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Background: Periprosthetic fractures are increasing in frequency. Classification: A treatment-oriented classification is the Vancouver classification. Therapy: Type A fractures will usually be treated conservatively, type C fractures are treated in the same way as shaft fractures, type B1 fractures are the domain of plate fixation and type B2 and B3 fractures require an exchange of the prosthesis possibly with bone augmentation. [ABSTRACT FROM AUTHOR]

Reinforced concrete is the most common construction material of civil infrastructure. In severe environment, e.g., chloride exposure, concrete deterioration can occur with consequences on the durability of the structure. The use of epoxy-coated reinforcement is a strategy to control chloride-induced reinforcement corrosion, particular by prolonging the initiation and propagation phase. The epoxy-coating acts as a physical barrier to chlorides and the electrolyte concrete. However, the effectiveness of the strategy in chloride environment and the corrosion performance of ECR in presence of coating defects is investigated by condition assessment of a Swiss pilot project after 24 years of field exposure. [ABSTRACT FROM AUTHOR]

Local energy markets are a promising approach for automatic and efficient matching of renewable energy with household demand in smart grids. Therefore, such markets can help to improve power system reliability and at the same reduce emissions. However, to participate in such markets, customers need to disclose private consumption data. A number of studies show that such data records may reveal a broad range of personal, sensitive information on the inhabitants. Privacy-enhancement mechanisms can be applied to preserve the privacy of individuals to modify the data reported to the market. Yet, these mechanisms can lower allocative efficiency and alter theoretical properties of the market mechanism. In this paper, we characterize both theoretically and numerically the effect of privacy mechanisms applied in a local energy market scenario. Our model considers demand side flexibility as well as energy storage systems. Furthermore, we allow for a free specification of the desired privacy enhancement level. We show that under certain natural assumptions market mechanisms retain in-expectation incentive compatibility despite the presence of privacy enhancement. Our numerical analysis based on real-world data shows that the welfare impact of privacy enhancement mechanisms is limited. Furthermore, energy storage can mitigate this efficiency loss to a large extent. [ABSTRACT FROM AUTHOR]

Multistate outbreaks of salmonellosis associated with live poultry contact have been occurring with increasing frequency. In 2013, multistate outbreaks of salmonellosis were traced back to exposure to live poultry, some of which were purchased at a national chain of farm stores (Farm store chain Y). This study was conducted at 36 stores of Farm store chain Y and was concurrent with the timing of exposure for the human outbreaks of salmonellosis in 2013. We used environmental swabs of arriving shipment boxes of hatchling poultry and shipment tracking information to examine the distribution, diversity and anti-microbial resistance of non-typhoidal Salmonella (NTS) across farm stores and hatcheries. Isolates recovered from shipment boxes underwent serotyping, anti-microbial resistance (AMR) testing and pulsed-field gel electrophoresis (PFGE). Postal service tracking codes from the shipment boxes were used to determine the hatchery of origin. The PFGE patterns were compared with the PFGE patterns of NTS causing outbreaks of salmonellosis in 2013. A total of 219 hatchling boxes from 36 stores in 13 states were swabbed between 15 March 2013 and 18 April 2013. NTS were recovered from 59 (27%) of 219 hatchling boxes. Recovery was not significantly associated with species of hatchlings, number of birds in the shipment box, or the presence of dead, injured or sick birds. Four of the 23 PFGE patterns and 23 of 50 isolates were indistinguishable from strains causing human outbreaks in 2013. For serotypes associated with human illnesses, PFGE patterns most frequently recovered from shipment boxes were also more frequent causes of human illness. Boxes positive for the same PFGE pattern most frequently originated from the same mail-order hatchery. Only one of 59 isolates was resistant to anti-microbials used to treat Salmonella infections in people. This study provides critical information to address recurrent human outbreaks of salmonellosis associated with mail-order hatchling poultry. [ABSTRACT FROM AUTHOR]

