bluuebunny/crossref_metadata_2025 huggingface dataset:
Colleen Jollie, State Tribal Liaison: A Story of Transformational Change
Authors: King Cheryl Simrell , Beeby Megan
Published: August 2010

Colleen Jollie, the state tribal liaison at the Washington State Department of Transportation, practices a form of transformational public administration that, at its heart, reflects a Coyote or “trickster” style of management. In indigenous stories across the world, the trickster uses his or her wiles to disrupt, refuse, and dismantle ways that are not working in order to creatively, and sometimes chaotically, build new ways. Jollie’s work as lead tribal liaison has transformed the agency, the tribes, and the relationships between tribes and the agency, creating a culture of cooperation across significant differences and honoring the transformational energy required to cooperate across difference. Like the Coyote, who does what needs to be done through many means, but mostly through thoughtful effort, Jollie works to create change that serves both the state and the tribes. As this profile indicates, the work isn’t always easy and the outcomes don’t always spell success, but the work is necessary for tribes and state governments to forge the kinds of relationships imagined in treaties and in other agreements between sovereign governments.
Strengthening Local Government Leadership and Performance: Reexamining and Updating the Winter Commission Goals
Authors: Svara James H.
Published: August 2010

The Winter Commission report of 1993 stressed cities with the mayor‐council form of government and emphasized removing barriers to executive authority in large cities. In order to assess and update the report, it is important to recognize that a majority of cities with populations over 100,000 use the council‐manager form, in which restrictions on the executive and fragmented authority are unlikely to be present because of the constitutional principles on which the form is based. There has been progress toward improved leadership in both forms of government and substantial management change, including the incorporation of reinventing government and e‐government practices, and large counties are more likely to have an elected or appointed executive. An emerging issue not considered by the commission but in line with its purpose is the increasing challenge of governing expanding metropolitan and megapolitan regions.
State and Local Government Procurement and the Winter Commission
Authors: Potoski Matthew
Published: August 2010

The Winter Commission proposed a state and local government procurement reform agenda that placed public managers at the core of a depoliticized, deregulated, and more pragmatic public sector contracting process. Drawing on the literature and data from several state and local government surveys, this article shows that between 1992 and 2003, state and local governments’ contracting practices moved in directions consistent with the commission’s reform agenda. By 2003, state and local governments had decentralized and deregulated their contracting processes, were contracting more effectively and in circumstances in which it is more likely to be successful, and had adopted several innovative technologies and management practices.
From Measurement to Management: Breaking through the Barriers to State and Local Performance
Authors: Sanger Mary Bryna
Published: August 2010

The Winter Commission’s aspirations for improvement of governance at the state and local level resulted in proposals to modernize public institutions and systems to remove the barriers on executive and managerial authority to act. Improving government performance and accountability to citizens requires leadership to empower employees by reducing rules, increasing discretion, and rewarding innovation. The performance measurement movement and its related performance management movement are public management trends of wide influence in state and local government that are both an adjunct to, and a reflection of those aspirations. Case studies of cities that have sought to develop and use performance measurement and engage citizens demonstrate great potential to improve governance and manage for results that citizens want. But even exemplary jurisdictions face challenges using evidence‐based, data‐driven performance management approaches. Promoting best practice requires better scholarship to understand the determinants of successful implementation, adoption, and use of performance measurement. The outcomes of performance management systems are generally unmeasured and little is known about their cost effectiveness or endurance over time. The promise is there, but our expectations should be tempered.
Electronic Funds and Benefits Transfers, E‐Government, and the Winter Commission
Authors: Pirog Maureen A. , Johnson Craig L.
Published: August 2010

This article examines how electronic funds transfers and electronic benefit transfers have become integral components of digital government. These technologies have forwarded many of the principles of the Winter Commission, including the development of lean, responsive government. The greater efficiency and cost savings for the federal and most state governments have not been achieved without encountering and dealing with serious matters related to customer service, contracting, collaboration, management, and implementation. These issues arise in the normal daily use of electronic payment technologies, but they are magnified in crisis situations, as demonstrated by disaster relief operations during Hurricane Katrina.
Federalism Revised: The Promise and Challenge of the No Child Left Behind Act
Authors: Wong Kenneth K.
Published: August 2010

