bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in ankle joint stiffness due to stretching: The role of tendon elongation of the gastrocnemius muscle
Authors: Kato Emika , Kanehisa Hiroaki , Fukunaga Tetsuo , Kawakami Yasuo
Published: February 2010

The purpose of this study was to investigate changes in ankle joint stiffness and the associated changes in the gastrocnemius muscle and tendon due to static stretching. Seven healthy male participants lay supine with the hip and knee joints fully extended. The right ankle joint was rotated into dorsiflexion from a 30° plantar flexed position and the torque measured by a dynamometer. The ankle joint was maintained in a dorsiflexed position for 20 min (static stretching of the calf muscles). We performed surface electromyography of the medial and lateral gastrocnemii, the soleus, and the tibialis anterior of the right leg to confirm no muscle activity throughout static stretching and the passive test (passive dorsiflexion). During static stretching, the ankle joint angle and elongation of the gastrocnemius were recorded by goniometry and ultrasonography, respectively. Tendon elongation of the gastrocnemius was calculated based on the changes in the ankle joint angle and muscle elongation. In addition, the relationships between passive torques and ankle joint angles, and elongation of muscle and tendon, were examined before and after static stretching. The ankle dorsiflexion angle and tendon elongation increased significantly by 10 min after the onset of static stretching, while there was no further increase in muscle length. In addition, ankle dorsiflexion angle and tendon elongation at an identical passive torque (30 N · m) increased significantly (from 24±7° to 33±5° and from 17±2 mm to 22±1 mm, respectively) after static stretching. However, muscle elongation was unchanged. In conclusion, the current results suggest that an increase in the ankle joint dorsiflexion angle due to static stretching is attributable to a change in tendon not muscle stiffness.
Measurement error associated with the SAGIT/Squash computer tracking software
Authors: Vučković Goran , Perš Janez , James Nic , Hughes Mike
Published: February 2010

The velocities and distances covered by players during competition serve as a basis for planning fitness regimes according to the specific demand of the sport. The techniques used to calculate these movement parameters have ranged from human judgements to technological solutions such as GPS and computer vision. This paper evaluates the accuracy of a computerized motion tracking system (SAGIT/Squash) that uses computer vision methods on video captured via a fixed single camera located centrally above the court. Digital images were processed automatically with operator supervision so that any tracking errors could be rectified and manual tagging of all shots added. Four separate experiments were used to assess the error associated with tracking adult players' velocities and positions with respect to the court floor. Experiment 1 involved players standing still in different areas of the court. The tracking software was found to be more accurate when a player was stood in the centre of the court (1.33 m · min−1 error) than in the corners (2.61 m · min−1 error), predominately due to systematic errors (e.g. calibration). Experiment 2 was conducted in the same manner as Experiment 1 except that the players vigorously swung a racket around their body continuously. This resulted in 15 times the error found in Experiment 1 for the distance covered during 1 min. However, this is an unrealistic estimate of the true error when assessing matches, as during matches the racket is only swung approximately 35% of the time. Experiment 3 involved a player running at different speeds around a rectangular path on the court. The resultant trajectory, as captured by the software, was compared using different Gaussian smoothing equations of kernel widths 0.25 s, 0.5 s, and 1 s. The best solution (0.5 s) resulted in the most accurate trajectory, although the difference in distance calculated between the different equations was negligible. Experiment 4 used the 0.5‐s smoothing equation to assess the tracking accuracy for a player running at a relatively steady speed in a more realistic circular trajectory. The trajectory of the pixel image was shown to have a smaller radius than the reference trajectory at increased speeds, due to the tendency of the player to lean over when negotiating a circular path. The error associated with the distance covered over 1 min was shown to range between 1.33 and 21 m depending on the nature and position of the player's movements. Values, typically somewhere in this range, are likely to be evident during typical use of this software.
Negative Numbers in Simple Arithmetic
Authors: Das Runa , LeFevre Jo-Anne , Penner-Wilger Marcie
Published: February 2010

Are negative numbers processed differently from positive numbers in arithmetic problems? In two experiments, adults ( N = 66) solved standard addition and subtraction problems such as 3 + 4 and 7 – 4 and recasted versions that included explicit negative signs—that is, 3 – (–4), 7 + (–4), and (–4) + 7. Solution times on the recasted problems were slower than those on standard problems, but the effect was much larger for addition than subtraction. The negative sign may prime subtraction in both kinds of recasted problem. Problem size effects were the same or smaller in recasted than in standard problems, suggesting that the recasted formats did not interfere with mental calculation. These results suggest that the underlying conceptual structure of the problem (i.e., addition vs. subtraction) is more important for solution processes than the presence of negative numbers.
Optimized soft magnetic properties and high frequency characteristics of obliquely deposited Co–Zr thin films
Authors: Zhang Zhengmei , Fan Xiaolong , Lin Min , Guo Dangwei , Chai Guozhi , Xue Desheng
Published: February 2010

