bluuebunny/crossref_metadata_2025 huggingface dataset:
Platelet lysates and their role in cell therapy
Authors: Radtke S. , Giebel B. , Wagner W. , Horn P. A.
Published: July 2014

There is an emerging field of application for human platelet concentrates as they are rich in growth factors for in vitro culture of various cell types. To this end, the platelets are lysed to release the growth factors to the culture medium, for example by freeze–thaw procedures or by ultrasonic treatment. This human platelet lysate (HPL) is advantageous as compared to the traditionally used foetal bovine serum (FBS): it is xenogen‐free – and hence suitable for generation of therapeutic products – and it further increases proliferation rates of cells in culture. On the other hand, neither HPL nor FBS are precisely defined, and there is notorious batch‐to‐batch variation. Further research is required to unravel the relevant compounds to generate fully defined synthetic culture media – until then, HPL provides a suitable and reliable cell culture supplement particularly in cellular therapy.
Managing the platelet refractory patient
Authors: Murphy M. F.
Published: July 2014

Platelet refractoriness is the repeated failure to obtain satisfactory responses to platelet transfusions. It is mainly due to shortened platelet survival associated with non‐immune clinical factors, such as infection and its treatment with antibiotics and antifungal drugs, disseminated intravascular coagulation (DIC) and splenomegaly. The main immune cause is HLA alloimmunization which occurs predominantly in females with a history of pregnancy. The incidence of alloimmune platelet refractoriness due to HLA antibodies has declined due to leucocyte reduction in blood components and more aggressive treatment for patients with haematological malignancies and other cancers. Responses to platelet transfusions should be carefully monitored. If platelet refractoriness occurs, a clinical assessment should be made for clinical factors associated with non‐immune platelet consumption. If there are no obvious clinical factors present, an immune mechanism should be suspected and testing for HLA antibodies conducted. If HLA antibodies are detected, HLA‐matched platelet transfusions should be used. There are a number of methods including computer algorithms to determine HLA compatibility and acceptable HLA mismatches. HLA‐matched platelet transfusions are not indicated when serological testing has failed to detect HLA antibodies; further consideration should be given to the presence of non‐immune clinical factors and testing for HPA antibodies. If there are improved responses to HLA‐matched platelet transfusions, they should be continued. If there are poor responses to HLA‐matched platelet transfusions, the reasons should be sought including HLA incompatibility which is most likely to occur in patients with unusual HLA types with few well‐matched donors, non‐immune platelet consumption, and HPA and ABO incompatibility. Further serological investigations including testing for HPA antibodies and/or platelet cross‐matching may be used to differentiate between these possibilities. The management of patients with HLA and/or HPA alloimmunization and no compatible donors may be very difficult. The management of patients with non‐immune platelet consumption is similarly problematic.
Five new blood group systems – what next?
Authors: Storry J. R.
Published: July 2014

At the meeting of the ISBT working party for red cell immunogenetics and blood group nomenclature in 2012, FORS, JR and LAN were ratified as blood group systems. Since then, the molecular basis of the Vel blood group antigen has been elucidated, and the complement regulator protein, CD59 has been shown itself to be a blood group antigen. These last two discoveries will no doubt lead to their elevation to blood group systems. How has this happened? It turns out to be a mixture of old and new techniques. Rapid advances in molecular biology and in our understanding of the human genome have opened new fields of discovery within human blood groups. The development of comprehensive SNP arrays, exome sequencing and rapid sequencing techniques, e.g. Next‐Generation sequencing, has provide us with tools for rapid discovery. Combining these with sophisticated algorithms for database mining has resulted in the identification of the molecular bases behind the hitherto unresolved, clinically relevant blood group antigens Jra (ABCG2) and Vel (SMIM1). However classic biochemistry and subsequent peptide and DNA‐sequencing still play an important role and lie behind the (simultaneous) discoveries of Jra and Vel, but also of Lan (ABCB6) and FORS (GBGT1). A rare CD59‐deficient patient produced an alloantibody to a high‐prevalence antigen that was shown to be targeted at CD59.
Pathogen reduction technologies
Authors: Marks D. C. , Faddy H. M. , Johnson L.
Published: July 2014

Background

Ideally, pathogen reduction technology (PRT) should provide proactive protection against emerging pathogens, reduce the need to introduce additional testing, minimize bacterial contamination and potentially replace processing steps such as gamma‐irradiation.

Material and Methods

Available literature regarding technologies currently in use or under development for the treatment of labile blood components during processing was reviewed.

Results

The INTERCEPT and Mirasol PRT systems are used widely in blood centres in Europe, Asia and the Middle East for the treatment of both platelets and plasma, whereas clinical trials of platelets treated using the THERAFLEX UV‐Platelets system are underway. In vitro data suggest that PRT treatment leads to some loss of platelet function. However, haemovigilance reports from countries where PRT‐treated platelets and plasma are transfused indicate no change in component usage, and indeed a reduction in transfusion‐related adverse events. Animal models are being used to elucidate mechanisms for these observed reductions. A second‐generation S‐303 system for red cells is also under development, as is a Mirasol PRT system for treatment of whole blood. Preliminary data indicate that these technologies may eventually become available.

