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Background: The concept of anterior cruciate ligament (ACL) reconstruction (ACLR) has become widely accepted, gaining increased attention in recent years and resulting in many research achievements in this field. Purpose: The aim of this study was to determine which original articles on ACLR have been most influential in this field by identifying and analyzing the characteristics of the 100 most cited articles. Study Design: Cross-sectional study. Methods: Articles on ACLR were identified via the Thomson ISI Web of Science database on November 30, 2019. The 100 most cited articles were identified based on inclusion and exclusion criteria. The data extracted from each article for the subsequent analysis included title, date of publication, total citations, average citations per year (ACY), journal name, first author, institutions, themes, level of evidence, and keywords. Results: The total number of citations was 29,629. The date of publication ranged from 1975 to 2015. A majority of the articles originated from the United States (58%) and were published in the 1990s (32%) and 2000s (48%). The mean ACY was 18.43 ± 9.51. Of the selected articles, nearly one-half were published in the American Journal of Sports Medicine (42%). The most prolific co-author and first author were Freddie H. Fu (n = 13) and K. Donald Shelbourne (n = 5), respectively. The most productive institution was the University of Pittsburgh (14%). Material comparison (19%) and technique comparison (16%) were the 2 most popular themes. More than one-quarter of articles were level 4 evidence (37%). Moreover, the keywords ACL, ACL reconstruction, ACL rupture, knee joint, knee injuries, and human showed the highest degree of centrality. Conclusion: By analyzing the characteristics of articles, this study demonstrated that ACLR is a growing and popular area of research, with the focus of research varying through timeline trends. Studies on anatomic reconstruction and biomechanics might be areas of future trends.

The article narrates a personal journey of learning and unlearning the images in school textbooks, its uses potentials and challenges as experienced by the author. It reflects upon the experiences of the process of selection of these images within the context of political science as a discipline. These experiences have been formed over a decade while working for Eklavya in Madhya Pradesh and Rajasthan, and also at the NCERT in New Delhi. It locates changes in understanding the perspectives on political cartoons and posters as could be used in a school textbook. It also argues that there is a need to rethink ways in which cartoons are used in textbooks. Furthermore, it tells us something about the way political science as a discipline is taught in schools across India.

This article describes our next generation human Liver Acinus MicroPhysiology System (LAMPS). The key demonstration of this study was that Zone 1 and Zone 3 microenvironments can be established by controlling the oxygen tension in individual devices over the range of ca. 3 to 13%. The oxygen tension was computationally modeled using input on the microfluidic device dimensions, numbers of cells, oxygen consumption rates of hepatocytes, the diffusion coefficients of oxygen in different materials and the flow rate of media in the MicroPhysiology System (MPS). In addition, the oxygen tension was measured using a ratiometric imaging method with the oxygen sensitive dye, Tris(2,2′-bipyridyl) dichlororuthenium(II) hexahydrate (RTDP) and the oxygen insensitive dye, Alexa 488. The Zone 1 biased functions of oxidative phosphorylation, albumin and urea secretion and Zone 3 biased functions of glycolysis, α1AT secretion, Cyp2E1 expression and acetaminophen toxicity were demonstrated in the respective Zone 1 and Zone 3 MicroPhysiology System. Further improvements in the Liver Acinus MicroPhysiology System included improved performance of selected nonparenchymal cells, the inclusion of a porcine liver extracellular matrix to model the Space of Disse, as well as an improved media to support both hepatocytes and non-parenchymal cells. In its current form, the Liver Acinus MicroPhysiology System is most amenable to low to medium throughput, acute through chronic studies, including liver disease models, prioritizing compounds for preclinical studies, optimizing chemistry in structure activity relationship (SAR) projects, as well as in rising dose studies for initial dose ranging. Impact statement Oxygen zonation is a critical aspect of liver functions. A human microphysiology system is needed to investigate the impact of zonation on a wide range of liver functions that can be experimentally manipulated. Because oxygen zonation has such diverse physiological effects in the liver, we developed and present a method for computationally modeling and measuring oxygen that can easily be implemented in all MPS models. We have applied this method in a liver MPS in which we are then able to control oxygenation in separate devices and demonstrate that zonation-dependent hepatocyte functions in the MPS recapitulate what is known about in vivo liver physiology. We believe that this advance allows a deep experimental investigation on the role of zonation in liver metabolism and disease. In addition, modeling and measuring oxygen tension will be required as investigators migrate from PDMS to plastic and glass devices.

Young people with congenital heart disease are often marginalised and may compensate for restricted physical and social abilities by substance abuse or risk-taking behaviour. We report on the judicial encounters of patients in an Adult Congenital Heart unit. Fifteen patients had court appearances and all were male. Seven served jail sentences, including four indigenous adolescents. All had multiple interventions for their cardiac conditions and four are now deceased. The majority of patients had mental health issues and substance misuse. These patients need psychological and medical support, and help with judicial authorities. Recommendations for ongoing care are provided.

