bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of glycaemic control and weight change in patients initiated with human or analog insulin in an US ambulatory care setting
Authors: McAdam‐Marx C. , Bouchard J. , Aagren M. , Nelson R. , Brixner D.
Published: September 2009

Background: Insulin is a mainstay in the treatment of type 1 diabetes and is a recommended option in patients with type 2 diabetes who fail to maintain glycaemic control on other non‐insulin therapies. The purpose of this study was to describe patient characteristics and evaluate changes in glycaemic control and weight in patients treated with insulin in an ambulatory care setting.

Methods: Patients with diabetes were identified from the General Electric electronic medical record (EMR) database (1 September 2004 to 30 April 2008). Patients were ≥18 years, insulin naï ve, newly treated with monoinsulin therapy (index date). Baseline characteristics were identified overall and stratified by insulin type (basal, mixed, and rapid). Basal insulins were described by human versus analog and for insulin detemir and insulin glargine. Change in haemoglobin A1C (HbA1C) and weight from baseline (45 days pre‐ to 15 days postindex date) to 6 months (±90 days) were compared. Regression analyses were used to evaluate HbA1C outcomes across insulins and for the likelihood of gaining 0.9 kg (2 lbs) for detemir versus glargine controlling for baseline characteristics.

Results: A total of 12 136 patients were included. A majority were initiated on a basal insulin (64.7%) followed by mixed (20.8%) and rapid (14.4%). Basal users had significantly higher mean body weight and lower mean baseline HbA1C than mixed users (p < 0.001 for all), and were significantly older, had higher baseline HbA1C and higher baseline body mass index (BMI) than rapid insulin users (p < 0.001 for all). Glargine patients had a significantly higher mean baseline HbA1C (p = 0.003) than detemir patients. The adjusted reduction in HbA1C was greater for rapid insulin than for mixed or basal insulin (p ≤ 0.05). The adjusted differences in HbA1C between basal human and basal analog insulins and between detemir and glargine were not statistically significant (p > 0.05). Patients using detemir were 30% less likely to gain 0.9 kg or more than glargine users (p < 0.05).

Conclusions: HbA1C outcomes in the ambulatory care setting were generally not different between insulin classes. The likelihood of weight gain was less with insulin detemir than with insulin glargine. Thus, real‐world weight outcomes for basal analog insulin may differ by specific product.
A national survey of the prevalence of childhood overweight and obesity in Italy
Authors: Binkin N. , Fontana G. , Lamberti A. , Cattaneo C. , Baglio G. , Perra A. , Spinelli A.
Published: September 2009

To estimate the prevalence of childhood overweight and obesity among Italian schoolchildren and to examine geographic differences and present and future implications for health care, we used data from a nationwide representative survey performed in May 2008 among third‐grade students in 18 of Italy's 21 regions. Cluster sampling was used to identify classes for participation. The study population included all children aged 8–9 years whose parents agreed to opt‐out consent. Parents, children and teachers completed brief questionnaires, and children were weighed and measured by trained staff using standardized equipment. Consent was obtained for 97% of 50 197 third‐graders, of whom 44 676 (89%) met study inclusion criteria. Obesity levels (defined using International Obesity Task Force cut‐offs) ranged from 7.5% (95% confidence intervals 6.7–8.2) in the north to 16.6% (95% confidence intervals 15.8–17.4) in the south. Behaviours known to be associated with obesity also showed geographic differences. The estimated burden of obesity‐related pathologies also increased from north to south. These findings suggest the need for community as well as individual interventions in all areas of the country but with particular attention to the south.
Relative changes in resting energy expenditure during weight loss: a systematic review
Authors: Schwartz A. , Doucet É.
Published: September 2009

A more comprehensive understanding of the effects of weight loss on the changes in resting energy expenditure (EE) is relevant. A MEDLINE search was performed to identify studies with information relevant to this systematic review. From this search, the mean rate of resting EE decrease relative to weight loss was calculated from 90 available publications. A decrease of resting EE relative to weight loss of −15.4 ± 8.7 kcal kg−1 was observed from 2996 subjects. No sex differences were noted in the overall resting EE decrease relative to weight loss. However, a significant sex differences was seen with pharmacological interventions, which seemed to depress the resting EE relative to weight loss to a greater extent in men than in women (P < 0.05). A greater drop in resting EE relative to weight loss was observed for short interventions (more than 2 but less than 6 weeks) when compared with long interventions (<6 weeks) (–27.7 ± 6.7 vs. −12.8 ±  7.1 kcal kg−1) (P < 0.001). Men and women have a similar decrease in resting EE relative to weight loss except in the case of pharmacological interventions. Short interventions also produced greater resting EE losses relative to weight loss.
How Does Stigma “Get Under the Skin”?
Authors: Hatzenbuehler Mark L. , Nolen-Hoeksema Susan , Dovidio John
Published: September 2009

