Previous Consensus Research Articles

On the edge of reality –an evaluation of parametric representations of creep strain and rupture data

Advances in the understanding of the physical processes that underlie creep deformation, damage and failure have led to the development of powerful models with demonstrable predictive ability. Some are specific to classes of material, or to particular creep mechanisms; others aim to be more general in application. The insights which they provide are of considerable value, and certain of them have proved sufficiently robust to be incorporated in the more advanced practical engineering procedures.Nevertheless, almost all design and most assessment work makes use, not of these theoretical models, but of simpler parametric descriptions of creep rupture, and occasionally of creep strain. Originating at a time when theories were less advanced and when much practical computation was by hand methods, their practical advantages are clear. They have also become familiar and it is therefore not unreasonable that they continue in use for basic calculation. However familiarity – though necessary – is not sufficient for understanding, and comparison of established and more recently published creep and rupture parameters reveals some features that continue to give rise to concern.This paper evaluates a number of creep rupture and creep strain parameters, contained within published standards and procedures, in terms of their descriptive accuracy and practical use. It is shown that the differences between them can often be attributed to:the distribution of the source datathe influence of other mechanismsthe form of mathematical representationSince these differences can be sufficiently large to have led to disputes between manufacturers and operators of plant, it is important that the reasons be identified and understood in each case. Recently, however, parameters have been published that in form and calculated behaviour are at considerable variance with the previous consensus. Whilst these features are demonstrable, they are not so readily explicable.As it is not reasonable to leave practical engineers with methods that predict lives differing by several orders of magnitude, the paper concludes with some provocative suggestions as to what a parametric creep description should be and should do.

Research Retreat IV: ACL Injuries—The Gender Bias

In April 2008, more than 80 attendees from across the United States and Canada participated in the fourth research retreat focused on the gender bias in anterior cruciate ligament (ACL) injury. The retreat was cofounded by Irene Davis, PhD, PT, and Mary Lloyd Ireland, MD, who hosted the 3 previous research retreats in Lexington, Kentucky, in April of 2001, 2003, and 2006. In the first year (2001), a consensus document of what we know, don't know, and still need to know related to this problem was developed.1 Each subsequent retreat has revisited and updated the previous consensus statement as new evidence has emerged.2,3 Over the past 6 years, the number of attendees has grown, and the retreats have attracted some of the foremost nationally and internationally known clinicians and scientists with a common interest in ACL injury. We were pleased to continue this important work by hosting Research Retreat IV in Greensboro, North Carolina.The meeting featured an opening presentation from ACL Retreat cofounder Mary Lloyd Ireland, MD; invited keynote presentations by Scott McLean, PhD, and Bruce Beynnon, PhD — expert scientists well known for their research into factors associated with the gender bias in ACL injury; and 31 fifteen-minute podium presentations of recently completed research relating to the gender bias in ACL injuries. The opening presentation set the stage for the meeting by providing a historical perspective of what research has taught us about the ACL injury gender bias over the past 20 years, and the keynote presentations focused on the current knowledge and theories associated with neuromuscular, biomechanical, anatomical, and hormonal risk factors. The podium presentations were organized into thematic sessions centered on sagittal-plane landing mechanics, sex comparisons in landing and cutting, fatigue and perturbation studies in landing and cutting, anatomical and hormonal factors, and risk factor screening and prevention. Significant time was provided for group discussion after each keynote and each group of podium presentations. At the conclusion of the meeting, participants revisited and updated the consensus statement from the 2006 retreat.2 Following are the consensus statement, keynote presentation summaries, and abstracts organized by topic and presentation order.

The evangelical matrix:

This paper examines evidence of contemporary British evangelical diversity, in terms of theological and socio-political convictions. Survey responses are analyzed from the leadership teams of prominent evangelical organisations, delegates at the most recent National Evangelical Assembly and theological college students. The contours of a modified theological consensus become apparent. Although evangelicals have embraced social justice – anti-racist, anti-sexist and favouring debt cancellation for the developing world – they remain conservative in terms of sexual ethics, supporting restrictive policies concerning abortion, censorship and divorce, with most rejecting the legalisation of marijuana. However, senior evangelical leaders are more inclined to restrictive social policies than evangelicals who are younger or female: socio-political concern among moderate evangelicals may therefore have begun to evolve towards the societal consensus. Given this emergent socio-political heterogeneity, traditional evangelical ethical givens are likely to become as contested as the previous conservative theological consensus.

