Ultrasonographic tissue characterisation of human Achilles tendons: quantification of tendon structure through a novel non-invasive approach

Objective To assess whether three-dimensional imaging of the Achilles tendon by ultrasonographic tissue characterisation (UTC) can differentiate between symptomatic and asymptomatic tendons. Design Case-control study. Setting Sports Medical Department of the Hague Medical Centre. Patients Twenty-six...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:British journal of sports medicine 2010-12, Vol.44 (16), p.1153-1159
Hauptverfasser: van Schie, H T M, de Vos, R J, de Jonge, S, Bakker, E M, Heijboer, M P, Verhaar, J A N, Tol, J L, Weinans, H
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 1159
container_issue 16
container_start_page 1153
container_title British journal of sports medicine
container_volume 44
creator van Schie, H T M
de Vos, R J
de Jonge, S
Bakker, E M
Heijboer, M P
Verhaar, J A N
Tol, J L
Weinans, H
description Objective To assess whether three-dimensional imaging of the Achilles tendon by ultrasonographic tissue characterisation (UTC) can differentiate between symptomatic and asymptomatic tendons. Design Case-control study. Setting Sports Medical Department of the Hague Medical Centre. Patients Twenty-six tendons from patients with chronic midportion Achilles tendinopathy were included. The “matched” control group consisted of 26 asymptomatic tendons. Interventions Symptomatic and asymptomatic tendons were scanned using the UTC procedure. One researcher performed the ultrasonographic data collection. These blinded data were randomised, and outcome measures were determined by two independent observers. Main outcome measurements The raw ultrasonographic images were analysed with a customdesigned algorithm that quantifies the three-dimensional stability of echo patterns, qua intensity and distribution over contiguous transverse images. This threedimensional stability was related to tendon structure in previous studies. UTC categorises four different echotypes that represent (I) highly stable; (II) medium stable; (III) highly variable and (IV) constantly low intensity and variable distribution. The percentages of echo-types were calculated, and the maximum tendon thickness was measured. Finally, the inter-observer reliability of UTC was determined. Results Symptomatic tendons showed less pixels in echo-types I and II than asymptomatic tendons (51.5% vs 76.6%, p
doi_str_mv 10.1136/bjsm.2009.061010
format Article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_954607573</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>818402748</sourcerecordid><originalsourceid>FETCH-LOGICAL-b501t-5ad37600aa762c59523ec84ba493497907202b77c7e6c0c810d090ae3f48580c3</originalsourceid><addsrcrecordid>eNqF0UFv0zAUB_AIgVgZ3DkhCw4cUMpz7NjxblO1MqQJdti4Wo7rLC6J3dlOxb4DHxpXqYaEhOaDfXi_956sf1G8xbDEmLDP7TaOywpALIFhwPCsWGDKSQm0gefFAgiwkjBOT4pXMW4BcFVD87I4wYLlU7FF8ft2SEFF7_xdULveapRsjJNBuldB6WSCjSpZ75DvUD-NyqFz3dthMBEl4zbexTN0PymXbGf1o5xLKKYw6TQFg1If_HTXI4Wc35sh3660bq-i3Rukdrvgle5fFy86NUTz5vieFrfri5vVZXn1_cvX1flV2daAU1mrDeEMQCnOKl2LuiJGN7RVVBAquABeQdVyrrlhGnSDYQMClCEdbeoGNDktPs5z89r7ycQkRxu1GQbljJ-iFDVlwGtOnpQNbihUnDZZvv9Hbv0UXP6GbChnmFMBGX34H8KcC8xFDjMrmJUOPsZgOrkLdlThQWKQh9zlIXd5yF3OueeWd8fBUzuazd-GY9AZlDOwMZlfj3UVfkrGCa_ltx8reX25XuMKbuR19p9m347bp9f_ARQ5xtQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1779179200</pqid></control><display><type>article</type><title>Ultrasonographic tissue characterisation of human Achilles tendons: quantification of tendon structure through a novel non-invasive approach</title><source>MEDLINE</source><source>BMJ Journals - NESLi2</source><creator>van Schie, H T M ; de Vos, R J ; de Jonge, S ; Bakker, E M ; Heijboer, M P ; Verhaar, J A N ; Tol, J L ; Weinans, H</creator><creatorcontrib>van Schie, H T M ; de Vos, R J ; de Jonge, S ; Bakker, E M ; Heijboer, M P ; Verhaar, J A N ; Tol, J L ; Weinans, H</creatorcontrib><description>Objective To assess whether three-dimensional imaging of the Achilles tendon by ultrasonographic tissue characterisation (UTC) can differentiate between symptomatic and asymptomatic tendons. Design Case-control study. Setting Sports Medical Department of the Hague Medical Centre. Patients Twenty-six tendons from patients with chronic midportion Achilles tendinopathy were included. The “matched” control group consisted of 26 asymptomatic tendons. Interventions Symptomatic and