The present study examined whether a new psychosocial control model of youth problem behaviours, including additional variables of sensation seeking and peer risk-taking behaviour, could be expanded to explain delinquency in early and mid-late adolescence, and emerging early- and mid-young adulthood. We also explored the possible mediating role of peer risk-taking behaviours on conventional social control risk factors of parent attachment, school connectedness, and perceived seriousness of risk-taking behaviours with delinquency. Using a recently updated Australian self-report delinquency measure that can capture undetected antisocial behaviour among both adolescents and adults, a sample of 329 secondary school students (age groups 13–14 and 15–17, 50.6% female) and 334 university students (age groups 18–20 and 21–24, 68.4% female) in Canberra, Australia participated. The new psychosocial control model explained variance in delinquency with medium to large effect sizes, and beyond the original psychosocial control variables in all four age cohorts. Peer risk-taking behaviour explained the largest proportion of variance across all four age groups; its mediating role was partially supported. Impulsivity predicted delinquency among 13–20 years olds as did sensation seeking among 15–24 years olds, suggesting different, yet overlapping influences on developmental trajectories of delinquency.

Background Transient ischemic attacks remain a clinical diagnosis with significant variability between physicians. Finding reliable biomarkers to identify transient ischemic attacks would improve patient care and optimize treatment. Aim Our aim is to identify novel serum TIA biomarkers through the use of mass spectroscopy-based proteomics. Methods Patients with transient neurologic symptoms were prospectively enrolled. Mass spectrometry-based proteomics, an unbiased method to identify candidate proteins, was used to test the serum of the patients for biomarkers of cerebral ischemia. Three candidate proteins were found, and serum concentrations of these proteins were measured by enzyme-linked immunosorbent assay in a second cohort of prospectively enrolled patients. The Student's t-test was used for comparison. The Benjamini–Hochberg false discovery rate controlling procedure for multiple comparison adjustments determined significance for the proteomic screen. Results Patients with transient ischemic attacks ( n = 20), minor strokes ( n = 15), and controls (i.e. migraine, seizure, n = 12) were enrolled in the first cohort. Ceruloplasmin, complement component C8 gamma (C8γ), and platelet basic protein were significantly different between the ischemic group (transient ischemic attack and minor stroke) and the controls ( P = 0·0001, P = 0·00027, P = 0·00105, respectively). A second cohort of patients with transient ischemic attack ( n = 22), minor stroke ( n = 20), and controls' ( n = 12) serum was enrolled. Platelet basic protein serum concentrations were increased in the ischemic samples compared with control (for transient ischemic attack alone, P = 0·019, for the ischemic group, P = 0·046). Ceruloplasmin trended towards increased concentrations in the ischemic group ( P = 0·127); no significant difference in C8γ ( P = 0·44) was found. Conclusions Utilizing mass spectrometry-based proteomics, platelet basic protein has been identified as a candidate serum biomarker for transient ischemic attack. This unbiased proteomic approach may be a promising method to identify novel biomarkers to more precisely diagnose transient ischemic attacks.

Background Extraction followed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis is the method of choice when it comes to the accurate quantification of 25-OH-vitamin D in blood samples. It is generally assumed that the addition of exogenous internal standard allows for the determination of the endogenous analyte concentration. In this study we investigated the extraction properties of endogenous and exogenous 25-OH-vitamin D. Methods Eight samples were used for the evaluation of the extraction procedure and 59 patients’ samples for a method comparison. The methanol-to-sample ratio (v/v) and the sample-to-hexane ratio (v/v) were varied and the LC-MS/MS signals of endogenous 25-OH-vitamin D3, spiked 25-OH-vitamin D2 and internal standard of the extracts recorded. The optimized ‘in-house’ LC-MS/MS assay was compared to two automated chemiluminescence immunoassays from DiaSorin and Abbott. Results Mathematical analysis of the data revealed a differential extraction of endogenous 25-OH-vitamin D3, spiked 25-OH-vitamin D2 and non-equilibrated internal standard. Exogenous 25-OH-vitamin D can be measured accurately if a definite methanol-to-sample ratio is used. Endogenous 25-OH-vitamin D is affected by critical quantification issues due to a differential slope in the extraction profile. The actual 25-OH-vitamin D concentration can be one-third above the measured extractable concentration. Results confirm that the ‘in-house’ LC-MS/MS assay provides reproducible 25-OH-vitamin D results. Conclusions Discordant concentrations of 25-OH-vitamin D from LC-MS/MS assays can be caused by selection of suboptimal extraction conditions. Furthermore, a different sample pretreatment or solvent extraction system may result in a different dissociation and extraction yield of endogenous 25-OH-vitamin D and therefore contribute to variations of LC-MS/MS results.

Over the past two decades, the traditional family of mother, father, and shared biological children as the dominant structure of a family has been replaced by the modern family—the stepfamily. The present study explored a stepfamily for the purpose of understanding a phenomenon, that is, a stepfamily’s experiences before and after the death of a custodial biological parent. This article, therefore, presents the findings of the examination of the stepparent–stepchild relationship and the effects of the death of the custodial biological parent on the stepfamily as individuals and as a family unit. Findings demonstrated the premises of Minuchin’s structural theory and Bowlby’s attachment theory as theoretical frameworks and Social Constructionism as the philosophical framework, respectively. Family counselors in their role as clinicians will be informed of a stepfamily’s relational associations, interactions, and cultural worldviews, thereby providing direction for clinical interventions from an empirically based perspective. Moreover, the findings will inform better practice through the understanding of how the death of a custodial biological parent affects continued association between a stepparent and stepchild (children).