Social complexity is argued to be a driving factor in the evolution of communicative complexity. Complex social systems require individuals to form relationships with many conspecifics and interact in a wide variety of contexts over time, thus selecting for acoustic communication systems complex enough to facilitate these relationships. To better understand the evolution of such social and communicative complexity, we investigated a nocturnal, solitary forager, Garnett's bushbaby ( Otolemur garnettii), as a lorisoid model for the ancestral primate social systems from which more complex systems evolved. We hypothesized that it would be advantageous for solitary foragers to have individual differences in long-distance calls, as this could be crucial to the maintenance of their dispersed social networks. We tested for individual differences in the long distance bark vocalization. We measured 6 frequency and temporal parameters for 120 barks (15 barks from each of 8 individuals housed at the University of Southern Mississippi). Principal component and discriminant function analyses assigned the calls to the respective individuals at a rate that was moderately accurate and higher than chance (binomial test: 54.2% correct, P < 0.001, chance = 12.5%). This pilot work provides moderate evidence for individual differences and is the first such study to be conducted on lorisoids. Because individual differences have been documented in the vocalizations of solitary foraging lemuroids, we suggest that moderate individual differences may have been present in ancestral primates and contributed to the dispersed social system that is thought to have been the foundation from which increased social complexity evolved in primates. [ABSTRACT FROM AUTHOR]

Background: Periprosthetic fractures are increasing in frequency. Classification: A treatment-oriented classification is the Vancouver classification. Therapy: Type A fractures will usually be treated conservatively, type C fractures are treated in the same way as shaft fractures, type B1 fractures are the domain of plate fixation and type B2 and B3 fractures require an exchange of the prosthesis possibly with bone augmentation. [ABSTRACT FROM AUTHOR]

The role of patient autonomy and influence of religious/spiritual beliefs on antiretroviral therapy (ART) adherence is to date not fully understood. This study assessed baseline predictors of high ART adherence (≥90%) measured by electronic drug monitors (EDM) at 12 and 24 weeks after enrollment in a randomized controlled trial testing behavioral interventions to improve ART adherence. Baseline data were collected with audio computer-assisted self interviews (ACASI) surveys among a diverse urban sample of HIV-infected participants ( n = 204) recruited from community clinics in a large midwestern city. Baseline variables included a range of established ART adherence predictors as well as several less frequently studied variables related to patient autonomy and religious/spiritual beliefs. Statistically significant ( p < 0.05) variables identified in univariate analyses were included in subsequent multivariate analyses predicting higher than 90% adherence at 12 and 24 weeks. Several baseline predictors retained statistical significance in multivariate analysis at 24 weeks. Baseline levels of autonomous support from friends and family, motivation to adhere, and having an active coping style were all positively associated with adherence, while the belief that God is in control of one's health was negatively associated with adherence. Results indicate that effective interventions should include a focus on promoting patients' autonomous regulation and religious/spiritual beliefs regarding ART adherence. [ABSTRACT FROM AUTHOR]

We investigate the dynamics of microcapsules in linear shear flow within a reduced model with two degrees of freedom. In previous work for steady shear flow, the dynamic phases of this model, i.e. swinging, tumbling and intermittent behaviour, have been identified using numerical methods. In this paper, we integrate the equations of motion in the quasi-spherical limit analytically for time-constant and time-dependent shear flow using matched asymptotic expansions. Using this method, we find analytical expressions for the mean tumbling rate in general time-dependent shear flow. The capsule dynamics is studied in more detail when the inverse shear rate is harmonically modulated around a constant mean value for which a dynamic phase diagram is constructed. By a judicious choice of both modulation frequency and phase, tumbling motion can be induced even if the mean shear rate corresponds to the swinging regime. We derive expressions for the amplitude and width of the resonance peaks as a function of the modulation frequency. [ABSTRACT FROM AUTHOR]

