RESULTS: Concentrated phosphoric acid was the ultimate cellulose solvent for dissolution

pretreatment since 5% w/w cellulosic fabric can be completed dissolved at 50 degrees C. After regeneration in water, the cellulosic precipitate was subjected to cellulase hydrolysis, resulting in at least 4-fold enhancement of saccharification rate and reducing sugars yield. The colored saccharification products can be utilized by G. xylinus to produce BC, approximately 1.8 g L(-1) SBE-β-CD ic50 BC pellicle was obtained after 7 days static cultivation.

CONCLUSION: Dyed and blended waste fabric can be pretreated effectively by dissolution to produce fermentable sugars by cellulase hydrolysis. Dissolution pretreatment can expose the dyed or polyester fiber covered digestible cellulosic fibers to cellulase and leads to selleck kinase inhibitor a significant enhancement of saccharification yield. The colored saccharification products have no significant inhibiting effect on the fermentation activity of G. xylinus for BC production. (C) 2010 Society of Chemical Industry”
“OBJECTIVE: To estimate the clinical significance of serum anti-human papillomavirus (HPV)

antibodies and high-risk cervical HPV DNA in cervical neoplasia.

METHODS: The study population comprised patients who were histopathologically diagnosed with cervical intraepithelial neoplasia (CIN) 1 (n=64), CIN 2 and 3 (n=241), cervical cancer (n=170), and normal control participants (n=975). Cervical HPV DNA tests were performed through nucleic GW4869 supplier acid hybridization assay tests, and serum anti-HPV 16 and 18 antibodies were measured by competitive immunoassay. The associations of HPV DNA and anti-HPV antibodies were evaluated with demographic characteristics and compared according to the levels of disease severity. Anti-HPV antibodies were also

investigated with clinicopathologic parameters, including survival data.

RESULTS: Among various demographic characteristics, factors involving sexual behavior had a higher tendency of HPV DNA positivity and HPV seropositivity. Human papillomavirus DNA mean titer and positivity were both increased in patients with cervical neoplasia compared with those with normal control participants, but there was no statistical difference among types of cervical neoplasia. Serum anti-HPV 16 antibodies were also able to differentiate cervical neoplasia from a normal control participant and furthermore distinguished CIN 1 from CIN 2 and 3 (odd ratio 2.87 [1.43-5.78], P=.002). In cervical cancer, HPV 16 seropositivity was associated with prolonged disease-free survival according to the univariable analysis (hazard ratio=0.12 [0.01-0.94], P=.044).

CONCLUSION: Serum anti-HPV 16 antibodies can distinguish cervical neoplasia from a normal control and has the advantage of identifying high-grade CIN.

Seemingly a logical choice for

use in situations in which continuous abstinence is required, it mostly has been employed in Europe with forensic populations such as alcoholics seeking drivers license reinstatement. Only two studies have been conducted in transplant patients. In both, hair testing detected more active users than other modalities.

Summary

Use of conventional biomarkers results in variable rates of drug detection, raising questions about fairness of the selection process. Hair analysis significantly increases detection rates. Programs adopting hair analysis should be prepared for more patients to be disqualified during the 6-month waiting period, but those testing negative at baseline could, theoretically, proceed with transplantation buy VX-680 sooner. Selection of more optimal candidates also could improve outcomes.”
“We experienced a case of uterine wall defect with amniocele in a primigravida woman without any history of uterine surgery. On admission due to acute abdominal pain at 32 weeks’ gestation, an ultrasound examination showed a 9×7-cm sized echogenic cystic area in the Morrison pouch. Color Doppler revealed a flow from the uterus into the cystic area through a myometrial defect. During the operation, a 1-cm defect in the uterine myometrium was found on the right fundus. An intact amniotic sac was prolapsed

into the abdominal cavity through the myometrial defect. This was an extremely rare case of unexplained uterine wall defect.”
“Purpose of review

Given Citarinostat supplier that the prevalence of psychiatric disorders in transplant candidates and recipients is substantially higher than in the general population, and that linkages between psychiatric disorders and medical outcomes for nontransplant-related diseases have been established, it is important to determine whether psychiatric disorders predict posttransplant medical outcomes.