In the United States, income inequality has escalated since the 1970s while millions of workers and their families are suffering the devastation of long-term unemployment or work that is insecure and unstable. Against this backdrop, a growing body of literature focuses on compassion in organizations, primarily at the individual and group level of analysis. However, the current economic system under which the U.S. economy operates might create a fundamental tension in this regard. That is, the tenets of American corporate capitalism (ACC) might be in contradiction to compassionate organizing. ACC is an ideology that emphasizes, among other things, the pursuit of self-interest, competition, market exchange, consumerism, and using a profit/loss criterion to make decisions in organizations. Members of a society in which ACC is dominant may come to internalize the beliefs and values underlying ACC (Kasser, Cohn, Kanner, & Ryan, 2007), which may be at odds with compassionate organizing. Indeed, management scholarship has tended to be dominated by a concern with economic performance and efficiency. In addition to this focus on efficiency and competitiveness as ultimate outcomes of interest, perhaps management scholars should also focus on social problems and social welfare concerns. Consistent with contemporary interest in compassion, key to advancing our knowledge in this area would be identifying the conditions under which organizations inflict the least harm and alleviate the most suffering. In this regard, several directions for future organizational research are provided.

Purpose: This study aimed to examine the role of a pharmacy technician-centered medication reconciliation (PTMR) program in optimization of medication therapy in hospitalized patients with HIV/AIDS. Methods: A chart review was conducted for all inpatients that had a medication reconciliation performed by the PTMR program. Adult patients with HIV and antiretroviral therapy (ART) and/or the opportunistic infection (OI) prophylaxis listed on the medication reconciliation form were included. The primary objective is to describe the (1) number and types of medication errors and (2) the percentage of patients who received appropriate ART. The secondary objective is a comparison of the number of medication errors between standard mediation reconciliation and a pharmacy-led program. Results: In the PTMR period, 55 admissions were evaluated. In all, 50% of the patients received appropriate ART. In 27of the 55 admissions, there were 49 combined ART and OI-related errors. The most common ART-related errors were drug–drug interactions. The incidence of ART-related medication errors that included drug–drug interactions and renal dosing adjustments were similar between the pre-PTMR and PTMR groups ( P = .0868). Of the 49 errors in the PTMR group, 18 were intervened by a medication reconciliation pharmacist. Conclusion: A PTMR program has a positive impact on optimizing ART and OI prophylaxis in patients with HIV/AIDS.

Background It is well known that plasma creatinine concentration is affected by muscle mass, while some studies have suggested cystatin C is affected by body mass index (BMI). Our aim was to assess the effects of lean versus fat mass on cystatin C and creatinine derivative equations in estimating glomerular filtration rate (GFR) in healthy young men. Methods Three groups of participants were studied: those classified as normal (BMI 18-25 kg/m 2 with body fat, 30%); muscular subjects (BMI .30 kg/m 2 and body fat, 20%); and obese subjects (BMI .30 kg/m 2 and body fat .30%). All underwent diethylenetriamine pentaacetic acid GFR, bio-electrical impedance and dual-energy X-ray absorptiometry body composition analysis, measurement of plasma cystatin C, creatinine and high-sensitivity C-reactive protein and completed a diet record. Results Cystatin C was highest in the obese group (0.77 mg/L; 95% confidence intervals [CI] 0.69-0.77) and creatinine was highest in the muscular group (90.1 μmol/L; 95% CI 84.3-96.0). On multivariate analysis, body fat and GFR (P = 0.003) were significant determinants of cystatin C; muscle mass and age affected creatinine significantly (P = 0.02). Using cystatin C equations, Le Bricon and Hoek showed significantly lower estimated GFR in the obese group but performed reasonably well within 50%, 30% and 20% of GFR. Creatinine equations showed significant underestimations of GFR for the muscular group. Conclusions Body fat is a significant determinant of cystatin C while creatinine concentration is highly affected by muscle mass and age. Body composition plays an important role in the interpretation of renal function. Cystatin C equations are still accurate in predicting GFR in our healthy male group without chronic kidney disease.

OBJECTIVE: To review the evidence surrounding a potential association between liraglutide and pancreatitis. DATA SOURCES: A literature search was conducted in MEDLINE (1948-July 12, 2012) and EMBASE (1974-week 27, 2012) using the search terms pancreatitis, liraglutide, and glucagon-like peptide 1/adverse effects. Reference citations from identified publications were reviewed. The manufacturer was contacted and regulatory documents from the Food and Drug Administration website were reviewed for unpublished data related to cases of pancreatitis associated with liraglutide use. STUDY SELECTION AND DATA EXTRACTION: All identified sources that were published in English were considered for inclusion. DATA SYNTHESIS: Eleven cases of pancreatitis have been reported in patients taking liraglutide. Seven were from the LEAD (Liraglutide Effect and Action in Diabetes) studies, 1 was reported in the extension of a clinical trial, and 1 was in an unpublished obesity trial. Two were published postmarketing case reports. Nine of the cases reported were diagnosed as acute pancreatitis, while 2 were classified as chronic pancreatitis. The mean age of the patients was 57.5 years and mean body mass index was 33.92 kg/m2. Six of the 11 cases occurred in male patients. Nine of the patients were white and 1 was African American. In 7 of the cases, onset occurred at liraglutide doses at or above 1.8 mg daily. Common comorbidities included history of pancreatitis, cholelithiasis, and diabetes. One case was fatal. CONCLUSIONS: Pancreatitis is a potential complication with liraglutide therapy. Liraglutide should be used cautiously in patients at risk of pancreatitis (eg, alcohol abuse, history of pancreatitis, cholelithiasis).