Federalism in education has undergone significant changes since the Winter Commission. During the early 1990s, federal policy makers faced the challenge of organizational fragmentation and policy incoherence in public education. In the last 15 years, the intergovernmental system has evolved from one that is predominantly compliance‐driven to one that is performance based, as suggested by the congressional adoption of the No Child Left Behind Act in 2001. While the former is often characterized by images of “picket fence” federalism and administrative silos, the latter remains very much a work in progress, with the promise of raising academic proficiency. This paper first examines the paradigm shift and then considers emerging politics in intergovernmental relations. The author explores the ways in which state and local policy makers are altering the rules governing education service provision in response to performance‐based federal expectations.
Axillary/Subclavian Vein Puncture Using Navigation by Parallax with an Imaginary Target
Authors: Lau Ernest W.
Published: August 2010

Background:

The parallax principles allow the relative positions of two overlapping objects with respect to the receiver of a two dimensional image to be determined, and can reliably navigate an object to a target in three dimensional space. Navigation by parallax can direct axillary/subclavian vein puncture under fluoroscopy with a guide wire inside the vein. The axillary/subclavian vein has a constant relationship with the first rib and an imaginary target just cranial and lateral to the middle part of the first rib may serve as a surrogate position marker for the vein adequate for guiding puncture.

Method:

Patients requiring axillary/subclavian vein puncture were considered for the new technique. In an appropriate postero‐anterior (P‐A) caudal projection such that the middle part of the first rib lay outside the second rib concavity, the needle was inserted into the body medial to the coracoid process and advanced dorsally and medially towards an imaginary target cranial and lateral to the middle part of the first rib. Once the needle tip had reached the imaginary target, it was moved ventro‐dorsally while staying stationary in the fluoroscopic image until venous blood was aspirated.

Result:

Navigation by parallax was successful in 21/24 cases (88%) and 42/45 separate venous punctures (93%) with an imaginary target, and in the remaining three cases with a real guide wire target. There were four insignificant axillary arterial punctures.

Conclusions:

Navigation by parallax with an imaginary or a real target is effective, easy, and simple, and should facilitate axillary/subclavian vein puncture in multiple clinical scenarios.
Azithromycin‐Induced Torsade De Pointes
Authors: HUANG BIEN‐HSIEN , WU CHI‐HUA , HSIA CHIH‐PING , YIN CHEN CHUNG
Published: August 2010

Although erythromycin frequently induces long QT interval and torsade de pointes, the newer drug, azithromycin, has rarely been reported to be associated with torsade de pointes. We report here the occurrence of a significant typical QT prolongation within a few hours after taking azithromycin which lead to torsade de pointes.
Clustering of Device‐Related Concerns and Type D Personality Predicts Increased Distress in ICD Patients Independent of Shocks1
Authors: PEDERSEN SUSANNE S , THEUNS DOMINIC AMJ , ERDMAN RUUD AM , JORDAENS LUC
Published: August 2010

Background: This study examined the impact of clustering of device‐related concerns and Type D personality on anxiety and depressive symptoms during a six‐month period and the clinical relevance of shocks, implantable cardioverter defibrillator (ICD) concerns, and Type D.

Methods: Consecutively implanted ICD patients (n = 176) completed questionnaires at baseline and six months and were divided into four risk groups: (1) No risk factors (neither ICD concerns nor Type D); (2) ICD concerns only; (3) Type D only; (4) Clustering (both ICD concerns and Type D).

Results: The prevalence of Type D and concerns were 21.6% and 34.7%. Analysis of variance for repeated measures showed a reduction in anxiety over time (P < 0.001), with the risk groups exerting a stable (P = 0.14) but differential effect (P < 0.001); the highest level was seen in the clustering group. Similar results were found for depression, although depressive symptoms did not decrease (P = 0.08) and the impact of clustering was less clear. These results were confirmed in adjusted analysis, with shocks (P = 0.024) also being associated with anxiety but not depression. The impact of ICD concerns and Type D personality on anxiety and depression at baseline and six months was large (≥0.8) compared to negligible to moderate for shocks (0.0–0.6).

