rCBF in hemorrhagic, non-hemorrhagic and mixed contusions after severe head injury and its effect on perilesional cerebral blood flow

Intracerebral contusions can lead to regional ischemia caused by extensive release of excitotoxic aminoacids leading to increased cytotoxic brain edema and raised intracranial pressure. rCBF measurements might provide further information about the risk of ischemia within and around contusions. Therefore, the aim of the presented study was to compare the intra- and perilesional rCBF of hemorrhagic, non-hemorrhagic and mixed intracerebral contusions. In 44 patients, 60 stable Xenon-enhanced CT CBF-studies were performed (EtCO2 30 +/- 4 mmHg SD), initially 29 hours (39 studies) and subsequent 95 hours after injury (21 studies). All lesions were classified according to localization and lesion type using CT/MRI scans. The rCBF was calculated within and 1-cm adjacent to each lesion in CT-isodens brain. The rCBF within all contusions (n = 100) of 29 +/- 11 ml/100 g/min was significantly lower (p < 0.0001, Mann-Whitney U) compared to perilesional rCBF of 44 +/- 12 ml/100 g/min and intra/perilesional correlation was 0.4 (p < 0.0005). Hemorrhagic contusions showed an intra/perilesional rCBF of 31 +/- 11/44 +/- 13 ml/100 g/min (p < 0.005), non-hemorrhagic contusions 35 +/- 13/46 +/- 10 ml/100 g/min (p < 0.01). rCBF in mixed contusions (25 +/- 9/44 +/- 12 ml/100 g/min, p < 0.0001) was significantly lower compared to hemorrhagic and non-hemorrhagic contusions (p < 0.02). Intracontusional rCBF is significantly reduced to 29 +/- 11 ml/100 g/min but reduced below ischemic levels of 18 ml/100 g/min in only 16% of all contusions. Perilesional CBF in CT normal appearing brain closed to contusions is not critically reduced. Further differentiation of contusions demonstrates significantly lower rCBF in mixed contusions (defined by both hyper- and hypodense areas in the CT-scan) compared to hemorrhagic and non-hemorrhagic contusions. Mixed contusions may evolve from hemorrhagic contusions with secondary increased perilesional cytotoxic brain edema leading to reduced cerebral blood flow and altered brain metabolism. Therefore, the treatment of ICP might be individually modified by the measurement of intra- and pericontusional cerebral blood.

Effect of initial treatment strategy on survival of patients with advanced-stage Hodgkin's lymphoma: a systematic review and network meta-analysis

BACKGROUND Several treatment strategies are available for adults with advanced-stage Hodgkin's lymphoma, but studies assessing two alternative standards of care-increased dose bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPPescalated), and doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD)-were not powered to test differences in overall survival. To guide treatment decisions in this population of patients, we did a systematic review and network meta-analysis to identify the best initial treatment strategy. METHODS We searched the Cochrane Library, Medline, and conference proceedings for randomised controlled trials published between January, 1980, and June, 2013, that assessed overall survival in patients with advanced-stage Hodgkin's lymphoma given BEACOPPbaseline, BEACOPPescalated, BEACOPP variants, ABVD, cyclophosphamide (mechlorethamine), vincristine, procarbazine, and prednisone (C[M]OPP), hybrid or alternating chemotherapy regimens with ABVD as the backbone (eg, COPP/ABVD, MOPP/ABVD), or doxorubicin, vinblastine, mechlorethamine, vincristine, bleomycin, etoposide, and prednisone combined with radiation therapy (the Stanford V regimen). We assessed studies for eligibility, extracted data, and assessed their quality. We then pooled the data and used a Bayesian random-effects model to combine direct comparisons with indirect evidence. We also reconstructed individual patient survival data from published Kaplan-Meier curves and did standard random-effects Poisson regression. Results are reported relative to ABVD. The primary outcome was overall survival. FINDINGS We screened 2055 records and identified 75 papers covering 14 eligible trials that assessed 11 different regimens in 9993 patients, providing 59 651 patient-years of follow-up. 1189 patients died, and the median follow-up was 5·9 years (IQR 4·9-6·7). Included studies were of high methodological quality, and between-trial heterogeneity was negligible (τ(2)=0·01). Overall survival was highest in patients who received six cycles of BEACOPPescalated (HR 0·38, 95% credibility interval [CrI] 0·20-0·75). Compared with a 5 year survival of 88% for ABVD, the survival benefit for six cycles of BEACOPPescalated is 7% (95% CrI 3-10)-ie, a 5 year survival of 95%. Reconstructed individual survival data showed that, at 5 years, BEACOPPescalated has a 10% (95% CI 3-15) advantage over ABVD in overall survival. INTERPRETATION Six cycles of BEACOPPescalated significantly improves overall survival compared with ABVD and other regimens, and thus we recommend this treatment strategy as standard of care for patients with access to the appropriate supportive care.