Objective To estimate the pre-eclampsia screening performance of placental growth factor (PlGF) and endoglin with second-trimester Quadruple test markers used for antenatal Down's syndrome screening. Methods A nested case-control study of 88 pregnant women with known early second-trimester Down's syndrome Quadruple test marker levels who subsequently developed pre-eclampsia and 275 unaffected controls. Frozen maternal serum samples were thawed and assayed for PlGF and endoglin. Monte Carlo simulation was used to estimate the pre-eclampsia screening performance of a pre-eclampsia detection algorithm using the Quadruple test markers with or without the addition of PlGF and/or endoglin. Results Median PlGF was 33% lower (95% confidence interval 24–41%) and endoglin 31% (20–43%) higher in pre-eclampsia than in unaffected pregnancies. Adding PlGF to the Quadruple test markers increased the pre-eclampsia detection rate from 34% to 45% at a 5% false-positive rate – it increased it to 43% with endoglin and to 50% with both. The corresponding estimates for early pre-eclampsia (before 36 weeks’ gestation) were a few percentage points higher (48%, 48% and 55% respectively). Including information on parity, pre-eclampsia in a previous pregnancy, family history (woman's mother) and assuming a pre-eclampsia prevalence of 2%, the detection rates for a 5% false-positive rate were 39% with the Quadruple test markers, 48% with addition of endoglin, 49% with addition of PlGF, and 54% with addition of both. Conclusions Adding PlGF to the Quadruple test Down's syndrome screening markers improves pre-eclampsia screening performance. There is a modest extra benefit in also adding the measurement of endoglin.

Brain Bingo is a tutorial activity for helping undergraduate psychology students learn complex physiological terms. In two experiments, the authors tested pretest and posttest knowledge, and in Experiment 2, the authors tested retention after 5 weeks. In Experiment 1 ( n = 41), the experimental group (Brain Bingo) recalled more terms than the control group (standard tutorial activities). In Experiment 2 ( n = 107), control and experimental groups did the Brain Bingo activity, but only the experimental group received feedback during the activity. Both groups recalled more terms at posttest and follow-up than at pretest, and the experimental group outperformed the control group at both time points. Brain Bingo, particularly with feedback, is a useful activity for learning physiological terminology.

Objectives Good interprofessional communication is fundamental to effective teamworking in medicine. Finalmed is a private course that teaches the principles and methods of clinical presenting as an iterative technique of reasoning though clinical data. We have tested the efficacy of this technique using a questionnaire-based study. Design An anonymized 10-point Likert scale questionnaire was designed. Setting Questionnaires were distributed at five UK courses and two UAE courses. Participants Questionnaires were given to all students attending these courses. Main outcome measures The questionnaire included pre- and post-course questions addressing self-reported confidence in clinical presenting (CCP) and effectiveness in clinical presenting (ECP). We also asked whether attendees felt that clinical presenting should be integrated formally into medical school curricula. Results A total of 331/395 questionnaires were returned. Median improvement in CCP was 50% ( P< 0.0001) and in ECP was 40% ( PConclusion Our study suggests that after a two- or three-day dedicated course, both self-reported confidence and effectiveness in clinical presenting significantly improve. Furthermore, students in the UK and the UAE returned a desire for integration into medical school curricula of IPC through the teaching of clinical presenting.

While research on affect in organizations has flourished, affect has tended to be approached in a piecemeal or asymmetrical fashion. Traditionally, researchers have focused on potential benefits of positive affect or potential downsides of negative affect. This paper suggests that both positive and negative affect are functional and adaptive and should be considered in tandem or from a dual-tuning perspective (George & Zhou, 2007). Positive and negative emotions are automatically and adaptively triggered in response to stimuli that have implications for well-being. Evolutionary psychology, the social-functionalist perspective, the nature of organizing, antecedents of emotions, emotional ambivalence, and the positivity offset and negativity bias all suggest that positive and negative emotions should be considered from a dual-tuning perspective. The effects of positive and negative mood on cognitive processes, motivation, and effort support a dual-tuning approach to mood. Implications of a dual-tuning approach for understanding affect in organizations are discussed.

We present four cases with clinical and biochemical hypocalcaemia and evidence supportive of hypoparathyroidism. One case had been previously ascribed a diagnosis of idiopathic hypoparathyroidism. Following the detection of relative hypercalciuria, all cases were found to have autosomal dominant hypocalcaemia with hypercalciuria and mutations of the calcium-sensing receptor gene, of which two were novel. Increased awareness of this condition and access to genotyping enables prompt accurate diagnosis and cascade screening of first-degree relatives.

Extending tokenism theory, the authors investigate psychological climate of gender inequity as a way to understand how token women experience their work environments. In the first study, responses from a sample of 155 women across varied occupations confirm the expectation that token women tend to perceive their organizational climates to be inequitable for women. The results of a second survey of 196 female managers suggest that the subjective processes of tokenism give rise to inequitable climate perceptions. Finally, the responses of 312 women in the construction industry indicate that the climate of gender inequity is related to job attitudes and behaviors.

