bluuebunny/crossref_metadata_2025 huggingface dataset:
Knowledge of and Compliance With Pitch Count Recommendations
Authors: Fazarale Joseph J. , Magnussen Robert A. , Pedroza Angela D. , Kaeding Christopher C.
Published: February 2012

Background: Pain and injuries suffered by youth pitchers are ongoing concerns that have been addressed through the institution of rules and recommendations regarding pitch counts and rest periods. The aim of our study was to see if coaches of youth baseball pitchers in our region were aware of the recommended guidelines and if they followed them.

Methods: An Internet-based survey consisting of 18 items including demographic information and questions concerning the USA Baseball Medical and Safety Advisory Committee pitching guidelines was sent to coaches affiliated with a local youth league to assess their knowledge of and reported compliance with these recommendations.

Results: Ninety-five of 228 coaches (41.4%) participated in the survey. On average, coaches answered 43% of questions regarding pitch count and rest periods correctly; 73% reported that they followed the recommendations, while only 53% felt that other coaches in the league abided by the recommendations. Thirty-five percent of coaches stated that their pitchers reported shoulder or elbow pain during the season, and 19% reported that one of their pitchers pitched a game with a sore or fatigued arm during the season. No coaches reported any pitching-related injuries among their players requiring surgery. Fewer than 10% of coaches reported that their players pitched in multiple leagues or participated in showcases, while 91% reported that pitchers attended camps or received specific instruction to improve their pitching form.

Conclusions: This study shows that this subset of youth baseball coaches is deficient with regard to knowledge of the USA Baseball Medical and Safety Advisory Committee pitching guidelines. This situation may put youth pitchers at increased risk for upper extremity pain and injuries.
On some Hadamard-type inequalities for product of two s-convex functions on the co-ordinates
Authors: Özdemir Muhamet Emin , Latif Muhammad Amer , Akdemir Ahmet Ocak
Published: February 2012

In this article, Hadamard-type inequalities for product of s-convex in the second sense on the co-ordinates in a rectangle from the plane are established.
The association between Toll-like receptor 2 single-nucleotide polymorphisms and hepatocellular carcinoma susceptibility
Authors: Junjie Xie , Songyao Jiang , Minmin Shi , Yanyan Song , Baiyong Shen , Xiaxing Deng , Jiabin Jin , Xi Zhan , Hao Chen
Published: February 2012

Background

Toll-like receptors (TLR) are key innate immunity receptors participating in an immune response. Growing evidence suggests that mutations of TLR2/TLR9 gene are associated with the progress of cancers. The present study aimed to investigate the temporal relationship of single nucleotide polymorphisms (SNP) of TLR2/TLR9 and the risk of hepatocellular carcinoma (HCC).

Methods

In this single center-based case-control study, SNaPshot method was used to genotype sequence variants of TLR2 and TLR9 in 211 patients with HCC and 232 subjects as controls.

Results

Two synonymous SNPs in the exon of TLR2 were closely associated with risk of HCC. Compared with those carrying wild-type homozygous genotypes (T/T), risk of HCC decreased significantly in individuals carrying the heterozygous genotypes (C/T) of the rs3804099 (adjusted odds ratio (OR), 0.493, 95% CI 0.331 - 0.736, P < 0.01) and rs3804100 (adjusted OR, 0.509, 95% CI 0.342 - 0.759, P < 0.01). There was no significant association found in two TLR9 SNPs concerning the risk of HCC. The haplotype TT for TLR2 was associated significantly with the decreased risk of HCC (OR 0.524, 95% CI 0.394 - 0.697, P = 0.000). Inversely, the risk of HCC increased significantly in patients with the haplotype CC (OR 2.743, 95% CI 1.915 - 3.930, P = 0.000).

Conclusions

These results suggested that TLR2 rs3804099 C/T and rs3804100 C/T polymorphisms were closely associated with HCC. In addition, the haplotypes composed of these two TLR2 synonymous SNPs have stronger effects on the susceptibility of HCC.
Low back pain in 17 year olds has substantial impact and represents an important public health disorder: a cross-sectional study
Authors: O'Sullivan Peter B , Beales Darren J , Smith Anne J , Straker Leon M
Published: February 2012

Background

Prevalence of low back pain (LBP) rises rapidly during adolescence, reaching adult levels by the age of 18. It has been suggested that adolescent LBP is benign with minimal impact, despite limited evidence.

Methods

The aim of this study was to investigate the impact of LBP and the influence of chronicity, gender and presence of other spinal pain comorbidities at age 17. Subjects (n = 1283) were categorised according to experiencing current and chronic LBP, gender and presence of other areas of spinal pain. LBP impact was ascertained via questions regarding seeking professional assistance, using medication, missing school/work, limited normal or recreational physical activity and health related quality of life (HRQOL).

Results

12.3% of participants reported current but not chronic LBP, while 19.9% reported current chronic LBP. LBP was more commonly reported by females than males. Other spinal pain comorbidities were common in the LBP groups. Impact was greater in subjects with chronic LBP, in females and in those with other spinal pain comorbidities.