Co100−x
Zr
x
(x ⩽ 16.7) films with designable in-plane uniaxial magnetic anisotropy have been prepared by oblique sputtering at room temperature. It has been found that the introduction of a small amount of Zr into obliquely deposited Co films results in excellent soft magnetic properties and high frequency responses. We have qualitatively explained that such an optimization comes from the enhancement of exchange coupling between the Co grains in the films by using the random anisotropy model. Thus, the magnetocrystalline anisotropy of grains can be suppressed and the ‘obliquely induced’ anisotropy can become dominant in determining the static and dynamic properties of the obliquely deposited films. Therefore, films with designable static and dynamic properties can be easily obtained by controlling the deposition angles, as illustrated in our data.
Instabilities in a non-transferred direct current plasma torch operated at reduced pressure
Authors: Huang Heji , Pan Wenxia , Guo Zhiying , Wu Chengkang
Published: February 2010

Using an oscilloscope, a high-speed video camera and a double-electrostatic probe system, the periodicity and amplitude of the fluctuations in arc voltage, jet luminance and ion saturation current of a plasma jet were monitored to investigate various sources of instabilities and their effects in a non-transferred dc plasma torch operated at reduced pressure. The results show that besides a 300 Hz main fluctuation inherited from the power supply, arc voltage fluctuation of 3–4 kHz with an amplitude less than 5% of the mean voltage was mainly affected by the total gas flow rate. The arc voltage fluctuation can affect the energy distribution of the plasma jet which is detectable by electrostatic probes and a high-speed video camera. The steadiness of energy transfer is also affected by the laminar or turbulent flow state of the plasma.
Experimental study of plasma non-uniformities and the effect of phase-shift control in a very high frequency capacitive discharge
Authors: Volynets Vladimir , Shin Hansoo , Kang Dongwoo , Sung Dougyong
Published: February 2010

Plasma spatial non-uniformities were studied experimentally in a very high frequency (100 MHz) capacitive triode-type reactor used for etching of 300 mm wafers. It has been shown that in the traditional mode of operation there is considerable plasma non-uniformity due to the electromagnetic effects, namely at a low power, the plasma density profile is determined by the standing-wave effect, while at a high power the skin effect dominates. The influence of phase-shift control on plasma uniformity was examined. Phase-shift control means applying to the top and the bottom electrodes very high frequency voltages with a controlled phase shift between them. The experiments were carried out in process (C4F8/O2/Ar) plasma in a wide range of pressures and powers. It has been shown that the phase-shift control can considerably improve the plasma uniformity under a wide range of experimental conditions.
Role of polymer structure and ceiling temperature in polymer roughening and degradation during plasma processing: a beam system study of P4MS and PαMS
Authors: Nest D , Chung T-Y , Végh J J , Graves D B , Bruce R L , Lin T , Phaneuf R J , Oehrlein G S , Long B K , Willson C G
Published: February 2010

The degradation and roughening of polymers during plasma processing are important for the understanding of patterning of critical dimension features for both current and future lithographic techniques. Recently, the role of plasma-generated VUV photons in both the roughening and smoothing of current generation 193 nm photoresist (PR) has been investigated. However, a general understanding of the importance of polymer chemistry and structure on the degradation and roughening of polymers during plasma processing, which could be useful for polymer selection for next generation lithography, is currently lacking. Through the use of a beam system approach, the effects of ion bombardment and VUV radiation during plasma processing are investigated for two polymers with the same composition but different structure: poly(4-methyl styrene) (P4MS) and poly(α-methyl styrene) (PαMS). PαMS degrades under VUV radiation when heated above room temperature while P4MS is stable up to 70 °C, the maximum temperature studied. Both polymers undergo a drastic reduction in ion sputter yield at an ion fluence of 1 × 1016 ions cm−2, associated with the formation of a highly modified near-surface region. Almost no surface roughness is generated after VUV radiation, with moderate surface roughness formed on PαMS after ion bombardment at 70 °C. In contrast, extreme levels of surface roughness (∼10 nm rms) are observed for PαMS after simultaneous exposure to VUV photons and ion bombardment at 70 °C. Similarities to the synergistic roughening of current generation 193 nm PR under simultaneous VUV photons and ion bombardment are discussed.
Sputtering-induced modification of the electronic properties of Ag/Cu(1 1 1)
Authors: Politano A , Chiarello G
Published: February 2010

High-resolution electron energy loss spectroscopy has been used to study the electronic properties of Ag thin films deposited on Cu(1 1 1) and modified by Ar+ sputtering. Ion sputtering strongly modifies the loss function in the region of single-particle transition as deduced from the appearance of sputtering-induced spectral features in the valence band. In contrast to unmodified Ag systems, in the sputtered films the centroid of the induced charge of the surface plasmon lies in the close vicinity of the jellium edge. In these modified Ag films, Landau damping processes are activated beyond a critical energy of 3.83 eV and a threshold wave vector of 0.2 Å−1. Moreover, we find that plural plasmonic losses arise upon increasing the Ar+dose. A comparison with the case of the sputtered Ag(1 0 0) surface is presented throughout the paper.
Low frequency vibration of multiwall carbon nanotubes with heterogeneous boundaries
Authors: Chowdhury R , Wang C Y , Adhikari S
Published: February 2010