Conclusions: ICD patients with psychosocial risk factor clustering had the highest level of anxiety, whereas the pattern for depression was less consistent. Shocks influenced outcomes, but the impact was smaller compared to ICD concerns and Type D personality. It may be timely to expand the focus beyond shocks when seeking to identify ICD patients at risk for adverse clinical outcome due to their psychological profile.
Health Status in Patients Treated with Cardiac Resynchronization Therapy: Modulating Effects of Personality
Authors: SCHIFFER ANGÉLIQUE A. , DENOLLET JOHAN , PEDERSEN SUSANNE S. , BROERS HERMAN , WIDDERSHOVEN JOS W.
Published: August 2010

Background: Cardiac resynchronization therapy (CRT) is a promising treatment in chronic heart failure (CHF). However, a subgroup of patients still report impaired health status, cardiac symptoms, and feelings of disability following CRT. The aims of this study were to examine (1) whether CHF patients treated with CRT improved in patient‐centered outcomes and functional capacity, and (2) whether personality traits exert a stable effect on these outcomes over two months.

Methods: Analyses are based on 31 patients (65% male; mean age 70 ± 8) with CHF treated with CRT. Two weeks before and two months after CRT, patients completed the Type‐D Scale (negative affectivity, i.e., tendency to experience negative emotions, and social inhibition, i.e., tendency to inhibit self‐expression), the Minnesota Living with Heart Failure Questionnaire (disease‐specific health status), and the Health Complaints Scale (cardiac symptoms and perceived disability), and performed the six‐minute walking test (functional capacity).

Results: There was an improvement in disease‐specific health status (P< 0.001), cardiac symptoms (P = 0.001), perceived disability (P< 0.001), and functional capacity (P = 0.007) in all patients over two months. However, high negative affectivity patients reported significantly lower disease‐specific health status (P = 0.046), and more cardiac symptoms (P = 0.035), and perceived disability (P = 0.015) as compared to low negative affectivity patients. There was no significant main effect for negative affectivity on functional capacity. High negative affectivity patients still reported lower disease‐specific health status (P = 0.06) and significantly more perceived disability (P = 0.04) when adjusting for left ventricular ejection fraction, gender, and age. The effects of negative affectivity on patient‐centered outcomes, as measured by Cohen's effect size index, were moderate to large.

Conclusions: Patient‐centered outcomes improved over a two‐month period in patients treated with CRT, but negative affectivity exerted a stable, negative effect on health status, cardiac symptoms, and perceived disability. Personality traits should be taken into account when evaluating effects of CRT.
A Real‐Time Three‐Dimensional Echocardiographic Validation of an Intracardiac Electrogram‐Based Method for Optimizing Cardiac Resynchronization Therapy
Authors: PORCIANI MARIA CRISTINA , RAO CARMELO MASSIMILIANO , MOCHI MATTEO , CAPPELLI FRANCESCO , BONGIORNO GABRIELLA , PERINI ALESSANDRO PAOLETTI , LILLI ALESSIO , RICCIARDI GIUSEPPE , HASHTROUDI LAWRENCE , SILVESTRI PAOLO , BAROLD S. SERGE , PADELETTI LUIGI
Published: August 2010

Introduction: Although optimization of atrioventricular and interventricular delays has been demonstrated to improve hemodynamics in patients with cardiac resynchronization therapy (CRT), the required time‐consuming procedure discourages its use in clinical practice. Recently, a new method for CRT optimization based on the intracardiac electrogram (IEGM) detected by the implanted leads, has been developed. We evaluated the effectiveness of this method in improving left ventricular (LV) asynchrony and performance using real‐time 3D echocardiography (RT3DE).

Methods and Results: Twenty patients with CRT were prospectively studied. RT3DE was performed before and after IEGM optimization. The standard deviation of the time to the regional LV minimum systolic volume (Tmsv) for all 16 segments (Tmsv 16‐SD), six basal and six mid segments (Tmsv 12‐SD), and the six basal segments (Tmsv 6‐SD) were assessed as a asynchrony indexes. LV end‐diastolic and end‐systolic volumes (EDV, ESV), stroke volume (SV), ejection fraction (EF), myocardial performance index (MPI), ejection time (ET), and filling time (FT), corrected by R‐R interval, were also evaluated.

After IEGM optimization, as compared with baseline Tmsv 12‐SD and Tmsv 16‐SD decreased (P = 0.01, P< 0.001, respectively), EF and SV improved (P < 0.001, P = 0.01 respectively), FT/RR and ET/RR increased (P = 0.02 for both), and MPI improved (P < 0.001). Tmsv 6‐SD, EDV and ESV did not change.