The disease activity score of 28 joints (DAS28) is now commonly used for the guidance of treatment decisions in rheumatoid arthritis (RA). The goal of this work was to determine whether patients with DAS28 > 3.2 but less than 2 swollen and 2 tender joints respond differently to treatment than patients with a higher number of active joints. One hundred and ninety two patients with active RA treated in a rheumatology hospital as in-patients were studied prospectively. At admission (T1), release (T2) and 3 months after release (T3) disease activity (DAS28-CRP at T1 + 2, RADAI at T1 + 3), pain (numeric scale at T1 − 3) and function (FFbH at T1 + 3) were measured. A total of 148 patients had two or more (group 1) and 44 less than 2 swollen and tender joints at admission (group 2) but both groups had similar over all DAS28-scores. The groups significantly differed in their outcome after 3 months: group 1 had a significant better reduction of disease activity, pain and functional deficit ( p < 0.001 for the fulfilment of defined response criteria and p < 0.05 for comparison of the mean values for pain and function) in comparison to group 2. Although the numbers were small sub-analysis suggested that the differences might be due to a better response to newly administered DMARD and TNF-alpha-inhibitor therapy in group 1. Active RA patients with less than 2 swollen and 2 tender joints represent a subgroup with lower response to treatment with DMARD or TNF-alpha-inhibitors. This has to be taken into account in the management of these patients. [ABSTRACT FROM AUTHOR]

Introduction: It was the purpose of this study to investigate how bone morphogenetic protein 2 (BMP-2) influences remodelling and the biomechanics of solvent- dehydrated bone in the long run. Furthermore, the early influence of this growth factor on the substitute was investigated. Materials and methods: Using a weight-bearing animal model, solvent-dehydrated bone was implanted in the tibial head of merino sheep (n= 12) after being loaded with BMP-2 (100 μg/100 μl). At 4 weeks (n=6) and 9 months (n=6) after surgery, histomorphological, histomorphometrical and biomechanical investigations were performed. Results: At 9 months after implantation of BMP-2-loaded specimens, the bone per tissue volume was high, with levels above those of physiological cancellous bone. The amount of remaining solvent-dehydrated bone was markedly decreased, and in contrast, the amount of newly formed bone was extremely high. The specimen degradation had already occurred within the first 4 weeks after implantation, showing no further impact throughout the 9-month period. Biomechanical investigations at 9 months after implantation demonstrated a yield strength which achieved levels at least equivalent to physiological cancellous bone. BMP-2 showed no significant impact on the biomechanical properties after 4 weeks, compared to specimens prior to im- plantation. Conclusion: BMP-2 predominantly has an impact on the early implant degradation as well as bone formation, which leads to an almost completed bone remodelling of the solvent-dehydrated specimen within the study period of 9 months. [ABSTRACT FROM AUTHOR]

Differences in the aetiology of osteoarthritis (OA) of the first carpometacarpal joints (CMC-1) and the interphalangeal joints (IP) have been reported. It was the purpose of this investigation to evaluate whether isolated OA of the first carpometacarpal joints and the interphalangeal joints differs in its aetiology, considering potential risk factors such as age, gender, body mass index, occupational history, OA in the hip or knee joints, hypertension and diabetes in patients with advanced hip or knee OA. Included in this investigation were 639 patients scheduled for either hip or knee replacement because of advanced OA. As well as a standardised interview and clinical examination, bilateral radiographs of both hands were obtained. According to the presence or absence of radiographic OA, participants were categorised as having CMC-1 OA (= 1 joint) or IP OA (= 2 joints), either isolated or in combination. Odds ratios (OR) and their 95% confidence intervals (CI) for potential determinants of OA were estimated using multivariable logistic regression.Of the total number of patients, 184 had CMC-1 OA and 424 IP OA. Patients with CMC-1 OA were more likely to be female (77.2%), and to have knee OA (62.5%) and hypertension (63.0%), than patients without CMC-1 OA. No differences between CMC-1 OA and IP OA were observed for the role of age, body mass index and diabetes. Age was associated with both CMC and IP OA. Female gender was independently associated with CMC-1 OA (OR=1.79; 95% CI: 1.16–2.74) but not with IP OA. Our data suggest a possible impact of age and female gender on the aetiology of CMC-1 OA and of age on IP-OA, at least in patients with advanced hip or knee OA. [ABSTRACT FROM AUTHOR]

There is abundant evidence that inequality between women and men is a very general feature of Western education systems. Differential treatment and differential outcomes for both staff and students have been extensively documented by research over the past decade. In the same period, considerable energy has been spent trying to change it. By and large the discussion of gender and education has been guided by the concept of sex roles. The idea that boys and girls are socialized into different but complementary roles, which then shape their expectations of life and other peoples expectations of them is an appealing one. It fits much common-sense knowledge of how children are treated and provides a language for describing the pressures exerted by parents, peers, mass media, and schools. There is no guarantee that these uncertainties and possibilities will be resolved in a progressive direction, that is, one that actually diminishes sex inequality and gender-related oppression. It is a mass of tensions, contradictions, and complexities that always have the potential for change.