Heterogeneous end constraints are imposed on multiwall carbon nanotubes (MWCNTs) by sequentially clamping one end of their originally simply supported constituent tubes. The finite element method is employed to study the vibration of such MWCNTs with an emphasis on the effect of the mixed boundary conditions. The results show that the clamping process constantly enhances the dynamic stiffness of MWCNTs, which leads to substantial frequency increase up to 50% and, in some cases, the transformation of the fundamental vibration mode. In particular, the vibration frequency is always found to be most sensitive to fixing the outermost tubes, showing the critical role of this individual tube in determining the structural stiffness of the whole MWCNTs as a coupled system.
Low-temperature solid state reaction synthesis and thermoelectric properties of high-performance and low-cost Sb-doped Mg2Si0.6Sn0.4
Authors: Liu Wei , Tang Xinfeng , Sharp Jeff
Published: February 2010

Mg2Si1−x
Sn
x
compounds are a type of low-price, environment-friendly medium temperature thermoelectric materials with very important prospects for practical application, and the exploration of high performance Mg2Si1−x
Sn
x
compounds is currently attracting worldwide interest. In this study, Sb-doped Mg2Si0.6Sn0.4 compounds were prepared through a two-step, low-temperature solid state reaction method combined with the spark plasma sintering technique for rapid densification. The influence of Sb doping amount on the thermoelectric properties of Mg2Si0.6−y
Sn0.4Sb
y
(0 ⩽ y ⩽ 0.015) compounds was investigated. The solid solubility limit of Sb in Mg2Si0.6Sn0.4 compounds was estimated around y = 0.0125. As y increased, the electrical conductivity of Mg2Si0.6−y
Sn0.4Sb
y
(0 ⩽ y ⩽ 0.0125) compounds increased considerably, while the absolute value of the Seebeck coefficient and the lattice thermal conductivity decreased. The sample with y = 0.0125 had the highest ZT, reaching 1.11 at 860 K, and the samples with 0.005 ⩽ y ⩽ 0.015 all attained ZT
max > 0.95. The adopted synthesis process also showed very good repeatability and regularity in obtaining thermoelectric properties, together with the capability of precise composition control of Mg2Si0.6−y
Sn0.4Sb
y
, making it promising for the practical application of Mg2Si based thermoelectric materials.
Viewing angle switching of liquid crystal display using fringe-field switching to control off-axis phase retardation
Authors: Lim Young Jin , Kim Jin Ho , Her Jung Hwa , Park Kyoung Ho , Lee Joun Ho , Kim Byeong Koo , Kang Wan-Seok , Lee Gi-Dong , Lee Seung Hee
Published: February 2010

A viewing angle switchable liquid crystal display associated with fringe-field switching mode is proposed. In the device, one pixel is composed of a main pixel and a sub-pixel, in which both pixels are formed to generate a fringe electric field. However, the field directions are different from each other so that in the main pixel, the fringe field rotates the liquid crystal for displaying the main image, whereas it controls only the tilt angle of the liquid crystal without rotating in the sub-pixel region. In this way, phase retardation to cause leakage of light at the off-normal axis can be generated in the sub-pixel, and by utilizing the light, the main displayed image in the normal direction can be blocked in the oblique viewing direction.
Cardiac resynchronization therapy may benefit patients with left ventricular ejection fraction >35%: a PROSPECT trial substudy
Authors: Chung Eugene S. , Katra Rodolphe P. , Ghio Stefano , Bax Jeroen , Gerritse Bart , Hilpisch Kathryn , Peterson Brett J. , Feldman David S. , Abraham William T.
Published: February 2010

Aims

Cardiac resynchronization therapy (CRT) is currently limited to those with left ventricular ejection fraction (LVEF) ≤35%. To evaluate whether patients with LVEF >35% might benefit from CRT, we performed a retrospective analysis of the predictors of response to CRT (PROSPECT) database.

Methods and results

PROSPECT was a prospective, multicentre study that enrolled CRT patients based on enrolling centre‐evaluated LVEF <35%, but all echocardiograms were subsequently analysed by a core laboratory. Patients with core laboratory‐measured LVEF >35% (OVER35) were compared with those whose LVEF was <35% (UNDER35). Clinical composite score (CCS) and change in LV end systolic volume (LVESV) were analysed from baseline to 6‐month follow‐up. Of 361 patients, 86 (24%) had LVEF >35%. At entry, OVER35 had smaller LV volumes, shorter QRS duration, shorter 6‐min walk distance, and were more likely to have ischaemic aetiology than UNDER35. Outcomes were comparable between the groups, with 62.8% of OVER35 improved in CCS (70.2% in UNDER35) and 50.8% of OVER35 improved in LVESV (57.8% in UNDER35).

Conclusion

Patients with LVEF >35%, New York heart association functional Class III–IV status, and QRS >130 ms appear to derive clinical and structural benefit from CRT. As CRT may offer a valuable option for these patients, this hypothesis should be formally tested in a prospective, randomized multicentre trial.
Optimizing survey design for Scandinavian harbour seals: population trend as an ecological quality element
Authors: Teilmann Jonas , Rigét Frank , Harkonen Tero
Published: February 2010

