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Knee dislocations (KDs) are complex injuries defined as incongruity of the tibiofemoral joint, which leads to tears of two or more of the main stabilising knee ligaments, and they are often associated with damage to surrounding soft tissue or neurovascular structures. A classification system for these injuries should be simple and reproducible and allow communication among surgeons for surgical planning and outcome prediction. The aim of this study was to formulate a list of factors, prioritised by high-volume knee surgeons, that should be included in a KD classification system.A global panel of orthopaedic knee surgery specialists participated in a Delphi process. The first survey employed 91 orthopaedic surgeons to generate a list of patient- and system-specific factors that should be included in a KD classification system that may affect surgical planning and outcomes. This list was subsequently prioritised by 27 identified experts (mean 15.3 years of experience) from Brazil (n = 9), USA (n = 6), South Africa (n = 4), India (n = 4), China (n = 2), and the United Kingdom (n = 2). The items were analysed to find factors that had at least 70% consensus for inclusion in a classification system.Of the 12 factors identified, four (33%) achieved at least 70% consensus for inclusion in a classification system. The factors deemed critical for inclusion in a classification system included vascular injuries (89%), common peroneal nerve injuries (78%), number of torn ligaments (78%), and open injuries (70%).Consensus for inclusion of various factors in a KD classification system was not easily achieved. The wide geographic distribution of participants provides diverse insight and makes the results of the study globally applicable. The most important factors to include in a classification system as determined by the Delphi technique were vascular injuries, common peroneal nerve injuries, number of torn ligaments, and open injuries. To date, the Schenck anatomic classification system most accurately identifies these patient variables with the addition of open injury classification. The authors propose to update the Schenck classification system with the inclusion of open injuries as an additional modifier, although this is only a small step in updating the classification, and further studies should evaluate the inclusion of more advanced imaging modalities. Future research should focus on integrating these factors into useful existing classification systems that are predictive of surgical treatment and patient outcomes.

Background Knowing the reliability of three-dimensional motion analysis to evaluate scapular kinematics during upper limb movements is essential to plan further research dedicated to understanding scapulothoracic joint movements relative to the global shoulder motion. Research question The aim of this study was to assess the intra-subject as well as intra- and interrater reliability of scapulothoracic joint angles during shoulder elevation in scapular plane and shoulder flexion. Methods Twenty healthy participants (26.6 ± 3.5 years) were asked to perform maximum shoulder elevation in scapular plane as well as shoulder flexion. Reliability was assessed using the intraclass correlation coefficient (ICC) and its 95% confidence interval of scapular kinematics (rotation, tilting, pro-retraction) at each degree of global motion (shoulder elevation or shoulder flexion) between 0° to 150°. Results ICCs above 0.60 were accepted as good indicators for reliability. Intra-subject reliability was found to be very high (>0.9 for most part) for all scapulothoracic joint angles during both movements. Intra- and interrater reliability also showed good reliability being above 0.60 for the most part (except scapula tilting during shoulder elevation). Scapular kinematics showed low reliability during the respective first 10° and 20° of shoulder elevation and shoulder flexion. Furthermore, decreasing reliability was found above 120° of shoulder elevation or flexion. Significance This study generally showed good to high levels of reliability in the range of interest (20–120°) in evaluating scapula kinematics in healthy adults during shoulder elevation and flexion; these results are important for future research providing a better understanding of scapular kinematics.

The purpose of this study was to retrospectively investigate changes in gait patterns after single-event multilevel surgery in children and adolescents with bilateral cerebral palsy. Three-dimensional instrumented pre- and postoperative gait data of 12 patients were compared to data of 12 healthy control subjects using principal component analysis to reduce the dimensionality of kinematic and kinetic gait data and detect gait differences. The differences between pre- and postoperative data and between postoperative data and data of control subjects were calculated using a linear mixed model. The results revealed 14 significant effects for pre- and postoperative waveforms and 11 significant effects for postoperative and control waveforms. Patients after single-event multilevel surgery walked with smaller internal foot progression angle throughout the gait cycle, lower knee flexion at initial swing, and earlier knee extension during terminal swing. Retained gait deviations included excessive pelvic tilt and internally rotated and flexed hips over the entire gait cycle. Contrary to our hypothesis, postoperative waveforms in the sagittal plane differed more from control waveforms than from preoperative waveforms. These results emphasize the importance of carefully planning further conservative therapy 2 years after single-event multilevel surgery.