Several studies show that the application of oral glucocorticoids in patients with active RA leads to fast resolution of disease activity []. Treatment strategies that include the initial application of glucocorticoids seem to have a favourable outcome in terms of long-term control of disease activity []. Moreover, when tapered down to low doses, glucocorticoids show disease-modifying actions such as the inhibition of progression of structural damage to the inflamed joints []. The goal of this study was to examine the predictors of short-term response to intermediate-dose glucocorticoids in patients with active RA. [ABSTRACT FROM AUTHOR]

Many factors can influence the parasite load of animal hosts, but integrative studies that simultaneously investigate several factors are still rare in many taxonomic groups. This study investigates the influence of host species, host population density, parasite transmission mode, sex, and two temporal (month, year) factors on gastrointestinal parasite prevalence and fecal egg counts of two endemic primate species from Madagascar, Microcebus ravelobensis and Microcebus murinus. A total of 646 fecal samples were available and analyzed from three dry seasons. Six different helminth egg morphotypes were found, and these were Subulura sp. (14.51 % prevalence), strongyle eggs (12.95 %), Ascaris sp. (7.94 %), Lemuricola sp. (0.17 %), and two forms of tapeworms ( Hymenolepis spp.) (1.73 and 0.69 %). Coinfection with more than one egg type was observed in 21.22 % of the samples containing eggs. Multivariate analyses revealed that host species and sex did neither explain significant variation in the prevalence and fecal egg counts of parasites with direct life cycles ( Ascaris sp., strongyle egg type, Lemuricola sp.) nor of arthropod-transmitted parasites ( Subulura sp.). However, fecal egg counts of Subulura sp. differed significantly between study sites, and the prevalence of Subulura sp. and of parasites with direct life cycles was influenced by temporal parameters, mainly by differences between study years and partly between months. When comparing the findings with the yearly and seasonal rainfall patterns in the area, most results are in accordance with the hypothesis of an increased vulnerability of the host toward infection under some sort of environmental challenge. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Phloroglucinol is used to prevent gastric, intestine or urogenital spasms. In France, many pregnant women are exposed to phloroglucinol for which no data are available about its use in pregnancy. The present study, using EFEMERIS database, investigates potential teratogenic risk of phloroglucinol in pregnancy. Materials and methods: EFEMERIS is a database including prescribed and delivered drugs during pregnancy (data from Caisse Primaire d’Assurance Maladie of Haute-Garonne) and outcomes (data from Maternal and Infant Protection Service and from Antenatal diagnostic Centre). Women delivered from July 1st 2004 to June 30th 2008 in Haute-Garonne and registered in the French Health Insurance Service were included into EFEMERIS database. We compared pregnancy outcomes and newborn health between women exposed to phloroglucinol during organogenesis and non-exposed women. Malformations were classified according to Eurocat classification. Results: Five thousand one hundred and thirty-two newborns (12.7%) exposed during organogenesis to phloroglucinol were compared to 35,223 controls (non exposed newborns). The mean number of different drugs prescribed during the first trimester of pregnancy per woman was higher in women exposed to phloroglucinol than in non-exposed women (6.4±4.3 versus 2.4±3.3, P <10−4). Among newborns, 126 (2.5%) had a malformation versus 804 (2.3%) in control newborns (OR=1.1, [0.9–1.3]). The present study was powered to find a 1.3 fold increase in the overall rate of major anomalies. Discussion and conclusion: This first epidemiologic study about phloroglucinol in pregnancy does not support evidence of a teratogenic risk for phloroglucinol in humans. [Copyright &y& Elsevier]