Effect of MGA on Performance, Sexual Behavior, Carcass Quality and Tenderness in Mixed-Sex Pens of Cattle

The effect of MGA in mixed pens of steers and heifers was evaluated over a three-year period at the ISU Armstrong Research Farm near Lewis, Iowa. Two pens of approximately 40 head were fed diets with or without MGA in each of three replications. Estrus and riding activity was monitored using the Heat Watchâ system. At slaughter, in addition to routine carcass data collection, a rib sample was collected from each carcass for tenderness evaluation. There was no effect on dry matter intake due to MGA treatment. Mixed-sex pens that were fed MGA were 4% more efficient than controls. MGA-fed steers gained similarly to control steers. MGA fed heifers gained 8% faster than control heifers. MGA highly reduced measures of estrus and riding activity throughout the feeding period. MGA feeding improved marbling and tenderness measured in both steers and heifers. These data suggest that MGA has potential to improve performance, quality grade and tenderness in mixed pens of steers and heifers.

Unique mixed phenotype and unexpected functional effect revealed by novel compound heterozygosity mutations involving SCN5A.

BACKGROUND Functional characterization of mutations involving the SCN5A-encoded cardiac sodium channel has established the pathogenic mechanisms for type 3 long QT syndrome and type 1 Brugada syndrome and has provided key insights into the physiological importance of essential structure-function domains. OBJECTIVE This study sought to present the clinical and biophysical phenotypes discerned from compound heterozygosity mutations in SCN5A on different alleles in a toddler diagnosed with QT prolongation and fever-induced ventricular arrhythmias. METHODS A 22-month-old boy presented emergently with fever and refractory ventricular tachycardia. Despite restoration of sinus rhythm, the infant sustained profound neurological injury and died. Using polymerase chain reaction, denaturing high-performance liquid chromatography, and direct DNA sequencing, comprehensive open-reading frame/splice mutational analysis of the 12 known long QT syndrome susceptibility genes was performed. RESULTS The infant had 2 SCN5A mutations: a maternally inherited N-terminal frame shift/deletion (R34fs/60) and a paternally inherited missense mutation, R1195H. The mutations were engineered by site-directed mutagenesis and heterologously expressed transiently in HEK293 cells. As expected, the frame-shifted and prematurely truncated peptide, SCN5A-R34fs/60, showed no current. SCN5A-R1195H had normal peak and late current but abnormal voltage-dependent gating parameters. Surprisingly, co-expression of SCN5A-R34fs/60 with SCN5A-R1195H elicited a significant increase in late sodium current, whereas co-expression of SCN5A-WT with SCN5A-R34fs/60 did not. CONCLUSIONS A severe clinical phenotype characterized by fever-induced monomorphic ventricular tachycardia and QT interval prolongation emerged in a toddler with compound heterozygosity involving SCN5A: R34fs/60, and R1195H. Unexpectedly, the 94-amino-acid fusion peptide derived from the R34fs/60 mutation accentuated the late sodium current of R1195H-containing Na(V)1.5 channels in vitro.

Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis.