Stigma is a risk factor for mental health problems, but few studies have considered how stigma leads to psychological distress. The present research examined whether specific emotion-regulation strategies account for the stigma-distress association. In an experience-sampling study, rumination and suppression occurred more on days when stigma-related stressors were reported than on days when these stressors were not reported, and rumination mediated the relationship between stigma-related stress and psychological distress. The effect of social support on distress was moderated by the concealability of the stigma: Lesbian, gay, and bisexual (LGB) respondents reported more isolation and less social support than African American respondents subsequent to experiencing stigma-related stressors, whereas African Americans reported greater social support than LGB participants. Social isolation mediated the stigma-distress association among LGB respondents. In a second experimental study, participants who ruminated following the recall of an autobiographical discrimination event exhibited prolonged distress on both implicit and explicit measures relative to participants who distracted themselves; this finding provides support for a causal role of rumination in the stigma-distress relationship.
Lower limb involvement in adult‐onset primary dystonia: frequency and clinical features
Authors: Martino D. , Macerollo A. , Abbruzzese G. , Bentivoglio A. R. , Berardelli A. , Esposito M. , Fabbrini G. , Girlanda P. , Guidubaldi A. , Liguori R. , Liuzzi D. , Marinelli L. , Morgante F. , Sabetta A. , Santoro L. , Defazio G.
Published: September 2009

Background and purpose:  Despite the growing number of reports describing adult‐onset primary lower limb dystonia (LLD) this entity has never been systematically evaluated in the general population of patients with primary adult‐onset dystonia.

Methods:  From outpatients with adult‐onset primary dystonia attending nine Italian University centres for movement disorders we consecutively recruited 579 patients to undergo a standardized clinical evaluation.

Results:  Of the 579 patients assessed, 11 (1.9%) (8 women, 3 men) had LLD, either alone (n = 4, 0.7%) or as part of a segmental/multifocal dystonia (n = 7, 1.2%). The age at onset of LLD (47.9 ± 17 years) was significantly lower than the age at onset of cranial dystonias (57.9 ± 10.7 years for blepharospasm, and 58.9 ± 11.8 years for oromandibular dystonia) but similar to that of all the other adult‐onset primary dystonias. The lower limb was either the site of dystonia onset (36.4%) or the site of dystonia spread (63.6%). In patients in whom LLD was a site of spread, dystonia seemed to spread following a somatotopic distribution. Only one patient reported a recent trauma involving the lower limb whereas 36.4% of the patients reported pain at the site of LLD. Only 64% of our patients needed treatment for LLD, and similarly to previously reported cases, the most frequently tried treatments was botulinum toxin and trihexyphenidyl.

Conclusion:  The lower limb is an uncommon but possible topographical site of dystonia in adulthood that should be kept in consideration during clinical evaluation.
Horizontal stretching concept in oncologic dermatologic surgery of the face
Authors: Amici JM , Bailly JY , Taieb A
Published: September 2009

Background  Skin cancer surgery is usually performed on the face, and more specifically on and around the midfacial apertures. Each defect generated by the exeresis of a face tumor can be repaired by various advancement, rotation or transposition flaps techniques. Therefore the choice of the closure axis of a defect and its cicatricial and orificial consequences is decisive.

Results  The closure of a defect is usually made by symmetrically suturing its edges, across the incision axis according to the rule of halves. However, the closure axis of a defect is intentional and characterized by the subcutaneous suture axis which determines the induced tension orientation, and thus the possible displacement of the aperture free margins. The horizontal stretching principle guarantees the lack of impact on the 3 major apertures of the midfacial frame: eye, nostril and mouth.

Conclusions  This biomechanical concept is decisive to repair midfacial defect with functional and aesthetic results. It also provides objective arguments for the reparative techniques prioritization and the ability to codify those to be recommended as first‐line treatment in the surgical management of the face cutaneous tumours.
Transposition of line‐length discrimination in African penguins (Spheniscus demersus)1
Authors: MANABE KAZUCHIKA , MURATA MINAMI , KAWASHIMA TAKASHI , ASAHINA KIYOSHI , OKUTSU KENJI
Published: September 2009

Four penguins (Spheniscus demersus) were trained to discriminate line length in a simultaneous discrimination task. After the birds' performances reached a discrimination criterion, the reinforcement ratio was decreased to .33. After the ratio of correct trials reached .90 in three successive sessions with a partial reinforcement procedure, probe‐test sessions were introduced. In the probe‐test trials, untrained lines were presented paired with the trained lines. The four probe‐test trials were mixed into 45 discrimination trials. In the probe‐test trials, the penguins that had been trained to peck shorter lines pecked the untrained shorter line rather than the longer line that was reinforced in the discrimination trials. In contrast, those birds that had been trained to peck the longer line pecked the untrained longer line, rather than the shorter line which was reinforced in the discrimination trials. All four birds demonstrated transposition in the line‐length discrimination task.
Predictive behavior and causal learning in animals and humans1
Authors: SAWA KOSUKE
Published: September 2009

The ability to learn causal relationships between external events is important for animals, including human beings, in order to select appropriate predictive behavior. Historically, associative theories have claimed that the association between events is crucial, and automatic bottom‐up processes play a role in achieving this goal, particularly in animals. Although associative theories could give a parsimonious explanation for predictive behavior in animals without the concept of causality, recently, several experiments have shown evidence that even rats can acquire and use causal knowledge to predict possible future events. In this article, I review the major contribution of associative theories to predictive behavior and also theoretical advances in causal reasoning in animals as strong counter‐evidence.
Elephant psychology: What we know and what we would like to know
Authors: IRIE NAOKO , HASEGAWA TOSHIKAZU
Published: September 2009