Objective: To determine the association between hysterectomy (HE) and patterns of osteoarthritis (OA) METHODS: We performed a large cross-sectional study including 504 female patients admitted for arthroplasty of knee or hip joint. Patients with OA were categorized as having bilateral or generalized OA (GOA) according to the presence of radiographic OA in the contralateral or different finger joints. Odds ratios (OR) and their 95% confidence intervals (CI) for the association between HE and OA patterns were estimated adjusting for potential confounders.Results: Hysterectomy (HE) was reported by 24.9 percent of the patients. Bilateral OA was present in 86.2 percent and GOA was present in 33.3 percent of the patients. HE was not associated with bilateral OA (adjusted OR=0.9; 95% CI: 0.5-1.8) but with a lower prevalence of GOA (adjusted OR=0.6; CI: 0.3-0.99).Conclusion: In contrast to earlier studies our results suggest that HE might be a marker for a reduced risk for a generalized pattern of OA. [ABSTRACT FROM AUTHOR]

A previously healthy 9-year-old girl presented to an emergency department (ED) with headache, dizziness, blurry vision, and abnormal visual perceptions. She was diagnosed with migraine, treated symptomatically, and discharged. Over the course of days, she became progressively somnolent, and returned to the ED, where she was found to have a right inferior quadrantanopsia and sixth nerve palsy. Magnetic resonance imaging (MRI) of the brain showed gyral swelling of the left parieto-occipital lobe. Continuous electroencephalogram (EEG) monitoring revealed focal non-convulsive status epilepticus (NCSE) in the left occipital region. Cerebrospinal fluid (CSF) was positive for antibodies directed against the N -methyl- D -aspartate receptor (NMDAR). This case is the fi rst report of anti-NMDAR encephalitis presenting with focal non-convulsive status epilepticus (NCSE). [ABSTRACT FROM AUTHOR]

This paper proposed a novel methodology to determine the angle of repose (AoR) of various biomass materials. Because of irregular shape and varying particle size distribution, slopes of biomass materials are uneven frequently and the two traditional measurement methods of AoR are therefore less applicable and reliable. In general, only partial slopes of heap surface are selected to measure AoR, although a representable slope is barely defined in standard methods. In this case, the subjective selection of slopes may result in significant deviations. Hence, we presented an efficient and reliable measurement method of AoR. In addition to the traditional bottomless cylinder test, the new technology, 3D scan, was used to digitize the generated bulk heap. Then, two data processing methods were introduced to deal with different heap forms: direct calculation based on the linear least-squares regression with regard to the whole heap surface and the pre-selection of planes for excluding outliners caused by particle bridging. For the purpose of simplifying the process, a self-developed graphic user interface (GUI) was used to analyze four kinds of biomass fuels, namely, olive stone, almond shells, forest residues and willow chips, and verify the proposed method. Both methods significantly decreased the deviations of results without increasing operating time and cost. • The first study to obtain angle of repose of biomasses efficiently by applying 3D scan with fewer individual interpretations. • Tests of four kinds of representative and widely available biomasses were used to verify the applicability of both methods. • Uneven slopes of biomass' cone are taken into consideration and the angle of repose is therefore more precise. • The methodology provides a possibility to reach valid result of material model calibration with lower measurement deviation. [ABSTRACT FROM AUTHOR]