BACKGROUND Non-steroidal anti-inflammatory drugs (NSAIDs) are the backbone of osteoarthritis pain management. We aimed to assess the effectiveness of different preparations and doses of NSAIDs on osteoarthritis pain in a network meta-analysis. METHODS For this network meta-analysis, we considered randomised trials comparing any of the following interventions: NSAIDs, paracetamol, or placebo, for the treatment of osteoarthritis pain. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the reference lists of relevant articles for trials published between Jan 1, 1980, and Feb 24, 2015, with at least 100 patients per group. The prespecified primary and secondary outcomes were pain and physical function, and were extracted in duplicate for up to seven timepoints after the start of treatment. We used an extension of multivariable Bayesian random effects models for mixed multiple treatment comparisons with a random effect at the level of trials. For the primary analysis, a random walk of first order was used to account for multiple follow-up outcome data within a trial. Preparations that used different total daily dose were considered separately in the analysis. To assess a potential dose-response relation, we used preparation-specific covariates assuming linearity on log relative dose. FINDINGS We identified 8973 manuscripts from our search, of which 74 randomised trials with a total of 58 556 patients were included in this analysis. 23 nodes concerning seven different NSAIDs or paracetamol with specific daily dose of administration or placebo were considered. All preparations, irrespective of dose, improved point estimates of pain symptoms when compared with placebo. For six interventions (diclofenac 150 mg/day, etoricoxib 30 mg/day, 60 mg/day, and 90 mg/day, and rofecoxib 25 mg/day and 50 mg/day), the probability that the difference to placebo is at or below a prespecified minimum clinically important effect for pain reduction (effect size [ES] -0·37) was at least 95%. Among maximally approved daily doses, diclofenac 150 mg/day (ES -0·57, 95% credibility interval [CrI] -0·69 to -0·46) and etoricoxib 60 mg/day (ES -0·58, -0·73 to -0·43) had the highest probability to be the best intervention, both with 100% probability to reach the minimum clinically important difference. Treatment effects increased as drug dose increased, but corresponding tests for a linear dose effect were significant only for celecoxib (p=0·030), diclofenac (p=0·031), and naproxen (p=0·026). We found no evidence that treatment effects varied over the duration of treatment. Model fit was good, and between-trial heterogeneity and inconsistency were low in all analyses. All trials were deemed to have a low risk of bias for blinding of patients. Effect estimates did not change in sensitivity analyses with two additional statistical models and accounting for methodological quality criteria in meta-regression analysis. INTERPRETATION On the basis of the available data, we see no role for single-agent paracetamol for the treatment of patients with osteoarthritis irrespective of dose. We provide sound evidence that diclofenac 150 mg/day is the most effective NSAID available at present, in terms of improving both pain and function. Nevertheless, in view of the safety profile of these drugs, physicians need to consider our results together with all known safety information when selecting the preparation and dose for individual patients. FUNDING Swiss National Science Foundation (grant number 405340-104762) and Arco Foundation, Switzerland.

Platforms, network effects and small business dynamics in China : case study of the Shanzhai cell phone industry

This paper seeks to argue the significance of platforms on emerging markets through a case study of the Shanzhai cell phone industry in Shenzhen, China. In this industry, value chains are being driven by both the technology platforms and the market platforms. The former include MTK baseband chipset, and so-called Shared PCBA and Shared Mould. The latter include the North Huaqiang Market and the Purchasing and Money Platform. Technology platforms greatly reduced the technological barriers to entry for independent design houses and system integrators, while market platforms markedly improved their poor marketing and purchasing abilities. Due to factors such as social networks, supporting industries, informality and platform governance, strong network effects have been exhibited in the two types of platforms, which have not only fostered numerous start-ups, but have also led to effective exploitation of emerging markets.

Promoting mixed stands through conversion treatments. Effect of holm oak coppices thinning on black pine regeneration

The effects of conversion treatments, depending on ecological factors and silvicultural parameters (thinning intensity, thinning type and rotation, among others) have been studied during the last fifteen years in an experimental trial in Central Spain. The general climate is continental Mediterranean; soils are low depth and limy; vegetation is an homogeneous dense coppices of Quercus ilex with isolated Pinus nigra trees. The experimental design (three locations) includes different thinning intensities (from 0 to 100% of extracted basal area). Inventories have been carried out in 1994 and 2010; thinning treatments were done in 1995 and 2011. Analysis of the effects of the conversion treatment show the increment of diameter and height growth rates, the canopy recovery and the stand resprouting, finding differences in these effects between thinning treatments. Besides the induced changes at holm oak stand, the application of conversion treatment clearly changed the woodland dynamics. Fifteen years after the thinnings, floristic composition varied and an abundant pine regeneration was installed in the woodland. In this work we describe the changes between inventories in tree species composition and diameter distribution, specially in the case of black pine. The conversion treatment caused changes in forest dynamics in the short term, increasing biodiversity and diversifying the forest structure. The fast installation of Pinus regeneration suggests the potential of the zone for the establishment of multipurpose mixed Quercus-Pinus stands in wide areas where Quercus species were favoured by human populations for firewood production. Conversion treatment of coppices, with the creation of mixed stands, constitutes a good management alternative for extensive areas and an interesting technique to adaptation to global change.