Conclusion

The challenge for blood services is to understand and rationalize the costs, risks and benefits of PRT compared with removing any tests or processes, whilst aiming to provide the highest level of blood safety. Ongoing post‐marketing surveillance and clinical trials are still required for all PRT systems.
Advances in granulocyte test methodologies
Authors: Matsuhashi M. , Tsuno N. H. , Iino J. , Nagura Y. , Okazaki H. , Santoso S.
Published: July 2014

Alloantibodies to human neutrophil antigens (HNA) are involved in clinical conditions such as neonatal alloimmune neutropenia (NAN), autoimmune neutropenia (AIN) and transfusion‐related acute lung injury (TRALI). For the diagnosis of these conditions, the detection of the causative antibody is essential. Presently, the use of a combination of granulocyte agglutination assay (GAT) and granulocyte immunofluorescence test (GIFT) for the screening of granulocyte antibodies, followed by the determination of antibody specificity by the monoclonal antibody‐specific immobilization of granulocyte antigens (MAIGA) is recommended by the ISBT Working Party on Granulocyte Immunobiology. In Japan, the mixed‐passive hemagglutination (MPHA) assay, a method originally developed for the detection of anti‐platelet antibodies, was adapted for the testing of anti‐granulocyte antibodies. Although various technologies are available, presently, no one of the methods alone is able to detect all clinically relevant antibodies, thus their combination is important, and the development of new methodologies is desired. In this review, we describe the presently available classical methods for anti‐granulocyte antibody detection, including GIFT, GAT, MAIGA and MPHA, and also the new technologies, especially focusing on the advantages and problems of the different methods.
New approaches for manufacturing plasma derivatives
Authors: Burnouf T.
Published: July 2014

Plasma fractionation is the large‐scale production process used to prepare an important class of protein products that are the only potential therapeutic options to treat, manage or prevent life‐threatening conditions resulting from immunological disorders, congenital plasma protein deficiencies, infections and trauma. The main plasma products include immunoglobulin G (IgG), coagulation factors, fibrinogen and albumin. The core plasma fractionation process, based on sequential ethanol precipitation steps, was developed in the 1940s. It has evolved over the years through implementation of chromatographic protein purification steps, viral safety treatments and automation into a complex biotechnological process. Industrial plasma fractionation is nowadays well mastered and scientifically understood in industrialized countries; product quality and safety benefit from the mature regulations overseeing the collection of plasma and licensing of therapeutic biologicals. Several emerging countries, interested in producing plasma products from local plasma resources to increase product supplies, have considered building fractionation plants. However, the complexities of the current plasma fractionation technology and its validation constitute a substantial barrier to entry into the field. Changes in plasma product drivers in industrialized countries have raised interest in novel, easily scalable plasma fractionation technologies capable of enhancing certain aspects, such as IgG recovery. Novel plasma fractionation approaches rely (1) on multiple chromatographic steps to capture target proteins in sequence, (2) membranes and differential electric potentials to partition proteins or (3) aqueous two‐phase system. A ‘mini‐pool’ method of fractionation and viral inactivation using disposable devices is being developed to fill in quality gaps between crude blood components and commercial products.
A fresh look at measuring quality in blood components
Authors: Devine D. V. , Chen D.
Published: July 2014

Production of blood components for transfusion requires that users have confidence in the quality of the products and that they will be safe and efficacious. The assurance of blood product quality requires the collection of data that demonstrate products are within specification. However, the linkage between confidence that an individual blood component unit will perform as expected and the conduct of quality testing is imperfect because quality testing is often done after product release and monitors process control, not quality control. In addition, the standards to assess blood components often allow a percentage of units to fail to meet user specifications. Ideally, there would be real time quality control measures made prior to unit release to the hospital blood bank, and these measures would be highly predictive of product efficacy. As a community, much work must be done to reach this state. First we must identify product characteristics that are strongly predictive of transfusion efficacy to use as standards. Improved production methods are only one way to impact component quality; another is to manage the characteristics of the donors themselves. Donor variation includes not only recognized wide ranges of traditional characteristics of normal healthy humans, but also extends to storage characteristics of components made from individual donations. This review covers the state of the science of product quality and the regulation of blood products, including new information arising from clinical studies and the application of modern scientific methods such as proteomics and metabolomics to blood component quality.
The First Integral Method for Exact Solutions of Nonlinear Fractional Differential Equations
Authors: Bekir Ahmet , Güner Özkan , Ünsal Ömer
Published: July 2014

In this paper, we establish exact solutions for some nonlinear fractional differential equations (FDEs). The first integral method with help of the fractional complex transform (FCT) is used to obtain exact solutions for the time fractional modified Korteweg–de Vries (fmKdV) equation and the space–time fractional modified Benjamin–Bona–Mahony (fmBBM) equation. This method is efficient and powerful in solving kind of other nonlinear FDEs.
Celebrating the 100th Anniversary of Inglis Result: From a Single Notch to Random Surface Stress Concentration Solutions
Authors: Medina Hector E. , Pidaparti Ramana , Hinderliter Brian
Published: July 2014