Recent findings

Most research has focused on the association between depression

( both pretransplant and posttransplant) and posttransplant mortality. Some research has examined transplant-related morbidity HIF inhibitor outcomes, such as graft rejection, posttransplant malignancies, and infection. However, methodological limitations make it difficult to compare existing studies in this literature directly. Overall, the studies presented in this review indicate that psychiatric distress occurring in the early transplant aftermath bears a stronger relationship to morbidity and mortality outcomes than psychiatric distress occurring before transplant.

Summary

The literature on the impact of psychiatric conditions on the morbidity and mortality of solid organ transplant recipients remains inconclusive. More research is needed in order to investigate these associations among a broader range of psychiatric predictors, morbidity outcomes, and recipient populations.

Results-Radiographic and arthroscopic findings were in agreement with respect to both number and location of fragments in 21 of the 48 (44%) joints. Ultrasonographic and arthroscopic findings were in agreement with respect to number and location of fragments

for 46 of the 48 (96%) joints. In the remaining 2 joints, arthroscopy revealed additional fragments that were not identified ultrasonographically. When ultrasonographic Staurosporine findings were compared with radiographic findings, more fragments were seen ultrasonographically in 3 joints and fewer fragments were seen ultrasonographically in 1 joint. Ultrasonographic findings also confirmed the absence (4 joints) or presence (3 joints) of fragmentation at the dorsoproximal aspect of the joint that had been suspected on the basis of radiographic findings. Ultrasonography was also able to determine the location of the fragments in the joints where this was

not possible radiographically.

Conclusions and Clinical Relevance-Results of the present study suggested that ultrasonography was a useful method for determining the number and location of fragments in horses with dorsal fragmentation of the Selleckchem ERK inhibitor MCP or MTP joint. (J Am Vet Med Assoc 2009;235:70-75)”
“Objective: To compare the effectiveness and safety of a combination of rituximab (RTX) with either methotrexate (MTX) or leflunomide (LEF) in the treatment of patients with active rheumatoid arthritis (RA) and inadequate response to anti-tumor necrosis factor agents or traditional disease-modifying antirheumatic drugs (DMARD) in a real-world setting.

Methods: Data from 77 consecutive unselected patients with active RA and treated with at least 1 cycle of RTX (1 g x 2 weeks) plus MTX or LEE were retrospectively collected. A comparative study between the 2 combinations of treatment (RTX+MTX and RTX+LEF) was performed at 6 months of follow-up considering 3 outcomes: the improvement of RA disease activity, the evolution of functional disability, and the tolerability and side effect profile.

Results: Of the 77 patients, 45 received RTX+MTX and 32 RTX+LEF. At baseline there were no significant differences

between the groups in terms of the main clinical and laboratory data, or in the number of previous DMARD and anti-tumor necrosis factor agents used. At 6 months of follow-up, we did GSK2126458 not find significant differences between the 2 combinations in the evolution of RA disease activity (DAS28 response, according to the European League Against Rheumatism (EULAR) improvement criteria) and functional disability progression (health assessment questionnaire) over time. Minor adverse events occurred in 9% of RTX+MTX patients and in 9% of RTX+LEF patients. None of the patients had serious adverse events and none discontinued the treatment during the study period.

Conclusions: Our preliminary data support the view that LEF is a useful alternative if MTX is contraindicated, since its effectiveness and safety seem similar. (C) 2011 Elsevier Inc.

Averaged over both years, total oil yields for the camelina-soybean and camelina-sunflower sequences were 704 and 1508 L ha(-1). Compared to conventionally produced mono-crops, on average, double-crop soybean and sunflower yielded 82% and 72% of their mono-cropped counterparts, respectively. As expected, double-crop production Sotrastaurin costs were greater than for conventional mono-crops. However, in 2009 if camelina prices were similar to canola, net returns for double-crop camelina and soybean were $172-352 ha(-1) higher than for soybean alone, with highest double-crop net returns for conventional tillage. Furthermore, double-crop soybean seed protein content was little affected

by late seeding, while double-crop sunflower oil content averaged over both years SHP099 purchase was about 13% lower than conventional sunflower sown at an optimum time. A winter camelina-food or -forage crop double-cropping system may be viable for the upper Midwest USA. Published by Elsevier B.V.”
“Study design: Mixed methods study design.