• MEG with SAM(g2) analysis can be used amongst pediatric patients with refractory epilepsy during presurgical workup. • MEG using SAM(g2) analysis provides significant information regarding likelihood of seizure freedom or reduced seizure frequency after surgery. • Amongst pediatric patients without a lesional MRI, MEG with SAM(g2) analysis may be valuable in assessment for resective epilepsy surgery. Resective surgery is the most effective treatment option for patients with refractory epilepsy; however identification of patients who will benefit from epilepsy surgery remains challenging. Synthetic aperture magnetometry and excess kurtosis mapping (SAM(g2)) of magnetoencephalography (MEG) is a non-invasive tool that warrants further examination in the pediatric epilepsy population. Here, we examined the utility of MEG with SAM(g2) to determine if MEG epileptiform foci correlates with surgical outcome and to develop a predictive model incorporating MEG information to best assess likelihood of seizure improvement/freedom from resective surgery. 564 subjects who had MEG at the Children's Hospital of Philadelphia between 2010–2015 were screened. Clinical epilepsy history and prior electrographic records were extracted and reviewed and correlated with MEG findings. MEG assessments were made by both a neurologist and neuroradiologist. Predictive models were developed to assess the utility of MEG in determining Engel class at one year and five years after resective epilepsy surgery. The number of MEG spike foci was highly associated with Engel class outcome at both one year and five years; however, using MEG data in isolation was not significantly predictive of 5 year surgical outcome. When combined with clinical factors; scalp EEG (single ictal onset zone), MRI (lesional or not), age and sex in a logistic regression model MEG foci was significant for Engel class outcome at both 1 year (p = 0.03) and 5 years (0.02). The percent correctly classified for Engel class at one year was 78.43% and the positive predictive value was 71.43. MEG using SAM(g2) analysis in an important non-invasive tool in the identification of those patients who will benefit most from surgery. Integrating MEG data analysis into pre-surgical evaluation can help to predict epilepsy outcome after resective surgery in the pediatric population if utilized with skilled interpretation. [ABSTRACT FROM AUTHOR]

The development and validation of the simulation approach for estimation of low frequency magnetic field coverage inside cars is addressed. Using electromagnetic simulation software based on the method of moments and specially developed simulation models the magnetic field has been computed inside a car. On-car measurement results confirm the simulated values of the magnetic field. [ABSTRACT FROM AUTHOR]

Résumé Le rein ectopique thoracique est une anomalie congénitale rare, le plus souvent asymptomatique. Cette ectopie est rarement associée à une hernie de coupole, ce qui conditionne le pronostic. Peu de cas de diagnostic anténatal ont été décrits. Nous rapportons le cas d’un nouveau-né de sexe féminin qui présentait l’association d’un rein droit ectopique thoracique et d’une hernie de coupole diaphragmatique droite diagnostiqués à la 33 e semaine d’aménorrhée. La prise en charge néonatale a nécessité une cure chirurgicale à la 3 e heure de vie et l’évolution clinique a été simple. Nous discutons à la lumière d’une revue de la littérature le pronostic favorable de cette association. Summary Ectopic intrathoracic kidney is a rare congenital anomaly, usually asymptomatic. This anomaly is sometimes associated with a diaphragmatic hernia. Few cases of this combination have been described, often in the absence of a prenatal diagnosis. We report on the case of a female newborn infant who was diagnosed with an ectopic intrathoracic right kidney and a diaphragmatic hernia upon 33 weeks of gestation. The patient underwent surgery on the first day of life and the respiratory and renal outcomes were simple. We review the literature and discuss the seemingly good prognosis of this combination. [ABSTRACT FROM AUTHOR]

For reinforced concrete structures a localisation of all significant critical areas can only be done by a full surface inspection. The economic advantages are obvious: uncritical areas have not to be repaired expensively 1. The first step of the assessment should always be a visual inspection 2. The range of deterioration causes can be limited and the degree of deterioration may be estimated roughly. The inspection program can be adjusted to the requirements. By means of a full surface potential mapping areas with a high risk for chloride induced reinforcement corrosion can be localised, although no deteriorations are visually detectable at the concrete surface. In combination with concrete cover depth and resistivity measurements areas with corrosion promoting exposure conditions can be localised even if the reinforcement is not yet depassivated. The following publication gives an overview about the essential full surface investigation methods to localise critical areas regarding corrosion of steel in concrete. The selection of methods is based on the inspection procedure given in 2. [ABSTRACT FROM AUTHOR]