Diagnosis of adult GH deficiency

Based on previous consensus statements, it has been widely accepted that the diagnosis of adult growth hormone deficiency (GHD) must be shown biochemically by provocative tests of GH secretion; in fact, the measurement of IGF-I as well as of other markers was considered unable to distinguish between normal and GHD subjects. The Insulin Tolerance Test (ITT) was indicated as that of choice and severe GHD defined by a GH peak lower than 3 microg/l. It is now recognized that, although normal IGF-I levels do not rule out severe GHD, very low IGF-I levels in patients highly suspected for GHD (i.e. patients with childhood-onset severe GHD or with multiple hypopituitarism acquired in adulthood) can be considered as definite evidence for severe GHD. However, patients suspected for adult GHD with normal IGF-I levels must be investigated by provocative tests. ITT remains a test of reference but it should be recognized that other tests are as reliable as ITT. Glucagon as classical test and, particularly, new maximal tests such as GHRH in combination with arginine or GH secretagogues (GHS) (i.e. GHRP-6) have well defined cut-off limits, are reproducible, able to distinguish between normal and GHD subjects. Overweight and obesity have confounding effect on the interpretation of the GH response to provocative tests. In adults cut-off levels of GH response below which severe GHD is demonstrated must be appropriate to lean, overweight and obese subjects to avoid false positive diagnosis in obese adults and false negative diagnosis in lean GHD patients.

Clarifying the semantics of value in use cases through Jackson's Problem Frames

Use cases constitute a popular technique to problem analysis, partly due to their focus on thinking in terms of the user needs. However this is not a guarantee for discovering all the subproblems that compose the structure of a given software problem. Moreover, a rigorous application of the technique requires a previous consensus about the meaning of I. Jacobson's statement “a use case must give a measurable value to a particular actor” (The Rational Edge, March 2003). This paper proposes a particular characterisation of the concept of “value” with the purpose of problem structuring. To this aim we base on the catalogue of frames for real software problems proposed by M. Jackson (Problem Frames, 2001) and we reason about what could be valuable for the user on each problem class. We illustrate our technique with the analysis of a web auction problem.

Novel Conantokins from Conus parius Venom Are Specific Antagonists of N-Methyl-D-aspartate Receptors

We report the discovery and characterization of three conantokin peptides from the venom of Conus parius. Each peptide (conantokin-Pr1, -Pr2, and -Pr3) contains 19 amino acids with three gamma-carboxyglutamate (Gla) residues, a post-translationally modified amino acid characteristic of conantokins. The new peptides contain several amino acid residues that differ from previous conantokin consensus sequences. Notably, the new conantokins lack Gla at the 3rd position from the N terminus, where the Gla residue is replaced by either aspartate or by another post-translationally modified residue, 4-trans-hydroxyproline. Conantokin-Pr3 is the first conantokin peptide to have three different post-translational modifications. Conantokins-Pr1 and -Pr2 adopt alpha-helical conformations in the presence of divalent cations (Mg2+ and Ca2+) but are generally unstructured in the absence of divalent cations. Conantokin-Pr3 adopts an alpha-helical conformation even in the absence of divalent cations. Like other conantokins, the new peptides induced sleep in young mice and hyperactivity in older mice upon intracranial injection. Electrophysiological assays confirmed that conantokins-Pr1, -Pr2, and -Pr3 are N-methyl-d-aspartate (NMDA) receptor antagonists, with highest potency for NR2B-containing NMDA receptors. Conantokin-Pr3 demonstrated approximately 10-fold selectivity for NR2B-containing NMDA receptors. However, conantokin-Pr2 showed minimal differences in potency between NR2B and NR2D. Conantokins-Pr1, -Pr2, and -Pr3 all demonstrated high specificity of block for NMDA receptors, when tested against various ligand-gated ion channels. Conus parius conantokins allow for a better definition of structural and functional features of conantokins as ligands targeting NMDA receptors.