Conclusion

LBP, and particularly chronic LBP, has a significant negative impact at 17 years. It is commonly associated with care seeking, medication use, school absenteeism, and reduced HRQOL. These findings support that adolescent LBP is an important public health issue that requires attention.
A strategy of gene overexpression based on tandem repetitive promoters in Escherichia coli
Authors: Li Mingji , Wang Junshu , Geng Yanping , Li Yikui , Wang Qian , Liang Quanfeng , Qi Qingsheng
Published: February 2012

Background

For metabolic engineering, many rate-limiting steps may exist in the pathways of accumulating the target metabolites. Increasing copy number of the desired genes in these pathways is a general method to solve the problem, for example, the employment of the multi-copy plasmid-based expression system. However, this method may bring genetic instability, structural instability and metabolic burden to the host, while integrating of the desired gene into the chromosome may cause inadequate transcription or expression. In this study, we developed a strategy for obtaining gene overexpression by engineering promoter clusters consisted of multiple core-tac- promoters (MCPtac s) in tandem.

Results

Through a uniquely designed in vitro assembling process, a series of promoter clusters were constructed. The transcription strength of these promoter clusters showed a stepwise enhancement with the increase of tandem repeats number until it reached the critical value of five. Application of the MCPtac s promoter clusters in polyhydroxybutyrate (PHB) production proved that it was efficient. Integration of the phaCAB genes with the 5CPtac s promoter cluster resulted in an engineered E.coli that can accumulate 23.7% PHB of the cell dry weight in batch cultivation.

Conclusions

The transcription strength of the MCPtac s promoter cluster can be greatly improved by increasing the tandem repeats number of the core-tac-promoter. By integrating the desired gene together with the MCPtac s promoter cluster into the chromosome of E. coli, we can achieve high and stale overexpression with only a small size. This strategy has an application potential in many fields and can be extended to other bacteria.
Could gastrointestinal disorders differ in two close but divergent social environments?
Authors: Grodzinsky Ewa , Hallert Claes , Faresjö Tomas , Bergfors Elisabet , Faresjö Åshild Olsen
Published: February 2012

Background

Many public health problems in modern society affect the gastrointestinal area. Knowledge of the disease occurrence in populations is better understood if viewed in a psychosocial context including indicators of the social environment where people spend their lives. The general aim of this study was to estimate the occurrence in the population and between sexes of common gastrointestinal conditions in two neighborhood cities representing two different social environments defined as a "white-collar" and a "blue-collar" city.

Methods

We conducted a retrospective register study using data of diagnosed gastrointestinal disorders (cumulative incidence rates) derived from an administrative health care register based on medical records assigned by the physicians at hospitals and primary care.

Results

Functional gastrointestinal diseases and peptic ulcers were more frequent in the white-collar city, while diagnoses in the gallbladder area were significantly more frequent in the blue-collar city. Functional dyspepsia, irritable bowel syndrome, and unspecified functional bowel diseases, and celiac disease, were more frequent among women while esophageal reflux, peptic ulcers, gastric and rectal cancers were more frequent among men regardless of social environment.

Conclusions

Knowledge of the occurrence of gastrointestinal problems in populations is better understood if viewed in a context were the social environment is included. Indicators of the social environment should therefore also be considered in future studies of the occurrence of gastrointestinal problems.
The relationship between polycystic ovary syndrome, glucose tolerance status and serum preptin level
Authors: Bu Zhiqin , Kuok Kakei , Meng Jie , Wang Rui , Xu Bei , Zhang Hanwang
Published: February 2012

Background

Polycystic ovary syndrome (PCOS) is linked to obesity, impaired glucose tolerance and diabetes. Recently, studies have found that preptin enhances insulin secretion in rats and might play a role in the pathogenesis of diabetes and PCOS in humans. The aim of this study was to evaluate the relationship between PCOS, glucose tolerance status, and serum preptin level.

Methods

This study was conducted in a university-affiliated hospital from October 2010 to August 2011. Anthropometric parameters, sex hormone concentrations, blood pressure, lipid profiles, fasting glucose and insulin, 2-h blood glucose after glucose overloaded (2hOGTT), glycosylated haemoglobin (HbA1c), homeostasis model assessment-insulin resistance index (HOMA-IR), and serum preptin of the samples were analyzed.

Results

Sixty-three PCOS patients, including 33 women with normal glucose tolerance (NGT) and 30 women with impaired glucose tolerance (IGT), and 63 patients without PCOS, including 35 women with NGT and 28 women with IGT were recruited in this study. For patients with and without PCOS, women with IGT had higher serum preptin levels compared with women with NGT. Preptin levels in PCOS patients were higher compared with patients without PCOS, but the difference was not significant. Fasting serum preptin levels correlated positively with TG, SBP, DBP, FBG, 2hOGTT, and HOMA-IR in simple regression analysis of the pooled data. While in multiple stepwise regression analysis, preptin levels were independently related with glucose tolerance, but not with PCOS.

