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This study is an analysis of the 100 most cited articles in mitral valve surgery. A bibliometric analysis is a tool to evaluate research performance in a given field. It uses the number of times a publication is cited by others as a proxy marker of its impact. The most cited paper Carpentier et al. discusses mitral valve repair in terms of restoring the geometry of the entire valve rather than simply narrowing the annulus (Carpentier, J Thorac Cardiovasc Surg 86:23–37, 1983). The first successful mitral valve repair was performed by Elliot Cutler at Brigham and Women’s Hospital in 1923 (Cohn et al., Ann Cardiothorac Surg 4:315, 2015). More recently percutaneous and minimally invasive techniques that were originally designed as an option for high risk patients are being trialled in other patient groups (Hajar, Heart Views 19:160–3, 2018). Comparison of percutaneous method with open repair represents an expanding area of research (Hajar, Heart Views 19:160–3, 2018). This study will analyse the top 100 cited papers relevant to mitral valve surgery, identifying the most influential papers that guide current management, the institutions that produce them and the authors involved.

Introduction Abdominal aortic aneurysm (AAA) repair may be performed through open or endovascular approaches, but the factors influencing a patient's repair-type preference are not well characterized. Here we performed a qualitative analysis to better understand factors influencing patient preference within the Preference for Open Versus Endovascular Repair of AAA Trial. Methods Open-ended responses regarding primary (n = 21) and secondary (n = 47) factors influencing patient preference underwent qualitative analysis using the constant comparative method with iterative reviews. Codes were used to generate themes and themes grouped into categories, with each step conducted via consensus agreement between three researchers. Relative prevalence of themes were compared to ascertain trends in patient preference. Results Patient responses regarding both primary and secondary factors fell into four categories: Short-term concerns, long-term concerns, advice & experience, and other. Patients most frequently described short-term concerns (23) as their primary influence, with themes including post-op complications, hospitalization & recovery, and intraoperative concerns. Long-term concerns were more prevalent (20) as secondary factors, which included themes such as survival, and chronic management. The average age of patients voicing only long-term concerns as a primary factor was 11 years younger than those listing only short-term concerns. Conclusion Short-term concerns relating to the procedure and recovery are more often the primary factor influencing patient preference, while long term concerns play a more secondary role. Long-term concerns are more often a primary factor in younger patients. Vascular surgeons should consider this information in shared decision making to reach an optimal outcome.

Recent guidelines concerning exercise for people with cancer provide evidence-based direction for exercise assessment and prescription for clinicians and their patients. Although the guidelines promote exercise integration into clinical care for people with cancer, they do not support strategies for bridging the guidelines with related resources or programs. Exercise program accessibility remains a challenge in implementing the guidelines, but that challenge might be mitigated with conceptual frameworks (&ldquo, pathways&rdquo, ) that connect patients with exercise-related resources. In the present paper, we describe a pathway model and related resources that were developed by an expert panel of practitioners and researchers in the field of exercise and rehabilitation in oncology and that support the transition from health care practitioner to exercise programs or services for people with cancer. The model acknowledges the nuanced distinctions between research and exercise programming, as well as physical activity promotion, that, depending on the available programming in the local community or region, might influence practitioner use. Furthermore, the pathway identifies and provides examples of processes for referral, screening, medical clearance, and programming for people after a cancer diagnosis. The pathway supports the implementation of exercise guidelines and should serve as a model of enhanced care delivery to increase the health and well-being of people with cancer.

Few breast cancer survivors (BCS) engage in sufficient physical activity (PA) to gain physical and mental health benefits. This may be due to a lack of appropriate PA information and support. While key messengers of PA information could be oncology clinicians, many do not consistently counsel their patients on PA. To examine factors affecting PA counseling in clinicians and inform future strategies. Focus groups were conducted with clinicians (N = 27) at four cancer hospitals to better understand factors that affect PA counseling. Focus group discussions were transcribed verbatim and analyzed using inductive thematic analysis. Clinicians perceived a lack of training and knowledge related to PA and BCS. Clinicians also discussed being unsure of when to integrate PA counseling into different phases of survivorship. Similarly, clinicians experienced barriers from hospital administration to maintain patient flow in-clinic, which decreased opportunities for PA counseling. Additionally, lack of awareness of community-based programs within large areas served by hospitals also decreased clinicians’ self-efficacy for counseling. In order to facilitate PA counseling, clinicians wanted resources that promote patient-managed PA, available on multiple platforms (e.g., printed and online). Continued education, highlighting recent research and effective implementation of PA, was noted as an important facilitator. Researchers are encouraged to develop research agendas and test educational strategies that are integrated into current practice, empirically test barriers that developed from this study with a larger, representative sample to determine salient barriers and develop PA counseling strategies that are clinician-initiated but not dependent on clinicians.