Although elephants are well‐known and one of the most popular species among people, their behavior and cognitive abilities have not been studied very extensively. But recently, more and more researchers are becoming interested in studying their cognition, particularly their general intelligence, including causal reasoning and mirror self recognition, memory, and numerical cognition. Although genetically elephants are more closely related to the small‐brained aardvarks and manatees than to primates, they hold enormous potential in their cognitive skills. Also, studying their cognition is important from the point of view of animal welfare in captivity.
The Siren Song of Substantivalism
Authors: Harré Rom
Published: September 2009

The defence of a process philosophy as the metaphysics for the foundation of social psychology is part of a general defence of scientific realism. Realists, be they classical or neo critical realists hope to construct a dual level science—a phenomenal level resting on a transcendent level required to account for the order and stability to be found in the unfolding of the phenomena. Also required is a driving force or agency. Discursive psychologists argue for a social ontology in which meanings are created and managed by people engaged in projects, made orderly by shared social representations. Concepts like “social structure” are convenient metaphors to describe clusters of discursive practices but should not be interpreted ontologically. Causal powers are revealed in dispositions, which as a matter of logic, must be ascribed to entities self‐identical over time. Only persons meet this condition. Discursive social psychology is quasi social in that Vygotsky wise it looks for a social origin for social representations, and quasi personal in that persons are the naturally active beings that drive the patterns of life forward. A defence of neo‐critical realism against Professor Ratner's criticisms can only be a more careful statement of the position since his specific criticisms do not address the position I have been advocating.
Concrete thinking or ideographic language: which is the reason for Chinese people's higher imagery‐generation abilities?
Authors: Liang Beichen , Cherian Joseph , Liu Yili
Published: September 2009

In this study, we attempted to separate the effects of culture and language on imagery generation. By asking subjects from China, Singapore and the US to read Chinese and/or English messages, we found that culture, as opposed to language of the message, drives Chinese people's imagery‐generation capabilities. Indeed, people from mainland China generated more images than both Singaporean Chinese people and Americans, even when tested in English. This is because their dominant way of thinking is concrete. Bilingual Singaporean Chinese subjects generated the same number of images when exposed to English and Chinese stimuli because they are equally adept at abstract and concrete thinking. However, their imagery‐generation ability could be manipulated by priming abstract or concrete thinking.
Agrarian Class Structure and Economic Development in Colonial British North America: The Place of the American Revolution in the Origins of US Capitalism
Authors: POST CHARLES
Published: September 2009

Social and economic historians have debated whether the rapid growth of agricultural and industrial commodity production in the United States was a continuation of or a radical break with the economic and social patterns of British colonial North America. At issue is whether the social and economic preconditions for capitalist industrialization existed before, or emerged only after the American Revolution and the establishment of an independent US state. The two major interpretive models – the ‘staples/commercialization’ and ‘frontier/demographic’ models – provide insights into the process of economic development in colonial North America. However, their inability to root their analyses in specificities of different forms of social labour leave them inadequate. This essay attempts to root the patterns of economic growth and development in the dynamics and transformation and preservation during the American Revolution of different social property relations (independent household production, petty‐commodity production, plantation slavery) in the seventeenth and eighteenth centuries.
Institutional Diversity and Capitalist Transition: The Political Economy of Agrarian Change in Arunachal Pradesh, India
Authors: HARRISS‐WHITE BARBARA , MISHRA DEEPAK K. , UPADHYAY VANDANA
Published: September 2009

This paper contributes a preliminary analysis of the process of agrarian capitalist transition in Arunachal Pradesh, one of the least studied regions of India. Primarily based on information collected through a field survey in eleven villages, the paper seeks to explain the nature and implications of institutional unevenness in the development of capitalism. Institutional diversity is not simply mapped across space, it is also manifested in the simultaneous existence of market and non‐market institutions across the means of production within the same village or spatial context. In addition, there is a continuous and complex interaction among these institutions which both shapes and is shaped by this capitalist transition. Primitive accumulation emerges as a continuing characteristic of the on‐going agrarian and non‐agrarian capitalist transition. Institutional adaptation, continuity and hybridity are as integral to the emergence of the market economy as are the processes of creation of new institutions and demise of others. There is no necessary correspondence between the emerging commercialization of the different productive dimensions of the agrarian economy. These uneven processes are deeply influenced by existing and emerging power relations and by the state. Framed by the Bernstein–Byres debate about the contemporary (ir)relevance of the agrarian question, evidence is presented to justify the conclusion that although the processes at work are far from the classical models of the transition to capitalism, all aspects of the agrarian question remain relevant.
Neuroprotective effect ofl‐dopa on dopaminergic neurons is comparable to pramipexol in MPTP‐treated animal model of Parkinson’s disease: a direct comparison study
Authors: Shin Jin Young , Park Hyun‐Jung , Ahn Young Hwan , Lee Phil Hyu
Published: September 2009