We celebrate the first quantitative evidence for the stress concentration effect of flaws analyzed by Inglis. Stress concentration factor (SCF) studies have evolved ever since Inglis' 1913 result related to the problem of the elliptical hole in a plate, which also approximately applies to the half-elliptical notch case. We summarize a hundred years of development of the SCF with the exclusive focus on analytical solutions, with a very specific route: the series of works reviewed and presented herein include a parade of solutions beginning with (and those that followed) Inglis famous result, continue with periodic discrete discontinuities, sinusoidal periodic surfaces, and end with more complex continuous configurations such as random surfaces. Furthermore, we show that the form of Inglis' result is powerful enough to serve as first-order approximation for some cases of multiple discontinuities and even continuous rough topologies. Thus, we proposed the Modified Inglis formula (MIF), to estimate the SCF for a variety of configurations, in honor to Inglis' historical result. The impetus of this review stems from the fact that for many engineering problems involving multiphysical solid–fluid interactions, there is a broad interest to couple stress concentration relationships with thermodynamics, fluid dynamics, or even diffusion equations in order to expand understanding on stress-driven interactions at the solid–fluid interface. Additionally, a handy first-order estimate of the SCF can serve in the initial stage of designs of structures and parts containing discontinuities.
Invariant Forms of Conservation Equations for Reactive Fields and Hydro-Thermo-Diffusive Theory of Laminar Flames
Authors: Sohrab Siavash H.
Published: July 2014

A scale-invariant model of statistical mechanics is described leading to invariant Enskog equation of change that is applied to derive invariant forms of conservation equations for mass, thermal energy, linear momentum, and angular momentum in chemically reactive fields. Modified hydro-thermo-diffusive theories of laminar premixed flames for (1) rigid-body and (2) Brownian-motion flame propagation models are presented and are shown to be mathematically equivalent. The predicted temperature profile, thermal thickness, and propagation speed of laminar methane–air premixed flame are found to be in good agreement with existing experimental observations.
Experimental Investigation of Enhanced Heat Transfer and Pressure Drop in a Solar Air Heater Duct With Discretized Broken V-Rib Roughness
Authors: Patil Anil Kumar , Saini J. S. , Kumar Krishna
Published: July 2014

The present study examines the augmentation in heat transfer and friction in a flow through solar air heater duct with discretized broken V-rib roughness. The experimental outcomes pertaining to Reynolds number from 3000 to 17,000, relative gap position (s′/s) from 0.2 to 0.8, relative staggered rib position (p′/p) from 0.2 to 0.8 have been presented and discussed. Discretized broken V-rib roughness brought out considerable enhancement in heat transfer rates over V-rib roughness and smooth duct. Effective efficiency of discretized broken V-rib roughened solar air heater is estimated and geometrical parameters of roughness are optimized with regard to temperature rise parameter and insolation.
Effect of Through-Silicon-Via Joule Heating on Device Performance for Low-Powered Mobile Applications
Authors: Mirza Fahad , Naware Gaurang , Jain Ankur , Agonafer Dereje
Published: July 2014

Three-dimensional (3D) through-silicon-via (TSV) technology is emerging as a powerful technology to reduce package footprint, decrease interconnection power, higher frequencies, and provide efficient integration of heterogeneous devices. TSVs provide high speed signal propagation due to reduced interconnect lengths as compared to wire-bonding. The current flowing through the TSVs results in localized heat generation (joule heating), which could be detrimental to the device performance. The effect of joule heating on performance measured by transconductance, electron mobility (e− mobility), and channel thermal noise is presented. Results indicate that joule heating has a significant effect on the junction temperature and subsequently results in 10–15% performance hit.
Transmission of Engine Harmonics to Synchronizer Mechanisms in Dual Clutch Transmissions
Authors: Walker Paul D. , Zhang Nong
Published: July 2014

Synchronizer mechanisms play an important role in the selection and engagement of gears in manual, automated manual, and dual clutch transmissions (DCTs). These mechanisms rely heavily on the balancing of torque loads in cone clutches, dog gears, and from losses in the gearbox to ensure repeatable and reliable actuation, with excessive wear on friction and contact surfaces, leading to degradation of actuation and potential mechanism failure. DCTs, in particular, provide a unique operating environment for synchronizers, most notably is its actuation with the engine still driving the wheels during normal driving conditions. Thus, the consideration of increased transmitted vibrations through the powertrain must be evaluated to study the impact of these vibrations on the synchronizer. To conduct this investigation, this paper develops a detailed multibody dynamic model of a typical automotive powertrain equipped with a DCT. This includes engine models with torque harmonics that capture the instantaneous torque variations from piston firing in the engine. As the main consideration of this paper is the influence of engine harmonics, the semidefinite powertrain model is simplified to a fixed-free system and the response of the synchronizer mechanism to harmonic torque inputs is analyzed. Parametric analysis of the system is conducted to analyze the influence of variables—including gear ratio, torsional damper, system damping, and engine configuration—on the dynamic response of the mechanism. Results demonstrate the influence of each of these variables on synchronizer dynamics in the steady state, with stiffness of torsional damper having the strongest influence on forced vibration. Additionally, results vary significantly between single and dual lay-shaft transmissions.
Transversal Method of Lines for Unsteady Heat Conduction With Uniform Surface Heat Flux
Authors: Campo Antonio , Garza José
Published: July 2014