Effective and organ doses from thoron decay products at different ages

The dosimetry of radon-220, often known as thoron, and its decay products has receivedless attention than has that of radon-222. Dose coefficients used by international bodiessuch as UNSCEAR and ICRP and by the UK’s former National RadiologicalProtection Board are based on calculations from the 1980s. We present calculations forthoron decay products using the most recent ICRP models. These indicate that theeffective dose is dominated by the doses to lung and that, under the present models,these doses are somewhat higher than under the previous consensus. Conversely,the present models give doses to organs outside the respiratory tract that aresomewhat lower than those previously calculated. Dose coefficients for children aresomewhat higher than those for adults. However, breathing rates for children arelower than those for adults and there are no great differences in annual doses.

Universal Definition of Myocardial Infarction

Myocardial infarction is a major cause of death and disability worldwide. Coronary atherosclerosis is a chronic disease with stable and unstable periods. During unstable periods with activated inflammation in the vascular wall, patients may develop a myocardial infarction. Myocardial infarction may be a minor event in a lifelong chronic disease, it may even go undetected, but it may also be a major catastrophic event leading to sudden death or severe hemodynamic deterioration. A myocardial infarction may be the first manifestation of coronary artery disease, or it may occur, repeatedly, in patients with established disease. Information on myocardial infarction attack rates can provide useful data regarding the burden of coronary artery disease within and across populations, especially if standardized data are collected in a manner that demonstrates the distinction between incident and recurrent events. From the epidemiological point of view, the incidence of myocardial infarction in a population can be used as a proxy for the prevalence of coronary artery disease in that population. Furthermore, the term myocardial infarction has major psychological and legal implications for the individual and society. It is an indicator of one of the leading health problems in the world, and it is an outcome measure in clinical trials and observational studies. With these perspectives, myocardial infarction may be defined from a number of different clinical, electrocardiographic, biochemical, imaging, and pathological characteristics. In the past, a general consensus existed for the clinical syndrome designated as myocardial infarction. In studies of disease prevalence, the World Health Organization (WHO) defined myocardial infarction from symptoms, ECG abnormalities, and enzymes. However, the development of more sensitive and specific serological biomarkers and precise imaging techniques allows detection of ever smaller amounts of myocardial necrosis. Accordingly, current clinical practice, health care delivery systems, as well as epidemiology and clinical trials all require a …

Enigmas y confusiones en el diagnóstico y tratamiento de la plagiocefalia posicional. Protocolo asistencial

Positional plagiocephaly is currently the most frequent cause of consultation at pediatric neurosurgical departments in Spain and other western countries. There is considerable confusion in the literature on the terminology and physiopathology of this deformity, as well as its differential diagnosis with true synostosis and treatment recommendations. To clarify these concepts and present a protocol for the management of positional plagiocephaly, which was recently requested by the Health Administration of the Community of Madrid. The protocol aims to achieve coordination among pediatricians and neurosurgeons, as well as to provide precise information on this deformity for parents, pediatricians and neurosurgeons. Previous consensus was reached on a series of data. Infants were classified into three categories of deformity (mild, moderate, severe) according to measurements on digital photographs. Diagnosis and treatment follows two phases: a pediatric phase (up to 5 months of age) and a neurosurgical phase (from 5 months onwards). Infants are referred to neurosurgical consultation only after being treated with postural changes and physiotherapy and only after reaching the age of 5 months. The reasons for this approach are explained in the protocol, which also defines the functions and responsibilities of each specialty. The treatment proposed in the protocol is staged, starting with postural changes and physiotherapy, followed by orthotic cranial devices and finally surgical treatment.