To evaluate the ability of a multimodal patient education initiative to improve adherence to healthy bone behaviors (HBBs) in men with prostate cancer receiving androgen deprivation therapy (ADT). This was a pilot prospective, single-site, before-and-after clinical trial. The control arm (n = 51) received routine care. The intervention arm (n = 52) received multimodal HBB education which included a healthy bones prescription (BoneRx), focused face-to-face education with an oncology nurse or physician, and customized educational materials. The primary endpoints were feasibility of study methods and self-reported adherence to HBBs (vitamin D intake ≥ 1000 IU/day, calcium intake 1000–1500 mg/day, and exercise ≥ 150 min/week) at 3-month follow-up. Secondary endpoints included receipt of bone mineral density (BMD) testing. Patients were satisfied with the study intervention, found educational materials easy to understand, and felt that it increased their knowledge about osteoporosis. Although the intervention appeared to be associated with trends toward improved levels of vitamin D intake (adjusted odds ratio [OR] 1.8, 95% confidence interval [CI] 0.74–4.5), calcium intake (OR 1.5, 95% CI 0.63–3.4), and exercise (OR 1.7, 0.75–3.9) as compared to the control arm, none of these were statistically significant. Patients who received the study intervention were more likely to receive BMD testing (OR 3.3, 95% CI 1.3–8.8). Although a brief, tailored educational intervention was feasible to implement and improve BMD test utilization, it did not increase HBB participation. Larger, well-designed trials are needed to clarify the effect of patient education interventions on HBB adherence. ClinicalTrials.gov ( NCT01973673 )

The COVID-19 pandemic has highlighted the need for generic reagents and flexible systems in diagnostic testing. Magnetic bead-based nucleic acid extraction protocols using 96-well plates on open liquid handlers are readily amenable to meet this need. Here, one such approach is rigorously optimized to minimize cross-well contamination while maintaining sensitivity.Article SummaryA scalable, non-proprietary, magnetic bead-based automated nucleic acid extraction protocol optimised for minimum cross-well contamination

The development of a portable strontium lattice clock is discussed. Solutions to many of the engineering challenges required to build the next generation of portable and ultraprecise clocks will be presented. In particular, a) the realisation of a compact laser module which produces multiple stable laser frequencies required for the experiment and b) the progress made in the development of the atomics module.

Atomic clocks have been in common use since the 1950s and over this period the clock community has had two main goals: increasing the performance of the clocks and increasing their portability. At Birmingham we aim to compress a strontium optical lattice clock, a clock with an extremely high accuracy, into a portable package. Many novel approaches need to be employed to allow such a clock to operate with a favorable SWaP while maintaining the low instability and uncertainty that makes optical clocks a desirable frequency standard. The focus of this work is to use laser activation of a strontium compound as the atomic source for the clock. Previously work published by this group [1] demonstrated that it is possible to release the strontium atoms from strontium oxide successfully load a magneto-optical trap (MOT).

Sequencing technology is increasingly essential in clinical cancer management. The majority of clinical cancer sequencing has focused on panel approaches, but recent trials have begun to report the use of transcriptome expression profiling to match patients to therapy. The Personalized OncoGenomics (POG) program at BC Cancer has sequenced over 500 patient tumors, integrating both whole genome and transcriptome data to inform treatment options for patients with advanced or metastatic disease. Here we present 570 patients who were sequenced from 2012 to 2017 and reviewed at the POG multidisciplinary molecular tumor board. Genome and transcriptome information identified clinically actionable targets in 83% (475/570) of sequenced cases, with 37% (209/570) receiving POG-informed therapy. Overall, 248 whole genome and transcriptome sequencing analysis (WGTA)-informed treatments were administered, with some patients receiving multiple treatment courses. Of the treated cases, 46% (114/248) were reported to have physician-assessed clinical benefit. Clinical benefit was assessed as per standard of care rather than strict timing as per RECIST criteria. Mutation, copy number, structural variant, expression, and genome signature data were all used individually or in combination to inform treatments. Treatments based in whole or in part from RNA expression data were the largest subgroup (66.9%, 166/248), and patients in this group had similar proportion of clinical benefit compared to those receiving treatments informed by DNA-based data. Importantly, the use of RNA data resulted in 14.5% (36/248) additional patients receiving WGTA-informed treatments with clinical benefit. Patients were directed to clinical trials, treated with therapeutics in off-label indications, or positioned to genomically-informed standard of care options. For a subset of 42 cases where the planned next line of therapy was documented prior to WGTA analysis, 76.2% (32/42) of genomically-informed standard therapies were different from those which would otherwise have been considered the next line of therapy by the treating clinician, or aided in a decision between multiple different therapy options under consideration. These results emphasize the importance of multiple data types, including expression information, to personalize treatment. We also observe that, in addition to positioning for trials or identifying cases for off-label treatment, choice of standard of care therapies is an important use of genomic data. Overall, our data supports the integration of whole genome and RNA sequencing data in the clinic, with implications both for cancer research and treatment, and ultimately the potential to improve cancer outcomes. Citation Format: Alexandra K. Bohm, Erin Pleasance, Emma Tittmus, Kathleen Wee, Gregory Taylor, Melika Bonakdar, Yaoqing Shen, Laura Williamson, Veronika Csizmok, Martin Jones, Jessica Nelson, Balvir Deol, Caralyn Reisle, Karen Mungall, Eric Chuah, Andrew Mungall, Richard Moore, Sophie Sun, Howard Lim, Daniel Renouf, Steven Jones, Marco Marra, Janessa Laskin. Personalized therapy choice integrating genome and expression data in advanced cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 98.