The transversal method of lines (TMOL) is a general hybrid technique for determining approximate, semi-analytic solutions of parabolic partial differential equations. When applied to a one-dimensional (1D) parabolic partial differential equation, TMOL engenders a sequence of adjoint second-order ordinary differential equations, where in the space coordinate is the independent variable and the time appears as an embedded parameter. Essentially, the adjoint second-order ordinary differential equations that result are of quasi-stationary nature, and depending on the coordinate system may have constant or variable coefficients. In this work, TMOL is applied to the unsteady 1D heat equation in simple bodies (large plate, long cylinder, and sphere) with temperature-invariant thermophysical properties, constant initial temperature and uniform heat flux at the surface. In engineering applications, the surface heat flux is customarily provided by electrical heating or radiative heating. Using the first adjoint quasi-stationary heat equation for each simple body with one time jump, it is demonstrated that approximate, semi-analytic TMOL temperature solutions with good quality are easily obtainable, regardless of time. As a consequence, usage of the more involved second adjoint quasi-stationary heat equation accounting for two consecutive time jumps come to be unnecessary.
Why do Earth satellites stay up?
Authors: Tremaine Scott , Yavetz Tomer D.
Published: July 2014

Satellites in low Earth orbits must accurately conserve their orbital eccentricity, since a decrease in perigee of only 5–10% would cause them to crash. However, these satellites are subject to gravitational perturbations from Earth's multipole moments, the Moon, and the Sun that are not spherically symmetric and hence do not conserve angular momentum, especially over the tens of thousands of orbits made by a typical satellite. Why then do satellites not crash? We describe a vector-based analysis of the long-term behavior of satellite orbits and apply this to several toy systems containing a single non-Keplerian perturbing potential. If only the quadrupole (or J2) potential from the Earth's equatorial bulge is present, all near-circular orbits are stable. If only the octupole (or J3) potential is present, all such orbits crash. If only the lunar or solar potential is present, all near-circular orbits with inclinations to the ecliptic exceeding 39° are unstable. We describe the behavior of satellites in the simultaneous presence of all of these perturbations and show that almost all low Earth orbits are stable because of an accidental property of the dominant quadrupole potential. We also relate these results to the phenomenon of Lidov–Kozai oscillations.
Generalized coherent states
Authors: Philbin T. G.
Published: July 2014

In the coherent state of the harmonic oscillator, the probability density is that of the ground state subjected to an oscillation along a classical trajectory. Senitzky and others pointed out that there are states of the harmonic oscillator corresponding to an identical oscillatory displacement of the probability density of any energy eigenstate. These generalizations of the coherent state are rarely discussed, yet they furnish an interesting set of quantum states of light that combine features of number states and coherent states. Here, we give an elementary account of the quantum optics of generalized coherent states.
Traditionally taught students learn; actively engaged students remember
Authors: Franklin Scott V. , Sayre Eleanor C. , Clark Jessica W.
Published: July 2014

A common narrative in physics education research is that students taught in lecture-based classes learn less than those taught with activity-based reformed methods. We show this narrative is simplistic and misses important dynamics of student learning. In particular, we find students of both methods show equal short-term learning gains on a conceptual question dealing with electric potential. For traditionally taught students, this learning rapidly decays on a time scale of weeks, vanishing by the time of the typical end-of-term post-test. For students in reform-based classes, however, the knowledge is retained and may even be enhanced by subsequent instruction. This difference explains the many previous pre- and post-test studies that have found minimal learning gains in lecture-based courses. Our findings suggest a more nuanced model of student learning, one that is sensitive to time-dependent effects such as forgetting and interference. In addition, the findings suggest that lecture-based courses, by incorporating aspects designed to reinforce student understanding of previously covered topics, might approach the long-term learning found in research-based pedagogies.
Motion of a rigid prolate spheroid in a sound wave field
Authors: Zhou Hongkun , Hong Lianjin
Published: July 2014

The motions of a rigid and unconstrained prolate spheroid subjected to plane sound waves are computed using preliminary analytic derivation and numerical approach. The acoustically induced motions are found comprising torsional motion as well as translational motion in the case of acoustic oblique incidence and present great relevance to the sound wavelength, body geometry, and density. The relationship between the motions and acoustic particle velocity is obtained through finite element simulation in terms of sound wavelengths much longer than the overall size of the prolate spheroid. The results are relevant to the design of inertial acoustic particle velocity sensors based on prolate spheroids.
Taking a Check on Chromosome Spacing
Authors: Hurtley Stella M.
Published: July 2014

A mitotic spindle midzone-associated Aurora B gradient monitors chromosome separation during cell division.
How the Worm Changes Its Tastes
Authors: Stern Peter
Published: July 2014

Calsyntenin-dependent activation of insulin-PI3K signaling in the synaptic region governs associative learning.
Two-for-One Suppression of the Antiviral Response
Authors: VanHook Annalisa M.
Published: July 2014