asymptomatic tendons were scanned using the UTC procedure. One researcher performed the ultrasonographic data collection. These blinded data were randomised, and outcome measures were determined by two independent observers. Main outcome measurements The raw ultrasonographic images were analysed with a customdesigned algorithm that quantifies the three-dimensional stability of echo patterns, qua intensity and distribution over contiguous transverse images. This threedimensional stability was related to tendon structure in previous studies. UTC categorises four different echotypes that represent (I) highly stable; (II) medium stable; (III) highly variable and (IV) constantly low intensity and variable distribution. The percentages of echo-types were calculated, and the maximum tendon thickness was measured. Finally, the inter-observer reliability of UTC was determined. Results Symptomatic tendons showed less pixels in echo-types I and II than asymptomatic tendons (51.5% vs 76.6%, p&lt;0.001), thus less three-dimensional stability of the echo pattern. The mean maximum tendon thickness was 9.2 mm in the symptomatic group and 6.8 mm in the asymptomatic group (p&lt;0.001). The Intraclass Correlation Coefficient (ICC) for the interobserver reliability of determining the echo-types I+II was 0.95. The ICC for tendon thickness was 0.84. Conclusion UTC can quantitatively evaluate tendon structure and thereby discriminate symptomatic and asymptomatic tendons. As such, UTC might be useful to monitor treatment protocols.</description><identifier>ISSN: 0306-3674</identifier><identifier>EISSN: 1473-0480</identifier><identifier>DOI: 10.1136/bjsm.2009.061010</identifier><identifier>PMID: 19666626</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine</publisher><subject>Achilles Tendon - diagnostic imaging ; Adolescent ; Adult ; Algorithms ; Asymptomatic ; Case-Control Studies ; Data collection ; Female ; Histology ; Humans ; Imaging, Three-Dimensional - methods ; Male ; Medicine ; Middle Aged ; Observer Variation ; Sports medicine ; Studies ; Tendinopathy - diagnostic imaging ; Tendons ; Tissues ; Ultrasonic imaging ; Ultrasonography ; Young Adult</subject><ispartof>British journal of sports medicine, 2010-12, Vol.44 (16), p.1153-1159</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>Copyright: 2010 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>Copyright BMJ Publishing Group Dec 2010</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b501t-5ad37600aa762c59523ec84ba493497907202b77c7e6c0c810d090ae3f48580c3</citedby><cites>FETCH-LOGICAL-b501t-5ad37600aa762c59523ec84ba493497907202b77c7e6c0c810d090ae3f48580c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://bjsm.bmj.com/content/44/16/1153.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttp://bjsm.bmj.com/content/44/16/1153.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,780,784,3196,23571,27924,27925,77600,77631</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19666626$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van Schie, H T M</creatorcontrib><creatorcontrib>de Vos, R J</creatorcontrib><creatorcontrib>de Jonge, S</creatorcontrib><creatorcontrib>Bakker, E M</creatorcontrib><creatorcontrib>Heijboer, M P</creatorcontrib><creatorcontrib>Verhaar, J A N</creatorcontrib><creatorcontrib>Tol, J L</creatorcontrib><creatorcontrib>Weinans, H</creatorcontrib><title>Ultrasonographic tissue characterisation of human Achilles tendons: quantification of tendon structure through a novel non-invasive approach</title><title>British journal of sports medicine</title><addtitle>Br J Sports Med</addtitle><description>Objective To assess whether three-dimensional imaging of the Achilles tendon by ultrasonographic tissue characterisation (UTC) can differentiate between symptomatic and asymptomatic tendons. Design Case-control study. Setting Sports Medical Department of the Hague Medical Centre. Patients Twenty-six tendons from patients with chronic midportion Achilles tendinopathy were included. The “matched” control group consisted of 26 asymptomatic tendons. Interventions Symptomatic and asymptomatic tendons were scanned using the UTC procedure. One researcher performed the ultrasonographic data collection. These blinded data were randomised, and outcome measures were determined by two independent observers. Main outcome measurements The raw ultrasonographic images were analysed with a customdesigned algorithm that quantifies