Parkinson’s disease (PD) is a chronic neurodegenerative disease characterized by selective loss of dopaminergic neurons in the pars compacta of the substantia nigra. Levodopa (l‐dopa) and dopamine agonists have been most commonly used for symptomatic treatment. However, there are discrepancies between clinical and experimental data with respect to the neuroprotective effects of these drugs on dopaminergic neurons. In this study, to determine whetherl‐dopa is toxic or dopamine agonist is neuroprotective to dopaminergic neurons, we evaluated the neuroprotective properties ofl‐dopa and the pramipexol (PPX), one of dopamine agonists, with a focus on the regulatory effects of the anti‐oxidant properties and cell survival or apoptotic signal pathways in the same experimental design, using 1‐methyl‐4‐phenyl‐1,2,3,6‐tetrahydropyridine (MPTP)‐treated PD animals. The glutathione level in MPTP‐treated mice was significantly increased by PPX administration but not by L‐dopa treatment. The expression of phosphorylated extracellular signal regulated kinase in MPTP‐treated mice was significantly increased only withl‐dopa treatment. Treatment with eitherl‐dopa or PPX in MPTP‐treated mice led to significantly decreased expressions of JNK phosphorylation, Bax, and cytochromecand to an increased level of Bcl‐2 expression with a similar degree, compared with the levels in MPTP‐only treated mice. Immunohistochemical analysis showed that bothl‐dopa and PPX increased significantly survival of dopaminergic neurons in MPTP‐treated mice. Our study demonstrated that bothl‐dopa and PPX had comparable neuroprotective properties for dopaminergic neurons in MPTP‐treated PD animal models, through modulation of cell survival and apoptotic pathways.
Identification of novel spartin‐interactors shows spartin is a multifunctional protein
Authors: Milewska Malgorzata , McRedmond James , Byrne Paula Catherine
Published: September 2009

Hereditary spastic paraplegia describes a group of neurodegenerative diseases characterized by lower limb progressive weakness and spasticity. Troyer syndrome is an autosomal recessive form of hereditary spastic paraplegia caused by a frameshift mutation (1110delA) in the SPG20 gene encoding spartin protein, the cellular function of which remains unknown. Knowledge about spartin‐interactors is also very limited. In this study, we apply a broad spectrum of proteomics techniques to identify novel spartin‐binding proteins. We used a Tandem Affinity Purification technique followed by HPLC‐mass spectrometry to characterize potential spartin‐binding partners. Selected putative interactions were confirmed by co‐immunoprecipitation experiments. We identified 94 potential spartin‐binding proteins which were grouped into functional categories. We performed co‐immunoprecipitation experiments to confirm that spartin interacts with GRP78, GRP75 and nucleolin proteins. Additionally, our mass spectrometry results confirmed previously published information about spartin interaction with ubiquitin and the E3 ubiquitin‐protein ligases, AIP4/Itch and AIP5/WWP1. Our studies suggest that spartin is a multifunctional protein and for the first time we suggest a role for spartin in protein folding and turnover both in mitochondria and endoplasmic reticulum. We also show for the first time interaction between spartin and a nucleolar protein, nucleolin.
Does the Stock Market See a Zero or Small Positive Earnings Surprise as a Red Flag?
Authors: KEUNG EDMUND , LIN ZHI‐XING , SHIH MICHAEL
Published: September 2009

This study shows that firms collectively incur a cost for managing earnings and analyst expectations to meet earnings forecasts. We compare the coefficient in the regression of abnormal stock returns on earnings surprise (the earnings response coefficient [ERC]) across ranges of earnings surprises. The ERC for earnings surprises in the range [0, 1¢] is significantly lower than ERCs for earnings surprises in adjacent ranges for firm‐quarters in the early and mid 2000s, but not for those in the 1990s. The results are robust to controlling for the sign of estimated discretionary accruals and the trajectory of analyst earnings forecasts. We further find that investors are right to be skeptical about earnings surprises in the range [0, 1¢]. The relation of future earnings surprise with current earnings surprise is more negative for current earnings surprises in that range than for those in any other range. Evidence also suggests analysts react negatively to earnings surprises in that range.
Evidence of Late Pleistocene ice‐dammed lakes in West Siberia
Authors: ASTAKHOV VALERY I.
Published: September 2009

The article discusses geological data on proglacial lakes and spillways in the West Siberian Plain, data on crucial features of the Late Pleistocene reorganization of the drainage pattern of northern Eurasia. The discussion focuses on Late Pleistocene sediments along the margin of the last ice sheet and south of it, including new data recently obtained by the Russian‐Norwegian project PECHORA in Trans‐Uralia. Based on these data, the margin of the last ice sheet in the western and central parts of West Siberia is localized well above the Arctic Circle, i.e. 150–250 km north of the previously suggested ice limit. The available geochronological evidence indicates that the last ice dam across West Siberia, which diverted the great Siberian rivers to the south, appeared at early stages of the last, Weichselian ice age. The normal, northbound, drainage was restored later, within the time‐span accessible to radiocarbon dating, when two pre‐Holocene river terraces with mammal fauna were formed. The Late Weichselian was the driest period with ubiquitous aeolian activity and an absence of large water bodies. Preceding ice‐dammed lakes of West Siberia could only drain through the Turgai valley which leads southward into the Aral and Caspian seas. The sedimentary sequence of this passage consists of lacustrine clay, diamictic gravity flows and aeolian sediments younger than 29 kyr which infilled the former spillway mainly in the Late Weichselian. The basal sand and gravel mantling the bedrock floor, which descends from 55 m a.s.l. at 55°N to 30–40 m a.s.l. in the south, is the only signature of a southward drainage. This fluvial episode probably reflects overflow of a Siberian proglacial lake whose water level could reach 60 m a.s.l. prior to 29 kyr BP.
First discovery of cryptotephra in Holocene peat deposits of Estonia, eastern Baltic
Authors: HANG TIIT , WASTEGÅRD STEFAN , VESKI SIIM , HEINSALU ATKO
Published: September 2009