We present research on the development of diode-pumped solid-state lasers suitable for quantum technologies applications at 698.45 nm and 780.24 nm targeting strontium (Sr) and rubidium (Rb) transitions.

We report on progress in the development of subsystem-level devices which serve as building blocks for the next generation of portable atomic clocks. Specifically, we discuss the engineering of small, low-power, low-temperature strontium vapour dispensers and a compact optical resonator useful for the stabilisation of multiple lasers.

Purpose: Continued smoking after a cancer diagnosis leads to poorer treatment outcomes, survival, and quality of life. We evaluated the perceptions of the effects of continued smoking on quality of life, survival, and fatigue among patients with cancer after a cancer diagnosis and the effects of these perceptions on smoking cessation. Patients and Methods: Patients with cancer from all disease subsites from Princess Margaret Cancer Centre (Toronto, Ontario) were surveyed between April 2014 and May 2016 for sociodemographic variables, smoking history, and perceptions of continued smoking on quality of life, survival, and fatigue. Multivariable regression models evaluated the association between patients’ perceptions and smoking cessation and the factors influencing patients’ perceptions of smoking. Results: Among 1,121 patients, 277 (23%) were smoking cigarettes up to 1 year before diagnosis, and 54% subsequently quit; 23% had lung cancer, and 27% had head and neck cancers. The majority felt that continued smoking after a cancer diagnosis negatively affected quality of life (83%), survival (86%), and fatigue (82%). Current smokers during the peridiagnosis period were less likely to perceive that continued smoking was harmful when compared with ex-smokers and never-smokers ( P < .01). Among current smokers, perceiving that smoking negatively affected quality of life (adjusted odds ratio [aOR], 2.68 [95% CI, 1.26 to 5.72]; P = .011), survival (aOR, 5.00 [95% CI, 2.19 to 11.43]; P < .001), and fatigue (aOR, 3.57 [95% CI, 1.69 to 7.54]; P < .001) were each strongly associated with smoking cessation. Among all patients, those with a greater smoking history were less likely to believe that smoking was harmful in terms of quality of life (aOR, 0.98 [95% CI, 0.98 to 0.99]; P < .001), survival (aOR, 0.98 [95% CI, 0.98 to 0.99]; P < .001), and fatigue (aOR, 0.99 [95% CI, 0.98 to 0.99]; P < .001). Conclusion: The perceptions of continued smoking after a cancer diagnosis among patients with cancer are strongly associated with smoking cessation. Counseling about the harms of continued smoking in patients with cancer, and in particular among those who have lower risk perceptions, should be considered when developing a smoking cessation program.

Introduction Low-risk papillary thyroid cancer (PTC) is increasingly being diagnosed throughout the world; yet the mortality risk is low compared with other malignancies. Traditional management includes thyroid surgery, sometimes followed by radioactive iodine and thyroid hormone treatment. Active surveillance (AS) has been proposed as a means to reduce overtreatment of PTC. AS involves close disease follow-up, with the intention to intervene if the disease progresses, or on patient request. Methods and analysis This is a multiphase prospective observational study. In the first phase of this study, consenting eligible adults with low-risk PTC, that is

Measuring the linewidth of single-frequency lasers is challenging, and great care must be taken to understand the capabilities and limitations of different measurement techniques to obtain consistent results. A detailed comparative study will be presented.

Recent research on nutrition and health is discussed, including the impact of folate intake during pregnancy on the incidence of autism, developmental delays in children, and typical child development. Recent studies are also providing insight into the health benefits of rice products, their arsenic content, and their impact on chronic diseases. Two European reports indicate higher dietary fiber intakes are associated with lower overall and specific disease mortality. The results support recommendations for high dietary fiber intake for health maintenance. Another study focused on death from ischemic heart disease (IHD), finding an association between increased dietary fiber intake and decreased risk of IHD. Recent studies also have shown that gluten and its resulting peptides can be degraded by prolyl endopeptidases. Thus, gluten-containing materials could potentially be rendered less problematic for most celiac patients through the use of these enzymes in the production of foods intended for this popula...

Adherence to a gluten-free diet is necessary for people with celiac disease and with other gluten-intolerance conditions. This article lists common foods and ingredients that do or do not contain gluten. In addition, recipes and practical hints for gluten-free baking are provided, plus recommendations of flour substitutes in place of normal wheat flour.

BXSB mice, a murine model of systemic lupus erythematosus (SLE), were treated with two different doses of fludarabine for a four-week period and examined two weeks after the final dose. Control mice were treated with saline or cyclophosphamide. Mice treated with fludarabine had a significant reduction in renal pathology compared to control mice. Fludarabine-treated mice also had an almost 10-fold increase in percentile of CD8+CD25+ T cells in the spleen and a smaller but significant increase in CD4+CD25+ cells. Mice treated with cyclophosphamide had a greater leucopenia compared to the other groups and a significant reduction in percentile of B220+ cells in peripheral blood and spleen. Serum autoantibody levels to dsDNA did not differ significantly among the groups, but were higher in 4/10 mice treated with fludarabine. Although few trials of fludarabine for human SLE have been conducted, additional studies may be warranted.