Objectives: The Work Rehabilitation Questionnaire-Self-Report Version (WORQ-SELF)

is an assessment tool based on the International Classification of Functioning, Disability and Health (ICF) developed to evaluate functioning in different patient populations in vocational rehabilitation (VR) settings. The objective of this study is to establish the content validity

of WORQ-SELF in a subgroup of spinal cord injury (SCI) patients in the early post-acute context.

Setting: Swiss Paraplegic Research and Swiss Paraplegic Centre, Nottwil, Switzerland.

Methods: Contents of WORQ-SELF were compared with semi-guided interviews with SCI patients in Switzerland, the Comprehensive ICF Core Set for SCI early post-acute, and outcome instruments used in VR and SCI. A frequency analysis was performed.

Results: WORQ-SELF represented 46 different ICF categories and of these 37 categories were confirmed by the patient interviews. The Comprehensive ICF Core Set for SCI confirmed 25 categories. Four instruments used in VR and IPI-145 supplier SCI setting were identified. Contents of those instruments confirmed 14 categories of WORQ-SELF. Overall, 26 categories of the WORQ-SELF were confirmed by at least 2 of the 3 sources, 13 categories by 1 source and 7 were not confirmed by any of the sources.

Conclusion: The WORQ-SELF proved to have content validity for utility in patients with SCI within the context of VR. WORQ-SELF can be used to assess the functioning and disability of patients in the return to work process.”
“OBJECTIVE: To investigate a possible direct, growth hormone-releasing, hormone-independent action of a growth hormone secretagogue, GHRP-2, in pituitary somatotroph cells in the presence of inactive growth hormone-releasing hormone receptors.

Genes associated with cell differentiation,

such as Gadd45b, were upregulated and prompted us to determine the expression of the Il-24 (Mda-7) gene using real-time PCR. There was an increase in the Mda-7 mRNA expression PD-1/PD-L1 inhibition in B16 and HMV-II melanoma cells, and in human melanocytes. To better visualize the cell morphology, F-actin staining was performed and the results showed an increase in the dendrite outgrowth in HA-treated cells. Silencing the Mc1r gene did not cause a change in the 816 cell morphology observed in cells treated with HA.

Conclusion: This study demonstrated that HA downregulates Mitf gene expression by regulating the expressions of the MAPK signaling pathway intermediates. In addition, the inhibited Mc1r gene expression also contributed to the overall Mitf downregulation but does not play a role in the observed change in B16 cell morphology. HA surprisingly can regulate genes associated with differentiating cells (Mda-7) suggesting a role for HA in the melanoma cell differentiation induction. While the exact molecular mechanism by which HA promotes cell differentiation remain to be determined, it is clear that HA can downregulate Mitf expression and promote cell differentiation and has the potential to be used in the development of therapy for melanoma. (C) 2012 Japanese Society for Investigative Dermatology. Published by Elsevier Ireland Ltd. All rights reserved.”
“Cellular electrophysiology

experiments, important for understanding cardiac arrhythmia mechanisms, are usually performed with channels expressed in non myocytes, or with non-human myocytes. Differences between BKM120 chemical structure cell types and species affect results.

Thus, an accurate model for the undiseased human ventricular action potential (AP) which reproduces a broad range of physiological behaviors is needed. Such a model requires extensive experimental data, but essential elements have been unavailable. HM781-36B in vivo Here, we develop a human ventricular AP model using new undiseased human ventricular data: Ca2+ versus voltage dependent inactivation of L-type Ca2+ current (I-CaL); kinetics for the transient outward, rapid delayed rectifier (I-Kr), Na+/Ca2+ exchange (I-NaCa), and inward rectifier currents; AP recordings at all physiological cycle lengths; and rate dependence and restitution of AP duration (APD) with and without a variety of specific channel blockers. Simulated APs reproduced the experimental AP morphology, APD rate dependence, and restitution. Using undiseased human mRNA and protein data, models for different transmural cell types were developed. Experiments for rate dependence of Ca2+ (including peak and decay) and intracellular sodium ([Na+](i)) in undiseased human myocytes were quantitatively reproduced by the model. Early afterdepolarizations were induced by I-Kr block during slow pacing, and AP and Ca2+ alternans appeared at rates >200 bpm, as observed in the nonfailing human ventricle.