Conclusions

Irrespective of PCOS status, women with IGT had higher serum preptin levels compared with women with NGT. Preptin levels are related with glucose tolerance status, but not with PCOS status.
Carbon nanotube bumps for the flip chip packaging system
Authors: Yap Chin Chong , Brun Christophe , Tan Dunlin , Li Hong , Teo Edwin Hang Tong , Baillargeat Dominique , Tay Beng Kang
Published: February 2012

Carbon nanotube [CNT] interconnection bump joining methodology has been successfully demonstrated using flip chip test structures with bump pitches smaller than 150 μm. In this study, plasma-enhanced chemical vapor deposition approach is used to grow the CNT bumps onto the Au metallization lines. The CNT bumps on the die substrate are then 'inserted' into the CNT bumps on the carrier substrate to form the electrical connections (interconnection bumps) between each other. The mechanical strength and the concept of reworkable capabilities of the CNT interconnection bumps are investigated. Preliminary electrical characteristics show a linear relationship between current and voltage, suggesting that ohmic contacts are attained.
Hybrid polymer/ZnO solar cells sensitized by PbS quantum dots
Authors: Wang Lidan , Zhao Dongxu , Su Zisheng , Shen Dezhen
Published: February 2012

Poly[2-methoxy-5-(2-ethylhexyloxy-p- phenylenevinylene)]/ZnO nanorod hybrid solar cells consisting of PbS quantum dots [QDs] prepared by a chemical bath deposition method were fabricated. An optimum coating of the QDs on the ZnO nanorods could strongly improve the performance of the solar cells. A maximum power conversion efficiency of 0.42% was achieved for the PbS QDs' sensitive solar cell coated by 4 cycles, which was increased almost five times compared with the solar cell without using PbS QDs. The improved efficiency is attributed to the cascade structure formed by the PbS QD coating, which results in enhanced open-circuit voltage and exciton dissociation efficiency.
Preparation of α-mannoside hydrogel and electrical detection of saccharide-protein interactions using the smart gel-modified gate field effect transistor
Authors: Maeda Yasuhiro , Matsumoto Akira , Miura Yoshiko , Miyahara Yuji
Published: February 2012

The purpose of this study was to detect saccharide-protein interaction capitalizing on the gel-modified field effect transistor [FET]. A lectin-sensitive polymer gel that undergoes volume changes in response to the formation of molecular complex between 'pendant' carbohydrate and a 'target' lectin concanavalin A [Con A] was synthesized. It was revealed that direction and magnitude of the gel response (swelling or deswelling) could be readily designed depending on composition and network density of the gel. The Con A-sensitive polymer gel has shown the ability to transduce the detection of saccharide-protein interactions into electrical signals for FET.

PACS: 87.85.jf, bio-based materials
Spectrum of gluten-related disorders: consensus on new nomenclature and classification
Authors: Sapone Anna , Bai Julio C , Ciacci Carolina , Dolinsek Jernej , Green Peter HR , Hadjivassiliou Marios , Kaukinen Katri , Rostami Kamran , Sanders David S , Schumann Michael , Ullrich Reiner , Villalta Danilo , Volta Umberto , Catassi Carlo , Fasano Alessio
Published: February 2012

A decade ago celiac disease was considered extremely rare outside Europe and, therefore, was almost completely ignored by health care professionals. In only 10 years, key milestones have moved celiac disease from obscurity into the popular spotlight worldwide. Now we are observing another interesting phenomenon that is generating great confusion among health care professionals. The number of individuals embracing a gluten-free diet (GFD) appears much higher than the projected number of celiac disease patients, fueling a global market of gluten-free products approaching $2.5 billion (US) in global sales in 2010. This trend is supported by the notion that, along with celiac disease, other conditions related to the ingestion of gluten have emerged as health care concerns. This review will summarize our current knowledge about the three main forms of gluten reactions: allergic (wheat allergy), autoimmune (celiac disease, dermatitis herpetiformis and gluten ataxia) and possibly immune-mediated (gluten sensitivity), and also outline pathogenic, clinical and epidemiological differences and propose new nomenclature and classifications.
P2X7 Receptors in Satellite Glial Cells Mediate High Functional Expression of P2X3 Receptors in Immature Dorsal Root Ganglion Neurons
Authors: Chen Yong , Li Guangwen , Huang Li-Yen Mae
Published: February 2012

Background:

The purinergic P2X3 receptor (P2X3R) expressed in the dorsal root ganglion (DRG) sensory neuron and the P2X7 receptor (P2X7R) expressed in the surrounding satellite glial cell (SGC) are two major receptors participating in neuron-SGC communication in adult DRGs. Activation of P2X7Rs was found to tonically reduce the expression of P2X3Rs in DRGs, thus inhibiting the abnormal pain behaviors in adult rats. P2X receptors are also actively involved in sensory signaling in developing rodents. However, very little is known about the developmental change of P2X7Rs in DRGs and the interaction between P2X7Rs and P2X3Rs in those animals. We therefore examined the expression of P2X3Rs and P2X7Rs in postnatal rats and determined if P2X7R-P2X3R control exists in developing rats.

Findings:

We immunostained DRGs of immature rats and found that P2X3Rs were expressed only in neurons and P2X7Rs were expressed only in SGCs. Western blot analyses indicated that P2X3R expression decreased while P2X7R expression increased with the age of rats. Electrophysiological studies showed that the number of DRG neurons responding to the stimulation of the P2XR agonist, α,β-meATP, was higher and the amplitudes of α,β-meATP-induced depolarizations were larger in immature DRG neurons. As a result, P2X3R-mediated flinching responses were much more pronounced in immature rats than those found in adult rats. When we reduced P2X7R expression with P2X7R-siRNA in postnatal and adult rats, P2X3R-mediated flinch responses were greatly enhanced in both rat populations.