Background: Although physical activity has been shown to contribute to long-term disease control and health in breast cancer survivors, a majority of breast cancer survivors do not meet physical activity guidelines. Past research has focused on promoting physical activity components for short-term breast cancer survivor benefits, but insufficient attention has been devoted to long-term outcomes and sustained exercise adherence. We are assessing a health coach intervention (iMOVE) that uses mobile technology to increase and sustain physical activity maintenance in initially inactive breast cancer survivors. Objective: This pilot randomized controlled trial (RCT) is an initial step in evaluating the iMOVE intervention and will inform development of a full-scale pragmatic RCT. Methods: We will enroll 107 physically inactive breast cancer survivors and randomly assign them to intervention or control groups at the University Health Network, a tertiary cancer care center in Toronto, Canada. Participants will be women (age 18 to 74 years) stratified by age (55 years and older/younger than 55 years) and adjuvant hormone therapy (AHT) exposure (AHT vs no AHT) following breast cancer treatment with no metastases or recurrence who report less than 60 minutes of preplanned physical activity per week. Both intervention and control groups receive the 12-week physical activity program with weekly group sessions and an individualized, progressive, home-based exercise program. The intervention group will additionally receive (1) 10 telephone-based health coaching sessions, (2) smartphone with data plan, if needed, (3) supportive health tracking software (Connected Wellness, NexJ Health Inc), and (4) a wearable step-counting device linked to a smartphone program. Results: We will be assessing recruitment rates; acceptability reflected in selective, semistructured interviews; and enrollment, retention, and adherence quantitative intervention markers as pilot outcome measures. The primary clinical outcome will be directly measured peak oxygen consumption. Secondary clinical outcomes include health-related quality of life and anthropometric measures. All outcome measures are administered at baseline, after exercise program (month 3), and 6 months after program (month 9). Conclusions: This pilot RCT will inform full-scale RCT planning. We will assess pilot procedures and interventions and collect preliminary effect estimates. Clinical Trial: ClinicalTrials.gov NCT02620735; https://clinicaltrials.gov/ct2/show/NCT02620735 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT02620735) [JMIR Res Protoc 2017;6(8):e165]

Singly ionized ytterbium, with ultranarrow optical clock transitions at 467 and 436 nm, is a convenient system for the realization of optical atomic clocks and tests of present-day variation of fundamental constants. We present the first direct measurement of the frequency ratio of these two clock transitions, without reference to a cesium primary standard, and using the same single ion of 171Yb+. The absolute frequencies of both transitions are also presented, each with a relative standard uncertainty of 6 × 10 -16. Combining our results with those from other experiments, we report a threefold improvement in the constraint on the time variation of the proton-to-electron mass ratio, mu-dot/mu = 0.2(1.1) × 10-16 yr-1, along with an improved constraint on time variation of the fine structure constant, alpha-dot/alpha = -0.7(2.1) x 10-17 yr-1.

Background: People with learning difficulties are nutritionally vulnerable for many reasons. There is a need for a nutrition screening tool (NST) to enable carers to identify those at nutritional risk. However, a validated NST for clients with learning difficulties does not exist.Aim: To assess the reliability and validity of a NST being used in a long-stay hospital in North Staffordshire for people with learning difficulties. The NST investigates three areas of risk: nutritional adequacy (food groups), weight and nutrition-related problems such as dysphagia or gastrointestinal disorders.Method: Thirty-six subjects were randomly selected. The reliability of the NST was assessed by three nurses familiar with the participants. Each subject was independently screened using the NST. Validity was assessed by forming an expert panel of three dietitians. Each participant's nutritional status for each of the three risk areas was assessed independently by the dietitians using their own methods. A comparison of the majority opinion of the dietitians with that of the nurses gave an indication of validity.Results: Reliability was analysed using variance component models and indices of agreement. There was good agreement between nurses in the assessment of risk relating to nutrition adequacy (r=0.658), moderate agreement in the assessment of nutrition-related problems (r=0.576), but only fair agreement in the assessment of weight-related risk (r=0.263). Validity was assessed using Cohen's kappa statistic. There was good agreement between the majority opinions of the nurses and dietitians for the assessment of nutritional adequacy-related risk (r=0.708) and for nutrition-related problems (r=0.691), but only fair agreement for weight (r=0.300).Conclusion: Use of the NST in the area of nutrition adequacy gave good repeatability and validity.Similarly, there was good validity in the area of nutrition-related problems. The NST was not satisfactory in assessing weight-related risk and further work is needed in this risk area. There was also a suggestion from the results of the study that the dietitians differed in their approach to assessing nutritional risk.