Weak Northern and Strong Tropical Land Carbon Uptake from Vertical Profiles of Atmospheric CO 2

Measurements of midday vertical atmospheric CO2 distributions reveal annual-mean vertical CO2 gradients that are inconsistent with atmospheric models that estimate a large transfer of terrestrial carbon from tropical to northern latitudes. The three models that most closely reproduce the observed annual-mean vertical CO2 gradients estimate weaker northern uptake of -1.5 petagrams of carbon per year (Pg C year(-1)) and weaker tropical emission of +0.1 Pg C year(-1) compared with previous consensus estimates of -2.4 and +1.8 Pg C year(-1), respectively. This suggests that northern terrestrial uptake of industrial CO2 emissions plays a smaller role than previously thought and that, after subtracting land-use emissions, tropical ecosystems may currently be strong sinks for CO2.

Extension of indoor residual spraying for malaria control into high transmission settings in Africa

Contrary to previous consensus, a recent WHO statement recommends a more dominant role for indoor residual spraying (IRS) in malaria control in high transmission settings of sub-Saharan Africa and re-emphasises the role of DDT. We review the issues related to this change in recommendation. In high transmission settings, IRS must be implemented indefinitely and at high quality to achieve control. As current infrastructure limitations and unpredictable funding make this unlikely, each country must carefully consider the role of IRS. There remains a need to support ongoing insecticide-treated net scale-up. Insecticide choice is hampered by the lack of economic costing data.

Construction of barley consensus map showing chromosomal regions associated with economically important traits

In the past, it has been difficult to accurately determine the location of many types of barley molecular markers due to the lack of commonality between international barley linkage maps. In this study, a consensus map of barley was constructed from five different maps (OWB, VxHs, KxM, barley consensus 2 and barley consensus 2003) to produce the consensus AD-2005 map with 1536 markers. The QTL that have been identified in previous barley studies were then incorporated into the integrated consensus map to provide a quick method of aligning and comparing barley linkage maps and to identify markers closely linked to barley traits. The markers placed on this map are consistent with respect to order on the chromosomes with the individual maps and other barley maps with a few minor differences. The consensus AD-2005 was compared with rice Cornell RFLP map to examine the reliability of the constructed map in comparative genomic studies. Unlike previous consensus maps, the purpose of this consensus map (containing QTL) is to provide a tool for scientists to accurately locate molecular markers to chromosome regions responsible for economically important traits. It is estimated that markers placed on the consensus map are located very close to their true positions as determined by the five maps used in this study. It is envisaged that the consensus map will benefit small-grain researchers by providing an efficient means of choosing markers of interest and identifying QTL regions for future genetic or plant breeding studies on a worldwide basis. Keywords: Barley, QTL, genetic linkage mapping, consensus map, comparative genome mapping

2196: Comparison of Two Types of Biochemical Failures Within the ASTRO and Phoenix Consensus Definitions in Patients Treated on RTOG 92–02 and 94–13

A small, but significant population of prostate cancer patients treated with external beam radiation that are classified as biochemical failures by the ASTRO Consensus Definition or the new Phoenix Consensus Definition may be those patients who were deemed failures due to the “start of any salvage hormonal therapy.” Some of these patients’ PSA patterns following radiation are clinically obvious to be immediately considered failures, while other patients’ non-PSA clinical data may induce the start of hormonal therapy. “Start of hormonal therapy” failure patients may have a different prognosis compared to those patients who were deemed failures due to “three consecutive rising PSAs.” Additionally, this group may provide some insight into extreme PSA patterns. With current work on an updated Consensus definition progressing, this group should be explored. The next Consensus definition should be able to identify these patients in addition to the mainstream patients. We conducted this study to determine the differences in outcome between those patients who failed due to “start of any salvage hormonal therapy” and those patients who failed due to ASTRO or Phoenix PSA criteria. 2,800 patients from RTOG 92–02 (1,521) and 94–13 (1,279) were analyzed. The ASTRO consensus definition defines biochemical failure as occurring after three consecutive PSA rises following a nadir (A1), or any non-A1 event that prompted the initiation of salvage therapy (A2) after the end of radiation therapy. The date of failure is defined as the point half way between the nadir date and the first rise for A1, or the start date of salvage hormone therapy before the three consecutive rises for A2. The Phoenix definition defines biochemical failure as occurring when PSA is greater than nadir + 2 ng/ml (P1), or any non-P1 event that prompted the initiation of salvage therapy (P2) after the end of radiation therapy. The date of failure was defined to be the date that PSA is greater than nadir + 2 ng/ml for P1, or the start date of salvage hormone therapy before PSA is greater than nadir + 2 ng/ml for P2. Time to biochemical failure is measured from the randomization date to the date of failure. The median time to biochemical failure for all patients, by biochemical failure type, was 24.0 months for A1, 21.5 months for A2, 34.5 months for P1, and 24.9 months for P2. Patients classified as A2 failures had a trend of earlier median time to failure compared to A1, and patients classified as P2 failures had a significantly earlier median time to failure in all arms of both studies than those classified as P1. 81 of 291 (27.8%) patients originally classified as A2 were captured as biochemical failure by PSA rise (P1). Overall survival, disease specific survival, and PSA kinetics for A1, A2, P1, and P2 will be reported. Patients deemed biochemical failures by A2 or P2 may have biologically more aggressive disease. Further investigation of this group’s PSA kinetics is warranted. While the Phoenix consensus definition can capture additional patients previously not deemed A1 failures by the previous ASTRO consensus definition, a large portion of A2 are still not captured with the nadir + 2ng/ml used in P1. Future use of Phoenix consensus definition should report the P2 group outcomes separately.