This article reports the first discovery of middle Holocene cryptotephra from a peat sequence in Estonia, eastern Baltic. Two sequences, Mustjärve and Parika (located 110 km apart), were chosen for a pilot study aimed at finding traces of tephra fallout during the middle Holocene. Peat accumulation at both sites started in the early Holocene (c. 9500–9000 14C yr BP; c. 11 000–10000 cal. yr BP) and continued throughout the whole Holocene. The radiocarbon‐dated intervals between c. 2000 and 5000 14C yr BP (c. 2000–5500 cal. yr BP) were chosen from both sites for the study. Colourless tephra shards were identified at 312–316 cm below the peat surface in the Mustjärve peat sequence, while no tephra was found in peat of the same age at Parika. Electron microprobe analyses suggest a correlation with the initial phase of the Hekla‐4 eruption (c. 4260 cal. yr BP), although the age‐depth model indicated an age around 4900 cal. yr BP. Small concentrations of colourless to light brown tephra shards at 266–270 cm in the Mustjärve sequence indicate that the Kebister tephra (c. 3750 cal. yr BP) might also be present, but geochemical analyses were not possible. The low concentration and small size of the tephra particles indicate that Estonian bogs are probably on the verge of where tephrochronology is possible in northwestern Europe. Further studies of full Holocene sequences are required in order to discover traces of other ash plumes reaching as far east as the eastern Baltic area.
Holocene climatic variations and postglacial sea‐level rise geochemically recorded in the sediments of the brackish karst lake An Loch Mor, western Ireland
Authors: SCHETTLER GEORG , ROMER ROLF L. , O'CONNELL MICHAEL , MOLLOY KAREN
Published: September 2009

Palaeohydrology of the brackish karst lake An Loch Mór (Inis Oirr) was reconstructed based on its 11 600 year sedimentation record. Low calcareous early Holocene sediments, characterized by high TOC contents and deposited at generally low accumulation rates, show a gradual decrease upwards in the concentration of the siliciclastic sediment until c. 7000 cal. yr BP. From c. 9000 cal. yr BP, sediment accumulation became increasingly dominated by the deposition of autochthonous calcite and organic matter. The deposition of autochthonous calcite and its chemical composition (Ca/Sr, Ca/Mg) are determined by the subsurface inflow of freshwater from the catchment of the lake and by the balance between freshwater and seawater influx. During the early Holocene, the lake mainly received input of sea salt by sea‐spray. The sediments document the further development from seasonal towards the onset of diurnal infiltration of seawater at c. 5100 cal. yr BP. At that time, the relative sea level must have risen nearly to its present level in Galway Bay. Diurnal seawater infiltration during high tides was controlled by freshwater input. Freshwater inflow from the catchment gradually increased with human impact on local vegetation (EVPT decrease). Permanent diurnal seawater infiltration in concert with this general freshwater increase made the geochemical sedimentation record highly sensitive to changes in annual precipitation. We use information from the palynological record to interpret geochemically inferred freshwater inflow variations in terms of dry and wet climatic periods and document distinct century‐scale successions between wet and dry climatic episodes for western Ireland.
Usability and Safety of Ventricular Assist Devices: Human Factors and Design Aspects
Authors: Geidl Lorenz , Zrunek Philipp , Deckert Zeno , Zimpfer Daniel , Sandner Sigrid , Wieselthaler Georg , Schima Heinrich
Published: September 2009

The purpose of this study was the investigation of the usability and ergonomics of ventricular assist devices (VADs) in everyday usage. Patients with four different VAD types were observed. After implantation, instruction, and discharge from the hospital, the patients returned on a regular basis to the outpatient clinic, where the investigation took place. Data collection took place in two phases. In phase I home‐released VAD patients were asked about perceived problems with the system at home. Additionally health‐care professionals were interviewed to gather information on frequent VAD inconveniences and shortcomings. This inquiry resulted in a standardized self‐assessment questionnaire and a manual skill test, which were performed in phase II by the whole collective (16 patients and ongoing). As a result, 38% of the patients disconnected parts of their system unintentionally at least once. All of them ascribed this problem to their own carelessness. Thirty‐eight percent had to replace a cable. Seventy‐five percent desired an additional cable strain relief. Thirty‐eight percent suffered from rubbing of parts on the body. Sixty‐three percent used a separate repository aside from the factory‐provided transportation systems. The overall noise emission (pump, ventilators, and alarms) annoyed 56%; however, for 32% the alarm signals were too quiet to wake them up. No correlation between the assessed manual skills and the number of adverse events was found. To conclude, this preliminary study revealed considerable potential for improvements in the usability of ventricular assist systems.
The Impact of Aortic/Subclavian Outflow Cannulation for Cardiopulmonary Bypass and Cardiac Support: A Computational Fluid Dynamics Study
Authors: Kaufmann Tim A.S. , Hormes Marcus , Laumen Marco , Timms Daniel L. , Linde Torsten , Schmitz‐Rode Thomas , Moritz Anton , Dzemali Omer , Steinseifer Ulrich
Published: September 2009

