Transvaginal versus transperineal ultrasonography: a blinded comparison in the assessment of cervical length at midgestation

OBJECTIVE: The study's objective was to determine the correlation and agreement between transperineal ultrasonography and transvaginal ultrasonography in the assessment of cervical length in gravid patients. STUDY DESIGN: After a pilot, unblinded series of transperineal and transvaginal cervical length measurements in 200 gravid patients, 206 study patients between 14 and 34 weeks' gestation with intact membranes and cervical dilatation of < or = 2 cm underwent transperineal and transvaginal cervical length assessment under a blinded, 2-sonographer protocol. The Pearson correlation coefficient, Lin concordance coefficient, and Bland-Altman plot were used. Acceptable concordance was defined as > 0.82, with an acceptable correlation of > 0.9 and an acceptable difference between the means of < 3 mm. The power of the study to detect this degree of concordance was estimated to be 95% at this sample size. RESULTS: Paired ultrasonographic measurements were obtained for all 206 study patients. Transperineal mean cervical length was 35 +/- 8.6 mm. Transvaginal mean cervical length was 35.9 +/- 8.8 mm. The Pearson correlation coefficient was 0.959, and the Lin concordance coefficient was 0.955, with a 95% confidence lower bound of 0.949. Close agreement between transperineal and transvaginal measurements was observed across the full range of cervical lengths (1-5 cm). The estimated difference between the paired means was 1 mm. The 95% tolerance interval for any given paired observation (Transperineal length - Transvaginal length) was -5.7 to +4 mm. CONCLUSIONS: Cervical length measured by transperineal ultrasonography demonstrates close correlation and agreement with transvaginal measurements. With sonographer experience and optimal technique, approximately 95% of transperineal cervical length observations can be expected to be within 5 mm of a given paired transvaginal measurement. Transperineal ultrasonography may be a preferred method of cervical length assessment for situations in which vaginal placement of instruments should be minimized.     

Towards a framework for business process re-engineering in small and medium-sized enterprises

Business process re-engineering (BPR) is the vogue, although somewhat discredited, change management method. It is as an information technology (IT)-based and customer-driven approach to organizational change, undertaken to enable superior performance, such as cost reduction, shorter cycle time, higher product quality and increased customer satisfaction. Although the literature on re-engineering principles and prospects is large, there is little empirical research evaluating the success or failure of BPR initiatives. This is especially so in small- and medium-sized enterprises (SMEs) in which the potential for BPR benefits may differ significantly from that in their larger counterparts. SMEs are the fastest growing segment of most economies and are perceived to be more flexible and adaptable in terms of structure and speed of response than larger organizations. The literature speculates that SMEs have as good a chance of re-engineering successfully as their larger counterparts, although this is untested. Yet, with limited resources, such as IT and BPR expertise, and financial constraints, SMEs may find it difficult to re-engineer. This paper addresses the role of BPR in SMEs and develops a framework to assess its implementation potential. Factors that facilitate and inhibit BPR performance are identified and analysed as the basis for empirical testing. A set of propositions is developed that allows operationalization of the framework. The ultimate goal is to develop a process and tool set to assist SMEs wishing to undertake business process re-engineering.     

Mechanism involved in generating the carboxyl-terminal half topology of P-glycoprotein

P-Glycoprotein (Pgp) is a polytopic membrane protein that consists of a tandem repeat of a transmembrane (TM) domain followed by a nucleotide-binding domain. For the carboxyl-terminal half (C-half) of Pgp, at least three different topological orientations have been observed. One major difference between these topologies is reflected in the membrane insertion property of TM8, which is predicted to (1) function as a stop-transfer sequence, (2) lack stop-transfer activity, or (3) function as a signal-anchor sequence. To understand the mechanism involved in generating multiple topological forms for the C-half of Pgp, we investigated the membrane insertion properties of TM segments using the Chinese hamster pgp1 Pgp as a model protein in a cell-free system. We found that TM8 alone or in the presence of TM7 functions as a signal-anchor sequence to insert into membranes with a cytoplasmic amino terminus and an extra-cytoplasmic carboxyl terminus. However, TM8 displayed stop-transfer activity when linked to the C-terminal end of the signal-anchor sequence, TM1. In addition, the membrane orientation of TM8 was found to be regulated by the charge distribution flanking TM8. Interestingly, we found that mammalian and wheat germ ribosomes differentially regulate the signal-anchor and stop-transfer properties of TM8. We conclude that the unique topogenic properties of TM8 direct the generation of multiple C-half topological orientations.     

Metacarpal and phalangeal fractures in athletes

The high demands placed on the upper extremity in sporting activities subject the competitive athlete to common injuries of the hand. Treatment options are based on the fracture configuration, associated extremity injuries, and status of the surrounding soft tissue. Metacarpal and phalangeal fractures may usually be treated by closed, nonoperative methods, and most athletes may quickly return to play with a protective orthosis. Supplemental methods of fixation, such as percutaneous pins and tension-band wires, may be used for unstable fractures. When required, open reduction and internal fixation can provide optimum stability to the fracture, which allows immediate range-of-motion and early return to play.     