In addition, the spin polarization of the 6s CE that mediate the exchange interaction between localized Ho 4f moments (the RKKY interaction) is found to

be positive, supporting earlier observations. (C) 2011 American Institute of Physics. [doi:10.1063/1.3556958]“
“Next-generation left ventricular assist devices such as the HeartMate II (Thoratec Corporation, Pleasanton, CA) have significantly improved patient outcomes. In particular, the incidence of thromboembolic events appears Copanlisib solubility dmso to be significantly reduced. Pump thrombosis has occurred, however, and is well reported in the literature. The thromboses reported with next-generation devices have generally been partial thromboses associated with significant abnormalities in the system performance data as displayed on the system monitor. We describe a case of complete thrombosis of a HeartMate II axial-flow AZD9291 solubility dmso pump resulting in cardiac arrest but in the absence of alarms or significant aberrations in the performance data.

J Heart Lung Transplant 2011;30:1197-9 (C) 2011 International Society for Heart and Lung Transplantation. All rights reserved.”
“PURPOSE: To assess the long-term outcomes after implantation of a foldable silicone refractive multifocal intraocular lens (IOL).

SETTING: Private practice, Osaka, Japan.

METHODS: This retrospective study evaluated eyes that had implantation of an Array SA40N silicone refractive multifocal IOL with a follow-up of up to 4 years. Outcome measures were refraction, corneal astigmatism, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, uncorrected (UNVA) and corrected (CNVA) near visual acuities, incidence of glare and halos, patient satisfaction, time to neodymium:YAG (Nd:YAG) laser capsulotomy, and spectacle dependence.

RESULTS: The study comprised 41 patients (72 eyes) with a mean age of 48.7 years +/- 13.4 (SD) (range 18 to Selleck MK 1775 71 years) and a mean scotopic pupil size of 5.7 +/- 1.0 mm (range 4.0 to 8.5 mm). The refraction and corneal astigmatism were stable throughout the 4-year follow-up. The mean acuity values 1 month postoperatively were as follows: UDVA, 0.06

logMAR; CDVA, 0.08 logMAR; UNVA, 0.24 logMAR; CNVA, 0.04 logMAR. The change at 4 years was not significant for any visual acuity (P>.64). Patient satisfaction with near vision decreased at 2 years (P = .054). An Nd:YAG laser capsulotomy was performed in 48 eyes (66.7%) a mean 21.7 +/- 16.3 months postoperatively.

CONCLUSIONS: The silicone refractive multifocal IOL provided good and stable distance and near visual acuities over the 4-year follow-up, even though it was anticipated that slight posterior capsule opacification would affect near vision.”
“Stoichiometric Sr2IrO4 is a ferromagnetic J(eff) [1/2] Mott insulator driven by strong spin-orbit coupling. Introduction of very dilute oxygen vacancies into single-crystal Sr2IrO4-delta with delta <= 0.

The biodistribution in mice was also changed after ITZ was encapsulated in CMC coated ICG-001 research buy liposomes. CMC-ITZ-Lips performed significant lung targeting efficiency with AUC, Te and Re of lung all showed obvious elevation. In this study itraconazole was successfully encapsulated into carboxymethyl chitosan-modified liposomes for application of injection.”
“Kim IK, Tan JC, Lapasia J, Elihu A, Busque S, Melcher ML. Incidental kidney stones: a single center experience with kidney donor selection. Abstract: The

presence of kidney stones has been a relative contraindication for living donation. With the widespread use of more sensitive imaging techniques as part of the routine living donor workup, kidney stones are more frequently detected, and their clinical significance in this setting is largely unknown. Records from 325 potential kidney donors who underwent MRA or CT-angiography were reviewed; 294 proceeded to donation. The prevalence of kidney stones found incidentally during donor evaluation was 7.4% (24 of 325). Sixteen donors with stones proceeded with kidney donation. All incidental calculi were nonobstructing and small (median 2 mm; range 19 mm). Eleven recipients were transplanted with allografts containing stones. One recipient developed symptomatic nephrolithasis after transplantation.