Conclusion: A simple IEGM‐based method of CRT optimization decreased LV dyssynchrony and improved systolic function.
Electrical Remodeling and Cardiac Dimensions in Patients Treated by Cardiac Resynchronization and Heart Failure Controls
Authors: STOCKBURGER MARTIN , NITARDY AISCHA , FATEH‐MOGHADAM SUZANNE , KREBS ALICE , CELEBI ÖZLEM , KARHAUSEN TIM , DIETZ RAINER
Published: August 2010

Background: Cardiac resynchronization therapy (CRT) reduces the left ventricular diameter (LVEDD) in heart failure (HF) patients with left bundle branch block (LBBB). The study compares structural and electrical remodeling in HF patients on CRT and matched HF controls without LBBB.

Methods

: In 42 patients (64 ± 9 years left ventricular ejection fraction [LVEF] 25 ± 8%, 16 coronary artery disease, 26 nonischemic cardiomyopathy, 21 with LBBB and CRT indication vs 21 controls [matched for gender, age, LVEF, and underlying disease]) an unpaced electrocardiogram (ECG) and echocardiogram were recorded at baseline (bl) and after 20.6 ± 13.8 months (fup). LVEDD, left atrial (LA) width, mitral regurgitation (MR), P‐wave, PR interval, QRS width, QRS vector, and QT interval were analyzed.

Results: LVEDD diminished with CRT (bl 68.7 ± 10.3 vs fup 62.0 ± 7.7 mm, P = 0.002). Controls showed no change (bl 64.1 ± 9.4 vs fup 64.8 ± 8.4 mm, P = n.s.). MR improved with CRT (bl 1.2 ± 0.6 vs fup 0.8 ± 0.7, P = 0.02), but not among controls. LA width tended to decrease on CRT (CRT bl 48.9 ± 4.4 vs fup 46.9 ± 7.2 mm, P = 0.17, controls bl 48.5 ± 5.1 vs fup 47.5 ± 6.5 mm, P = 0.49). PR interval lengthened in both groups (CRT bl 175 ± 29 vs fup 188 ± 30 ms, P = 0.03, controls bl 177±25 vs fup 187 ± 19 ms, P = 0.27). QRS increased in both groups (CRT bl 165 ± 22 vs fup 171 ± 20 ms, P = 0.07, controls bl 111 ± 17 vs fup 118 ± 19 ms, P = 0.01). Analyses revealed no significant association of echocardiographic and ECG parameters.

Conclusions

: Despite LVEDD reduction with CRT, electrical activation does not recover. Electrical remodeling does not differ between LBBB patients under CRT and matched controls without CRT indication.
Atrial Activation Occurring Immediately after Successful Cardioversion of Atrial Fibrillation
Authors: MARTÍN PEÑATO MOLINA ARTURO , COSÍO FRANCISCO G. , PASTOR AGUSTÍN , NÚÑEZ AMBROSIO , AWAMLEH PAULA
Published: August 2010

Background and Objective: Electrical defibrillation is very effective in interrupting atrial fibrillation (AF). However, its mechanism is not completely understood. We report our observations in patients subjected to external electriocardioversion (ECV) of atrial fibrillation and contrast them with recent theories about defibrillation mechanism.

Methods: In 13 consecutive patients transthoracic electrical cardioversion for AF was performed during an electrophysiological study (11 monophasic ‐200–360 J‐ and 9 biphasic shocks ‐50–150 J‐). About 10–16 electrograms were obtained with multipolar catheters recording right atrium, coronary sinus, and right pulmonary artery. AF was defined by interelectrogram intervals and changing sequences among recordings, indicating complete lack of organization.

We evaluated the presence of propagated activations immediately (<300 ms) after successful shocks (≥1 discrete electrogram in all recordings). In unsuccessful shocks we evaluated changes in electrogram morphology (discrete/fragmented) and interelectrogram intervals before and after defibrillation.

Results: About 16/20 shocks terminated AF. In 6/16 one or two cycles of atrial activation were recorded just after the shock and before AF ended. In 10/16 AF was interrupted immediately after the shock. 4/20 shocks did not interrupt the arrhythmia. After these shocks, transient organization of recorded activity with longer interelectrogram cycle length and disappearance of fragmented activity were transiently observed.