Teilmann, J., Rigét, F., and Harkonen, T. 2010. Optimizing survey design for Scandinavian harbour seals: population trend as an ecological quality element. – ICES Journal of Marine Science, 67: 952–958. To be successful, conservation and management programmes require accurate data on abundance and population trends. Noise caused by within- and among-year variance should be minimized to optimize the statistical power for detecting changes in abundance. A total of 30 years of monitoring data from seven distinct subpopulations of harbour seals (Phoca vitulina) in southern Scandinavia was used to investigate the relative contributions of factors affecting the power to detect trends in abundance. The power is typically doubled under the conditions tested when carrying out annual surveys compared with every second year. The power also increases substantially when carrying out replicate surveys during the annual moult. The gain in power increases steeply up to three annual replicates, but then levels off, and it is further increased when the mean of the two highest counts of three annually repeated counts is used. We propose that harbour seal haul-out sites are surveyed every year during the moult, with at least three replicate surveys per year. This would provide robust data for analyses of population trends, facilitating management and identification of potential influences of diseases and anthropogenic activities.
Laboratory Yields and Process Stream Compositions from E‐Mill and Dry‐Grind Corn Processes Using a Granular Starch Hydrolyzing Enzyme
Authors: Arora Amit , Dien Bruce S. , Belyea Ronald L. , Wang Ping , Singh Vijay , Tumbleson M. E. , Rausch Kent D.
Published: February 2010

In dry‐grind corn processing, the whole kernel is fermented to produce ethanol and distillers dried grains with solubles (DDGS); the E‐Mill process was developed to generate coproducts in addition to DDGS. Compositions of thin stillage and wet grains obtained from the E‐Mill process will be different from the dry‐grind process. Knowledge of thin stillage compositions will provide information to improve coproducts from both processes. Laboratory dry‐grind and E‐Mill processes that used granular starch hydrolyzing enzymes (GSHE) were compared and process yields determined. Two methods, centrifugation and screening, were used to produce thin stillage and wet grains from the laboratory processes. Compositions of process streams were determined. In the dry‐grind process using GSHE, solids contents of beer, whole stillage, and wet grains were higher compared to the same fractions from the E‐Mill process using GSHE. Solids contents of mash for both processes were similar. Total solids, soluble solids, and ash contents of thin stillage were similar for the two processes. Fat content of thin stillage from E‐Mill was lower than that from the dry‐grind process; protein content of E‐Mill thin stillage was higher than that from dry‐grind thin stillage. Removal of germ and fiber before fermentation changed composition of thin stillage from the E‐Mill process. The screening method produced higher thin stillage and lower wet grains yields than using a centrifugation method. The screening method was less time consuming but resulted in limited wet grains material for additional analyses or processing. The centrifugation method of thin stillage separation removed more solids from thin stillage than the screening method.
Association of Size‐Exclusion HPLC of Endosperm Proteins with Dough Mixing and Breadmaking Characteristics in a Recombinant Inbred Population of Hard Red Spring Wheat
Authors: Tsilo Toi J. , Ohm Jae‐Bom , Hareland Gary A. , Anderson James A.
Published: February 2010

Variation of polymeric proteins affects wheat end‐use quality. This research investigated associations of polymeric proteins with dough mixing strength and breadmaking characteristics in a near‐homogenous population of 139 recombinant inbred lines (RILs) derived from a cross between two hard red spring wheat breeding lines. Flours from the RILs grown at three locations were analyzed for molecular weight (MW) distribution of SDS‐extractable and unextractable proteins using size‐exclusion HPLC protocol. Correlations were calculated between mixing and breadmaking properties and HPLC absorbance data obtained a 0.01‐min retention time interval to identify protein fractions that had a significant effect on the quality traits. Very high MW polymeric proteins in the unextractable fraction had more distinct and positive associations with dough mixing strength and bread loaf volume than did other polymeric protein fractions, whereas extractable polymeric had negative influence. Consequently, the ratio of unextractable very high MW polymeric proteins to extractable polymeric proteins had greater correlations with dough mixing parameters than other HPLC absorbance area data. Covariate‐effect biplots also visually validated positive effects of unextractable very high MW polymeric proteins and negative effects of extractable polymeric proteins on mixing properties and loaf volume across three growing locations.
Characterization and analysis of carbon fibre-reinforced polymer composite laminates with embedded circular vasculature
Authors: Huang C.-Y. , Trask R. S. , Bond I. P.
Published: February 2010

A study of the influence of embedded circular hollow vascules on structural performance of a fibre-reinforced polymer (FRP) composite laminate is presented. Incorporating such vascules will lead to multi-functional composites by bestowing functions such as self-healing and active thermal management. However, the presence of off-axis vascules leads to localized disruption to the fibre architecture, i.e. resin-rich pockets, which are regarded as internal defects and may cause stress concentrations within the structure. Engineering approaches for creating these simple vascule geometries in conventional FRP laminates are proposed and demonstrated. This study includes development of a manufacturing method for forming vascules, microscopic characterization of their effect on the laminate, finite element (FE) analysis of crack initiation and failure under load, and validation of the FE results via mechanical testing observed using high-speed photography. The failure behaviour predicted by FE modelling is in good agreement with experimental results. The reduction in compressive strength owing to the embedding of circular vascules ranges from 13 to 70 per cent, which correlates with vascule dimension.
Paradoxical conservation of a set of three cellulose-targeting genes in Mycobacterium tuberculosis complex organisms
Authors: Mba Medie Felix , Ben Salah Iskandar , Drancourt Michel , Henrissat Bernard
Published: February 2010