This recipient was found to have newly formed stones secondary to hyperoxaluria, suggesting a recipient-driven MS-275 manufacturer propensity for stone formation. The remaining ten recipients have stable graft function, postoperative ultrasound negative

for nephrolithiasis, and no sequelae from stones. No donor developed symptomatic nephrolithiasis following donation. Judicious use of allografts with small stones in donors with normal metabolic studies may be acceptable, and careful follow-up in recipients of such allografts is warranted.”
“Efficient schemes for the non-equilibrium Green’s function simulation in the mode space formalism of electron-phonon scattering using the self-consistent Born approximation in nanoscale devices are presented, both using an “”exact”" and phenomenological Buttiker probe treatment of electron-phonon-scattering. Crenolanib mouse In both cases we have generalized the expressions previously developed for the case of uncoupled mode space to coupled mode space. In the case of the phenomenological Buttiker probe treatment, we have also adapted the expressions used in the exact treatment in order to propose a new microscopic approach of phonon scattering using no analytical or average relaxation time approximations. This allows us to evaluate the accuracy and validity of the Buttiker probe assumption of the existence of a Fermi function in nanoscale devices. Our findings are that if the trends of the exact scattering are approximately reproduced by the Buttiker probe method, it seems to overestimate the on-current for a large range of devices with a channel length of a few tens of nanometers and a drain voltage higher than 100 mV.

Conclusion: Women with leiomyoma

infarction above 90% on contrast-enhanced MR images after UAE show significantly better symptom control and fewer reinterventions than do patients with a lower infarction rate.”
“Out-coupling of light from organic light emitting diodes (OLEDs) is a significant challenge for the application of OLEDs in solid state lighting. Most of the light is trapped in the stratified thin film structure and the glass substrate. In this study, an optical model is developed to simulate the optical electrical field for OLEDs with a stratified structure based on the dipole source term and transfer matrix approach. The exciton click here distribution is also considered in the proposed model. OLEDs with weak microcavity are selected to evaluate the model. Calculation of the electroluminescence spectrum, device efficiency as well as the angular dependence is shown to have a good agreement with the experimental data. Moreover, by using the weak microcavity design, an OLED of more than 70% improved efficiency is achieved. (C) 2011 American Institute of Physics. [doi:10.1063/1.3553837]“
“Sap2 (secreted aspartyl proteinase2) is a member of the Sap family of Candida albicans, a human opportunistic pathogen, which acts as a

virulence factor in experimental animal models of mucosal candidiasis. The C. albicans SAP2 was subcloned into vector pDS56-RBSII-6xhis, under the control of an inducible promoter to produce a truncated 6xhis-tagged, enzymatically inactive Sap2, lacking the N-terminus 76 amino acids (rSap2t). This recombinant Autophagy high throughput screening protein was purified to homogeneity by one-step nickel-chelate affinity chromatography and used to immunize intravaginally oophorectomized estradiol-treated rats. These animals raised local anti-rSap2t immunoglobulin G (IgG) and IgA antibodies and were protected from the challenge of a highly vaginopathic strain of the fungus. Protection was possibly due to the specific antibodies as suggested by the passive transfer selleck chemical of immune vaginal fluid and the protective effects of passive vaccination with anti-rSap2t IgM and IgG monoclonal antibodies. Hence, this

new recombinant proteinase constitutes a novel tool to investigate mechanisms of anti-Candida protection at the vaginal level and as vaccination against vaginal candidiasis, a common, frequently recurrent and sometimes antimycotic-refractory infection in women.”
“Vertical microcavity surface-emitting lasers employing quantum wells and small aperture buried-oxide current and field confinement are demonstrated with wider mode spacing and faster spontaneous carrier recombination (enhanced Purcell factor), lower threshold current, larger side mode suppression ratio (SMSR), and higher photon density and temperature insensitivity. The result is a microcavity laser that achieves higher microwave modulation bandwidth (f(-3dB) = 15.8 GHz) at ultra-low power consumption (1.5 mW) with a slope for the modulation current efficiency factor (MCEF) 17.

An enhanced fluorescence emission coupled with a reduced fluorophore lifetime suggests both an electric field and plasmon-coupling component are the underlying mechanisms for tin-based MEF. In addition, an enhanced fluorophore photostability

is observed near-to tin nanodeposits.”
“Purpose: The present study was designed to evaluate the effects of sequential exposures to low doses of gamma-radiation that induce a radioadaptive response to a later high-dose of radiation in CHO-K1 cells. Materials and methods: Cells were cultured in four dilution cycles and grown to confluency. Radiation treatment was performed Stem Cell Compound Library nmr once per cycle with 0.1 Gy gamma-rays. After the last radiation period (chronic radiation) the culture was irradiated with a higher dose (1 Gy). Each cell culture was immediately divided into two fractions: one of them was used to carry out the comet assay and the other for the structural chromosome aberration test. In the first fraction, genotoxic damage was evaluated by degree of damage in 300 cells per experimental point. The second assay was performed with 400 cells per treatment. The statistical analysis was carried out using the 2-test. Results: Results from these assays demonstrated a genotoxic effect for both the adaptive and acute treatments (p0.001). The comet assay showed a significant increase in damage for the combined treatment