Small-scale variation of vegetation in a mixed forest understorey is partly controlled by the effect of overstory composition on litter accumulation

We investigated how richness and composition of vascular plant species in the understory of a mixed hardwood forest stand varied with respect to the abundance and composition of the overstory. The stand is in central Spain and represents the southernmost range of distribution of several tree and herbaceous species in Europe. Understory species were identified in 46 quadrats (0.25 m2) where variables litter depth and light availability were measured. In addition, we estimated tree density, basal area, and percent basal area by tree species within 6-m-radius areas around each plot. Species richness and composition were studied using path analysis and scale-dependent geostatistical methods, respectively. We found that the relative abundance of certain trees species in the overstory was more important than total overstory abundance in explaining understory species richness. Richness decreased as soil litter depth increased, and soil litter increased as the relative proportion of Fagus sylvatica in the overstory increased, which accounted for a negative, indirect effect of Fagus sylvatica on richness. Regarding understory species composition, we found that some species distributed preferentially below certain tree species. For example, Melica uniflora was most frequent below Fagus sylvatica and Quercus petraea while the increasing proportion of Q. pyrenaica in the overstory favored the presence of Cruciata glabra, Arenaria montana, Prunus avium, Conopodium bourgaei, Holcus mollis, Stellaria media and Galium aparine in the understory. Overall, these results emphasize the importance of individual tree species in controlling the assemblage and richness of understory species in mixed stands. We conclude that soil litter accumulation is one way through which overstory composition shapes the understory community.

Natural regeneration in mediterranean mixed forests: effect of environmental conditions on the physiological optimum niche of the species = Regeneración natural en masas mixtas mediterráneas: efecto de las condiciones ambientales en el nicho óptimo fisiológico de las especies