The genome of the tuberculosis agent Mycobacterium tuberculosis encodes a putative cellulose-binding protein (CBD2), one candidate cellulase (Cel12), and one fully active cellulase (Cel6). This observation is puzzling, because cellulose is a major component of plant cell walls, whereas M. tuberculosis is a human pathogen without known contact with plants. In order to investigate the biological role of such cellulose-targeting genes in M. tuberculosis we report here the search for and transcription analysis of this set of genes in the genus Mycobacterium. An in silico search for cellulose-targeting orthologues found that only 2.5 % of the sequenced bacterial genomes encode the Cel6, Cel12 and CBD2 gene set simultaneously, including those of the M. tuberculosis complex (MTC) members. PCR amplification and sequencing further demonstrated the presence of these three genes in five non-sequenced MTC bacteria. Among mycobacteria, the combination of Cel6, Cel12 and CBD2 was unique to MTC members, with the exception of Mycobacterium bovis BCG Pasteur, which lacked CBD2. RT-PCR in M. tuberculosis H37Rv indicated that the three cellulose-targeting genes were transcribed into mRNA. The present work shows that MTC organisms are the sole mycobacteria among very few organisms to encode the three cellulose-targeting genes CBD2, Cel6 and Cel12. Our data point toward a unique, yet unknown, relationship with non-plant cellulose-producing hosts such as amoebae.
Accurate detection and genotyping of SNPs utilizing population sequencing data
Authors: Bansal Vikas , Harismendy Olivier , Tewhey Ryan , Murray Sarah S. , Schork Nicholas J. , Topol Eric J. , Frazer Kelly A.
Published: February 2010

Next-generation sequencing technologies have made it possible to sequence targeted regions of the human genome in hundreds of individuals. Deep sequencing represents a powerful approach for the discovery of the complete spectrum of DNA sequence variants in functionally important genomic intervals. Current methods for single nucleotide polymorphism (SNP) detection are designed to detect SNPs from single individual sequence data sets. Here, we describe a novel method SNIP-Seq (single nucleotide polymorphism identification from population sequence data) that leverages sequence data from a population of individuals to detect SNPs and assign genotypes to individuals. To evaluate our method, we utilized sequence data from a 200-kilobase (kb) region on chromosome 9p21 of the human genome. This region was sequenced in 48 individuals (five sequenced in duplicate) using the Illumina GA platform. Using this data set, we demonstrate that our method is highly accurate for detecting variants and can filter out false SNPs that are attributable to sequencing errors. The concordance of sequencing-based genotype assignments between duplicate samples was 98.8%. The 200-kb region was independently sequenced to a high depth of coverage using two sequence pools containing the 48 individuals. Many of the novel SNPs identified by SNIP-Seq from the individual sequencing were validated by the pooled sequencing data and were subsequently confirmed by Sanger sequencing. We estimate that SNIP-Seq achieves a low false-positive rate of ∼2%, improving upon the higher false-positive rate for existing methods that do not utilize population sequence data. Collectively, these results suggest that analysis of population sequencing data is a powerful approach for the accurate detection of SNPs and the assignment of genotypes to individual samples.
Strengthening the Financial Reporting System: Can Audit Committees Deliver?
Authors: Bédard Jean , Gendron Yves
Published: February 2010

This paper reviews the literature on audit committees in order to evaluate the extent to which committees are effective in terms of strengthening financial reporting. The paper aims to achieve two goals: first. to provide updated information about the effectiveness of the audit committee, and second to identify research opportunities. Compared with other reviews on the matter, we cover a broader spectrum of theoretical perspectives from various fields, methods, and countries. In particular, our review investigates from a meta‐perspective the results reported in studies which examine the relationship between certain audit committee characteristics and measures of audit committee effectiveness. It is hoped that this work will sensitize accounting researchers about the appropriateness of extending the boundaries of research on audit committees, from methodological, theoretical, and geographical points of view.
Prospects for the manufacture of red cells for transfusion
Authors: Mountford Jo , Olivier Emmanuel , Turner Marc
Published: February 2010

Whilst red cell transfusion is a well established cellular therapy, the problems of insufficiency of supply, transfusion transmitted infections and the requirement for immunological matching persist. The possibility of generating large numbers of O Rh D negative red cells at Good Manufacturing Practice grade as a route to circumvent these issues is therefore an attractive proposition. Significant numbers of erythrocytes can be generated from somatic haematopoietic stem cells, but it seems unlikely that these can provide sufficient volumes for large scale manufacture. However, human embryonic stem cells (hESC) and, potentially, induced pluripotent stem cells (iPSC), may provide a route to this objective. Red cell transfusion is an attractive goal for pluripotent stem cell‐derived therapeutics because it is a well‐characterised single cell suspension that lacks nucleated cells and has a low expression of human leucocyte antigen molecules, but many challenges remain in translating this cellular therapy to the clinic.
Clinical utility of routine MPL exon 10 analysis in the diagnosis of essential thrombocythaemia and primary myelofibrosis
Authors: Boyd Elaine M. , Bench Anthony J. , Goday‐Fernández Andrea , Anand Shubha , Vaghela Krishna J. , Beer Phillip , Scott Mike A. , Bareford David , Green Anthony R. , Huntly Brian , Erber Wendy N.
Published: February 2010