the three-dimensional stability of echo patterns, qua intensity and distribution over contiguous transverse images. This threedimensional stability was related to tendon structure in previous studies. UTC categorises four different echotypes that represent (I) highly stable; (II) medium stable; (III) highly variable and (IV) constantly low intensity and variable distribution. The percentages of echo-types were calculated, and the maximum tendon thickness was measured. Finally, the inter-observer reliability of UTC was determined. Results Symptomatic tendons showed less pixels in echo-types I and II than asymptomatic tendons (51.5% vs 76.6%, p&lt;0.001), thus less three-dimensional stability of the echo pattern. The mean maximum tendon thickness was 9.2 mm in the symptomatic group and 6.8 mm in the asymptomatic group (p&lt;0.001). The Intraclass Correlation Coefficient (ICC) for the interobserver reliability of determining the echo-types I+II was 0.95. The ICC for tendon thickness was 0.84. Conclusion UTC can quantitatively evaluate tendon structure and thereby discriminate symptomatic and asymptomatic tendons. As such, UTC might be useful to monitor treatment protocols.</description><subject>Achilles Tendon - diagnostic imaging</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Algorithms</subject><subject>Asymptomatic</subject><subject>Case-Control Studies</subject><subject>Data collection</subject><subject>Female</subject><subject>Histology</subject><subject>Humans</subject><subject>Imaging, Three-Dimensional - methods</subject><subject>Male</subject><subject>Medicine</subject><subject>Middle Aged</subject><subject>Observer Variation</subject><subject>Sports medicine</subject><subject>Studies</subject><subject>Tendinopathy - diagnostic imaging</subject><subject>Tendons</subject><subject>Tissues</subject><subject>Ultrasonic imaging</subject><subject>Ultrasonography</subject><subject>Young Adult</subject><issn>0306-3674</issn><issn>1473-0480</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqF0UFv0zAUB_AIgVgZ3DkhCw4cUMpz7NjxblO1MqQJdti4Wo7rLC6J3dlOxb4DHxpXqYaEhOaDfXi_956sf1G8xbDEmLDP7TaOywpALIFhwPCsWGDKSQm0gefFAgiwkjBOT4pXMW4BcFVD87I4wYLlU7FF8ft2SEFF7_xdULveapRsjJNBuldB6WSCjSpZ75DvUD-NyqFz3dthMBEl4zbexTN0PymXbGf1o5xLKKYw6TQFg1If_HTXI4Wc35sh3660bq-i3Rukdrvgle5fFy86NUTz5vieFrfri5vVZXn1_cvX1flV2daAU1mrDeEMQCnOKl2LuiJGN7RVVBAquABeQdVyrrlhGnSDYQMClCEdbeoGNDktPs5z89r7ycQkRxu1GQbljJ-iFDVlwGtOnpQNbihUnDZZvv9Hbv0UXP6GbChnmFMBGX34H8KcC8xFDjMrmJUOPsZgOrkLdlThQWKQh9zlIXd5yF3OueeWd8fBUzuazd-GY9AZlDOwMZlfj3UVfkrGCa_ltx8reX25XuMKbuR19p9m347bp9f_ARQ5xtQ</recordid><startdate>20101201</startdate><enddate>20101201</enddate><creator>van Schie, H T M</creator><creator>de Vos, R J</creator><creator>de Jonge, S</creator><creator>Bakker, E M</creator><creator>Heijboer, M P</creator><creator>Verhaar, J A N</creator><creator>Tol, J L</creator><creator>Weinans, H</creator><general>BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M2P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20101201</creationdate><title>Ultrasonographic tissue characterisation of human Achilles tendons: quantification of tendon structure through a novel non-invasive approach</title><author>van Schie, H T M ; de Vos, R J ; de Jonge, S ; Bakker, E M ; Heijboer, M P ; Verhaar, J A N ; Tol, J L ; Weinans, H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b501t-5ad37600aa762c59523ec84ba493497907202b77c7e6c0c810d090ae3f48580c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Achilles Tendon - diagnostic imaging</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Algorithms</topic><topic>Asymptomatic</topic><topic>Case-Control Studies</topic><topic>Data collection</topic><topic>Female</topic><topic>Histology</topic><topic>Humans</topic><topic>Imaging, Three-Dimensional - methods</topic><topic>Male</topic><topic>Medicine</topic><topic>Middle Aged</topic><topic>Observer Variation</topic><topic>Sports medicine</topic><topic>Studies</topic><topic>Tendinopathy - diagnostic imaging</topic><topic>Tendons</topic><topic>Tissues</topic><topic>Ultrasonic imaging</topic><topic>Ultrasonography</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van Schie, H T M</creatorcontrib><creatorcontrib>de Vos, R J</creatorcontrib><creatorcontrib>de Jonge, S</creatorcontrib><creatorcontrib>Bakker, E M</creatorcontrib><creatorcontrib>Heijboer, M P</creatorcontrib><creatorcontrib>Verhaar, J A N</creatorcontrib><creatorcontrib>Tol, J