The Diagnosis of the Antiphospholipid Syndrome

The concurrence of antiphospholipid (aPL) antibodies and thrombosis or pregnancy loss defines the 'antiphospholipid syndrome' (APS). The Sydney update of the classification criteria for definite APS diagnosis introduced numerous ameliorations to the previous preliminary consensus statement. Clinical criteria are now better defined as vascular thrombosis must be diagnosed on the basis of objective criteria. Moreover,additional risk factors for thrombosis or pregnancy loss must be taken into account before the diagnosis is made and should be described in detail in scientific reports. As far as laboratory criteria are concerned,the lack of standardization and the misinterpretation of results remain major problems often leading to overdiagnosis. A single positive test result out of the possible assays determining aPL antibodies (Lupus Anticoagulant, LAC, anticardiolipin, aCL and anti. beta2-Glycoprotein I, beta2-GPI, antibodies) is still sufficient,according to the Sydney criteria, to justify a diagnosis of APS. Nevertheless single test positivity may result in overdiagnosis or identification of low risk patients and use of all three tests seems more reasonable. Multiple positivity or (better) triple positivity in our experience allows for the identification of high risk patients for possible recurrence. In the near future, coagulation tests discriminating between a beta2-GPI and anti-prothrombin LAC may be useful in identifying high risk patients.

Multiple adsorption configurations ofNH3molecules on the Si(001) surface

Initial adsorption configurations of $\mathrm{N}{\mathrm{H}}_{3}$ molecules on the Si(001) surface are studied by using scanning tunneling microscopy (STM) and ab initio pseudopotential calculations. In contrast to the previous consensus of single configuration, we demonstrate that there exist two distinct STM features. One is found to be the existing model of on-dimer configuration, that is characterized by the previously unreported ``U-shape'' empty-state feature. The other is identified to be $\mathrm{N}{\mathrm{H}}_{2}$ and H adsorbed at the same side of two adjacent dimers along the dimer row. The identification of all the adsorption configurations would be useful for the quantitative analysis of Si nitridation.