Approximately 50% of essential thrombocythaemia and primary myelo‐fibrosis patients do not have a JAK2 V617F mutation. Up to 5% of these are reported to have a MPL exon 10 mutation but testing for MPL is not routine as there are multiple mutation types. The ability to routinely assess both JAK2 and MPL mutations would be beneficial in the differential diagnosis of unexplained thrombocytosis or myelofibrosis. We developed and applied a high resolution melt (HRM) assay, capable of detecting all known MPL mutations in a single analysis, for the detection of MPL exon 10 mutations. We assessed 175 ET and PMF patients, including 67 that were JAK2 V617F‐negative by real time polymerase chain reaction (PCR). Overall, 19/175 (11%) patients had a MPL exon 10 mutation, of whom 16 were JAK2 V617F‐negative (16/67; 24%). MPL mutation types were W515L (11), W515K (4), W515R (2) and W515A (1). One patient had both W515L and S505N MPL mutations and these were present in the same haemopoietic colonies. Real time PCR for JAK2 V617F analysis and HRM for MPL exon 10 status identified one or more clonal marker in 71% of patients. This combined genetic approach increases the sensitivity of meeting the World Health Organization diagnostic criteria for these myeloproliferative neoplasms.
The management of pregnancy in paroxysmal nocturnal haemoglobinuria on long term eculizumab
Authors: Kelly Richard , Arnold Louise , Richards Stephen , Hill Anita , Bomken Charlotte , Hanley John , Loughney Andrew , Beauchamp Jon , Khursigara Gus , Rother Russell P. , Chalmers Elizabeth , Fyfe Andrew , Fitzsimons Edward , Nakamura Ryotaro , Gaya Anna , Risitano Antonio M. , Schubert Jörg , Norfolk Derek , Simpson Nigel , Hillmen Peter
Published: February 2010

In Paroxysmal nocturnal haemoglobinuria (PNH), pregnancy is associated with increased maternal and foetal complications to such an extent that the condition has been considered relatively contra‐indicated in PNH. Eculizumab has revolutionized the treatment of PNH. We evaluate its use in pregnancy to date. We report on seven patients exposed to eculizumab at different stages of pregnancy including the first two patients to receive the drug from conception to delivery. There was no evidence of complement blockade from cord blood samples taken at delivery. Eculizumab appears safe to use in this setting and is likely to prevent many of the complications usually observed.
The role of haematopoietic growth factors granulocyte colony‐stimulating factor and granulocyte‐macrophage colony‐stimulating factor in the management of drug‐induced agranulocytosis
Authors: Andrès Emmanuel , Maloisel Frédéric , Zimmer Jacques
Published: February 2010

Drug‐induced agranulocytosis (neutrophil count <0·5 × 109/l) is a rare haematological complication with an incidence of no more than 10 cases per million inhabitants per year in Europe. Over the past few years there has been a steady decline in mortality rate, (currently at <5%), which can be partly explained by earlier recognition and the improved clinical management of associated intercurrent infections that may lead to severe sepsis if left untreated. The true impact of the use of haematopoietic growth factors, such as granulocyte colony‐stimulating factor (G‐CSF) and granulocyte‐macrophage colony‐stimulating factor (GM‐CSF), on the decreased mortality rate remains unknown. Yet, most studies show that these molecules, especially G‐CSF, reduce the duration of agranulocytosis, antibiotic course and length of hospital stay. Their use is particularly recommended in patients with poor prognostic factors, such as a neutrophil count <0·1 × 109/l, age over 65 years, severe infection or multiple co‐morbidities. In all cases, the drug responsible for causing the agranulocytosis must be discontinued and remain permanently contraindicated. The appropriate Medicines Regulatory Agency must also be notified of the adverse event.
Influence of dietary vitamin K intake on subtherapeutic oral anticoagulant therapy
Authors: Rombouts Eva K. , Rosendaal Frits R. , Van Der Meer Felix J. M.
Published: February 2010

It is unclear what advice should be given to patients using vitamin K antagonists with respect to dietary vitamin K intake. We performed a nested case–control study in patients attending a Dutch anticoagulation clinic, to determine the association between vitamin K intake and subtherapeutic International Normalized Ratio (INR) values and the interaction between usual and recent vitamin K intake. Compared to patients with a normal usual vitamin K intake, those with a high vitamin K intake had a decreased risk of a subtherapeutic INR [Hazard Ratio (HR) 0·80, 95% confidence interval (CI): 0·56–1·16] and patients with a low vitamin K intake an increased risk (HR 1·33, 95% CI: 0·79–2·25). In patients with a low usual vitamin K intake, recent vitamin K intake was twice as high in cases as in controls (164 vs. 85 μg/d). Such a difference was not observed in patients with a normal or high usual vitamin K intake. Our results suggest that a high vitamin K intake reduces the risk of a low INR by lessening the influence of incidental consumption of vitamin K rich food on the INR. These findings support the recommendation for patients on vitamin K antagonists to eat a sufficient amount of vitamin‐K containing foods.
Behaviour of male and female parasitoids in the field: influence of patch size, host density, and habitat complexity
Authors: MARTIJN BEZEMER T. , HARVEY JEFFREY A. , KAMP ANDRÉ F. D. , WAGENAAR ROEL , GOLS RIETA , KOSTENKO OLGA , FORTUNA TAIADJANA , ENGELKES TIM , VET LOUISE E. M. , VAN DER PUTTEN WIM H. , SOLER ROXINA
Published: February 2010

1. Two field experiments were carried out to examine the role of patch size, host density, and complexity of the surrounding habitat, on the foraging behaviour of the parasitoid wasp Cotesia glomerata in the field.