Conclusions:

These results show that the P2X7R expression increases as rats age. In addition, P2X7Rs in SGCs exert inhibitory control on the P2X3R expression and function in sensory neurons of immature rats, just as observed in adult rats. Regulation of P2X7R expression is likely an effective way to control P2X3R activity and manage pain relief in infants.
MAVIDOS Maternal Vitamin D Osteoporosis Study: study protocol for a randomized controlled trial. The MAVIDOS Study Group
Authors: Harvey Nicholas C , Javaid Kassim , Bishop Nicholas , Kennedy Stephen , Papageorghiou Aris T , Fraser Robert , Gandhi Saurabh V , Schoenmakers Inez , Prentice Ann , Cooper Cyrus
Published: February 2012

MAVIDOS is a randomised, double-blind, placebo-controlled trial (ISRCTN82927713, registered 2008 Apr 11), funded by Arthritis Research UK, MRC, Bupa Foundation and NIHR.

Background

Osteoporosis is a major public health problem as a result of associated fragility fractures. Skeletal strength increases from birth to a peak in early adulthood. This peak predicts osteoporosis risk in later life. Vitamin D insufficiency in pregnancy is common (31% in a recent Southampton cohort) and predicts reduced bone mass in the offspring. In this study we aim to test whether offspring of mothers supplemented with vitamin D in pregnancy have higher bone mass at birth than those whose mothers were not supplemented.

Methods/Design

Women have their vitamin D status assessed after ultrasound scanning in the twelfth week of pregnancy at 3 trial centres (Southampton, Sheffield, Oxford). Women with circulating 25(OH)-vitamin D levels 25-100 nmol/l are randomised in a double-blind design to either oral vitamin D supplement (1000 IU cholecalciferol/day, n = 477) or placebo at 14 weeks (n = 477). Questionnaire data include parity, sunlight exposure, dietary information, and cigarette and alcohol consumption. At 19 and 34 weeks maternal anthropometry is assessed and blood samples taken to measure 25(OH)-vitamin D, PTH and biochemistry. At delivery venous umbilical cord blood is collected, together with umbilical cord and placental tissue. The babies undergo DXA assessment of bone mass within the first 14 days after birth, with the primary outcome being whole body bone mineral content adjusted for gestational age and age. Children are then followed up with yearly assessment of health, diet, physical activity and anthropometric measures, with repeat assessment of bone mass by DXA at age 4 years.

Discussion

As far as we are aware, this randomised trial is one of the first ever tests of the early life origins hypothesis in human participants and has the potential to inform public health policy regarding vitamin D supplementation in pregnancy. It will also provide a valuable resource in which to study the influence of maternal vitamin D status on other childhood outcomes such as glucose tolerance, blood pressure, cardiovascular function, IQ and immunology.
Wnt proteins regulate acetylcholine receptor clustering in muscle cells
Authors: Zhang Bin , Liang Chuan , Bates Ryan , Yin Yiming , Xiong Wen-Cheng , Mei Lin
Published: February 2012

Background

The neuromuscular junction (NMJ) is a cholinergic synapse that rapidly conveys signals from motoneurons to muscle cells and exhibits a high degree of subcellular specialization characteristic of chemical synapses. NMJ formation requires agrin and its coreceptors LRP4 and MuSK. Increasing evidence indicates that Wnt signaling regulates NMJ formation in Drosophila, C. elegans and zebrafish.

Results

In the study we systematically studied the effect of all 19 different Wnts in mammals on acetylcholine receptor (AChR) cluster formation. We identified five Wnts (Wnt9a, Wnt9b, Wnt10b, Wnt11, and Wnt16) that are able to stimulate AChR clustering, of which Wnt9a and Wnt11 are expressed abundantly in developing muscles. Using Wnt9a and Wnt11 as example, we demonstrated that Wnt induction of AChR clusters was dose-dependent and non-additive to that of agrin, suggesting that Wnts may act via similar pathways to induce AChR clusters. We provide evidence that Wnt9a and Wnt11 bind directly to the extracellular domain of MuSK, to induce MuSK dimerization and subsequent tyrosine phosphorylation of the kinase. In addition, Wnt-induced AChR clustering requires LRP4.

Conclusions

These results identify Wnts as new players in AChR cluster formation, which act in a manner that requires both MuSK and LRP4, revealing a novel function of LRP4.
The predominantly selfing plant Arabidopsis thaliana experienced a recent reduction in transposable element abundance compared to its outcrossing relative Arabidopsis lyrata
Authors: de la Chaux Nicole , Tsuchimatsu Takashi , Shimizu Kentaro K , Wagner Andreas
Published: February 2012

Background

Transposable elements (TEs) are major contributors to genome evolution. One factor that influences their evolutionary dynamics is whether their host reproduces through selfing or through outcrossing. According to the recombinational spreading hypothesis, for instance, TEs can spread more easily in outcrossing species through recombination, and should thus be less abundant in selfing species. We here studied the distribution and evolutionary dynamics of TE families in the predominantly selfing plantArabidopsis thalianaand its close outcrossing relativeArabidopsis lyrataon a genome-wide scale. We characterized differences in TE abundance between them and asked which, if any, existing hypotheses about TE abundances may explain these differences.

Results

We identified 1,819 TE families representing all known classes of TEs in both species, and found three times more copies in the outcrossingA. lyratathan in the predominantly selfingA. thaliana, as well as ten times more TE families unique toA. lyrata. On average, elements inA. lyrataare younger than elements inA.thaliana. In particular,A. thalianashows a marked decrease in element number that occurred during the most recent 10% of the time interval sinceA. thalianasplit fromA. lyrata. This most recent period in the evolution ofA. thalianastarted approximately 500,000 years ago, assuming a splitting time of 5 million years ago, and coincides with the time at which predominant selfing originated.