Theorizing and research in organizational behavior implicitly or explicitly assumes that behavior is the product of conscious will. However, an extensive body of literature suggests that much of human behavior is automatic and that nonconscious thoughts and feelings are primary drivers of reactions and behavior. Relying on propositions in use in job design theory and research as a critical case in point, the author reviews the literatures on automatic thought and nonconscious emotions and their implications. Based on these literatures, the author develops alternative propositions for job design theory and research that are based on more realistic assumptions about the mind and human functioning. In addition to discussing implications of nonconscious processes for job design, the author draws broader implications for the field of organizational behavior.

Interference in immunoassays is a widely recognized problem, which could potentially lead to unnecessary investigations and treatment. We describe a case where interference in a cortisol immunoassay led to a falsely low serum cortisol concentration and interference in the free thyroxine assay led to falsely elevated serum thyroxine concentrations, in the same patient. A 42-year-old woman with documented hypothyroidism underwent a synacthen test for suspected adrenal insufficiency. Previous thyroid function tests had been discordant and difficult to interpret, with elevated thyroxine and non-suppressed thyroid-stimulating hormone. The synacthen test showed a subnormal cortisol response and she was commenced on cortisol replacement. Clinically, it was doubted whether she had true adrenal insufficiency and it was thought that the cortisol results might be artefactually low due to assay interference. Cortisol was measured by an alternative immunoassay, before and after incubation in an antibody blocking tube (‘Scantibodies’), after heat treatment and also after treatment with Protein A. The results supported assay interference and cortisol ‘replacement’ was stopped. Thyroxine had been discontinued although thyroid function tests (TFTs) were significantly different between analytical platforms, also consistent with interference. Thyroxine replacement was restarted and once on a stable dose, the discrepancy in TFTs was also investigated by similar procedures as for cortisol. Good clinician–laboratory interface and laboratory work-up of patients with results that are discordant from the clinical findings can reduce unnecessary investigation and inappropriate treatment.

Abnormalities in the DAX-1 gene (dosage-sensitive sex reversal–adrenal hypoplasia gene on the X chromosome) are a well-recognized cause of congenital adrenal hypoplasia. DAX-1 is expressed in the adrenal cortex, gonads, hypothalamus and anterior pituitary, which gives rise to the clinical features of this deletion. Presentations are varied but salt-wasting and/or hypoglycaemia are the most common in an infant, with late onset of hypogonadotrophic hypogonadism. Over 80 different mutations in this gene have been identified. We present three unrelated cases with variable clinical presentations, all with novel mutations in the DAX-1 gene.

A 20-year-old fit male soldier presented on two separate occasions 16 months apart with severe, symptomatic hyponatraemia and a clinical and biochemical picture consistent with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). In the intervening period, repeated plasma sodium values were in the reference range. Intensive investigation failed to reveal a cause for SIADH that was initially considered idiopathic. The description of a family comprising several adults with intermittent or water load induced-hyponatraemia associated with an activating mutation in the arginine vasopressin (AVP) receptor type 2 (AVPR2) raised the question of whether our patient could have a similar ‘nephrogenic syndrome of inappropriate antidiuresis’. Mutational screening of AVPR2 in our patient revealed a single missense mutation (R137C) in the second intracellular loop, which has been associated with constitutive activation of the AVPR2. In conclusion, adults with intermittent, severe hyponatraemia may have a constitutively activating mutation in the AVPR2 with resultant nephrogenic syndrome of inappropriate antidiuresis. Patients with idiopathic SIADH, particularly those with unmeasurable circulating AVP concentrations, should be considered for mutational screening of AVPR2.

A numerical modelling technique for predicting the detailed performance of a double-inlet type two-stage pulse tube refrigerator has been developed. The pressure variations in the compressor, pulse tube, and reservoir were derived, assuming the stroke volume variation of the compressor to be sinusoidal. The relationships of mass flowrates, volume flowrates, and temperature as a function of time and position were developed. The predicted refrigeration powers are calculated by considering the effect of void volumes and the phase shift between pressure and mass flowrate. These results are compared with the experimental results of a specific pulse tube refrigerator configuration and an existing theoretical model. The analysis shows that the theoretical predictions are in good agreement with each other.

Motivational interviewing (MI) with personalized feedback, particularly related to biological markers of risk or harm, has been found effective for alcohol use disorders, but has not been fully investigated in cocaine use disorders. A randomized, controlled pilot study evaluating the feasibility and preliminary efficacy of a brief MI intervention using EEG/ERP graphical feedback for cocaine abusers was conducted. Treatment-seeking cocaine abusers (N = 31) were randomly assigned to a two-session MI intervention or a minimal control condition. All participants received EEG assessments at intake and post-treatment. Results indicated that the MI intervention was feasible and the subjective impact of the EEG feedback was positive. Significant group differences in percentage of cocaine positive urine screens across the study were found, favoring the MI group; 84.9% for the control group and 62.6% in the MI group, p.05. Further research must determine the specific conditions under which MI is most appropriate and efficacious.