A system for articulated tracking incorporating a clothing model

In this paper an approach for motion capture of dressed people is presented. A cloth draping method is incorporated in a silhouette based motion capture system. This leads to a simultaneous estimation of pose, joint angles, cloth draping parameters and wind forces. An error functional is formalized to minimize the involved parameters simultaneously. This allows for reconstruction of the underlying kinematic structure, even though it is covered with fabrics. Finally, a quantitative error analysis is performed. Pose results are compared with results obtained from a commercially available marker based tracking system. The deviations have a magnitude of three degrees which indicates a reasonably stable approach.     

Polyaniline Nanofiber Based Surface Acoustic Wave Gas Sensors—Effect of Nanofiber Diameter on H2 Response

A template-free rapidly mixed reaction was employed to synthesize polyaniline nanofibers using chemical oxidative polymerization of aniline. Hydrochloric acid (HCl) and camphor sulfonic acid (CSA) were used in the synthesis to obtain 30- and 50-nm average diameter polyaniline nanofibers. The nanofibers were deposited onto layered ZnO/64deg YX LiNbO₃ surface-acoustic-wave transducers. The sensors were tested toward hydrogen (H₂) gas while operating at room temperature. The dopant for the polyaniline nanofiber synthesis was found to have a significant effect on the device sensitivity. The sensor response was found to be larger for the 50-nm diameter CSA-doped nanofiber based sensors, while the response and recovery times were faster for the 30-nm diameter HCl-doped nanofibers     

Assessing Walking Limitations in Stroke Survivors: Are Self-Reports and Proxy-Reports Interchangeable?

Objective: To examine the extent to which proxy-report measures adequately assess walking limitations and are interchangeable with self-report measures in stroke survivors. Design and Participants: Self-report, proxy-report, and observed performance measures of walking limitations were compared cross-sectionally on 3 occasions following the discharge from hospital of 101 stroke survivors. Correlations between measures, differences between mean scores, and agreement of self- and proxy reports were analyzed. Results and Conclusions: Self- and proxy-report measures correlated significantly with each other and with observed performance measures; differences between mean scores were not found. Agreement between individual self- and proxy-report pairs was poor, however, indicating that freely substituting proxy-report data for self-report data when self-report data are unavailable is inappropriate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sub-pixel mapping of urban land cover using multiple endmember spectral mixture analysis: Manaus, Brazil

The spatial and spectral variability of urban environments present fundamental challenges to deriving accurate remote sensing products for urban areas. Multiple endmember spectral mixture analysis (MESMA) is a technique that potentially addresses both challenges. MESMA models spectra as the linear sum of spectrally pure endmembers that vary on a per-pixel basis. Spatial variability is addressed by mapping sub-pixel components of land cover as a combination of endmembers. Spectral variability is addressed by allowing the number and type of endmembers to vary from pixel to pixel. This paper presents an application of MESMA to map the physical components of urban land cover for the city of Manaus, Brazil, using Landsat Enhanced Thematic Mapper (ETM+) imagery.We present a methodology to build a regionally specific spectral library of urban materials based on generalized categories of urban land-cover components: vegetation, impervious surfaces, soil, and water. Using this library, we applied MESMA to generate a total of 1137 two-, three-, and four-endmember models for each pixel; the model with the lowest root-mean-squared (RMS) error and lowest complexity was selected on a per-pixel basis. Almost 97% of the pixels within the image were modeled within the 2.5% RMS error constraint. The modeled fractions were used to generate continuous maps of the per-pixel abundance of each generalized land-cover component. We provide an example to demonstrate that land-cover components have the potential to characterize trajectories of physical landscape change as urban neighborhoods develop through time. Accuracy of land-cover fractions was assessed using high-resolution, geocoded images mosaicked from digital aerial videography. Modeled vegetation and impervious fractions corresponded well with the reference fractions. Modeled soil fractions did not correspond as closely with the reference fractions, in part due to limitations of the reference data. This work demonstrates the potential of moderate-resolution, multispectral imagery to map and monitor the evolution of the physical urban environment.     

EGF receptor signaling inhibits keratinocyte apoptosis: evidence for mediation by Bcl-XL

Signaling through the epidermal growth factor receptor (EGFR) has been primarily implicated in the growth of epithelial cells including keratinocytes. However, the mechanism by which EGFR stimulation promotes keratinocyte cell growth is poorly understood. Here we report that human keratinocytes undergo apoptosis when incubated with the blocking EGFR monoclonal antibody 225 IgG, or PD153035, a highly specific EGFR tyrosine kinase inhibitor. Endogenous mRNA and protein levels of Bcl-XL, a member the Bcl-2 family which suppresses apoptosis, were specifically inhibited by EGFR blockade. Furthermore, stimulation of EGFR signaling through two natural ligands, transforming growth factor (TGF)-alpha and epidermal growth factor (EGF), increased the expression of Bcl-XL in quiescent keratinocytes and HaCaT cells. Finally, ectopic expression of Bcl-XL in HaCaT cells increased survival after EGFR blockade when compared to untransfected cells or HaCaT keratinocytes transfected with empty vector. These results suggest that the anti-apoptotic protein Bcl-XL plays an important role in the maintenance of keratinocyte survival in response to EGFR signaling.