Conclusion: Our clinical findings in atrial defibrillation in vivo reproduce experimental data that show myocardial activations early after successful direct current shocks. These observations suggest that successful defibrillation depends not only on the immediate effects of the shock, but also on transient effects on electrophysiological properties of the myocardium, capable of interrupting persistent or reinitiated activations.
Left‐Sided Accessory Pathway with Ostial Atresia of the Coronary Sinus: A Case Report
Authors: KIM JUN , KIM JUNE HONG , CHUN KOOK JIN , HONG TAEK JONG , SHIN YUNG WOO
Published: August 2010

We report a case of atrioventricular (AV) reentrant tachycardia with ostial atresia of the coronary sinus (CS). On levophase coronary venogram, dual anomalous venous drainage into both atria was seen; no ostium of the CS and no persistent left superior vena cava were noted. Based on mapping, radiofrequency (RF) energy was applied at the mitral ring and the bypass tract was eliminated. Eight months after the procedure, the patient has remained completely symptom‐free.
Intrinsic Pulmonary Vein Automaticity with Continuous Bigeminal Depolarizations after Pulmonary Vein Isolation
Authors: YAMADA TAKUMI , HUIZAR JOSE F. , MCELDERRY HUGH T. , KAY G. NEAL
Published: August 2010

A 70‐year‐old man with atrial fibrillation underwent pulmonary vein (PV) isolation (PVI). Bigeminal concealed PV depolarizations persisted within the right superior PV throughout the PVI. Though the PV depolarizations was suppressed after successful PVI, PV depolarization, following a slow intrinsic PV automatic rhythm, was observed. The coupling interval of the PV depolarizations during the PV automaticity was identical to that of the PV depolarizations during sinus rhythm before the PVI. This case demonstrated that PV depolarization does not always depend on an intact left atrial input, but may depend on some types of triggering electrical activity.
The Inferior Radiolucent Area Within the Cardiac Silhouette: Validation as a Landmark for Coronary Sinus Catheterization
Authors: GONZALEZ‐VASSEROT MAR , GNOATTO MARIANA , MERINO JOSE L. , PEINADO RAFAEL , ABELLO MAURICIO , SOBRINO JOSE A. , LÓPEZ‐SENDON JOSE L.
Published: August 2010

Background:

Catheterization of the coronary sinus (CS) plays a preponderant role in device implantation and electrophysiology. Nevertheless, catheterization of this structure can be time‐consuming and is related to operator experience. An inferior radiolucent area of the cardiac right anterior oblique (RAO) view has been suggested as a landmark to guide CS catheterization. However, the true relationship of this area with the CS ostium (CSO) has not been studied.

Methods:

Thirty‐five consecutive patients who underwent right coronary angiography were prospectively enrolled in the study. Fluoroscopic images of the heart in the right anterior oblique, both immediately before and during the venous phase of right coronary angiography, were recorded and digitally stored. Postprocedure measurements of the inferior radiolucent area within the cardiac silhouette and, subsequently, the distance of this area to the CSO, were performed by two independent observers.

Results:

A radiolucent area of 9.5 ± 3.0 × 11.0 ± 3.4 mm was identified in the inferior annulus by the two evaluators in all patients. No significant differences in the dimensions of this area were found between the two observers. The CSO was 9.6 ± 7.2 mm superior and 0.1 ± 9.0 mm posterior to the radiolucent area and no statistically significant differences were found between the two observers.

Conclusion:

An inferior radiolucent area can be identified within the cardiac silhouette in most patients in the RAO view. This area is slightly anterior and inferior to the CSO and can be used for catheterization guidance of this latter structure.
Four‐Chamber Pacing in Patients with Poor Ejection Fraction but Normal QRS Durations Undergoing Open Heart Surgery
Authors: PICHLMAIER MAXIMILIAN , BAGAEV ERIC , LICHTENBERG ARTHUR , TEEBKEN OMKE , KLEIN GUNNAR , NIEHAUS MICHAEL , HAVERICH AXEL
Published: August 2010

Background:

Poor ejection fraction (EF) comprises a critical risk factor in cardiac bypass surgery (CABG). It has been unclear, whether biventricular or four‐chamber pacing confers benefit upon patients with intact atrioventricular and interventricular conduction especially following surgery.

Methods:

Twenty‐one consecutive patients with an EF ≤ 35% underwent hemodynamic evaluation (continuous pressures and thermodilution) 3, 6, and 18 hours post‐CABG and biatrial (AA), biatrial‐right ventricular (AAV), and biatrial‐biventricular (AAVV) pacing were compared.