In the fall of 1997, the US Food and Drug Administration (FDA) proposed to add onto the existing 1994 regulations dealing with the “pediatric use” subsection of prescription drug labels. These new regulations were titled Docket No. 97N-0165 “Regulations Requiring Manufacturers to Assess the Safety and Effectiveness of New Drugs and Biological Products in Pediatric Patients”1. These new rules will require pharmaceutical companies to collect data for those drugs whose indications may be applicable to usage in children before the compound will be approved (or soon thereafter). In some cases, manufacturers will also have to provide this information (within a length of time determined by both the FDA and the manufacturer) for drugs already marketed. It is proposed that, by including safety and effectiveness information on the label, the pediatric population will be less likely to have serious adverse events or subtherapeutic treatments. This article will cover in detail the 1997 proposed regulations an...

Introduction Anatomic injury, physiological derangement, age, and injury mechanism are well-founded predictors of trauma outcome. We aimed to develop and validate the first Scandinavian survival prediction model for trauma. Methods Eligible were patients admitted to Oslo University Hospital Ulleval within 24 h after injury with Injury Severity Score ≥ 10, proximal penetrating injuries or received by a trauma team. The derivation dataset comprised 5363 patients (August 2000 to July 2006); the validation dataset comprised 2517 patients (August 2006 to July 2008). Exclusion because of missing data was

The release of nitrogen and sulfur during the combustion of coal chars is a major environmental problem. Model coal chars, prepared by the high-pressure carbonisation of polynuclear aromatic precursors to 873 K and subsequent calcination at atmospheric pressure to 1273 K, were studied using temperature-programmed combustion (TPC) in 20% O 2 He . These carbons, which are derived from pure organic precursors with well-defined nitrogen and sulfur functionality, are highly reproducible and are virtually free of catalytic effects due to the absence of metallic species. The reactions were conducted using a thermogravimetric analyser coupled to a quadrupole mass spectrometer (TG-MS). The evolved gases were analysed throughout the course of the combustion. Sampling of the gases directly above the sample by means of a heated capillary line allowed the detection of reactive species including HCN, C2N2, and OCS. Sampling the gases at the exhaust of the TGA allowed the estimation of the gas composition at nearequilibrium conditions. In this case, the reactive species were no longer detected and gas-phase reactions, such as the conversion of HCN and C2N2 to NO and the conversion of CO to CO2, were apparently occurring in the gas phase. The results are discussed in terms of the nature of the surface nitrogen and sulfur species present during combustion.

This study focused on the belief of some nurse educators that caring cannot be taught directly and is learned by students from faculty role-modeling and faculty student interactions in clinical, classroom, and other situations. The purpose was to further explore these beliefs to determine if nursing students perceived that they learn caring behaviors through observing role-modeling by faculty, as well as to explore students' perceptions of other means by which they learn about caring. Since opportunities for faculty to model nurse caring behaviors in the clinical setting are varied and serendipitous, a videotaped scenario simulating a patient care situation, using professional actors, was created and shown to nursing students. The videotape was seen by 137 BSN and ADN students who then recorded their perceptions on a two-page open-ended questionnaire developed by the researchers. Results from this study indicated that students do learn about caring from faculty role-modeling, as well as from health care staff they encounter, often in a very paradoxical way. Many interesting and unintended results also occurred through the use of this research approach.

FRACTURE-LUXATION of the right central tarsal bone is one of the most common career-threatening injuries to racing greyhounds. The injury usually occurs on the bends, where the pressure on the medial aspect of the right hock joint is highest, resulting in either a cranial slab fracture or a

OBJECTIVE--To assess patients' satisfaction with postoperative pain relief. DESIGN--A descriptive and questionnaire study of patients' experience. SETTING--Two surgical and two gynaecological wards. PATIENTS--50 Patients admitted to hospital for cholecystectomy and 51 admitted for hysterectomy. MAIN OUTCOME MEASURES--Visual analogue scales with no divisions were completed by the patients immediately after each dose of postoperative analgesia was administered throughout their stay in hospital. A questionnaire completed on the fifth postoperative day recorded patients' recollections of their experience. Opinions were also sought from medical and nursing staff. RESULTS--During the first 24 hours after surgery recorded pain levels were 60% of the maximum and were not influenced by age, sex, or the type of operation performed. The median interval between the return of pain and a further injection of analgesic was 2 hours (interquartile range 1 to 3.5 hours). Expectations of pain relief were low, and for 70% of the patients the pain was at least as bad as they had expected. Only half of the medical and nursing staff questioned thought that postoperative analgesia should relieve pain completely; drugs were prescribed and administered with too little attention to the patient's response and too much concern about adverse effects and opioid dependence. CONCLUSIONS--The results suggest that the standard of postoperative pain relief is poor because of inadequate education of patients in what to expect (and demand), and of medical and nursing staff in how to prescribe and administer analgesia with reference to individual drug response.