The V protein of measles virus suppresses the antiviral response by two distinct mechanisms that target protein phosphatase 1.
Switching Partners by Phosphorylation
Authors: Ferrarelli Leslie K.
Published: July 2014

Crosstalk between MAPK and Hippo pathways is mediated by phosphorylation-regulated competition for interaction with the kinase RAF-1.
Modulation of HCV replication after combination antiretroviral therapy in HCV/HIV co-infected patients
Authors: Sherman Kenneth E. , Guedj Jeremie , Shata Mohamed Tarek , Blackard Jason T. , Rouster Susan D. , Castro Mario , Feinberg Judith , Sterling Richard K. , Goodman Zachary , Aronow Bruce J. , Perelson Alan S.
Published: July 2014

Treatment of HIV patients co-infected with hepatitis C virus (HCV) with HIV antiretroviral drug therapy reduces HCV replication.
Defective PTEN regulation contributes to B cell hyperresponsiveness in systemic lupus erythematosus
Authors: Wu Xiang-ni , Ye Yan-xia , Niu Jing-wen , Li Yang , Li Xin , You Xin , Chen Hua , Zhao Li-dan , Zeng Xiao-feng , Zhang Feng-chun , Tang Fu-lin , He Wei , Cao Xue-tao , Zhang Xuan , Lipsky Peter E.
Published: July 2014

Decreased expression of PTEN regulated by miR-7 contributes to B cell hyperresponsiveness and disturbed B cell homeostasis in SLE.
Swimming in Autism Mutations
Authors: Schaefer Anne
Published: July 2014

Mutations in a gene that encodes a putative chromatin remodeler cause a distinct subtype of autism.
All Systems Point to
TREML4
Authors: Tsalik Ephraim L.
Published: July 2014

RNA, DNA, and protein expression patterns were integrated to identify a genetic cause of coronary artery calcification.
Assessment of administrative claims data for public health reporting of Salmonella in Tennessee
Authors: Marder Ellyn , Garman Katie , Jones Timothy F , Dunn John , Jones Stephen
Published: July 2014

In the USA, approximately 4% of the estimated 1 million Salmonella infections occurring annually are reported to public health. Administrative claims data from large health insurance companies capture disease-specific data which could potentially enhance public health surveillance. To determine the utility of medical claims data for public health reporting of Salmonella, we assessed medical claims data from BlueCross BlueShield of Tennessee (BCBST) members compared to Tennessee Department of Health (TDH) surveillance data. BCBST Salmonella cases diagnosed during 2007–2011 were matched to TDH Salmonella cases reported during the same time period. Matches and non-matches were validated using medical records. Of the 450 BCBST cases identified, 72% matched TDH cases. All culture-confirmed BCBST cases were reported to TDH. Non-matched BCBST cases included clinical diagnoses which were culture negative or not tested. Our findings indicate administrative claims data are not currently a viable mechanism for enhancing routine reporting of Salmonella infections.
Effectiveness and implementation of enhanced recovery after surgery programmes: a rapid evidence synthesis
Authors: Paton Fiona , Chambers Duncan , Wilson Paul , Eastwood Alison , Craig Dawn , Fox Dave , Jayne David , McGinnes Erika
Published: July 2014

Objectives

To assess the evidence on the impact of enhanced recovery programmes for patients undergoing elective surgery in acute hospital settings in the UK.

Design

Rapid evidence synthesis. Eight databases were searched from 1990 to March 2013 without language restrictions. Relevant reports and guidelines, websites and reference lists of retrieved articles were scanned to identify additional studies. Systematic reviews, RCTs not included in the systematic reviews, economic evaluations and UK NHS cost analysis, implementation case studies and surveys of patient experience in a UK setting were eligible for inclusion.

Primary and secondary outcome measures

We assessed the impact of enhanced recovery programmes on health or cost-related outcomes, and assessed implementation case studies and patient experience in UK settings. Studies were quality assessed where appropriate using the Centre for Reviews and Dissemination Database of Abstracts of Reviews of Effects critical appraisal process.

Results

17 systematic reviews and 12 additional RCTs were included. Ten relevant economic evaluations were included. No cost analysis studies were identified. Most of the evidence focused on colorectal surgery. 14 innovation case studies and 15 implementation case studies undertaken in National Health Service settings described factors critical to the success of an enhanced recovery programme.

Evidence for colorectal surgery suggests that enhanced recovery programmes may reduce hospital stays by 0.5–3.5 days compared with conventional care. There were no significant differences in reported readmission rates. Other surgical specialties showed greater variation in reductions in length of stay reflecting the limited evidence identified. Findings relating to other outcomes were hampered by a lack of robust evidence and poor reporting.

Conclusions

There is consistent, albeit limited, evidence that enhanced recovery programmes can reduce length of patient hospital stay without increasing readmission rates. The extent to which managers and clinicians considering implementing enhanced recovery programmes in UK settings can realise savings will depend on length of stay achieved under their existing care pathway.
A new patient information leaflet for Dermatology outpatients
Authors: Becker Katrin , whittam lindsay
Published: July 2014

Lack of provision of information was the single most common cause of poor performance in the 2008/2009 NHS Patient Survey Programme of trusts in the UK. Information leaflets have been shown to improve patient satisfaction with consultations.