Study design:Multi-center, prospective, cohort study.Objectives:To assess the validity and reliability of the Spinal Cord Independence Measure (SCIM III) in measuring functional ability in persons with spinal cord injury (SCI).Setting:Inpatient rehabilitation hospitals in the United States (US).Methods:Functional ability was measured with the SCIM III during the first week of admittance into inpatient acute rehabilitation and within one week of discharge from the same rehabilitation program. Motor and sensory neurologic impairment was measured with the American Spinal Injury Association Impairment Scale. The Functional Independence Measure (FIM), the default functional measure currently used in most US hospitals, was used as a comparison standard for the SCIM III. Statistical analyses were used to test the validity and reliability of the SCIM III.Results:Total agreement between raters was above 70% on most SCIM III tasks and all κ-coefficients were statistically significant (P<0.001). The coefficients of Pearson correlation between the paired raters were above 0.81 and intraclass correlation coefficients were above 0.81. Cronbach's-α was above 0.7, with the exception of the respiration task. The coefficient of Pearson correlation between the FIM and SCIM III was 0.8 (P<0.001). For the respiration and sphincter management subscale, the SCIM III was more responsive to change, than the FIM (P<0.0001).Conclusion:Overall, the SCIM III is a reliable and valid measure of functional change in SCI. However, improved scoring instructions and a few modifications to the scoring categories may reduce variability between raters and enhance clinical utility. [ABSTRACT FROM AUTHOR]

Study design:Multi-center, prospective, cohort study.Objectives:To assess the validity and reliability of the Spinal Cord Independence Measure (SCIM III) in measuring functional ability in persons with spinal cord injury (SCI).Setting:Inpatient rehabilitation hospitals in the United States (US).Methods:Functional ability was measured with the SCIM III during the first week of admittance into inpatient acute rehabilitation and within one week of discharge from the same rehabilitation program. Motor and sensory neurologic impairment was measured with the American Spinal Injury Association Impairment Scale. The Functional Independence Measure (FIM), the default functional measure currently used in most US hospitals, was used as a comparison standard for the SCIM III. Statistical analyses were used to test the validity and reliability of the SCIM III.Results:Total agreement between raters was above 70% on most SCIM III tasks and all κ-coefficients were statistically significant (P<0.001). The coefficients of Pearson correlation between the paired raters were above 0.81 and intraclass correlation coefficients were above 0.81. Cronbach's-α was above 0.7, with the exception of the respiration task. The coefficient of Pearson correlation between the FIM and SCIM III was 0.8 (P<0.001). For the respiration and sphincter management subscale, the SCIM III was more responsive to change, than the FIM (P<0.0001).Conclusion:Overall, the SCIM III is a reliable and valid measure of functional change in SCI. However, improved scoring instructions and a few modifications to the scoring categories may reduce variability between raters and enhance clinical utility. [ABSTRACT FROM AUTHOR]

Learning from worked-out examples has been shown to be very effective in initial cognitive skill acquisition. In order to fully exploit the potential of example-based learning, teachers should, however, know how to effectively employ such examples in classroom instruction. Therefore, we have designed a computer-based learning environment in which mathematics and science teachers learn how to effectively employ worked-out examples. The learning environment was developed according to approved design criteria. The topics that are addressed in the learning environment were chosen in response to the results of a needs assessment that analysed schoolbooks and classroom videos, and took interviews with teachers into account. In experiments as well as in several teacher trainings on example-based learning, the computer-based learning environment was evaluated and improved accordingly. On a more general level, our research and development project showed that a computer-based learning programme could be a sensible tool that supports follow-up work in teacher training contexts. [ABSTRACT FROM AUTHOR]

The aim of our study was to assess the utility and reliability of magnetic resonance imaging (MRI) in antenatal diagnosis of craniosynostosis. We retrospectively reviewed the MRI examinations of the head of 15 fetuses requested over a period of 11 years on the basis of sonographic suspicion of craniosynostosis. The postnatal diagnosis was available for 14 neonates. No termination of pregnancy was performed. There were four neonates with sporadic multisuture craniosynostoses, three of which were syndromic, including one Crouzon and one Pfeiffer syndrome. Eight neonates were normal, two showed cranial vault deformities without synostosis, and one was lost to follow-up. MRI showed a high predictive value for craniosynostosis, as there were no false-negative or false-positive diagnoses. However, the severity of the abnormalities were underestimated in two neonates. We suggest that prenatal MRI has diagnostic value when synostosis is suspected on ultrasonography. Moreover, MRI is accurate in the detection of associated brain abnormalities, which is an important prognostic issue in this diagnosis. Prenatal diagnosis of craniosynostosis is difficult and could benefit from three-dimensional ultrasonography and three-dimensional CT. [ABSTRACT FROM AUTHOR]