Conclusions

Our results indicate that the mating system may be important for determining TE copy number, and that selfing species are likely to have fewer TEs.
Insertion site preference of Mu, Tn5, and Tn7 transposons
Authors: Green Brian , Bouchier Christiane , Fairhead Cécile , Craig Nancy L , Cormack Brendan P
Published: February 2012

Background

Transposons, segments of DNA that can mobilize to other locations in a genome, are often used for insertion mutagenesis or to generate priming sites for sequencing of large DNA molecules. For both of these uses, a transposon with minimal insertion bias is desired to allow complete coverage with minimal oversampling.

Findings

Three transposons, Mu, Tn5, and Tn7, were used to generate insertions in the same set of fosmids containing Candida glabrata genomic DNA. Tn7 demonstrates markedly less insertion bias than either Mu or Tn5, with both Mu and Tn5 biased toward sequences containing guanosine (G) and cytidine (C). This preference of Mu and Tn5 yields less uniform spacing of insertions than for Tn7, in the adenosine (A) and thymidine (T) rich genome of C. glabrata (39% GC).

Conclusions

In light of its more uniform distribution of insertions, Tn7 should be considered for applications in which insertion bias is deleterious.
Germline DNA copy number variation in familial and early-onset breast cancer
Authors: Krepischi Ana CV , Achatz Maria Isabel W , Santos Erika MM , Costa Silvia S , Lisboa Bianca CG , Brentani Helena , Santos Tiago M , Gonçalves Amanda , Nóbrega Amanda F , Pearson Peter L , Vianna-Morgante Angela M , Carraro Dirce M , Brentani Ricardo R , Rosenberg Carla
Published: February 2012

Introduction

Genetic factors predisposing individuals to cancer remain elusive in the majority of patients with a familial or clinical history suggestive of hereditary breast cancer. Germline DNA copy number variation (CNV) has recently been implicated in predisposition to cancers such as neuroblastomas as well as prostate and colorectal cancer. We evaluated the role of germline CNVs in breast cancer susceptibility, in particular those with low population frequencies (rare CNVs), which are more likely to cause disease."

Methods

Using whole-genome comparative genomic hybridization on microarrays, we screened a cohort of women fulfilling criteria for hereditary breast cancer who did not carry BRCA1/BRCA2 mutations.

Results

The median numbers of total and rare CNVs per genome were not different between controls and patients. A total of 26 rare germline CNVs were identified in 68 cancer patients, however, a proportion that was significantly different (P = 0.0311) from the control group (23 rare CNVs in 100 individuals). Several of the genes affected by CNV in patients and controls had already been implicated in cancer.

Conclusions

This study is the first to explore the contribution of germline CNVs to BRCA1/2-negative familial and early-onset breast cancer. The data suggest that rare CNVs may contribute to cancer predisposition in this small cohort of patients, and this trend needs to be confirmed in larger population samples.
Breast cancer risk prediction and individualised screening based on common genetic variation and breast density measurement
Authors: Darabi Hatef , Czene Kamila , Zhao Wanting , Liu Jianjun , Hall Per , Humphreys Keith
Published: February 2012

Introduction

Over the last decade several breast cancer risk alleles have been identified which has led to an increased interest in individualised risk prediction for clinical purposes.

Methods

We investigate the performance of an up-to-date 18 breast cancer risk single-nucleotide polymorphisms (SNPs), together with mammographic percentage density (PD), body mass index (BMI) and clinical risk factors in predicting absolute risk of breast cancer, empirically, in a well characterised Swedish case-control study of postmenopausal women. We examined the efficiency of various prediction models at a population level for individualised screening by extending a recently proposed analytical approach for estimating number of cases captured.

Results

The performance of a risk prediction model based on an initial set of seven breast cancer risk SNPs is improved by additionally including eleven more recently established breast cancer risk SNPs (P = 4.69 × 10-4). Adding mammographic PD, BMI and all 18 SNPs to a Swedish Gail model improved the discriminatory accuracy (the AUC statistic) from 55% to 62%. The net reclassification improvement was used to assess improvement in classification of women into low, intermediate, and high categories of 5-year risk (P = 8.93 × 10-9). For scenarios we considered, we estimated that an individualised screening strategy based on risk models incorporating clinical risk factors, mammographic density and SNPs, captures 10% more cases than a screening strategy using the same resources, based on age alone. Estimates of numbers of cases captured by screening stratified by age provide insight into how individualised screening programs might appear in practice.

Conclusions

Taken together, genetic risk factors and mammographic density offer moderate improvements to clinical risk factor models for predicting breast cancer.
Costs and benefits of rapid screening of methicillin-resistant Staphylococcus aureus carriage in intensive care units: a prospective multicenter study
Authors: Wassenberg Marjan , Kluytmans Jan , Erdkamp Stephanie , Bosboom Ron , Buiting Anton , van Elzakker Erika , Melchers Willem , Thijsen Steven , Troelstra Annet , Vandenbroucke-Grauls Christina , Visser Caroline , Voss Andreas , Wolffs Petra , Wulf Mireille , van Zwet Ton , de Wit Ardine , Bonten Marc
Published: February 2012

Introduction

Pre-emptive isolation of suspected methicillin-resistant Staphylococcus aureus (MRSA) carriers is a cornerstone of successful MRSA control policies. Implementation of such strategies is hampered when using conventional cultures with diagnostic delays of three to five days, as many non-carriers remain unnecessarily isolated. Rapid diagnostic testing (RDT) reduces the amount of unnecessary isolation days, but costs and benefits have not been accurately determined in intensive care units (ICUs).