Los montes Mediterráneos han experimentado múltiples cambios en las últimas décadas (tanto en clima como en usos), lo que ha conducido a variaciones en la distribución de especies. El aumento previsto de las temperaturas medias junto con la mayor variabilidad intra e inter anual en cuanto a la ocurrencia de eventos extremos o disturbios naturales (como periodos prolongados de sequía, olas de frío o calor, incendios forestales o vendavales) pueden dañar significativamente al regenerado, llevándolo hasta la muerte, y jugando un papel decisivo en la composición de especies y en la dinámica del monte. La amplitud ecológica de muchas especies forestales puede verse afectada, de forma que se esperan cambios en sus nichos actuales de regeneración. Sin embargo, la migración latitudinal de las especies en busca de mejores condiciones, podría ser una explicación demasiado simplista de un proceso mucho más complejo de interacción entre la temperatura y la precipitación, que afectaría a cada especie de un modo distinto. En este sentido tanto la capacidad de adaptación al estrés ambiental de una determinada especie, así como su habilidad para competir por los recursos limitados, podría significar variaciones dentro de una comunidad. Las características fisiológicas y morfológicas propias de cada especie se encuentran fuertemente relacionadas con el lugar donde cada una puede surgir, qué especies pueden convivir y como éstas responden a las condiciones ambientales. En este sentido, el conocimiento sobre las distintas respuestas ecofisiológicas observadas ante cambios ambientales puede ser fundamentales para la predicción de variaciones en la distribución de especies, composición de la comunidad y productividad del monte ante el cambio global. En esta tesis investigamos el grado de tolerancia y sensibilidad que cada una de las tres especies de estudio, coexistentes en el interior peninsular ibérico (Pinus pinea, Quercus ilex y Juniperus oxycedrus), muestra ante los factores abióticos de estrés típicos de la región Mediterránea. Nuestro trabajo se ha basado en la definición del nicho óptimo fisiológico para el regenerado de cada especie a través de la investigación en profundidad del efecto de la sequía, la temperatura y el ambiente lumínico. Para ello, hemos desarrollado un modelo de predicción de la tasa de asimilación de carbono que nos ha permitido identificar las condiciones óptimas ambientales donde el regenerado de cada especie podría establecerse con mayor facilidad. En apoyo a este trabajo y con la idea de estudiar el efecto de la sequía a nivel de toda la planta hemos desarrollado un experimento paralelo en invernadero. Aquí se han aplicado dos regímenes hídricos para estudiar las características fisiológicas y morfológicas de cada especie, sobre todo a nivel de raíz y crecimiento del tallo, y relacionarlas con las diferentes estrategias en el uso del agua de las especies. Por último, hemos estudiado los patrones de aclimatación y desaclimatación al frio de cada especie, identificando los periodos de sensibilidad a heladas, así como cuellos de botella donde la competencia entre especies podría surgir. A pesar de que el pino piñonero ha sido la especie objeto de la gestión de estas masas durante siglos, actualmente se encuentra en la posición más desfavorable para combatir el cambio global, presentado el nicho fisiológico más estrecho de las tres especies. La encina sin embargo, ha resultado ser la especie mejor cualificada para afrontar este cambio, seguida muy de cerca por el enebro. Nuestros resultados sugieren una posible expansión en el rango de distribución de la encina, un aumento en la presencia del enebro y una disminución progresiva del pino piñonero a medio plazo en estas masas. ABSTRACT Mediterranean forests have undergone multiple changes over the last decades (in both climate and land use), which have lead to variations in the distribution of species. The expected increase in mean annual temperature together with the greater inter and intra-annual variability in extreme events and disturbances occurrence (such as prolonged drought periods, cold or heat waves, wildfires or strong winds) can significantly damage natural regeneration, up to causing death, playing a decisive role on species composition and forest dynamics. The ecological amplitude for adaptation of many species can be affected in such a way that changes in the current regeneration niches of many species are expected. However, the forecasted poleward migration of species seeking better conditions could be an oversimplification of what is a more complex phenomenon of interactions among temperature and precipitation, that would affect different species in different ways. In this regard, either the ability to adapt to environmental stresses or to compete for limited resources of a single species in a mixed forest could lead to variations within a community. The ecophysiological and morphological traits specific to each species are strongly related to the place where each species can emerge, which species can coexist, and how they respond to environmental conditions. In this regard, the understanding of the ecophysiological responses observed against changes in environmental conditions can be essential for predicting variations in species distribution, community composition, and forest productivity in the context of global change. In this thesis we investigated the degree of tolerance and sensitivity that each of the three studied species, co-occurring in central of the Iberian Peninsula (Pinus pinea, Quercus ilex and Juniperus oxycedrus), show against the typical abiotic stress factors in the Mediterranean region. Our work is based on the optimal physiological niche for regeneration of each species through in-depth research on the effect of drought, temperature and light environment. For this purpose, we developed a model to predict the carbon assimilation rate which allows us to identify the optimal environmental conditions where regeneration from each species could establish itself more easily. To obtain a better understanding about the effect of low temperature on regeneration, we studied the acclimation and deacclimation patterns to cold of each species, identifying period of frost sensitivity, as well as bottlenecks where competition between species can arise. Finally, to support our results about the effect of water availabilty, we conducted a greenhouse experiment with a view of studying the drought effect at the whole plant level. Here, two watering regimes were applied in order to study the physiological and morphological traits of each species, mainly at the level of the root system and stem growth, and so relate them to the different water use strategies of the species. Despite the fact that stone pine has been the target species for centuries, nowadays this species is in the most unfavorable position to cope with climate change. Holm oak, however, resulted the species that is best adapted to tolerate the predicted changes, followed closely by prickly juniper. Our results suggest a feasible expansion of the distribution range in holm oak, an increase in the prickly juniper presence and a progressive decreasing of stone pine presence in the medium term in these stone pine-holm oak-prickly juniper mixed forests.

Guidelines for permitting overloads. Part I: effect of overloaded vehicles on the Indiana highway network. Final report.

Indiana Department of Transportation, Indianapolis

Automatic control of attenuation in a digital communication network

This thesis describes the investigation of an adaptive method of attenuation control for digital speech signals in an analogue-digital environment and its effects on the transmission performance of a national telecommunication network. The first part gives the design of a digital automatic gain control, able to operate upon a P.C.M. signal in its companded form and whose operation is based upon the counting of peaks of the digital speech signal above certain threshold levels. A study was ma.de of a digital automatic gain control (d.a.g.c.) in open-loop configuration and closed-loop configuration. The former was adopted as the means for carrying out the automatic control of attenuation. It was simulated and tested, both objectively and subjectively. The final part is the assessment of the effects on telephone connections of a d.a.g.c. that introduces gains of 6 dB or 12 dB. This work used a Telephone Connection Assessment Model developed at The University of Aston in Birmingham. The subjective tests showed that the d.a.g.c. gives advantage for listeners when the speech level is very low. The benefit is not great when speech is only a little quieter than preferred. The assessment showed that, when a standard British Telecom earphone is used, insertion of gain is desirable if speech voltage across the earphone terminals is below an upper limit of -38 dBV. People commented upon the presence of an adaptive-like effect during the tests. This could be the reason why they voted against the insertion of gain at level only little quieter than preferred, when they may otherwise have judged it to be desirable. A telephone connection with a d.a.g.c. in has a degree of difficulty less than half of that without it. The score Excellent plus Good is 10-30% greater.