Background: The recommended spectrophotometric scanning for diagnosis of subarachnoid haemorrhage (SAH) is relatively expensive, not fully automated and often requires expert interpretation. Analysis of cerebrospinal fluid (CSF) bilirubin offers an alternative approach and may obviate the need for scanning and, hence, we undertook a prospective validation study. Methods: CSF bilirubin and spectrophotometric scans were compared from 193 patients in our institution over a two-year period and for this 162 clinical records (83.9%) were reviewed. CSF bilirubin was tested for its ability to predict elevated net bilirubin absorbance by spectrophotometry. Final outcomes were obtained by review of clinical records and contacting the New Zealand Health Information Service. Results: From receiver operating characteristic curve analysis, there was an area under the curve of 0.99 (95% confidence interval: 0.97-1.00). At a cut-off of 359 nmol/L, corresponding to our upper reference interval, CSF bilirubin assay had a sensitivity of 100%, a specificity of 92.2% and a negative predictive value of 100%. There were no outcomes to suggest that SAH had been missed in any case. Conclusion: CSF bilirubin is a robust screening test that accurately identifies those samples needing to be scanned and eliminates the need for this to be done in most others.

Objective To validate empirically the accuracy of antenatal Down's syndrome screening using the Integrated test, to compare this with other screening tests (including the Integrated test with the addition of cross trimester [CT] marker ratios) and to suggest how such validation analyses should be presented and interpreted. Methods Using data from 7809 unaffected and 27 Down's syndrome pregnancies that had had an Integrated test, risk estimates for various screening tests (maternal age, Double, Triple, Quadruple, Combined, Integrated and serum Integrated tests) that use Integrated test markers were categorized according to quintile categories of risk estimates of the 27 affected pregnancies. For each screening test, the median risk estimate for each category was plotted against the observed prevalence within each category. Such validation plots were also produced for the Integrated test with CT marker ratios by measuring the level of the serum markers in the trimester of pregnancy not already measured in stored samples of all affected and a one-in-five sample of unaffected pregnancies. The robustness of the method was assessed by repeating the analysis for the Integrated test after re-classifying affected pregnancies with low risk estimates as unaffected, simulating the underascertainment of cases. Results The validation plots (i) confirmed the accuracy of risk estimation for the different tests (by how close the points lay to the line of identity between predicted risk and observed prevalence), (ii) demonstrated the differences in screening performance of the different tests (by the range of risk spanned by the points and, in particular, the separation between the points representing the lowest risk and the next point), and (iii) are robust to underascertainment of affected pregnancies (by having little influence on the closeness of the points to the line of identity). Conclusion The validation plot is a useful, simple and robust way to assess the validity of new screening methods, to assess the accuracy of risk estimation and to audit the performance of screening programmes.

Background: Neuroblastoma patients may be classified as normal or abnormal depending on reference interval and decision points for urine catecholamine metabolites. We therefore evaluated the utility of positive likelihood ratios (LR+) based on data from patients in whom the diagnosis was suspected. Methods: Urine samples from 249 patients (122 male, 127 female) suspected of neuroblastoma were assayed for VMA by spectrophotometry and dopamine by HPLC. Ratios of VMA to creatinine (VMA/Cr) and dopamine to creatinine (DA/Cr) were calculated and age-related median scores derived relative to patients without neuroblastoma. Receiver operator characteristic (ROC) curve analysis was undertaken for the ability of median scores to identify neuroblastoma. Results: Of the 249 patients, there were 20 confirmed cases of neuroblastoma, with ages ranging from 0 (congenital tumour) to 8.4 years. From ROC curves, VMA/Cr was found to have an area under the curve 0.96 (95% confidence interval [CI] 0.92-0.98) compared with 0.72 (95% CI 0.66-0.77) for DA/Cr, P=0.001. At the optimal decision point for VMA/Cr, LR+ was 7.2, identifying cases with a sensitivity of 95% and a specificity of 86%, and comparing favourably with published intervals. Conclusions: VMA/Cr is more accurate than DA/Cr for the diagnosis of neuroblastoma. Reporting LR+ may also be more informative than using reference intervals and decision points.

This study focuses on how employees cope with dueling social identities when one is of relatively low status compared to the other by studying local senior executives in mulinational corporations’ (MNC’s) subsidiaries who can identify with the local staff and/or headquarters’ management. As hypothesized, perceptions of local staff incompetence are positively related to executives’ turnover intentions. This relationship becomes weaker if they have high-quality communication with, or high levels of trust in, headquarters’ management. Results suggest that employees disidentify with a stigmatized identity group by intending to quit; however, identification with a higher status alternative identity group can mitigate this effect.

Hepatocytes in adults are in a nonproliferative state but they have high capacity to regenerate within few hours after an Injury. After partial hepatectomy or chemical injury, hepatocytes undergo a synchronized multistep process consisting of prlming/initiation, proliferation, and termination. These distinct steps are essential for restoring the structure and functions of liver. The mechanisms involved in each of these steps of regeneration are well documented from various laboratories and are described in several reviews. We briefly describe these steps and the Involvement of various cytokines and growth factors for cell regeneration in this short review. Liver cell regeneration may also involve stem cell proliferation. The regenerating cells require large amounts of zinc within a short time, and this requirement is met by induction of a zinc and copper binding protein, metallothionein (MT), during the priming step, soon after an injury. There are several reports on the transfer of zinc from MT to various metalloenzymes and transcription factors. Genetically modified mouse models have been used to study the Involvement of interleukin (IL)-6 and tumor necrosis factor (TNF)-α in cell regeneration. The use of an MT-knockout mouse has enabled us to Investigate the specific role of MT in liver regeneration after partial hepatectomy, chemical injury, and fibrosis. Several studies have suggested a defective liver regeneration after an Injury in MT-knockout mice. There is cumulative evidence that indicates an essential role for MT in liver cell regeneration.