Methods

Embedded in a multi-center hospital-wide study in 12 Dutch hospitals we quantified cost per isolation day avoided using RDT for MRSA, added to conventional cultures, in ICUs. BD GeneOhm™ MRSA PCR (IDI) and Xpert MRSA (GeneXpert) were subsequently used during 17 and 14 months, and their test characteristics were calculated with conventional culture results as reference. We calculated the number of pre-emptive isolation days avoided and incremental costs of adding RDT.

Results

A total of 163 patients at risk for MRSA carriage were screened and MRSA prevalence was 3.1% (n = 5). Duration of isolation was 27.6 and 21.4 hours with IDI and GeneXpert, respectively, and would have been 96.0 hours when based on conventional cultures. The negative predictive value was 100% for both tests. Numbers of isolation days were reduced by 44.3% with PCR-based screening at the additional costs of €327.84 (IDI) and €252.14 (GeneXpert) per patient screened. Costs per isolation day avoided were €136.04 (IDI) and €121.76 (GeneXpert).

Conclusions

In a low endemic setting for MRSA, RDT safely reduced the number of unnecessary isolation days on ICUs by 44%, at the costs of €121.76 to €136.04 per isolation day avoided.
Sharpening of the anterior neural border in the chick by rostral endoderm signalling
Authors: Sanchez-Arrones Luisa , Stern Claudio D. , Bovolenta Paola , Puelles Luis
Published: February 2012

The anterior border of the neural plate, presumed to contain the prospective peripheral portion (roof) of the prospective telencephalon, emerges within a vaguely defined proneural ectodermal region. Fate maps carried out at HH4 in the chick reveal that this region still produces indistinctly neural, placodal and non-neural derivatives; it does not express neural markers. We examined how the definitive anterior border domain of the rostral forebrain becomes established and comes to display a neural molecular profile, whereas local non-neural derivatives become separated. The process, interpreted as a border sharpening mechanism via intercalatory cell movements, was studied using fate mapping, time-lapse microscopy and in situ hybridization. Separation of neural and non-neural domains proceeds along stages HH4-HH4+, is well advanced at HH5, and is accompanied by a novel dorsoventral intercalation, oriented orthogonal to the border, that distributes transitional cells into molecularly distinct neural and non-neural fields. Meanwhile, neuroectodermal Sox2 expression spreads peripherally from the neighbourhood of the node, reaching the nascent anterior border domain at HH5. We also show that concurrent signals from the endodermal layer are necessary to position and sharpen the neural border, and suggest that FGF8 might be a component of this signalling.
Musculin and TCF21 coordinate the maintenance of myogenic regulatory factor expression levels during mouse craniofacial development
Authors: Moncaut Natalia , Cross Joe W. , Siligan Christine , Keith Annette , Taylor Kevin , Rigby Peter W. J. , Carvajal Jaime J.
Published: February 2012

The specification of the skeletal muscle lineage during craniofacial development is dependent on the activity of MYF5 and MYOD, two members of the myogenic regulatory factor family. In the absence of MYF5 or MYOD there is not an overt muscle phenotype, whereas in the double Myf5;MyoD knockout branchiomeric myogenic precursors fail to be specified and skeletal muscle is not formed. The transcriptional regulation of Myf5 is controlled by a multitude of regulatory elements acting at different times and anatomical locations, with at least five operating in the branchial arches. By contrast, only two enhancers have been implicated in the regulation of MyoD. In this work, we characterize an enhancer element that drives Myf5 expression in the branchial arches from 9.5 days post-coitum and show that its activity in the context of the entire locus is dependent on two highly conserved E-boxes. These binding sites are required in a subset of Myf5-expressing cells including both progenitors and those which have entered the myogenic pathway. The correct levels of expression of Myf5 and MyoD result from activation by musculin and TCF21 through direct binding to specific enhancers. Consistent with this, we show that in the absence of musculin the timing of activation of Myf5 and MyoD is not affected but the expression levels are significantly reduced. Importantly, normal levels of Myf5 expression are restored at later stages, which might explain the absence of particular muscles in the Msc;Tcf21 double-knockout mice.
Prevalence and Benefits of Care Plans and Care Planning for People with Long-Term Conditions in England
Authors: Burt Jenni , Roland Martin , Paddison Charlotte , Reeves David , Campbell John , Abel Gary , Bower Peter
Published: February 2012

Objectives

Among patients with long-term conditions, to determine the prevalence and benefits of care planning discussions and of care plans.

Methods

Data from the 2009/10 General Practice Patient Survey, a cross sectional survey of 5.5 million patients in England. Outcomes were patient reports of: care planning discussions; perceived benefit from care planning discussions and resultant care plans. Patient and practice variables were included in multilevel logistic regression to investigate predictors of each outcome.

Results

Half the respondents (49%) reported a long-term condition and were eligible to answer the care planning questions. Of these, 84% reported having a care planning discussion during the last 12 months and most reported some benefit. Only 12% who reported a care planning discussion also reported being told they had a care plan. Patients who reported having a care plan were more likely to report benefits from care planning discussions. Several factors predicted the reporting of care planning and care plans of which the most important was patients' reports of the quality of interpersonal care.