L</creatorcontrib><creatorcontrib>Weinans, H</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing &amp; Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of sports medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van Schie, H T M</au><au>de Vos, R J</au><au>de Jonge, S</au><au>Bakker, E M</au><au>Heijboer, M P</au><au>Verhaar, J A N</au><au>Tol, J L</au><au>Weinans, H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ultrasonographic tissue characterisation of human Achilles tendons: quantification of tendon structure through a novel non-invasive approach</atitle><jtitle>British journal of sports medicine</jtitle><addtitle>Br J Sports Med</addtitle><date>2010-12-01</date><risdate>2010</risdate><volume>44</volume><issue>16</issue><spage>1153</spage><epage>1159</epage><pages>1153-1159</pages><issn>0306-3674</issn><eissn>1473-0480</eissn><abstract>Objective To assess whether three-dimensional imaging of the Achilles tendon by ultrasonographic tissue characterisation (UTC) can differentiate between symptomatic and asymptomatic tendons. Design Case-control study. Setting Sports Medical Department of the Hague Medical Centre. Patients Twenty-six tendons from patients with chronic midportion Achilles tendinopathy were included. The “matched” control group consisted of 26 asymptomatic tendons. Interventions Symptomatic and asymptomatic tendons were scanned using the UTC procedure. One researcher performed the ultrasonographic data collection. These blinded data were randomised, and outcome measures were determined by two independent observers. Main outcome measurements The raw ultrasonographic images were analysed with a customdesigned algorithm that quantifies the three-dimensional stability of echo patterns, qua intensity and distribution over contiguous transverse images. This threedimensional stability was related to tendon structure in previous studies. UTC categorises four different echotypes that represent (I) highly stable; (II) medium stable; (III) highly variable and (IV) constantly low intensity and variable distribution. The percentages of echo-types were calculated, and the maximum tendon thickness was measured. Finally, the inter-observer reliability of UTC was determined. Results Symptomatic tendons showed less pixels in echo-types I and II than asymptomatic tendons (51.5% vs 76.6%, p&lt;0.001), thus less three-dimensional stability of the echo pattern. The mean maximum tendon thickness was 9.2 mm in the symptomatic group and 6.8 mm in the asymptomatic group (p&lt;0.001). The Intraclass Correlation Coefficient (ICC) for the interobserver reliability of determining the echo-types I+II was 0.95. The ICC for tendon thickness was 0.84. Conclusion UTC can quantitatively evaluate tendon structure and thereby discriminate symptomatic and asymptomatic tendons. As such, UTC might be useful to monitor treatment protocols.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine</pub><pmid>19666626</pmid><doi>10.1136/bjsm.2009.061010</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 0306-3674
ispartof British journal of sports medicine, 2010-12, Vol.44 (16), p.1153-1159
issn 0306-3674
1473-0480
language eng
recordid cdi_proquest_miscellaneous_954607573
source MEDLINE; BMJ Journals - NESLi2
subjects Achilles Tendon - diagnostic imaging
Adolescent
Adult
Algorithms
Asymptomatic
Case-Control Studies
Data collection
Female
Histology
Humans
Imaging, Three-Dimensional - methods
Male
Medicine
Middle Aged
Observer Variation
Sports medicine
Studies
Tendinopathy - diagnostic imaging
Tendons
Tissues
Ultrasonic imaging
Ultrasonography
Young Adult
title Ultrasonographic tissue characterisation of human Achilles tendons: quantification of tendon structure through a novel non-invasive approach
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-18T22%3A29%3A43IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Ultrasonographic%20tissue%20characterisation%20of%20human%20Achilles%20tendons:%20quantification%20of%20tendon%20structure%20through%20a%20novel%20non-invasive%20approach&rft.jtitle=British%20journal%20of%20sports%20medicine&rft.au=van%20Schie,%20H%20T%20M&rft.date=2010-12-01&rft.volume=44&rft.issue=16&rft.spage=1153&rft.epage=1159&rft.pages=1153-1159&rft.issn=0306-3674&rft.eissn=1473-0480&rft_id=info:doi/10.1136/bjsm.2009.061010&rft_dat=%3Cproquest_cross%3E818402748%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1779179200&rft_id=info:pmid/19666626&rfr_iscdi=true