Approximately 100 000 cases of oxygen deficiency in the brain occur during cardiopulmonary bypass (CPB) procedures each year. In particular, perfusion of the carotid and vertebral arteries is affected. The position of the outflow cannula influences the blood flow to the cardiovascular system and thus end organ perfusion. Traditionally, the cannula returns blood into the ascending aorta. But some surgeons prefer cannulation to the right subclavian artery. A computational fluid dynamics study was initially undertaken for both approaches. The vessel model was created from real computed tomography/magnetic resonance imaging data of young healthy patients. The simulations were run with usual CPB conditions. The flow distribution for different cannula positions in the aorta was studied, as well as the impact of the cannula tip distance to vertebral artery for the subclavian position. The study presents a fast method of analyzing the flow distribution in the cardiovascular system, and can be adapted for other applications such as ventricular assist device support. It revealed that two effects cause the loss of perfusion seen clinically: a vortex under the brachiocephalic trunk and low pressure regions near the cannula jet. The results suggest that cannulation to the subclavian artery is preferred if the cannula tip is sufficiently far away from the branch of the vertebral artery. For the aortic positions, however, the cannula should be injected from the left body side.
Emergency Use of Extracorporeal Membrane Oxygenation in Cardiopulmonary Failure
Authors: Arlt Matthias , Philipp Alois , Zimmermann Markus , Voelkel Sabine , Amann Matthias , Bein Thomas , Müller Thomas , Foltan Maik , Schmid Christof , Graf Bernhard , Hilker Michael
Published: September 2009

Severe pulmonary and cardiopulmonary failure resistant to critical care treatment leads to hypoxemia and hypoxia‐dependent organ failure. New treatment options for cardiopulmonary failure are necessary even for patients in outlying medical facilities. If these patients are in need of specialized center treatment, additional emergency medical service has to be carried out quick and safely. We describe our experiences with a pumpless extracorporeal lung assist (PECLA/iLA) for out‐of‐center emergency treatment of hypercapnic respiratory failure and the use of a newly developed hand‐held extracorporeal membrane oxygenation (ECMO) system in cardiac, pulmonary, and cardiopulmonary failure (EMERGENCY‐LIFE Support System, ELS System, MAQUET Cardiopulmonary AG, Hechingen, Germany). Between March 2000 and April 2009, we used the PECLA System (n = 20) and the ELS System (n = 33) in adult patients. Cannulation was employed using percutaneous vessel access. The new hand‐held ELS System consists of a centrifugal pump and a membrane oxygenator, both mounted on a special holder system for storing on a standard patient gurney for air or ground ambulance transfer. Bedside cannulation processes were uneventful. The PECLA System resulted in sufficient CO2 removal. In all ECMO patients, oxygen delivery and systemic blood flow could be restored and vasopressor support was markedly down. Hospital survival rate in the PECLA group was 50%, and 61% in the ECMO group. Out‐of‐center emergency treatment of hypercapnic pulmonary failure with pumpless extracorporeal gas exchange and treatment of cardiac, pulmonary, and cardiopulmonary failure with this new hand‐held ECMO device is safe and highlyeffective. Patient outcome in cardiopulmonary organ failure could be improved.
Design of a Small Centrifugal Blood Pump With Magnetic Bearings
Authors: Jahanmir Said , Hunsberger Andrew Z. , Ren Zhaohui , Heshmat Hooshang , Heshmat Crystal , Tomaszewski Michael J. , Walton James F.
Published: September 2009

Design of a blood pump with a magnetically levitated rotor requires rigorous evaluation of the magnetic bearing and motor requirements and analysis of rotor dynamics and hydraulic performance with attention to hemolysis and thrombosis potential. Given the desired geometric dimensions, the required operating speed, flow in both the main and wash flow regions, and magnetic bearing performance, one of several design approaches was selected for a new prototype. Based on the estimated operating speed and clearance between the rotor and stator, the motor characteristics and dimensions were estimated. The motor stiffness values were calculated and used along with the hydraulic loading due to the fluid motion to determine the best design for the axial and radial magnetic bearings. Radial and axial stability of the left ventricular assist device prototype was verified using finite element rotor dynamic analysis. The analysis indicated that the rotor could be completely levitated and spun to the desired operating speed with low power loss and no mechanical contact. In vitro experiments with a mock loop test setup were performed to evaluate the performance of the new blood pump prototype.
Improvement of the Accuracy in the Optical Hematocrit Measurement by Optimizing Mean Optical Path Length
Authors: Oshima Shiori , Sankai Yoshiyuki
Published: September 2009