Conclusions

There is a gap between policy and current practice which might reflect uncertainty as to the benefits of care plans. There is, therefore, a need for rigorous evaluation of care plans.
Can Competition Improve Outcomes in UK Health Care? Lessons from the Past Two Decades
Authors: Gaynor Martin , Moreno-Serra Rodrigo , Propper Carol
Published: February 2012

UK governments of all political colours have sought to improve productivity in health care by introducing pro-competitive reforms in the National Health Service (NHS) during the last two decades. The first wave of reform operated from 1991 to 1997. The second wave was introduced in England only in the mid 2000s. In 2010, further reform in England, intended to increase the extent of competition, was proposed by the Coalition administration. But the effect of competition on productivity in health care and in particular on the quality of health care remains a contested issue. This paper reviews the evidence, focusing on robust and recent evidence, on the use of competition as a mechanism for improving quality. The consensus is that competition will increase quality in health care, but that institutional details matter. Given this, we end by discussing whether the current plans to make the buyers of care family doctors and other professionals and to allow some local price variation are likely to be beneficial in the UK context of full public funding for health care.
Implementing World Class Commissioning Competencies
Authors: McCafferty Sara , Williams Iestyn , Hunter David , Robinson Suzanne , Donaldson Cam , Bate Angela
Published: February 2012

Background

The world class commissioning (WCC) programme was introduced in the English NHS in 2007 to develop primary care trust (PCT) commissioning of health services. There has been limited evaluation of health commissioning initiatives over the years and in particular little is known about how commissioners interpret and implement initiatives and guidance intended to strengthen commissioning. This research explores the development and implementation of WCC and draws implications for future commissioning arrangements.

Methods

This research draws on interviews with key informants (n = 6) and a literature review to analyse the aims of, and stimulus for, WCC. In-depth interviews (n = 38) were conducted in three PCTs in the north of England in 2009 to analyse the interpretation and implementation of WCC.

Results

The aims and rationale of WCC, in particular, the specification of commissioning skills and the aspirations to improve health outcomes, were largely welcomed and supported by interviewees. However, the implementation of WCC posed a number of challenges, including: availability of resources and knowledge; lack of a supportive organizational culture and networks; and the dominance of central government control.

Conclusions

The findings have implications for emerging clinical commissioning groups (CCGs) in the English NHS. Specifically, the research highlights the need for a system-wide approach to improving commissioning, including appropriately aligned policy and objectives underpinned by a co-ordinated and supportive organizational culture.
Evaluating Labour'S Market Reforms, 2002-10
Authors: Mays Nicholas , Tan Stefanie
Published: February 2012

Starting in 2002, the UK Labour government of 1997-2010 introduced a series of changes to the National Health Service (NHS) in England designed to increase individual NHS patient choice of place of elective hospital care and competition among public and private providers of elective hospital services for NHS-funded patients. In 2006, the Department of Health initiated the Health Reform Evaluation Programme (HREP) to assess the impact of the changes. The changes broadly had the effects that proponents had predicted but the effects were mostly modest. Most of the undesirable impacts feared by critics appeared not to have materialized to any discernible extent, at least by early in 2010. Labour's market appeared to have generated stronger incentives for quality and efficiency than its 1990s predecessor with no obvious detriment to equity of access. However, this high level conclusion conceals a far more nuanced and complex picture of both the process of implementation and the impact of the changes, as the papers in this supplement drawn from the HREP show.
Thrombotic Microangiopathy and Purtscher-like Retinopathy as a Rare Presentation of Juvenile Dermatomyositis
Authors: Bader-Meunier Brigitte , Monnet Dominique , Barnerias Christine , Halphen Isabelle , Lambot-Juhan Karen , Chalumeau Martin , Costedoat-Chalumeau Nathalie , Ribeil Jean-Antoine , Bodemer Christine , Gherardi Romain
Published: February 2012

Juvenile dermatomyositis is a rare systemic vasculopathy that may sometimes present with acute complications. We report here the case of a 7-year-old boy with severe dermatomyositis associated with thrombocytopenia and blurry vision. The presence of schistocytosis and the secondary occurrence of hemolytic anemia were consistent with a diagnosis of thrombotic thrombocytopenic purpura (TTP). Further investigations demonstrated the association of TTP with muscular microangiopathy and Purtscher-like retinopathy. Retinal and hematologic involvements dramatically improved after the initiation of plasma exchange in emergency. This report emphasizes that early recognition of TTP and prompt plasmapheresis are important in a child with severe juvenile dermatomyositis associated with thrombocytopenia.
End-of-Life Decisions in Abusive Head Trauma
Authors: Ellingson Clifford C. , Livingston Jared S. , Fanaroff Jonathan M.
Published: February 2012