2. First, released parasitoids were recaptured on patches of one or four Brassica nigra plants, each containing 10 hosts that were placed in a mown grassland area. Recaptures of females were higher than males, and males and females aggregated at patches with four plants.

3. In experiment 2, plants containing 0, 5 or 10 hosts were placed in unmown grassland plots that differed in plant species composition, on bare soil, and on mown grassland. Very low numbers of parasitoids were recaptured in the vegetated plots, while high numbers of parasitoids were recaptured on plants placed on bare soil or in mown grassland. Recaptures were higher on plants on bare soil than on mown grassland, and highest on plants containing 10 hosts. The host density effect was significantly more apparent in mown grassland than on bare soil.

4. Cotesia glomerata responds in an aggregative way to host density in the field. However, host location success is determined mostly by habitat characteristics, and stronger host or host‐plant cues are required when habitat complexity increases.
Using discrete choice experiment to elicit doctors' preferences for the report card design of diabetes care in Taiwan – a pilot study
Authors: Chen Tsung‐Tai , Chung Kuo‐Piao , Huang Heng‐Chiang , Man Lao‐Nga , Lai Mei‐Shu
Published: February 2010

Objectives  Little is known about doctors' preferences regarding public report card design. Taiwan just announced the first diabetes report card on April 2008. The aim of this study was to investigate the Diabetes Mellitus (DM) providers' preferences towards four report card attributes: update frequency, risk adjustment, content information and display format.

Methods  A discrete choice questionnaire was mailed to hospital and primary care doctors in the northern part of Taiwan, with 221 study targets. The response rate was 29%.

Results  Using random effect logistic regression, doctors' preference attribute rankings were risk adjustment for patients (44.7%), content information (25.2%), display format (18.3%) and update frequency (11.8%). One‐year update frequency, risk adjustment, detailed scores of technical quality and interpersonal quality and bar chart display were the most important items noted in our survey.

Conclusions  This is the first study to investigate provider's preferences for a diabetes report card. It enables the policy maker to clearly see the implication of trade‐offs between different choices when designing a report card that doctors will like. Our findings suggest that doctors do not favour the ‘less is more’ principle, or the higher frequency of updates that patients may prefer. Rather, our findings suggest that risk adjustment and more information content are the most important factors for doctors. Future studies should use discrete choice experiment on different aspects of report card design, such as vulnerable patients or health care administrations.
Impact of prevention structures and processes on pressure ulcer prevalence in nursing homes and acute‐care hospitals
Authors: Lahmann Nils A. , Halfens Ruud J. G. , Dassen Theo
Published: February 2010

Aim  The study aimed to give a description analysis of pressure ulcer‐related structures, processes and outcomes in nursing homes and acute‐care hospitals that participated once, twice and thrice in prevalence surveys.

Design  Repeated nationwide, multicentre, cross sectional surveys have been conducted.

Methods  A total of 7377 residents in 60 nursing homes and 28,102 patients in 82 acute‐care hospitals in Germany participated in annual point prevalence surveys. Because of their strong differences in sampling and in order to be able to display the differences occurring during the repeated (first, second and third) participation of the institutions, they were arranged according to their frequency and order of participation. The percentage of used guidelines and risk assessment scales (structures), prevention devices and measures (processes), and prevalence and nosocomial prevalence (outcomes) among all persons at risk was calculated.

Results  The samples within the arranged groups showed no clinically relevant demographical differences. Nosocomial prevalence rates in hospitals dropped from 26.3% in the first year to 11.3% in the last year (nursing homes from 13.7% to 6.4%). The use of pressure ulcer‐related structures remarkably increased during each repetition to more than 90%. Regarding the use of preventive measures and devices as an indicator for pressure ulcer‐related processes results were more incoherent.

Conclusion  Repeated participation in pressure ulcer surveys led to a decrease in outcomes (lower pressure ulcer prevalence rates), to high opposite effects regarding pressure ulcer‐related structures (increased use of all guidelines/risk assessment scales) and to moderate adverse effects regarding pressure ulcer‐related processes (increased use of most preventive measures and devices).
Training inpatient mental health staff how to enhance patient engagement with medications: Medication Alliance training and dissemination outcomes in a large US mental health hospital
Authors: Byrne Mitchell K. , Willis Aimee , Deane Frank P. , Hawkins Barbara , Quinn Rebecca
Published: February 2010

Rationale, aims and objectives  The Medication Alliance training programme has previously been shown to be effective in enhancing clinician knowledge, attitudes and skills in regard to non‐adherent individuals in a community‐based psychiatric setting. The current study attempts to replicate these findings in an inpatient setting and assess the feasibility of dissemination using a train‐the‐trainer model.

Method  One hundred and thirteen staff from four wards at an inpatient psychiatric facility attended Medication Alliance training workshops over 3 days. Two wards comprised an expert trained group (n = 67); and the remaining two wards made up a novice trained group (n = 46). The novice trained group attended training 6 months after the expert group, and were trained by selected trainees from the expert group. Participants completed a package of questionnaires both before and after their training to determine if Medication Alliance resulted in any changes in knowledge, attitudes and skills.