Results:

Patients (65 ± 9 years) presented with an average EF of 29.5% (15–35%). 514 measurements of cardiac index (CI) were taken. Nineteen patients (91%) showed highly significant increases in CI with AAVV as compared to AA pacing (P < 0,001) at all times post surgery. The increase in CI with pacing mode varied from 6% to 25% and decreased with time following surgery. No consistent difference in CI was seen between four‐chamber (AAVV) and biventricular pacing (AVV). The QRS‐widths prior to surgery never exceeded 120 ms; postoperatively QRS‐complexes widened in all patients on average by 15.9 ms ±6 and returned to starting values by 48 hours.

Conclusions:

Biventricular pacing improves CI in patients with poor EF following cardiac surgery in the absence of preoperative atrioventricular‐ or interventricular conduction block. This benefit decreases with time after surgery as the QRS width returns to preoperative values. Four‐chamber pacing did not confer additional benefit as compared to biventricular pacing in this series. Biventricular pacing should be considered as an adjunct in patients with critically low EF undergoing cardiac surgery.
“Left‐Variant” Adenosine‐Sensitive Atrial Reentrant Tachycardia Ablated from the Left Coronary Aortic Sinus
Authors: OTOMO KIYOSHI , NAGATA YASUTOSHI , UNO KIKUYA , IESAKA YOSHITO
Published: August 2010

Adenosine‐sensitive reentrant atrial tachycardia (AT) is usually amenable to ablation at the right superoseptum near the His bundle. We report a case with “left‐variant” adenosine‐sensitive reentrant AT. The AT was reproducibly induced by atrial extrastimulation with negative correlation between the coupling interval and return cycle, and was terminated by atrial extrastimulation and bolus of 2 mg of adenosine 5'‐triphosphate. Ablations at the right superoseptum were unsuccessful; however, the AT was successfully ablated from the left coronary aortic sinus (LCAS) where the earliest atrial activation was recorded. Ablation at the LCAS might be effective in this entity resistant to right‐sided ablation.
Technical Aspects of Pacing in Adult and Pediatric Congenital Heart Disease
Authors: KARPAWICH PETER P.
Published: August 2010

As intuitive as it might appear, it must be remembered that children are not little adults and congenital heart defects do not equate to normal cardiac anatomy. In addition, repaired congenital heart defects in adults (ACHD) might also not equate to normal anatomy. In each of these clinical situations, pacemaker device therapy may dramatically differ from most of the published information available in the field of internal medicine cardiology. Since there are now more patients with structural congenital heart defects over than under the age of 21 years, all present and future generations of pacemaker implanters need to recognize the plethora of anatomical and structural nuances potentially associated with the implantation of device therapy in this continually expanding patient population. Fortunately, advances in pacemaker and lead technology over the past 20 years, which now permit precise implantation at selective endocardial sites other than the right ventricular apex or atrial appendage and improved epicardial leads, have greatly facilitated optimization of pacing therapy. Whereas past interests have focused on lead performance issues such as dislodgement, fractures, and exit block, improvements in lead design technologies now permit more interest in maintaining or improving paced myocardial function by optimizing lead placement at alternate or more select sites. This article reviews recent applications and future directions of these pacing technologies and emphasizes differences among patients with congenital heart defects.
Experience with Implantable Cardioverter‐Defibrillator Therapy in Grown‐Ups with Congenital Heart Disease
Authors: TOMASKE MAREN , BAUERSFELD URS
Published: August 2010

Implantable cardioverter‐defibrillators (ICD) are increasingly implanted for primary or secondary prevention of sudden death in young patients with congenital heart disease, cardiomyopathies, or channelopathies. Although major advances in ICD technology and implant techniques have facilitated ICD therapy in young patients, complications such as lead failures, inappropriate shocks, system infections, and negative psychosocial impacts are of concern. The various underlying cardiovascular disease states and a lack of standardized ICD protocols for young patients often necessitate individualized implant techniques, ICD programming, and follow‐up. Young ICD patients need a thorough follow‐up to ensure adequate therapy, and psychosocial problems have to be addressed.
Drug Management of Fetal Tachyarrhythmias: Are We Ready for a Systematic and Evidence‐Based Approach?
Authors: VAN DEN HEUVEL FREEK , BINK‐BOELKENS MARGREET Th.E. , SARVAAS GIDEON J. DU MARCHIE , BERGER ROLF M.F.
Published: August 2010