Recent studies have indicated a critical role for vascular endothelial growth factor (VEGF) during the process of endochondral ossification, in particular in coupling cartilage resorption with bone formation. Therefore, we studied the chemoattractive and proliferative properties of human VEGF-A on primary human osteoblasts (PHO) and compared these data with the effects of human basic fibroblast growth factor (bFGF) and human bone morphogenetic protein-2 (BMP-2). Furthermore, initial experiments were carried out to characterize VEGF-binding proteins on osteoblastic cells possibly involved in the response. For the first time, to our knowledge, we could demonstrate a chemoattractive effect of VEGF-A, but not VEGF-E, on primary human osteoblasts. The effect of VEGF-A was dose-dependent and did not reach a maximum within the concentration range tested (up to 10 ng/mL). The maximal effect observed was a chemotactic index (CI) of 2 at a concentration of 10 ng/mL. bFGF and BMP-2 exhibited maxima at 1.0 ng/mL with CI values of 2.5 and 2, respectively. In addition to its effect on cell migration, VEGF-A stimulated cell proliferation by up to 70%. Reverse transcription-polymerase chain reaction (RT-PCR) analysis revealed the expression of VEGF receptors VEGFR-1 (Flt-1), VEGFR-2 (Kdr), and VEGFR-3 (Flt-4), as well as neuropilin-1 and -2. An in vitro kinase assay failed to demonstrate activation of VEGFR-2 upon stimulation with either VEGF-E or VEGF-A, consistent with the idea that the effect of VEGF-A on primary human osteoblasts is mediated via VEGFR-1. Taken together, our data establish that human osteoblasts respond to VEGF-A, suggesting a functional role for this growth factor in bone formation and remodeling. [Copyright &y& Elsevier]

A 6½-month-old male with severe combined immunodeficiency (SCID) had a low percentage and number of T cells (11%; 241/mm³) and a high percentage and number of B cells (52%; 1187/ mm³) and null cells (37%;, 868/mm³). In vitro studies were performed to determine if this child's primary defect involved differentiation of both T and B lymphocytes or if failure of B lymphocytes to differentiate into immunoglobulin producing cells was secondary to T lymphocyte abnormalities. Immunoglobulin production by lymphocytes in response to polyclonal mitogens (pokeweed mitogen and foetal calf serum) was measured by pulse-labelling cells with ³H-leucine and then precipitating cytoplasmic and secreted immunoglobulins with polnalent anti-human immunoglobulin and S. aureus (Cowan strain I) protein A. The patient's lymphocytes did not synthesize immunoglobulins in vitro in response to mitogens, They did not suppress synthesis of immunoglobulins by normal lymphocytes. However, addition of normal purified T cells, which themselves did not synthesize immunoglobulins, enabled the patient's B lymphocytes to become immunoglobulin synthesizing and secreting cells. Gamma, mu, and light chains were secreted. This suggests that the primary abnormality was in the T-cell axis at the level of lymphoid stem cells or prothymocytes and that failure of B lymphocytes to become immunoglobulin-producing cells was secondary to this defect. [ABSTRACT FROM AUTHOR]

Blunt dissection of the esophagus is considered the least invasive technique in the treatment of either benign or malignant diseases of the esophagus. Its disadvantage is that it has to be carried out blindly. The results may be uncontrollable hemorrhage, unrecognized injuries to the trachea, and damage to the recurrent laryngeal nerve. In order to reduce the degree of invasiveness a new endoscopic microsurgical technique for the dissection of the esophagus has been developed and tried out in animals. This paper presents the operative technique. Our new endoscopic microsurgical technique obviates a thoracotomy, while direct endoscopic vision results in improved dissection. The magnified endoscopic view permits selective exposure of blood vessels and prevents injury to the adjacent organs. [ABSTRACT FROM AUTHOR]