This paper presents results from an ongoing effort to develop and validate a two-equation eddy-viscosity turbulence model for computational fluid dynamics (CFD) prediction of transitional and turbulent flow. The new model is based on a k-ω model framework, making it more easily implemented into existing general-purpose CFD solvers than other recently proposed model forms. The model incorporates inviscid and viscous damping functions for the eddy viscosity, as well as a production damping term, in order to reproduce the appropriate effects of laminar, transitional, and turbulent boundary layer flow. The new model has been implemented into a Mississippi State University (MSU) Computational Simulation and Design Center (SimCenter) developed flow solver (U2NCLE), as well as a commercially available CFD code (FLUENT). For model validation, comparisons were made to experimental data for an incompressible, zero-pressure gradient, flat plate geometry over a range of freestream turbulence quantities, using both of the flow solvers. Additional test cases were performed with the in-house flow solver and compared to experimental data for two sharp-cone geometries. The Mach number for the cone cases ranged from 0.4 to 2. The results presented in this document show that the new model performed well for the 2-D test cases and showed agreement with the experimental data of the 3-D geometries. The results illustrate the ability of the model to yield reasonable predictions of transitional flow behavior using a very simple modeling framework, including an appropriate response to freestream turbulence quantities.Copyright © 2007 by ASME

This paper presents the initial development and validation of a modified two-equation eddy-viscosity turbulence model for computational fluid dynamics (CFD) prediction of transitional and turbulent flow. The new model is based on a k-ω model framework, making it more easily implemented into existing general-purpose CFD solvers than other recently proposed model forms. The model incorporates inviscid and viscous damping functions for the eddy viscosity, as well as a production damping term, in order to reproduce the appropriate effects of laminar, transitional, and turbulent boundary layer flow. It has been implemented into a commercially available flow solver (FLUENT) and evaluated for simple attached and separated flow conditions, including 2-D flow over a flat plate and a circular cylinder. The results presented show that the new model is able to yield reasonable predictions of transitional flow behavior using a very simple modeling framework, including an appropriate response to freestream turbulence and boundary layer separation.Copyright © 2006 by ASME

SummaryAbnormal cervical cytology has been associated with vaginal infection with a variety of organisms, that most commonly implicated is chlamydia trachomatis, We undertook a prospective population study of 505 consecutive women attending clinics for routine cervical smears, when an endocervical swab was also obtained for chlamydia testing. Multivariate analysis demonstrated a significant relationship between chlamydial infection and inadequate cervical cytology due to excessive numbers of polymorphonuclear cells, young age and single status. We recommend that women with inadequate cervical cytology due to excess polymorphonuclear cells should be screened for chlamydial infection and treated with appropriate antimicrobial agents prior to a repeat cervical smear.

Nuclear electric propulsion (NEP) offers significant benefits to missions for outer planet exploration. Reaching outer planet destinations, especially beyond Jupiter, is a struggle against time and distance. For relatively near missions, such as a Europa lander, conventional chemical propulsion and NEP offer similar performance and capabilities. For challenging missions such as a Pluto orbiter, neither chemical nor solar electric propulsion are capable while NEP offers acceptable performance. Three missions are compared in this paper: Europa lander, Pluto orbiter, and Titan sample return, illustrating how performance of conventional and advanced propulsion systems vary with increasing difficulty. The paper presents parametric trajectory performance data for NEP. Preliminary mass/performance estimates are provided for a Europa lander and a Titan sample return system, to derive net payloads for NEP. The NEP system delivers payloads and ascent/descent spacecraft to orbit around the target body, and for sample return, delivers the sample carrier system from Titan orbit to an Earth transfer trajectory. A representative scientific payload 500 kg was assumed, typical for a robotic mission. The resulting NEP systems are 100-kWe class, with specific impulse from 6000 to 9000 seconds.

The exploration of our solar system will require spacecraft with much greater capability than spacecraft which have been launched in the past. This is particularly true for exploration of the outer planets. Outer planet exploration requires shorter trip times, increased payload mass, and ability to orbit or land on outer planets. Increased capability requires better propulsion systems, including increased specific impulse. Chemical propulsion systems are not capable of delivering the performance required for exploration of the solar system. Future propulsion systems will be applied to a wide variety of missions with a diverse set of mission requirements. Many candidate propulsion technologies have been proposed but NASA resources do not permit development of a] of them. Therefore, we need to rationally select a few propulsion technologies for advancement, for application to future space missions. An effort was initiated to select and prioritize candidate propulsion technologies for development investment. The results of the study identified Aerocapture, 5 - 10 KW Solar Electric Ion, and Nuclear Electric Propulsion as high priority technologies. Solar Sails, 100 Kw Solar Electric Hall Thrusters, Electric Propulsion, and Advanced Chemical were identified as medium priority technologies. Plasma sails, momentum exchange tethers, and low density solar sails were identified as high risk/high payoff technologies.