We introduced a new patient information leaflet about the scheduled consultation in a district hospital´s dermatology outpatient clinic. We then assessed in a small study its effect on the patients regarding helpfulness, preparation for and satisfaction with the out-patient consultation.

Via the hospital´s booking office, leaflets were sent to all patients (n=32) due to attend two outpatient clinics, accompanied by a letter about the survey. After the consultation, patients were given a short anonymous questionnaire to complete.

Of the 32 patients, 12 patients did not receive the leaflet, three did not attend their consultation, and two left before they were handed the questionnaire. We gave out 15 questionnaires, and received 15 responses (100%).

46.9% of patients (n=15) answered the questionnaire. Of these 33.3% were new patients (n=5). 86.7% (n=13) found the leaflet helpful and 33% excellent (n=5). 86.7% felt well prepared for the consultation, 40% excellently (n=6). 86.7% were satisfied with the consultation, 73% rated their satisfaction as excellent (n=11). 60% of patients brought a list with their medication (n=9), 80% of the new patients (n=4). 13.3% of patients (n=2) wrote down questions prior to the consultation. Comments suggested the leaflet would be more useful for new patients.

Patients scored highly for satisfaction with the consultation, whether or not they had received and information leaflet (we asked n=20 patients without leaflet). This short survey supports the idea that patients find it helpful to receive an information leaflet, and actively prepare by bringing a list of their medication, and thinking of questions.
Smoking cessation for hospital inpatients
Authors: Bickerstaffe Gary
Published: July 2014

People who smoke make up a significant number of those admitted to hospital (NICE 2014). Being admitted to hospital can present a unique opportunity to attempt to stop smoking. Many smokers find quitting very difficult (Rigotti et al 2007), in large part due to them living and working in environments that contain many cues and triggers associated with nicotine consumption and smoking behaviours. Hospitals generally do not contain such environmental prompts to smoke. In the community, smokers have access to numerous types of support including GP's, pharmacies and Stop Smoking Services (SSS). Once admitted to hospital access to such support is significantly diminished. Given that many patients may be highly motivated to attempt to stop smoking due to heightened concerns about their health and being in an environment not associated with their smoking habits, it seems prudent to ensure there is access to all the levels of smoking cessation support available outside of the hospital. Not providing such support neglects implementing an evidence based, cost-effective health intervention in a major health setting (NICE 2014). A SSS pathway was designed that enabled existing hospital healthcare staff to be trained to identify patients that smoke, ask if the patient is considering quitting or abstaining whilst in hospital. If motivated to quit or abstain, to complete an assessment. This being based around dependence to nicotine and motivation to quit. Access to all available stop smoking medications should be included. Medication should only be provided alongside some level of motivational support up to discharge. Training core staff was felt to be the best option. They are available outside of office hours and access hospital systems such as pharmacy more readily than satellite staff.

On discharge the patient is 'handed over' to SSS for continued contact and support once at home. Over 200 staff are trained to complete the assessment and support inpatients to stop or abstain. Approximately 30-35 referrals are made to the local SSS each month, the quit rate at 4 weeks averaging around 40-45%. Most referrals are seen from cardiology and respiratory. All hospital departments should identify staff to be trained to offer cessation support to their patients .
Efficacy of the jet injector in local anaesthesia for small wound sutures: a randomised clinical trial compared with the needle infiltration technique
Authors: Saghi Bijan , Momeni Mehdi , Saeedi Morteza , Ghane Mohammadreza
Published: July 2014

Background

Despite advances in the application of needle free devices in medical procedure, there is a paucity of knowledge on the efficacy of the jet injector for suturing skin wounds.

Aims

Our study aimed to compare the severity of pain and time to initiation of anaesthesia between two methods of local anaesthesia for skin suturing of small facial wounds.

Methods

We conducted a double blind randomised clinical trial between December 2012 and February 2013 at a university hospital in Tehran, Iran. 53 patients with small facial wounds needing skin closure with sutures were assigned to either the jet injection group or the needle infiltration group. Pain severity after administration of local anaesthesia and during the stitching procedure, and time to initiation of skin numbness were evaluated.

Results

Mean pain score during the anaesthetic procedure was 1.1±1 in the jet injector group compared with 4.4±1.4 in the needle infiltration group (p<0.0001). Moreover, time to initiation of local numbness was significantly longer in the jet injection group than in the needle infiltration group (p<0.0001). Nevertheless, suture procedure related pain scores did not differ significantly between the two groups (p>0.05).

Conclusions

The jet injector is an effective device in reducing the pain of the anaesthetic procedure for small facial wounds. However, the remarkably lower pain should be evaluated in light of other parameters, including acceptance and preference of the newly introduced technique.

Trial registration No

IRCT201201308872N3.
Second opinion in breast pathology: policy, practice and perception
Authors: Geller Berta M , Nelson Heidi D , Carney Patricia A , Weaver Donald L , Onega Tracy , Allison Kimberly H , Frederick Paul D , Tosteson Anna N A , Elmore Joann G
Published: July 2014

Aims

To assess the laboratory policies, pathologists’ clinical practice and perceptions about the value of second opinions for breast pathology cases among pathologists practising in the USA.