Abusive head trauma is a significant and tragic cause of morbidity and mortality in infants and its victims often have a poor prognosis. With such high rates of morbidity and mortality, health care providers and parents are often faced with the decision to continue or discontinue life support for an affected child. Sadly, however, this decision becomes complicated when parents are accused of causing the victim-child's current state. In this situation, if life support is withdrawn, criminal charges for the accused may escalate from assault to murder. This escalation of legal charges creates a conflict of interest for accused parents. As a result, parents have a strong incentive to avoid murder charges by using their parental decision-making rights to keep the child alive, even when treatment is deemed futile or inhumane. In this article, we discuss the legal challenges health care providers may face when parents place their interest above their child’s. We also propose solutions that give greater deference to the rights and interest of these critically ill children while still preserving protected parental rights.
Features of Formation of Composite Nanopowders Based on Al2O3 and AlN
Authors: Vlasova M. , Márquez Aguilar P. A. , Kakazey M. , Stetsenko V. , Bykov A. , Tomila T.
Published: February 2012

Two technological processes of synthesis of nanopowders containing Al2O3, AlN, and AlON have been investigated. It has been established that AlN nanoparticles formed on the base of ablation products (Al and N2) during laser irradiation of AlN targets are coated with AlON films of different composition and have a complex surface defective structure. In composite powders obtained by carbothermal reduction of Al2O3, along with AlN and AlON, initial oxide Al2O3 is present, which indicates the incompleteness of the process.
Characterization of dispersion of carbon nanotubes in polymer matrices
Authors: Peña-Parás Laura , Phillips Hubert , Barrera Enrique V.
Published: February 2012

Dispersions of carbon nanotube polymer composites were characterized by Raman mapping.Single-walled nanotubes (SWNTs), double-walled nanotubes (DWNTs), multi-walled nanotubes (MWNTs), and XD-grade carbon nanotubes (XD-CNTs) were dispersed in a vinyl ester (VE) resin using an ultrasonic probe at a fixed frequency. SWNTs were functionalized with succinic acid peroxide (SAP) to enhance dispersion. Increasing ultrasonication energy was found to improve the distribution of carbon nanotubes (CNTs) and decrease the size of ropes, whereas excessive amounts of energy were found to result in damage. The quality of dispersion was verified through optical microscopy and scanning electron microscopy (SEM).
Surface physical property of the CrO2 thin films prepared using a closed chemical vapor deposition method
Authors: Muraoka Y. , Yoshida S. , Wakita T. , Hirai M. , Yokoya T.
Published: February 2012

We have examined the intrinsic surface physical property of a CrO2 thin film by means of surface sensitive photoemission spectroscopy. Epitaxial thin film of CrO2(100) has been grown on TiO2(100) by a closed chemical vapor deposition method using a Cr8O21 precursor. Low-energy electron diffraction (LEED) observations find that epitaxial growth of rutile-phase CrO2 occurs to the top monolayer of the film. Surface sensitive x-ray photoemission spectroscopy (XPS) measurements show a finite intensity in the region of the Fermi energy. The result evidences that the physical nature of near topmost layer of CrO2 thin film is metallic. Progress of understanding of the surface physical property of CrO2 thin film helps not only perform a reliable photoemission study to understand the physics of ferromagnetic metal in CrO2, but also develop the CrO2-based devices using a half-metallic nature for spintronics applications.
Surface Decontamination by Photocatalysis
Authors: Wilbraham Richard J. , Boxall Colin , Taylor Robin J.
Published: February 2012

Currently in the nuclear industry, surface contamination in the form of radioactive metal or metal oxide deposits is most commonly removed by chemical decontamination, electrochemical decontamination or physical attrition. Physical attrition techniques are generally used on structural materials (concrete, plaster), with (electro)chemical methods being used to decontaminate metallic or painted surfaces. The most common types of (electro)chemical decontamination are the use of simple mineral acids such as nitric acid or cerium (IV) oxidation (MEDOC). Use of both of these reagents frequently results in the dissolution of a layer of the substrate surface increasing the amount of secondary waste which leads to greater burden on downstream effluent treatment and waste management plants. In this context, both mineral acids and MEDOC can be indiscriminate in the surfaces attacked during deployment, e.g. attacking in transit through a pipe system to the site of contamination resulting in both diminished effect of the decontaminating reagent upon arrival at its target site and an increased secondary waste management requirement. This provides two main requirements for a more ideal decontamination reagent: Improved area specificity and a dissolution power equal to or greater than the previously mentioned current decontaminants.

Photochemically promoted processes may provide such a decontamination technique. Photochemical reduction of metal ion valence states to aid in heavy metal deposition has already been extensively studied, with reductive manipulation also being achieved with uranium and plutonium simulants (Ce). Importantly photooxidation of a variety of solution phase metals, including neptunium, has also been achieved. Here we briefly review existing decontamination techniques and report on the potential application of photo promoted oxidation technologies to metal dissolution (including process steels) and to the dissolution of adsorbed actinide contaminants.
Choice of allowable long-term strains for reinforced embankments on a rate-sensitive foundation
Authors: Taechakumthorn C. , Rowe R.K.
Published: February 2012

ABSTRACT: The time-dependent behavior of reinforced embankments constructed over rate-sensitive soils is examined for different maximum allowable long-term reinforcement strains using finite element analysis. The long-term service height, lateral toe spreading, maximum differential settlement and maximum settlement of reinforced embankments are examined. The viscoelastic nature of geosynthetic reinforcement is considered. Various factors affecting the performance of reinforced embankments on rate-sensitive soil are investigated: soil viscosity, reinforcement type and construction rate. Based on a series of finite element analyses, the ideal allowable long-term reinforcement strains that control the embankment deformations to modest levels while maximizing the long-term service height of reinforced embankments, considering the combined effect of soil and reinforcement viscosity, are suggested.