Objective: Adenoviral gene transfer to the arrested heart during cardiopulmonary bypass (CPB) is a novel method of allowing prolonged vector contact with the myocardium. In this model we investigated the importance of temperature, duration of arrest and cardioplegia on transgene expression. Methods: First-generation adenoviral vector (1 £ 10 12 total viral particles) containing the transgene for the human b2adrenoceptor (Adeno-b2AR) or b-galactosidase (Adeno-bgal) was delivered to neonatal piglets via the proximal aorta, during simulated cardiac surgery, and allowed to dwell for the cross-clamp duration. Four treatment groups received Adeno-b2AR. Groups A (n ¼ 4) and B (n ¼ 6) underwent cold crystalloid cardioplegia arrest for 10 and 30 min, respectively, Group C (n ¼ 5) underwent warm crystalloid cardioplegia arrest for 10 min, and Group D (n ¼ 5) underwent warm fibrillatory arrest for 10 min. Group E (n ¼ 6) received Adenobgal and underwent cold crystalloid cardioplegia arrest (30 min). Animals were weaned off CPB and recovered for 2 days. Receptor density was assessed in membrane fractions using radioligand binding and compared using the Mann-Whitney U-test. Results: Left ventricular transgene overexpression, as evidenced by elevated bAR density, following Adeno-b2AR treatment was greatest with cold cardioplegia (Group A 588 ^ 288.8 fmol/mg; P ¼ 0:002 and Group B 520 ^ 250.9 fmol/mg; P ¼ 0:01) versus control (Group E 109 ^ 8.4 fmol/mg). Overexpression also occurred with warm cardioplegia (Group C 274 ^ 69.5 fmol/mg; P ¼ 0:05) and ventricular fibrillation (Group D 215 ^ 48.4 fmol/mg; P ¼ 0:02) versus control. Comparison of the combined cold cardioplegia groups versus those treated with warm conditions showed a trend towards increased expression with cold conditions (P ¼ 0:1). Receptor density was also significantly increased in the right ventricle of animals in Group B (165 ^ 18.1 fmol/mg; P ¼ 0:03) and Group D (181 ^ 23.4 fmol/mg; P ¼ 0:02) versus control (Group E 118 ^ 5.8 fmol/mg). Conclusions: Cold crystalloid cardioplegia is not detrimental to gene transfer in vivo. In fact, there was a trend towards increased left ventricular transgene expression when the adenoviral vector was delivered following cold versus warm cardioplegia. Shorter periods of contact with the vector may reduce transgene overexpression. Therefore, gene transfer is possible during cardiac surgery with clinically used myocardial protection techniques. q 2002 Elsevier Science B.V. All rights reserved.

Cardiovascular responses were compared with equimolar infusions of B-type (BNP) and C-type (CNP) with atrial natriuretic peptide (ANP) in conscious, instrumented dogs. On separate days, each natriuretic peptide or vehicle was infused (intravenously) at step-up doses of 2, 5, 10, and 20 pmol ⋅ kg−1 ⋅ min−1(20 min each dose) to increase circulating levels of the infused peptide from ∼2- to 20-fold. Like ANP, infusions of BNP caused dose-related increases ( P < 0.05) in mesenteric vascular resistance, urine flow, natriuresis, and hematocrit (changes at highest doses were 60 ± 9, 334 ± 113, 313 ± 173, and 12 ± 2%, respectively). BNP also lowered ( P < 0.05) plasma renin activity (−43 ± 11%) and arterial pressure (−10 ± 3%). Effects of BNP were independent of reflex sympathetic activation, since autonomic ganglion blockade did not attenuate the responses. CNP infusions had little effect except to increase ( P < 0.05) mesenteric vascular resistance (27 ± 10%) and plasma ANP (41 ± 7%). Cardiovascular actions of BNP, like those of ANP, counteract the renin-ANG system and may protect the heart by lowering cardiac preload (venous return) and afterload (arterial pressure) while maintaining blood flow to extrasplanchnic regions.

BACKGROUND: Patients with non-tuberculous mycobacteria are usually started on conventional antituberculous triple therapy once acid fast bacilli are detected, before the exact type of mycobacteria has been identified. The ability to identify the characteristics of patients with tuberculous and non-tuberculous mycobacteria may be helpful in identifying before treatment those patients more likely to have non-tuberculous infection. METHODS: A retrospective study was conducted of all patients in one unit in whom non-tuberculous mycobacteria were identified in sputum or bronchoalveolar washings in the period 1987-93. The pattern of drug resistance was determined from laboratory records, and all case notes and chest radiographs were reviewed to identify the underlying disease and treatment outcome. All cases were compared with a matched control group of patients with culture positive Mycobacterium tuberculosis diagnosed during the same period. RESULTS: In the period studied there were 70 non-tuberculous and 221 tuberculous isolates. The non-tuberculous bacteria were typed as follows: M xenopi 23 (33%), M kansasii 19 (27%), M fortuitum 14 (20%), others 14 (20%). Of those with non-tuberculous mycobacteria, 83% were white subjects compared with 47% for tuberculosis. Patients with non-tuberculous mycobacteria were older than those with tuberculosis. Pre-existing lung disease or AIDS was present in 81% of patients with non-tuberculous mycobacteria and in 17% of patients with tuberculosis. Sensitivity to rifampicin and ethambutol was seen in 95% of M xenopi and 96% of M kansasii isolates. Relapse occurred in 60% of cases infected with M xenopi, 20% infected with M kansasii, and in 7% of cases with tuberculosis. CONCLUSIONS: In the population studied non-tuberculous mycobacteria occurred most frequently in elderly white subjects with pre-existing lung disease. If mycobacteria are detected in this group, consideration should be given to the possibility of non-tuberculous infection before embarking on treatment. A combination containing rifampicin and ethambutol is effective. The relapse rate for infection with M xenopi is high and prospective studies of the effect of the above combination of antituberculosis drugs are needed.