Methods

Cross-sectional data were collected from 252 pathologists who interpret breast specimens in eight states using a web-based survey. Descriptive statistics were used to characterise findings.

Results

Most participants had >10 years of experience interpreting breast specimens (64%), were not affiliated with academic centres (73%) and were not considered experts by their peers (79%). Laboratory policies mandating second opinions varied by diagnosis: invasive cancer 65%; ductal carcinoma in situ (DCIS) 56%; atypical ductal hyperplasia 36% and other benign cases 33%. 81% obtained second opinions in the absence of policies. Participants believed they improve diagnostic accuracy (96%) and protect from malpractice suits (83%), and were easy to obtain, did not take too much time and did not make them look less adequate. The most common (60%) approach to resolving differences between the first and second opinion is to ask for a third opinion, followed by reaching a consensus.

Conclusions

Laboratory-based second opinion policies vary for breast pathology but are most common for invasive cancer and DCIS cases. Pathologists have favourable attitudes towards second opinions, adhere to policies and obtain them even when policies are absent. Those without a formal policy may benefit from supportive clinical practices and systems that help obtain second opinions.
Gastric neuroendocrine neoplasms and related precursor lesions
Authors: La Rosa Stefano , Vanoli Alessandro
Published: July 2014

Gastric neuroendocrine neoplasms (NENs) are a heterogeneous group of tumours showing different clinicopathological features and behaviour, implying a wide spectrum of therapeutic options. They are currently classified using the 2010 WHO classification of digestive neuroendocrine neoplasms into G1-neuroendocrine tumours (NETs), G2-NETs, neuroendocrine carcinomas (NECs) and mixed adenoneuroendocrine carcinomas (MANECs). However, most gastric NENs are composed of ECL-cells (ECL-cell NETs) that can be preceded by ECL-cell hyperplastic and dysplastic lesions, whose oncologic potential has not yet been completely elucidated. ECL-cell NETs differ considerably in terms of prognosis depending on the proliferative status and clinicopathological background. The integration of both aspects in the diagnostic pathway may help to better classify tumours in different prognostic categories, especially when diagnosing them in small bioptic specimens. NECs are all poorly differentiated, highly aggressive carcinomas, while MANECs can show different morphological features that are directly associated with different prognoses. Precursor lesions of such carcinomas are not entirely understood. In this review, the clinicopathological features of gastric NENs and related precursor lesions will be described to give the reader a comprehensive overview on this topic.
An evaluation of commissioning arrangements for intrauterine and subdermal contraception services from general practitioners in London, UK
Authors: Ma Richard , Brown Eleanor
Published: July 2014

Objectives

General practitioners (GPs) in the UK may be commissioned to provide long-acting reversible contraception (LARC), which may have a role in reducing rates of abortion and unintended pregnancies. Primary care trusts (PCTs) in England had commissioning arrangements with GPs to provide LARC but little is known about such contractual arrangements. We studied the commissioning arrangements in some London PCTs to evaluate the cost and clinical governance of these contracts.

Methods

We requested commissioning contract specifications and activities for intrauterine contraception (IUC) and subdermal implants (SDI) from responsible officers in each PCT in London relating to activities in three financial years, namely 2009/2010 to 2011/2012. We evaluated each contract using a structure, process and outcome approach.

Results

Half (15/31) the PCTs responded and submitted 20 contracts used to commission their GPs to provide IUC, SDI or a combination of these with testing for sexually transmitted infections. The information regarding service activity was inadequate and inconsistent so had to be abandoned. Information from 20 contracts suggested there was a variation in clinical governance and quality assurance mechanisms; there was also a range in the reimbursement for IUC insertion (£77.50 to £105.00), SDI insertion (£25.00 to £81.31) and SDI removal (£30.00 to £100.00) at 2011 prices.

Conclusion

It was not clear from non-responders if these PCTs had a service in place. Of those that did commission IUC and SDI services, some specifications were lacking in detail regarding aspects of clinical governance. New commissioners should make explicit references to quality and safety criteria as poor-quality specifications can give rise to serious untoward incidents and litigation.
Patellar ligament rupture in the dog: repair methods and patient outcomes in 43 cases
Authors: Das S. , Thorne R. , Lorenz N. D. , Clarke S. P. , Madden M. , Langley‐Hobbs S. J. , Perry K. L. , Burton N. J. , Moores A. L. , Mosley J. R.
Published: July 2014