Results  Paired t‐tests showed significant improvements across both groups for knowledge, attitudes and one skill domain following training in Medication Alliance. There were no differences at baseline between groups and analysis of post‐test scores yielded no significant difference between the groups in terms of training effect for knowledge, attitudes or skills.

Conclusions  Medication Alliance can be successfully implemented in an inpatient setting, enhancing knowledge, attitudes and at least some skill domains of staff in dealing with non‐adherent patients. The equivalence of results between the expert and novice trained training groups suggests that Medication Alliance may be more broadly disseminated using a cost‐effective train‐the‐trainer model.
Does the organization of care processes affect outcomes in patients undergoing total joint replacement?
Authors: Vanhaecht Kris , Bellemans Johan , De Witte Karel , Diya Luwis , Lesaffre Emmanuel , Sermeus Walter
Published: February 2010

Background  Surgeons realize that safe and efficient care processes for total joint replacement requires more than just well‐performed operations. Orthopaedic teams are reorganizing care process to improve efficacy and shorten length of stay. Little is known on the impact of organizational changes on patient outcome. This paper studies the relation between the organization of care processes and patient outcomes in hip and knee. Clinical pathways are used as one of the methods to structure the care process. Although evidence is available on the effect of pathways in total joint replacement, their impact with the organization of the care process has not been studied previously.

Methods  A cross‐sectional multicentre study was performed on 39 care processes and 737 consecutive patients. Regression models were used to analyse the relation between the organization of the care process and risk‐adjusted patient outcomes. The use of pathways and the organization of the care process, measured by the Care Process Self Evaluation Tool (CPSET), were measured at organizational level. Length of stay, pain, mobility and elapsed time to discharge were measured at patient level.

Results  The use of pathways had a positive effect on four out of five subscales and the overall CPSET score. Using pathways decreased length of stay (P = 0.014), pain (P = 0.052) and elapsed time to discharge (P = 0.003). The CPSET subscale communication was related with three risk adjusted outcomes. Multivariate analysis demonstrated a significant effect by three different variables on the length of stay; (1) use of pathways; (2) coordination of care processes; and (3) communication with patients and family. Both the use of pathways and coordination of the care process were determinants for the elapsed time to discharge. A significant interaction effect was found between use of pathways and coordination of the care process.

Conclusion  This large multicentre study revealed the relation between the use of pathways, organization of the care process and patient outcomes. This information is important for both clinicians and managers to understand and further improve the organization of orthopaedic care.

Level of evidence  Level I prognostic study.
Knowledge and attitudes about oral cancer among dentists in Spain
Authors: López‐Jornet Pia , Camacho‐Alonso Fabio , Molina‐Miñano Francisco
Published: February 2010

Objectives  Detecting oral cancer (OC) at an early stage is the most effective means of improving survival and reducing morbility from disease. The objective was to study the knowledge, opinions and attitudes held by general dentists in Spain regarding aspects of OC in general clinic practice.

Methods  A 44‐item questionnaire relating to OC was randomly distributed by email to 1000 dentists in the different autonomous communities in Spain.

Results  The response rate was 42.7%. Only 49.7% of the dentists who replied considered themselves to have up‐to‐date knowledge on OC. A total of 94.7% of those interviewed hold the opinion that it is the dentists who are qualified to carry out the oral examination. In addition, 41.8% felt that family doctors and 13.8% that dental hygienists were also capable of making this examination. We should highlight that dentists who rated their undergraduate OC training favourably were more likely to agree that their OC knowledge was current than those who rated their undergraduate training unfavourably [odds ratio (OR) = 4.1, 95% confidence interval (CI) = 1.1–4.2, P = 0.019). Respondents who performed oral cancer examinations on all patients 40 years of age or older were 1.8 times more likely to agree that their OC knowledge was current; however, the differences were not significant (OR = 1.3, 95% CI = 0.6–2.7, P = 0.392).

Conclusions  Gaps in knowledge exist, strongly suggesting the need for continued courses of education detection and prevention of OC.
The evidence base for the evaluation and management of dizziness
Authors: Kerber Kevin A. , Fendrick A. Mark
Published: February 2010

Objectives  Dizziness presentations pose many clinical challenges. The objective of this study is to broadly summarize the evidence base that supports clinical decisions in dizziness presentations.

Methods  MEDLINE (1966 to September 2007), Web of Science and The Cochrane Library were searched for articles with clinical relevance on topics concerning dizziness. Additional sources were also searched for clinical practice guidelines. The following information was abstracted from each article: year of publication, journal type, type of article and the topics of the article.

Results  Of nearly 3000 articles identified, 1244 articles met the inclusion criteria. The most common article type was a case report or case series, followed by expert opinion or review articles, studies of medical tests and clinical trials. Meta‐analyses and systematic reviews were found on benign paroxysmal positional vertigo and Meniere's disease, but only a few other topics. No clinical practice guidelines were found that focus specifically on dizziness.

Conclusions  The evidence base for the evaluation and management of dizziness seems to be weak. Future work to establish or summarize evidence in clinically meaningful ways could contribute to efforts to optimize patient care and health care utilization for one of the most common presenting symptoms.