Effect of dopamine on synchronous neuronal oscillations in the globus pallidus-subthalamic nucleus network

Changes in the pattern of activity of neurones within the basal ganglia are relevant in the pathophysiology and symptoms of Parkinson’s disease. The globus pallidus (GP) – subthalamic nucleus (STN) network has been proposed to form a pacemaker driving regenerative synchronous bursting activity. In order to test whether this activity can be sustained in vitro a 20o parasagittal slice of mouse midbrain was developed which preserved functional connectivity between the STN and GP. Mouse STN and GP cells were characterised electrophysiologically by the presence or absence of a voltage sag in response to hyperpolarising current steps indicative of Ih and the presence of rebound depolarisations. The presence of evoked and spontaneous post-synaptic GABA and glutamatergic currents indicated functional connectivity between the STN and GP. In control slices, STN cells fired action potentials at a regular rate, activity which was unaffected by bath application of the GABAA receptor antagonist picrotoxin (50 μM) or the glutamate receptor antagonist CNQX (10 μM). Paired extracellular recordings of STN cells showed uncorrelated firing. Oscillatory burst activity was induced pharmacologically using the glutamate receptor agonist, NMDA (20 μM), in combination with the potassium channel blocker apamin (50 -100 nM). The burst activity was unaffected by bath application of picrotoxin or CNQX while paired STN recordings showed uncorrelated activity indicating that the activity is not produced by the neuronal network. Thus, no regenerative activity is evident in this mouse brain preparation, either in control slices or when bursting is pharmacologically induced, suggesting the requirement of other afferent inputs that are not present in the slice. Using single-unit extracellular recording, dopamine (30 μM) produced an excitation of STN cells. This excitation was independent of synaptic transmission and was mimicked by both the Dl-like receptor agonist SKF38393 (10 μM) and the D2-like receptor agonist quinpirole (10 μM). However, the excitation was partially reduced by the D1-like antagonist SCH23390 (2 μM) but not by the D2-like antagonists sulpiride (10 μM) and eticlopride (10 μM). Using whole-recordings, dopamine was shown to induce membrane depolarisation. This depolarisation was caused either by a D1-like receptor mediated increase in a conductance which reversed at -34 mV, consistent with a non-specific cation conductance, or a D2-like receptor mediated decrease in conductance which reversed around -100 mV, consistent with a potassium conductance. Bath application of dopamine altered the pattern of the burst-firing produced by NMDA an apamin towards a more regular pattern. This effect was associated with a decrease in amplitude and ll1crease in frequency of TTX-resistant plateau potentials which underlie the burst activity.

The effect of zinc and titanium on the structure of calcium-sodium phosphate based glass

An array of different structural probes has been used to define the effect of adding Zn and Ti to a sodium-calcium phosphate glass. X-ray absorption spectroscopy at the Zn K-edge suggests that the Zn atoms occupy mixed (4- and 6-fold) sites within the glass matrix. X-ray diffraction reveals a feature at 2.03 angstrom that develops with the addition of Zn and Ti and is consistent with Zn-O and Ti-O near-neighbour distances. Neutron diffraction is used to resolve two distinct P-O distances and highlights the decrease in P center dot center dot center dot P coordination number from 2.0 to 1.7 as the Ti metal concentration rises, which is attributed to the O/P fraction moving away from the metaphosphate value of 3.0 to 3.1 with the addition of Ti. Other correlations, such as those associated with CaO(x) and NaO(x) polyhedra, remain largely unaffected. These results suggest that the network forming P center dot center dot center dot P correlation is most disrupted, with the disorder parameter rising from 0.07 to 0.10 angstrom with the additional modifiers. Zn appears to be introduced into the network as a direct replacement for Ca and causes no structural variation over the composition range studied.