Optical techniques have been developed to acquire blood information (e.g., hematocrit [Hct], saturation of oxygen, thrombus) noninvasively and continuously in an artificial heart. For the practical use of an optical Hct measurement, Twersky's theory has been shown to be useful and have a good agreement in forward‐scattered measurements. However, it was not applied to backward‐scattered measurements, which can provide the measurement with a less demanding spatial requirement. Additionally, optimal measurement for accuracy is not well examined. Therefore, we developed an accurate Hct measurement in an artificial heart using current optical devices. To this end, we focused on optimizing an emitter–detector distance to provide a maximum optical path length. We attached optical emitter and detector fibers on Tygon tubing at various distances to measure forward‐ and backward‐scattered light. Fresh bovine blood (Hct: 30–50%) was circulated in the tubing by a nonpulsatile artificial heart. We calculated the optical path length at various emitter–detector distances by fitting the measured optical outputs and the reference Hcts to Twersky's theory. Then, we performed Hct measurements. As a result, Twersky's theory is applicable not only to forward‐ but also to backward‐scattered measurements in the physiogical Hct range. In both forward‐ and backward‐scattered measurements, calculated optical path lengths become maximum at the same emitter–detector distance. The accuracy of Hct measurement is improved two to three times with the emitter–detector distance compared with other distances. The mean error is less than 1 Hct%. This result shows that an accurate Hct measurement is realized by selecting the optimal emitter–detector distance, which provides maximum optical path length defined by Twersky's theory. Our study provides a framework for the practical and less restrictive application of the optical Hct measurement to patients with an artificial heart.
Development of a Disposable Maglev Centrifugal Blood Pump Intended for One‐Month Support in Bridge‐to‐Bridge Applications: In Vitro and Initial In Vivo Evaluation
Authors: Someya Takeshi , Kobayashi Mariko , Waguri Satoshi , Ushiyama Tomohiro , Nagaoka Eiki , Hijikata Wataru , Shinshi Tadahiko , Arai Hirokuni , Takatani Setsuo
Published: September 2009

MedTech Dispo, a disposable maglev centrifugal blood pump with two degrees of freedom magnetic suspension and radial magnetic coupling rotation, has been developed for 1‐month extracorporeal circulatory support. As the first stage of a two‐stage in vivo evaluation, 2‐week evaluation of a prototype MedTech Dispo was conducted. In in vitro study, the pump could produce 5 L/min against 800 mm Hg and the normalized index of hemolysis was 0.0054 ± 0.0008 g/100 L. In in vivo study, the pump, with its blood‐contacting surface coated with biocompatible 2‐methacryloyloxyethyl phosphorylcholine polymer, was implanted in seven calves in left heart bypass. Pump performance was stable with a mean flow of 4.49 ± 0.38 L/min at a mean speed of 2072.1 ± 64.5 rpm. The maglev control revealed its stability in rotor position during normal activity by the calves. During 2 weeks of operation in two calves which survived the intended study period, no thrombus formation was seen inside the pump and levels of plasma free hemoglobin were maintained below 4 mg/dL. Although further experiments are required, the pump demonstrated the potential for sufficient and reliable performance and biocompatibility in meeting the requirements for cardiopulmonary bypass and 1‐week circulatory support.
First Clinical Application of the DuraHeart Centrifugal Ventricular Assist Device for a Japanese Patient
Authors: Yoshitake Isamu , El‐Banayosy Aly , Yoda Masataka , Hata Mitsumasa , Sezai Akira , Niino Tetsuya , Wakui Shinji , Koerfer Reiner , Minami Kazutomo
Published: September 2009

The DuraHeart ventricular assist device (VAD) is a third‐generation implantable centrifugal pump with a magnetically levitated impeller. Since February 2007, the device has been clinically applied with excellent results as a bridge to heart transplantation in Europe. As of this writing, however, the device has yet to be approved by the Ministry of Health, Labour and Welfare for clinical use in Japan. We herein report the first clinical application of this device for a Japanese patient. A 31‐year‐old man with dilated cardiomyopathy was transferred to the Heart and Diabetes Center NRW (HDZ‐NRW) in Bad Oeynhausen, Germany, where he was to await heart transplantation. The transfer was safely completed under management with low‐dose dopamine. His condition gradually deteriorated at HDZ‐NRW, and the DuraHeart left ventricular assist device was implanted for the left ventricle at 7 weeks after admission. Shortly thereafter, however, on POD 7, a Thoratec VAD had to be inserted on the right side due to refractory right heart failure. The right ventricular assist device could be explanted after a 3‐month assist, and the patient is now waiting for heart transplantation at home in Germany.
The Influence of Microtopography on Soil Nutrients in Created Mitigation Wetlands
Authors: Moser Kurt F. , Ahn Changwoo , Noe Gregory B.
Published: September 2009

