor of adults. We show that the common activating epidermal growth factor receptor (EGFR) mutation (EGFRvIII) stimulates mTORC2 kinase activity, which is partially suppressed by PTEN. mTORC2 signaling promotes GBM growth and survival and activates NF-κB. Importantly, this mTORC2–NF-κB pathway renders GBM cells and tumors resistant to chemotherapy in a manner independent of Akt. These results highlight the critical role of mTORC2 in the pathogenesis of GBM, including through the activation of NF-κB downstream of mutant EGFR, leading to a previously unrecognized function in cancer chemotherapy resistance. These findings suggest that therapeutic strategies targeting mTORC2, alone or in combination with chemotherapy, will be effective in the treatment of cancer.

Significance: This study demonstrates that EGFRvIII-activated mTORC2 signaling promotes GBM proliferation, survival, and chemotherapy resistance through Akt-independent activation of NF-κB. These results highlight the role of mTORC2 as an integrator of two canonical signaling networks that are commonly altered in cancer, EGFR/phosphoinositide-3 kinase (PI3K) and NF-κB. These results also validate the importance of mTORC2 as a cancer target and provide new insights into its role in mediating chemotherapy resistance, suggesting new treatment strategies. Cancer Discovery; 1(6); 524–38. ©2011 AACR.

Read the Commentary on this article by Wick et al., p. 475

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Survival Analysis II: Cox Regression
Authors: Stel Vianda S. , Dekker Friedo W. , Tripepi Giovanni , Zoccali Carmine , Jager Kitty J.
Published: September 2011

In contrast to the Kaplan-Meier method, Cox proportional hazards regression can provide an effect estimate by quantifying the difference in survival between patient groups and can adjust for confounding effects of other variables. The purpose of this article is to explain the basic concepts of the Cox regression method, and to provide some guidance regarding the presentation of the results.
Relationship between Red Cell Distribution Width and Microalbuminuria: A Population-Based Study of Multiethnic Representative US Adults
Authors: Afonso Luis , Zalawadiya Sandip K. , Veeranna Vikas , Panaich Sidakpal S. , Niraj Ashutosh , Jacob Sony
Published: September 2011

Introduction: Microalbuminuria (MA), a renal marker of vascular injury, is an independent predictor of cardiovascular (CV) events. Red cell distribution width (RDW), an emerging CV risk predictor, has not been evaluated for its association with MA. Methods: We evaluated 8,499 participants of the National Health and Nutrition Examination Survey (NHANES) 1999–2006, where RDW was evaluated as a continuous variable and in quartiles (Q1 ≤12.1, Q2 12.2–12.5, Q3 12.6–13 and Q4 >13). Multivariate adjusted logistic regression analysis was performed to estimate the odds of having MA (n = 1,736; adjusted for traditional CV risk factors, race, BMI, estimated glomerular filtration rate, hemoglobin, mean corpuscular volume, high-sensitivity C-reactive protein and nutritional factors deficiencies of iron, folate and vitamin B12). Results: The prevalence of MA increased with increasing RDW (13.52% in Q1 vs. 30.02% in Q4, p < 0.001). The odds of having MA for those in Q4 was 2.49 (95% CI: 1.95–3.18, p < 0.001) compared to those in Q1 after the adjustments. No effect modification was observed by covariates on the association between RDW and MA. Conclusion: Elevated RDW is independently associated with a higher risk of MA. An interaction between chronic inflammation, oxidative stress, neurohumoral overactivity and endothelial dysfunction may explain this association and the attendant elevated CV/renal risk.
A Boy with Holt-Oram Syndrome Caused by Novel Mutation c.1304delT in the TBX5 Gene
Authors: Muru K. , Kalev I. , Teek R. , Sõnajalg M. , Kuuse K. , Reimand T. , Õunap K.
Published: September 2011

Holt-Oram syndrome (HOS) is an autosomal dominant developmental defect involving preaxial radial ray upper limb deformity and variable cardiac defects. It has been demonstrated that HOS is caused by mutations in the T-box transcription factor gene TBX5. Numerous germline mutations (more than 60) of this gene produce preterminal stop codons, which lead to synthesis of a truncated nonfunctional TBX5 protein. The haplo-insufficiency of the TBX5 gene is the most significant cause of HOS. We report on a sporadic patient with clinical features of HOS. Our patient had a cardiac anomaly – a muscular ventricular and atrial septal defect, patent ductus arteriosus and a conduction defect (a first-step atrioventricular block). Upper limb anomalies in our patient were relatively mild and unusual to HOS – distally displaced thumbs, narrow shoulders and hypotrophy of the muscles in the shoulder region. Molecular analysis identified a novel and unusual heterozygous frameshift mutation – c.1304delT (p.Leu435fsX146) – in exon 9 of the TBX5 gene, which is predicted to cause an elongated TBX5 protein with 84 miscoding amino acids and 62 supernumerary C-terminal amino acids. To the best of our knowledge, only one such type of elongation mutation has thus far been reported in the TBX5 gene.
PHF6 Deletions May Cause Borjeson-Forssman-Lehmann Syndrome in Females
Authors: Berland S. , Alme K. , Brendehaug A. , Houge G. , Hovland R.
Published: September 2011

In a 16-year-old girl with intellectual disability, irregular teeth, slight body asymmetry, and striated skin pigmentation, highly skewed X-inactivation increased the likelihood of an X-linked cause of her condition. Among these, prominent supraorbital ridges and hearing loss suggested a filaminopathy, but no filamin A mutation was found. The correct diagnosis, Borjeson-Forssman-Lehmann syndrome (BFLS, MIM#301900), was first made when a copy number array identified a de novo 15-kb deletion of the terminal 3 exons of the PHF6 gene. In retrospect, her phenotype resembled that of males with BFLS. Such deletions of PHF6 have not been reported previously. This might be because PHF6 mutations are rarely looked for in females since classical BFLS so far has been thought to be a male-specific syndrome, and large PHF6 deletions might be incompatible with male fetal survival. If this is the case, sporadic BFLS could be more frequent in females than in males.
Genetic Variation in Candidate Genes Like the HMGA2 Gene in the Extremely Tall
Authors: Hendriks A.E.J. , Brown M.R. , Boot A.M. , Oostra B.A. , Drop S.L.S. , Parks J.S.
Published: September 2011

Background/Aims: Genetic variation in several candidate genes has been associated with short stature. Recently, a high-mobility group A2 (HMGA2) gene SNP has been robustly associated with height in the general population. Only few have attempted to study these genes in extremely tall stature. We therefore studied common genetic variation in candidate genes for height in extremely tall Dutch. Methods: We included 116 constitutionally tall cases with height >2 SD and 103 controls with normally distributed height <2 SD. We genotyped 10 common polymorphisms previously associated with height variation. Results: The HMGA2 gene SNP was significantly associated with tall stature. Using a logistic regression model, we calculated that carrying the HMGA2 (rs1042725) C allele significantly increased the odds of being tall (OR = 1.53, 95% CI 1.02–2.28; p = 0.03). In addition, controls with one or two copies of the C allele were significantly taller than controls carrying the TT genotype [TC: mean (SD) +0.61 (0.21) SDS; p = 0.004, and CC: +0.77 (0.25) SDS; p = 0.003]. Conclusion: Our study shows that a common polymorphism in the HMGA2 gene is not only associated with height variation in the general population but also plays an important role in one of the extremes of the height distribution.