In this carbonyl sulfide (COS) study, magnetic resonance microscopy (MRM) and detailed light microscopic evaluation effectively functioned in parallel to assure that the distribution and degree of pathology in the brain was accurately represented. MRM is a powerful imaging modality that allows for excellent identification of neuroanatomical structures coupled with the ability to acquire 200 or more cross-sectional images of the brain, and the ability to display them in multiple planes. F344 rats were exposed to 200—600 ppm COS for up to 12 weeks. Prior to MRM, rats were anesthetized and cardiac perfused with McDowell Trump's fixative containing a gadolinium MR contrast medium. Fixed specimens were scanned at the Duke Center for In Vivo Microscopy on a 9.4 Tesla magnetic resonance system adapted explicitly for microscopic imaging. An advantage of MRM in this study was the ability to identify lesions in rats that appeared clinically normal prior to sacrifice and the opportunity to identify lesions in areas of the brain which would not be included in conventional studies. Other advantages include the ability to examine the brain in multiple planes (transverse, dorsal, sagittal) and obtain and save the MRM images in a digital format that allows for postexperimental data processing and manipulation. MRM images were correlated with neuroanatomical and neuropathological findings. All suspected MRM images were compared to corresponding H&E slides. An important aspect of this study was that MRM was critical in defining our strategy for sectioning the brain, and for designing mechanistic studies (cytochrome oxidase evaluations) and functional assessments (electrophysiology studies) on specifically targeted anatomical sites following COS exposure.

Are schoolchildren able to follow what civics textbooks try to teach? This field study in Madhya Pradesh examined what they understood of three basic themes in civics—the formation of an elected government, its functions and its major institutions. Contrasting images gained from the social world with the images presented in textbooks, the study indicates serious problems with the conventional way of teaching civics and our expectations of what children learn. A major part of the problem lies in the way we conceptualise civics education itself. Selecting a constitutional framework and packing it with lists of rules and regulations makes in incomprehensible. Besides, its sterile, non-controversial nature makes it so remote from children's lives that they are unable to relate to what is being taught.

This article analyses the way the individual change process unfolds when major; second-order changes are required. Using a framework that integrates both the cognitive and affective components of individual sensemaking and interpretation, we develop a process model that systematically analyses the psychology of the individual change process, and, in particular, the sources of resistance to change or inertia. A series of steps in the change process are identified if second-order change is to come about, and a series of testable propositions about the forces that may facilitate or stymie change are developed.

This paper suggests that feelings (moods and emotions) play a central role in the leadership process. More specifically, it is proposed that emotional intelligence, the ability to understand and manage moods and emotions in the self and others, contributes to effective leadership in organizations. Four major aspects of emotional intelligence, the appraisal and expression of emotion, the use of emotion to enhance cognitive processes and decision making, knowledge about emotions, and management of emotions, are described. Then, I propose how emotional intelligence contributes to effective leadership by focusing on five essential elements of leader effectiveness: development of collective goals and objectives; instilling in others an appreciation of the importance of work activities; generating and maintaining enthusiasm, confidence, optimism, cooperation, and trust; encouraging flexibility in decision making and change; and establishing and maintaining a meaningful identity for an organization.

Although time has been included in theory and theory building as a boundary condition, this paper argues that time can and should play a more important role because it can change the ontological description and meaning of a theoretical construct and of the relationships between constructs. We suggest that theorists explicitly incorporate multiple aspects of temporality into the “what, how, and why” building blocks of their theories. First, we describe six important time dimensions that we propose are especially relevant to theory building about people, groups, and organizations: the past, future, and present and the subjective experience of time; time aggregations; duration of steady states and rates of change; incremental versus discontinuous change; frequency, rhythms, and cycles; and spirals and intensity. Second, we put forward a series of time-related questions that can serve as a guide or template for improving theory building through the incorporation of temporality into the what, how, and why of theories. Third, we propose how temporality can be incorporated into theorizing, viewed from a process standpoint. Lastly, we demonstrate how the explicit incorporation of time into theoretical analyses may not only lead to better theorizing and theories but also shed light on ongoing debates in the organizational literature.

Quartz stones are often considered to be of non-human origin or factitious, although in some cases, they may have a biological aetiology. X-ray diffraction (XRD) spectroscopy was used to analyse fragmented renal stones from a 61-year-old lady who presented with bilateral nephrocalcinosis. Analysis of the calculi from the left kidney showed a mixed composition: 50% calcium oxalate monohydrate and 50% quartz. This case highlights the usefulness of XRD in the differentiation of authentic from possibly factitious renal calculi.

Clinical staff perfusionists are responsible for training perfusion students to perform tasks and manage patients in the clinical setting. They are often the least prepared to assume this teaching role. To address this need, a modular programme has been developed to provide the teaching staff with instructional skills. Adult learning theory specifies that an effective learning environment addresses issues of saliency, motivation, retention and transfer. Adults have different expectations, so this programme is designed to maximize this process. The programme is comprehensive and may be used for didactic instruction as well. Derived from a model designed for physicians as teachers, five modules provide theoretical support for teaching techniques, learning tools and management techniques for giving feedback and evaluating performance. Specifically, the topics address the following subjects: managing and motivating learners; teaching medical problem solving; teaching clinical skills; giving feedback and evaluating performance. The short curriculum is based on teaching principles that apply to adult learners with diverse learning styles. While presenting techniques to use with different types of learners, the programme itself incorporates these techniques in teaching the teachers. The modules use lectures, demonstrations, role playing and video taping to challenge teachers and learners in the cognitive, psychomotor and affective domains. The success of this programme is its ability to engage each participant in the learning process.