This study explores the relationship between microtopography and soil nutrients (and trace elements), comparing results for created and reference wetlands in Virginia, and examining the effects of disking during wetland creation. Replicate multiscale tangentially conjoined circular transects were used to quantify microtopography both in terms of elevation and by two microtopographic indices. Corresponding soil samples were analyzed for moisture content, total C and N, KCl‐extractable NH4–N and NO3–N, and Mehlich‐3 extractable P, Ca, Mg, K, Al, Fe, and Mn. Means and variances of soil nutrient/element concentrations were compared between created and natural wetlands and between disked and nondisked created wetlands. Natural sites had higher and more variable soil moisture, higher extractable P and Fe, lower Mn than created wetlands, and comparatively high variability in nutrient concentrations. Disked sites had higher soil moisture, NH4–N, Fe, and Mn than did nondisked sites. Consistently low variances (Levene test for inequality) suggested that nondisked sites had minimal nutrient heterogeneity. Across sites, low P availability was inferred by the molar ratio (Mehlich‐3 [P/(Al + Fe)] < 0.06); strong intercorrelations among total C, total N, and extractable Fe, Al, and P suggested that humic–metal–P complexes may be important for P retention and availability. Correlations between nutrient/element concentrations and microtopographic indices suggested increased Mn and decreased K and Al availability with increased surface roughness. Disking appears to enhance water and nutrient retention, as well as nutrient heterogeneity otherwise absent from created wetlands, thus potentially promoting ecosystem development.
A Spatial Model to Prioritize Sagebrush Landscapes in the Intermountain West (U.S.A.) for Restoration
Authors: Meinke Cara W. , Knick Steven T. , Pyke David A.
Published: September 2009

The ecological integrity of Sagebrush (Artemisia spp.) ecosystems in the Intermountain West (U.S.A.) has been diminished by synergistic relationships among human activities, spread of invasive plants, and altered disturbance regimes. An aggressive effort to restore Sagebrush habitats is necessary if we are to stabilize or improve current habitat trajectories and reverse declining population trends of dependent wildlife. Existing economic resources, technical impediments, and logistic difficulties limit our efforts to a fraction of the extensive area undergoing fragmentation, degradation, and loss. We prioritized landscapes for restoring Sagebrush habitats within the intermountain western region of the United States using geographic information system (GIS) modeling techniques to identify areas meeting a set of conditions based on (1) optimum abiotic and biotic conditions favorable for revegetation of Sagebrush; (2) potential to increase connectivity of Sagebrush habitats in the landscape to benefit wildlife; (3) location of population strongholds for Greater Sage‐Grouse (Centrocercus urophasianus, a species of conservation concern); and (4) potential impediments to successful restoration created by Cheatgrass (Bromus tectorum, an invasive exotic annual grass). Approximately 5.8 million ha in southwestern Idaho, northern Nevada, and eastern Oregon met our criteria for restoring Wyoming big sagebrush (Artemisia tridentata ssp. wyomingensis) and 5.1 million ha had high priority for restoring Mountain big sagebrush (A. tridentata ssp. vaseyana). Our results represent an integral component in a hierarchical framework after which site‐specific locations for treatments can be focused within high‐priority areas. Using this approach, long‐term restoration strategies can be implemented that combine local‐scale treatments and objectives with large‐scale ecological processes and priorities.
When Invasive Plants Disappear: Transformative Restoration Possibilities in the Western United States Resulting from Climate Change
Authors: Bradley Bethany A. , Wilcove David S.
Published: September 2009

Most ecologists believe that climate change poses a significant threat to the persistence of native species. However, in some areas climate change may reduce or eliminate non‐native invasive species, creating opportunities for restoration. If invasive species are no longer suited to novel climate conditions, the native communities that they replaced may not be viable either. If neither invasive nor native species are climatically viable, a type of “transformative” restoration will be required, involving the translocation of novel species that can survive and reproduce under new climate conditions. Here, we illustrate one approach for restoration planning by using bioclimatic envelope modeling to identify restoration opportunities in the western United States, where the invasive plant cheatgrass (Bromus tectorum) is no longer climatically viable under 2100 conditions projected by the Geophysical Fluid Dynamics Laboratory (GFDL2.1) coupled atmosphere‐ocean general circulation model. We then select one example of a restoration target area and identify novel plant species that could become viable at the site in the wake of climate change. We do so by identifying the closest sites that currently have climate conditions similar to those projected at the restoration target area in 2100. This approach is a first step toward identifying appropriate species for transformative restoration.
Carbon Offsets as Ecological Restorations
Authors: Galatowitsch Susan M.
Published: September 2009

The explosive growth of carbon markets is creating unprecedented opportunities for landscape‐scale restoration worldwide. Most mandatory and voluntary greenhouse gas reduction programs allow use of carbon offset credits, including biosequestration projects, to replace actual emission reductions. Are the market schemes configured in a way that promotes ecosystem recovery and long‐term carbon storage? As importantly, is it likely that these efforts will provide significant social and environmental co‐benefits to justify trading offsets rather than actually reducing emissions? Compared with social scientists working in sustainable development, restoration ecologists have not offered much advice on the way carbon markets could be configured to support lasting restorations. Under current standards, the market price is likely governing the quality of restorations, not the reverse. A variety of reforms are needed to ensure that biosequestration projects deliver real, additional, and permanent removals of carbon dioxide. In particular, developing and adopting social and environmental impact assessment tools, changing accounting practices to allow for natural disturbances, universal adoption of strong additionality testing, and supporting critical research through tonnage fees could substantially improve what is accomplished through carbon offsets. Given the magnitude and importance of what carbon markets are attempting to achieve, insights from restoration ecologists are urgently needed to help shape their future.