17DMAG purchase when compared with 1 Gy treatment (p0.001). The frequency of chromosomal aberrations (CA) was lower for the combined treatment than for that using the highest radiation dose. Conclusions: These results suggest the possible induction of a radioadaptive response after the sequential exposure to very low doses of radiation. selleck inhibitor The

finding of decreased cytogenetic damage after one cell cycle and not immediately after radiation could indicate the eventual potentiation of repair mechanisms.”
“Introduction: Idiopathic hypocitraturia is a known risk factor for urolithiasis. Several studies have shown an association between vitamin D receptor (VDR) gene polymorphisms and urolithiasis. The aim of this study was to investigate the relationship between VDR gene polymorphisms and idiopathic hypocitraturia in a Chinese population. Subjects and Methods: We chose 50 Chinese subjects with normal urinary citrate levels (N) and 31 Chinese subjects with idiopathic hypocitraturia (L). The VDR polymorphisms BsmI, FokI, TaqI, and ApaI were detected using the PCR-RFLP technique, and the relationship between these polymorphisms and the presence of idiopathic hypocitraturia was analyzed. Results: We found that the prevalence of ‘bb’, ‘ff’, and ‘TT’ VDR genotypes were significantly higher in the ‘L’ group than in the ‘N’ group (p < 0.05). We also found much lower 24-hour urinary citrate concentrations in patients with ‘bb’, ‘ff’, and ‘TT’ genotypes than in patients with other genotypes (p < 0.05).

Heat resistant ear development can be targeted for genetic improvement (C) 2010 Elsevier Masson SAS. All rights reserved.”
“Anbconvulsant activity for Morinda tinctoria was evaluated in albino mice of either sex at 3 different dose levels (200, 400 and 600 mg/kg ip) by MES

and chemical methods The extract showed significant (p<0 001) against both MES (maximal electroshock) and chemical methods”
“Progressive osseous heteroplasia (POH), characterized by progressive heterotopic ossifications of the dermis, skeletal muscle and deep connective tissues, is caused by inactivating mutations of GNAS1 of a paternally transmitted allele. We report a novel GNAS1 mutation in a patient with POH. The patient is a 6 year-old boy, VX-680 datasheet whose short stature came to medical attention

in infancy. He was diagnosed with growth hormone (GH) deficiency, and subsequent selleck GH therapy resulted in catch-up growth. lie developed soft tissue masses in the right heel and right elbow that were calcified or ossified on plain radiographs. MR imaging raised a suspicion of heterotopic ossification; thus, GNAS1 was analyzed. A novel nonsense mutation p.R342X was observed in the patient, but not in his parents. Single nucleotide polymorphism analysis revealed paternal transmission of the mutant allele. RT-PCR analysis

demonstrated expression of both normal and mutant GNAS1 transcripts in the patient. Thus, the patient is considered to have XMU-MP-1 in vitro developed POH because of the non-functioning truncated G(s)alpha protein.”
“In 2008, the World Health Organisation (WHO) recommended practices to ensure the safety of patients worldwide. This led to the development of the Surgical Safety Checklist (SSC). Ireland has endorsed the SSC Ireland has endorsed the SSC(www.hiqa.ie/press-release/2008-06-17-health-information-and-quality-authority-launches-world-health-organization, 10).

We aimed to determine (i) whether SSC is being implemented, (ii) whether it promotes a safer surgical environment and (iii) identify problems associated with its introduction and on-going implementation.

All hospitals in Ireland with operating departments (n = 61) were invited to participate in an online survey.

The response rate was 67 %. The WHO SSC or modified version is in place in 78 % (mean time: 20 months) of operating departments that responded. Partaking in Time Out as a team was reported as occurring in 57 % of cases. Greater than 60 % of respondents reported that the SSC was difficult to introduce and implement and that its introduction was time consuming. Further training in using the SSC was reported as desirable by 84 % of respondents.