The porphyrias are a group of inborn or acquired disorders of haem synthesis that can result in neurovisceral or dermatological symptoms. Diagnosis is usually made using a combination of clinical presentation and biochemical parameters. This case report describes a 25-year-old woman clinically presenting with a rash and then found to have elevated porphobilinogen concentrations in her urine. The initial presumptive diagnosis of variegate porphyria was not supported by analysis of her plasma, urine and faeces, which suggested a combination of acute intermittent porphyria and porphyria cutanea tarda. Sequencing of the hydroxymethylbilane synthase and uroporphyrinogen decarboxylase genes confirmed the relatively rare diagnosis of dual porphyria, and revealed a novel uroporphyrinogen decarboxylase mutation.

This paper describes a model (the VAM model) which integrates three of the most significant dimensions of the work experience, work values, attitudes, and moods, into one overarching framework. The VAM model proposes that a rich and more complete understanding of the experience of work necessitates the simultaneous consideration of work values, attitudes, and moods. After describing how work values, attitudes, and moods, each capture key aspects of experiencing work, we discuss three important dimensions along which they vary: time, dynamism, and focus. These dimensions underscore the need for the simultaneous consideration of values, attitudes, and moods for a fuller understanding of the work experience. We then describe how work values, attitudes, and moods have the potential to influence each other. Finally, we discuss the implications of the VAM model for understanding important organizational outcomes including extra-role behavior, job performance, social loafing, absenteeism, and turnover.

This article is a selective review of important issues, themes, and topics regarding the effects of personality on organizational behavior. Recent literature on the impact of personality on job attitudes and affective states at work is reviewed. Two traits, positive affectivity and negative affectivity, are presented as the key dispositional determinants of affective reactions at work. Criticisms of the dispositional approach are addressed and the integrative perspective of interactional psychology is discussed. The distinction between traits and states is explained and it is shown how states mediate the effects of traits on behavior with states essentially capturing the person-situation interaction. Theorizing and research on person-environment fit, a complementary perspective on person-situation interactions, is discussed, followed by a discussion of the links between personality and three organizationallyrelevant outcomes: prosocial behavior, effort and performance, and leadership. Finally, the links between two personality traits, negative affectivity and the Type A behavior pattern, and work-related distress are elucidated.

A recent study from our laboratory has shown that cadmium, a toxic heavy metal, is one of the most effective agents known for inducing hepatocytic transdifferentiation of the rat pancreas. With repeated injections of cadmium, the incidence of rats with pancreatic hepatocytic foci can be as high as 93%. Cadmium is also well known as a very potent inducer of metallothionein, a metal-binding protein that appears to be important in the biologic response to several toxic heavy metals in most tissues, including the pancreas. Therefore, the present study sought to determine if metallothionein was associated with cadmium-induced transdifferentiation of pancreatic cells. Expression of metallothionein was studied immunohistochemically by the peroxidase-antiperoxidase method in tissue sections of the pancreas of rats with pancreatic hepatocytes. High levels of metallothionein were localized primarily within the pancreatic hepatocytes. Surrounding normal pancreatic islet and acinar cells were not immunoreactive. Thus, metallothionein is expressed actively in cells transdifferentiated to hepatocytes by cadmium within the pancreas.

Objective: To report a case of warfarin-cranberry juice interaction, which resulted in an international normalized ratio (INR) elevation on 2 separate occasions. Case Summary: A 46-year-old female was receiving a total weekly dose of 56 mg of warfarin. During the 4 months prior to the incident INR. her average INR was 2.0. with a range of 1.6-2.2, while taking the same weekly dose of warfarin. Her INR increased to 4.6 after drinking approximately 1.5 quarts (1420 mL) of cranberry juice cocktail daily for 2 days. Her INR 14 days later without cranberry juice cocktail consumption was 2.3. For the next 3 months, while taking warfarin 56 mg per week, her average INR was 2.1, with a range of 1.4-2.5. At a subsequent visit, after drinking approximately 2 quarts (1S93 mL) of cranberry juice cocktail daily for 3-4 days, her INR had increased to 6.5. Her INR after holding warfarin for 3 days was 1.86. Her INR 7 days after resuming the weekly dose of warfarin 56 mg was 3.2. During both of the elevated INR episodes, no other factors were identified that would have resulted in an elevated INR, such as drug, herbal, disease, or other food interactions. An objective causality assessment revealed the interaction was highly probable. Discussion: Warfarin is the most commonly used anticoagulant for chronic therapy. There have been several case reports of cranberry juice or cranberry sauce potentiating the effects of warfarin by elevating the INR; however, clinical trials evaluating this interaction have failed to demonstrate a significant effect on an INR. Conclusions: Our case report describes INR elevations in a patient previously stable on warfarin after ingestion of cranberry juice cocktail daily for several days. This elevation occurred on 2 separate occasions, which distinguishes our case from other published literature.