Refining a probabilistic model for interpreting verbal autopsy data

To build on the previously reported development of a Bayesian probabilistic model for interpreting verbal autopsy (VA) data, attempting to improve the model's performance in determining cause of death and to reassess it. An expert group of clinicians, coming from a wide range geographically and in terms of specialization, was convened. Over a four-day period the content of the previous probabilistic model was reviewed in detail and adjusted as necessary to reflect the group consensus. The revised model was tested with the same 189 VA cases from Vietnam, assessed by two local clinicians, that were used to test the preliminary model. The revised model contained a total of 104 indicators that could be derived from VA data and 34 possible causes of death. When applied to the 189 Vietnamese cases, 142 (75.1%) achieved concordance between the model's output and the previous clinical consensus. The remaining 47 cases (24.9%) were presented to a further independent clinician for reassessment. As a result, consensus between clinical reassessment and the model's output was achieved in 28 cases (14.8%); clinical reassessment and the original clinical opinion agreed in 8 cases (4.2%), and in the remaining 11 cases (5.8%) clinical reassessment, the model, and the original clinical opinion all differed. Thus overall the model was considered to have performed well in 170 cases (89.9%). This approach to interpreting VA data continues to show promise. The next steps will be to evaluate it against other sources of VA data. The expert group approach to determining the required probability base seems to have been a productive one in improving the performance of the model.

Discriminating between micrometastases and isolated tumor cells in a regional and institutional setting

The reproducibility of diagnosing isolated tumor cells (ITC) and micrometastases has been recently tested by expert breast pathologists, but might be different in a community setting. Digital images of 50 cases of low volume nodal involvement were circulated among pathologists from the Piedmont region (Italy) and from the Helios Medical Center in Berlin. Participants were asked to categorize the lesions into micrometastasis, ITC or others. The test was performed on the basis of a previous consensus statement. Kappa statistics were used for the assessment of interobserver variability. The kappa values for the consistency of categorizing cases were 0.47 and 0.57 for the regional and the institutional tests, respectively. Our study suggests that the reproducibility of diagnosing micrometastases and ITC in a community setting may reach that of experts, but is in the moderate range, and this may interfere with studies trying to solve the prognostic significance of these diagnostic categories.

The Texas Implementation of Medication Algorithms

A panel consisting of academic psychiatrists and pharmacist administrators of the Texas Department of State Health Services (formerly Texas Department of Mental Health and Mental Retardation), community mental health physicians, advocates, and consumers met in May 2004 to review new evidence in the pharmacologic treatment of bipolar I disorder (BDI). The goal of the consensus conference was to update and revise the current treatment algorithm for BDI as part of the Texas Implementation of Medication Algorithms, a statewide quality assurance program for the treatment of major psychiatric illness. The guidelines for evaluating possible medications, the criteria for selection and ranking, and the updated algorithms are described. Principles from previous consensus conferences were reviewed and amended. Medication algorithms for the acute treatment of hypomanic/manic or mixed and depressive episodes in BDI were developed after examining recent efficacy and safety and tolerability data. Recommendations for maintenance treatments were developed. The panel updated the 2 primary algorithms (hypomanic/manic/mixed and depressive) based on clinical evidence for efficacy, tolerability, and safety developed since 2000. Expert consensus was utilized where clinical evidence was limited. Prevention of new episodes or prophylaxis treatment recommendations were developed based on recent data from longer-term trials. Maintenance recommendations are provided as levels versus a specified staged algorithm, as for acute treatment, due to the relatively limited database to inform treatment. These algorithms for the treatment of BDI represent the recommendations based on the most recent evidence available. These recommendations are meant to provide a framework for clinical decision making, not to replace clinical judgment. As with any algorithm, treatment practices will evolve beyond the recommendations of this consensus conference as new evidence and additional medications become available.

Efficient low-contention asynchronous consensus with the value-oblivious adversary scheduler

We consider asynchronous consensus in the shared-memory setting. We present the first efficient low-contention consensus algorithm for the weak-adversary-scheduler model. The algorithm achieves consensus in O(n log2 n) total work and O(log n) (hot-spot) contention, both expected and with high probability. The algorithm assumes the value-oblivious scheduler, which is defined in the paper. Previous efficient consensus algorithms for weak adversaries suffer from Ω(n) memory contention.

History, scope and methodology of the 3rd International Consensus Workshop on Ovarian Cancer 2004

This document reports the history of the two previous ovarian cancer consensus meetings and the scope and methodology of the 3rd International Ovarian Cancer Consensus Conference, which was held by the GCIG from 5–9 September 2004 in Baden-Baden, Germany. This conference was supported by an unrestricted grant from Bristol-Myers-Squibb. Selection of participants, agenda and deliberations were not influenced by the financial support provider.