This paper examines the growth-orientation effects of specific entrepreneurial expertise in an emerging economy. It draws on face-to-face interviews with entrepreneurs of young high-tech small and medium-sized enterprises in the Chinese provinces of Guangdong and Guangxi. Using four measures of firm-level performance – that is, employment, profitability, sales turnover and internationalization – the findings show that different types of entrepreneurial teams have different growth intentions depending on the strengths of the team members. The ‘mixed’ type of team optimized performance in general and employment growth in particular, while ‘technology entrepreneurial’ teams were more profit-oriented, and ‘business practice entrepreneurial’ teams were more export-oriented.

Simian retrovirus type 2 (SRV-2) is a natural pathogen of Macaca fascicularis. Although SRV-2 may be endemic in macaque colonies, it is not necessarily detected in all individuals suggesting differential susceptibility to SRV-2; factors contributing to this susceptibility are not fully understood. We have investigated the role of host genetic origin on virus susceptibility. We have shown that high levels of anti-SRV-2 antibodies correlate with failure to establish persistent virus infection, thus we targeted our genetic analysis of virus susceptibility with an investigation of the role of the polymorphic macaque major histocompatibility complex (MHC) class II locus. DRB genotypes, both novel and previously characterised, were identified in individuals and family groups. A discordance with SRV-2 infection status suggests that an Mhc II DRB genotype is not overtly associated with the outcome of viral infection.

The CD28-specific mAb TGN1412 rapidly caused a life-threatening “cytokine storm” in all six healthy volunteers in the Phase I clinical trial of this superagonist, signaling a failure of preclinical safety testing. We report novel in vitro procedures in which TGN1412, immobilized in various ways, is presented to human white blood cells in a manner that stimulates the striking release of cytokines and profound lymphocyte proliferation that occurred in vivo in humans. The novel procedures would have predicted the toxicity of this superagonist and are now being applied to emerging immunotherapeutics and to other therapeutics that have the potential to act upon the immune system. Data from these novel procedures, along with data from in vitro and in vivo studies in nonhuman primates, suggest that the dose of TGN1412 given to human volunteers was close to the maximum immunostimulatory dose and that TGN1412 is not a superagonist in nonhuman primates.

The twentieth century saw a dramatic rise in scientific cosmology, with its roots in the great telescopic discoveries, in the realisation that geometry need not be Euclidean, and in Einstein's general theory of relativity. The most consequential early finding was that the universe of galaxies is expanding, so that extrapolating backwards in time brings us to a singularity that might somehow be described as ‘the origin of the universe’. This brief historical survey illustrates ways in which scientific cosmologists -I ignore the theologians who have commented on their works - have been tempted to make theological utterances. Does the singularity correspond to the moment of creation of the world by God, for example? Others have postulated alternative forms of a ‘creation of matter’, and again theological asides and retorts have often proved irresistible. For some, creation from nothing violates energy conservation and is therefore miraculous and therefore wrong. For others it is indeed miraculous, an...

Although they are not the only conduit for knowledge, advisers can diffuse new methods, knowledge and best practice to SMEs Existing work suggests advice as a resource available for the small firm manager. Whether the manager takes that advice depends on the trust between owner-manager and adviser, the degree to which the owner-manager perceives themselves to need advice, the ‘knowledge gap hypothesis’ and the degree to which they feel able to interact with advisers and implement advice. In this paper, we model whether a small firm manager takes advice from formal sources, including public and private suppliers.

This study assessed the effects of acupressure wrist bands on the nausea and vomiting ofterminally ill patients. Using a single subject experimental design, six hospice patients were exposed to three conditions: • An acupressure wrist band; • A placebo wrist band; • A no wrist band condition. Patients and their caregivers rated nausea and vomiting during the treatment. Despitesome difficultyobtaining complete data, the results of this preliminary test indicate that acupressure wrist bandswere not effective in reducing nausea and vomiting in this small sample of hospice patients.

To document the utilization of radiologic imaging in pregnant patients at one academic institution during a 10-year period (1997-2006).The study was approved by the hospital institutional review board and was compliant with HIPAA. Informed consent was waived. At the authors' institution, pregnant patients exposed to radiation during imaging are recorded in a database compiled by the medical physics department. The authors retrospectively reviewed this database to document the number of patients, number of each type of imaging examination, date of the examination, and the estimated radiation dose to the fetus from 1997 to 2006. The authors searched the institution's medical records to obtain the total number of deliveries by year as a control for the total pregnant patient population.During the 10-year period, 5270 examinations were performed in 3285 pregnant patients (mean age, 28 years). The number of patients and examinations increased from 237 patients undergoing 331 studies in 1997 to 449 patients undergoing 732 examinations in 2006, an increase of 89% in patients and 121% in examinations. The total number of pregnant patients measured by deliveries increased 7%--from 8661 in 1997 to 9264 in 2006. Utilization rates (examinations per 1000 deliveries) of all radiologic examinations increased 107% from 1997 to 2006. The number of conventional radiographic examinations increased by an average of 7% per year, nuclear medicine examinations by 12% per year, and computed tomographic (CT) examinations by 25% per year. The average estimated fetal radiation exposure per examination was 0.43 mGy (range, 0.01-22.5 mGy) for conventional radiography, 4.3 mGy (range, 0.01-43.9 mGy) for CT, and 0.40 mGy (range, 0.01-7.7 mGy) for nuclear medicine examinations.For the comparison of 1997 to 2006, the radiologic utilization rate in pregnant patients increased by 107% from 1997 to 2006. The greatest increase was in CT.