The medical records of dogs receiving surgery for unilateral patellar ligament rupture between 1999 and 2012 at 12 multidisciplinary referral centres were reviewed. Forty‐three cases were identified; 26 were traumatic in origin; almost one‐third were iatrogenic, of which over three‐quarters occurred as a complication following surgical stabilisation of patellar luxation. Treatment involved primary reapposition of the ligament (36 cases). The repair was protected by circumpatellar and/or transpatellar loop(s) of orthopaedic wire, nylon, polypropylene or polydioxanone suture (34 cases). Wire loops were more likely to require surgical removal compared with loops of other materials (P=0.0014). The stifle joint was immobilised postoperatively by the applications of a transarticular external skeletal fixator (taESF) in 17 cases and by external coaptation (EC) in 8 cases; in 18 cases, no postoperative joint immobilisation was provided. Complications specific to the method of immobilisation occurred in seven of the cases with taESF and six of the cases with EC. Revision surgery to address failure of repair was required in five cases. Outcome was classified as acceptable or good in over three‐quarters of the cases (31/40) and poor in less than a quarter (9/40). These data highlight patellar ligament rupture as a complication of surgical stabilisation of patellar luxation.
Antimicrobial drug use in Austrian pig farms: plausibility check of electronic on‐farm records and estimation of consumption
Authors: Trauffler M. , Griesbacher A. , Fuchs K. , Köfer J.
Published: July 2014

Electronic drug application records from farmers from 75 conventional pig farms were revised and checked for their plausibility. The registered drug amounts were verified by comparing the farmers' records with veterinarians' dispensary records. The antimicrobial consumption was evaluated from 2008 to 2011 and expressed in weight of active substance(s), number of used daily doses (nUDD), number of animal daily doses (nADD) and number of product‐related daily doses (nPrDD). All results were referred to one year and animal bodyweight (kg biomass). The data plausibility proof revealed about 14 per cent of unrealistic drug amount entries in the farmers' records. The annual antimicrobial consumption was 33.9 mg/kg/year, 4.9 UDDkg /kg/year, 1.9 ADDkg /kg/year and 2.5 PrDDkg /kg/year (average). Most of the antimicrobials were applied orally (86 per cent) and at group‐level. Main therapy indications were metaphylactic/prophylactic measures (farrow‐to‐finish and fattening farms) or digestive tract diseases (breeding farms). The proportion of the ‘highest priority critically important antimicrobials’ was low (12 per cent). After determination of a threshold value, farms with a high antimicrobial use could be detected. Statistical tests showed that the veterinarian had an influence on the dosage, the therapy indication and the active substance. Orally administered antimicrobials were mostly underdosed, parenterally administered antimicrobials rather correctly or overdosed.
Characterization of human mutations in phosphorylatable amino acids of the cytosolic regulatory tail of SLC9A1
Authors: Alves Claudia , Ma Yike , Li Xiuju , Fliegel Larry
Published: July 2014

The NHE1 isoform of the mammalian Na+/H+ exchanger is a ubiquitous plasma membrane protein that regulates intracellular pH in cells by removing one intracellular proton in exchange for one extracellular sodium. Genetic defects in NHE1 have been shown to affect the growth and motor ability of mice, but mutations in humans have not been studied. NHE1 has a cytosolic C-terminal regulatory domain of approximately 300 amino acids. We investigated the functional effects of two human mutations found in the regulatory phosphorylatable amino acids Ser703 and Ser771. A Ser703Pro mutant protein had essentially the same activity, expression, and targeting as the wild type NHE1 protein. In contrast, the Ser771Pro protein had reduced activity and expression of NHE1 protein, though cell surface targeting was normal. In dual pulse assays the Ser771Pro mutant was not further activated by sustained intracellular acidosis but displayed an unusual activation by brief pulses of acidosis. The results demonstrate that the Ser771Pro human genetic mutation has significant and detrimental physiological effects on the activity of the NHE1 protein, SLC9A1.
Geochemical characteristics of glacial Lake Agassiz sediments and new ages for the Moorhead Phase at Fargo, North Dakota, USA
Authors: Liu Xiuju , Fisher Timothy G. , Lepper Kenneth , Lowell Thomas V.
Published: July 2014

The cause and age of the Moorhead low-water Phase of glacial Lake Agassiz remains uncertain. New geochemical (X-ray fluorescence (XRF) and elemental analysis) and chronological (optically stimulated luminescence (OSL)) data are used to test for evaporative enrichment within lacustrine sediment from Rabbit Lake, a small basin just above the highest Lake Agassiz strandline, and from two Lake Agassiz sediment cores at Fargo, North Dakota. Increases in quartz and gypsum interpreted to be of aeolian origin suggest increased aridity at Rabbit Lake sometime after 13 540–13 750 cal years BP. From the Fargo cores, lacustrine sediment of the Brenna and Sherack formations did not show convincing evidence for evaporative enrichment. However, this result is complicated by an erosional contact at the top of the Brenna Formation. A thin middle sand unit between the Brenna and Sherack formation clays is stratigraphically equivalent to the Poplar River Formation, West Fargo Member, but its properties differ from the fluvial sand of the West Fargo Member. Four OSL ages from the organic-poor, middle sand unit at Fargo range between 12.8 ± 0.2 and 13.5 ± 0.2 ka (with ±1.6 ka uncertainty) and suggest lake level fell at Fargo at, or before, 13.1 ± 0.2 ka, the average of the OSL ages. With different sedimentological properties, and a difference of ∼1750 years between the new OSL ages and previously published ages on the West Fargo Member sand, additional work is required to determine whether the middle sand unit is a new member of the Poplar River Formation, recording an earlier and different depositional environment than the West Fargo Member. From a plot of available ages for the Moorhead Phase, the regression remains poorly constrained in time.