We report five children with tranverse defects of the upper limb who developed calcified deposits at the distal end of the limb. The lesions were excised from two children and had the typical histological appearance of tumoral calcinosis but on clinical grounds it is unlikely that this is the same condition as that previously described as tumoral calcinosis.

A 69-year-old patient underwent simultaneous transhiatal esophagectomy for carcinoma of the esophagogastric junction and benign spindle cell gastric tumor and coronary artery bypass grafting without cardiopulmonary bypass. A standard technique of transhiatal esophagectomy was used. The long saphenous vein was grafted to the left anterior descending artery and to the distal circumflex artery. The total theatre time was 6.5 h and the total ischemic time was 19 min. The patient made a good recovery and was discharged on day 18. He is enjoying an active lifestyle 6 months post-operatively.

Background: Evidence suggests that education alone is unlikely to elicit dietary-behavioural change (Contento, 1995). Consequently, many dietitians are moving from a traditional advice-giving role to one which utilises ‘behaviour change skills’ (BCS) in dietary counselling. BCS is an umbrella term used to cover a wide range of skills and techniques drawn from the fields of counselling, motivational interviewing (MI) and cognitive behavioural therapy (CBT). In order to assess the efficacy of this approach, a means of quantifying BCS-use is required. This two-stage study aimed to validate a newly-devised scale to assess dietitians’ BCS-use in one-to-one dietary counselling. Methods: Items for the scale were generated by drawing on the literature, syllabi for training in BCS and its parent disciplines (counselling, MI and CBT), and specialist dietitians. The resulting scale and manual were revised following assessment of content validity by expert panel and piloting. In stage one, 21 dietetic consultations were audiotaped and rated for BCS-use by three BCS-trained dietitians. Inter-rater agreement was calculated using the kappa statistic and intra-class correlation (ICC), to give a ‘chance corrected’ measure of agreement. Validity was tested using a psychologist's subjective assessment of BCS-use as a proxy ‘gold-standard’ compared with the dietitians’ ratings, again using kappa and ICC. In stage two the scale was further revised before an additional 20 audiotaped consultations were analysed using the same procedure. Ethical approval for the study was given by the appropriate NHS and university research ethics committees. Results: At stage one, although kappas were fairly poor for agreement on individual criteria, the ICC for overall scores indicated a ‘fair’ level of agreement, according to Shrout's (1998) classifications: ICC = 0.584 (CI 0.339–0.784). Results for validity were poor with the psychologist frequently rating higher than the dietitians. At stage two, following scale revision, results for inter-rater agreement improved with more criteria showing ‘moderate’ or ‘substantial’ agreement. Ten out of the 21 criteria achieved levels of agreement classified as ‘fair’ or higher for all three rater pairs. The ICC for overall scores improved to indicate ‘moderate’ agreement: ICC = 0.640 (CI 0.404–0.821). Validity results remained poor. Discussion: The moderate level of overall inter-rater agreement observed in the revised scale is considered acceptable (Jones, 2006) and indicates this tool is useful. This measure is more relevant to the purpose of the tool than agreement on individual criteria given it is intended to classify consultations overall as low/medium/high use of BCS rather than to examine individual skills. However, in terms of validity, the discrepancy between dietitian and psychologist ratings requires further investigation. It is hypothesized that the dietitians had higher expectations of what a dietitian could achieve in terms of proficiency in BCS and, as such, rated more stringently than the psychologist. Achieving a clear picture of validity usually necessitates a series of assessments (Murphy & Davidshofer, 2005); the BCS rating scale is no exception with further testing required. Conclusions: The revised scale shows acceptable inter-rater reliability and robust content validity in our study sample. However, quantitative examination of validity gave poor results and further assessment is required to provide a tool with which we can confidently assess dietitians’ use of BCS. References Contento, I., Balch, G.I., Bronner, Y.L. et al. (1995) The effectiveness of nutrition education and implications for nutrition education policy, programs, and research: a review of the research. J. Nutr. Educ.27, 355–364. Jones, J.M. (2006) Nutritional Screening and Assessment Tools. New York: Nova Science Publishers. Murphy, K.R. & Davidshofer, C.O. (2005) Psychological Testing – Principles and Applications, 6th edn. New Jersey: Pearson Education Inc. Shrout, P. (1998) Measurement reliability and agreement in psychiatry. Stat. Methods Med. Res. 7, 301–317.

There are few reports in the literature concerning non-union of Colles’ fractures or its treatment. We describe two cases in which the fractures had been treated in the standard manner by reduction and plaster immobilisation for six weeks. The wrists of both patients were mobilised free of external support for several months before the complication of non-union was diagnosed. A simple radiographic technique for the diagnosis of non-union is described, using flexion and extension views of the wrist, and a method of treatment is outlined.

In this communication, the temperature-programmed reduction with on-line mass spectrometry has been conducted on the series of four fenolic resites (cured resoles) containing different sulfur functionalities in a TGA apparatus to ascertain whether the release of SO 2 is dependent primarily on sulfur functionality or whether other factors, particularly the concentration of volatile matter and chemistry involving the interconversion of sulfur forms, are also important for macromolecular systems