In order to test the hypothesis that CD8 + cytotoxic T lymphocytes mediate protection against acute superinfection, we depleted >99% of CD8 + lymphocytes in live attenuated simian immunodeficiency virus macC8 (SIVmacC8) vaccinees from the onset of vaccination, maintained that depletion for 20 days, and then challenged with pathogenic, wild-type SIVmacJ5. Vaccinees received 5 mg per kg of humanized anti-CD8 monoclonal antibody (MAb) 1 h before inoculation, followed by the same dose again on days 3, 7, 10, 13, and 17. On day 13, peripheral CD8 + T lymphocytes were >99% depleted in three out of four anti-CD8 MAb-treated vaccinees. At this time attenuated SIVmacC8 viral RNA loads in anti-CD8 MAb-treated vaccinees were significantly higher than control vaccinees treated contemporaneously with nonspecific human immunoglobulin. Lymphoid tissue CD8 + T lymphocyte depletion was >99% in three out of four anti-CD8 MAb-treated vaccinees on the day of wild-type SIVmacJ5 challenge. All four control vaccinees and three out of four anti-CD8 MAb-treated vaccinees were protected against detectable superinfection with wild-type SIVmacJ5. Although superinfection with wild-type SIVmacJ5 was detected at postmortem in a single anti-CD8 MAb-treated vaccinee, this did not correlate with the degree of preceding CD8 + T lymphocyte depletion. Clearance of attenuated SIVmacC8 viremia coincided with recovery of normal CD8 + T lymphocyte counts between days 48 and 76. These results support the view that cytotoxic T lymphocytes are important for host-mediated control of SIV primary viremia but do not indicate a central role in protection against acute superinfection conferred by inoculation with live attenuated SIV.

This study’s aim was to identify the effect of oscillation of torques in isometric tasks under identical mechanical conditions on the muscle synergies used. It was hypothesized that bi-functional muscles would play a lesser role in torque oscillation, because they would also generate an undesired oscillation. Thus, changes in muscle synergies were expected as a consequence of oscillation in torque generation. The effect of the trajectory of torque generation was investigated in dual-degrees-of-freedom submaximal isometric oscillation torque tasks at the elbow. The torques were flexion-extension and supination-pronation. Oscillation torques were compared with static torque generations at four torque positions during oscillation. Muscle activity was determined with surface electromyography. Compared with the static torque tasks, the oscillation tasks showed an overall increased muscle activity. The oscillation tasks, however, showed similar activity patterns and muscle synergies compared to the static composite tasks. It was found that the motor system is well able to control different orthogonal combinations of slow torque oscillations and constant torques by employing a single oscillating muscle synergy.

Endemic simian retrovirus (SRV) infection can cause fatal simian AIDS in Macaca fascicularis , but many individuals survive with few clinical signs. To further clarify the parameters of SRV pathogenesis, we investigated the persistence of viral DNA forms in relation to active viremia, antibody response, and transmissibility of infection. In M. fascicularis from endemically SRV-2-infected colonies, viral DNA was present in both linear and unintegrated long terminal repeat circular forms in peripheral blood mononuclear cells of all viremic and many nonviremic animals. Long-term followup of three individuals with distinct infection patterns demonstrated persistence of linear and circular forms of viral DNA in peripheral blood mononuclear cells and tissues, irrespective of viremia or antibody status, but reactivation of latent infections was not observed. The role of viral DNA in transmission and early pathogenesis of SRV-2 was investigated by inoculation of SRV-2 DNA-positive blood into groups of naïve M. fascicularis from either a viremic or nonviremic donor and subsequent analysis of the virological and serological status of the recipients. Transmission of SRV and development of anti-SRV antibodies were only observed in recipients of blood from the viremic donor; transfer of SRV provirus and unintegrated circular DNA in blood from the nonviremic donor did not lead to infection of the recipients. These results indicate that a proportion of M. fascicularis are able to effectively control the replication and infectivity of SRV despite long-term persistence of viral DNA forms in infected lymphocytes.