Fetal tachyarrhythmias are a life‐threatening condition complicating a small proportion of normal pregnancies. Despite major advances in the (intrauterine) pharmacologic treatment of these arrhythmias over the last years major uncertainties remain. Among these are controversies in the choice of agents in relation to arrhythmia type, and timing and duration of treatment. Currently, no evidence‐based approach to the management of fetal tachyarrhythmias is available. An international registry is proposed as an important step toward obtaining the necessary data to develop evidence‐based management strategies.
Sensory Analysis: Relevance for Prebiotic, Probiotic, and Synbiotic Product Development
Authors: Cruz Adriano G. , Cadena Rafael S. , Walter Eduardo H.M. , Mortazavian Amir M. , Granato Daniel , Faria José A.F. , Bolini Helena M.A.
Published: August 2010

Abstract:  Sensory analysis represents a decisive step during the various stages of food product development. For probiotic, prebiotic, and synbiotic foods, which have shown continuous and significant consumption in the functional food category, the choice of an appropriate technique allows obtaining relevant sensory information that contributes to consumer acceptance. This review focuses on the importance of sensory analytical techniques in prebiotic and probiotic food product development. Examples of the most known sensory methodologies applied to these important functional foods are presented, as well as some considerations about consumer attitudes that can influence acceptance of these products. Moreover, applications of such techniques on functional product evaluation are provided.
Nurses’ Perceptions and Experiences at Daycare for Elderly With Stroke
Authors: Park Yeon‐Hwan , Han Hae‐Ra
Published: August 2010

Purpose: While adult daycare (ADC) is considered a culturally acceptable model of long‐term care in countries with a tradition of family‐oriented caregiving, Korea is struggling as soaring needs for ADC outpace qualified staff and regulatory systems. This study aimed to describe Korean daycare nurses’ perceptions of key daycare services and their working experiences with stroke patients and their families.

Design: A mixed‐method design was used. First, we conducted a cross‐sectional descriptive survey to assess Korean nurses’ perceptions about the importance of daycare services. Then focus group interviews were performed to explore the nurses’ experiences at ADC.

Methods: Seventy of a total of 96 nurses at ADC that specialized in the care of stroke patients responded to the survey (response rate 72.9%) and rated the importance of 11 key daycare service items on a visual analogue scale (0–10). Using a purposive sampling design, 16 eligible nurses were interviewed as a group. The qualitative data from focus group interviews were analyzed using thematic analysis to classify common themes into larger categories.

Findings: Survey data revealed that the nurses perceived “skilled nursing services,”“functional recovery,” and “general health counseling” as the most important daycare service areas. Focus group data resulted in five themes: “Providing the same, standard care,”“Lack of partnership with family caregivers,”“Conflict with other staff: ambiguity of the roles and tasks,”“Lack of proper education and training,” and “Need for quality control and monitoring.”

Conclusions: Daycare nurses fully recognized the importance of direct nursing care services that are keys to adequate recovery and rehabilitation of older patients with stroke. However, they experienced substantial barriers to carrying out these services due to role confusion, insufficient number of qualified nursing staff, and lack of partnership with family caregivers.

Clinical Relevance: The results provide insight into changing healthcare policy to support daycare nurses in a country with limited resources and regulations. Strategies such as better quality control and monitoring of daycare services, provision of continuing education, and prioritizing key services should be considered as a way to address challenges experienced by daycare nurses.
Occurrence of a New Microsporidan: Enterocytozoon bieneusi n. g., n. sp., in the Enterocytes of a Human Patient with AIDS1
Authors: Desportes I. , Charpentier Y. Le , Galian A. , Bernard F. , Cochand‐Priollet B. , Lavergne A. , Ravisse P. , Modigliani R.
Published: August 2010

A new microsporidium is reported infesting the enterocytes of a Haitian patient with AIDS. The stages observed were diplokaryotic cells, sporogonial plasmodia, unikaryotic sporoblasts, and spores. Neither a sporophorous vesicle (pansporoblastic membrane) nor parasitophorous vacuole were differentiated around the developmental stages, which were in direct contact with the host cell cytoplasm. The polar tube (5‐6 coils) was differentiated before fission of the sporogonial plasmodium. The mature spores measured 1.5 m̈m × 0.5 m̈. The spore wall was very thin as the endospore was absent or poorly differentiated. The organism is named Enterocytozoon bieneusi n. g., n. sp. and is assigned to the suborder Apansporoblastina.
Fine Structure of Hepatozoon mocassini (Apicomplexa, Eucoccidiorida) Gamonts and Modifications of the Infected Erythrocyte Plasmalemma1
Authors: Nadler Steven A. , Miller Joseph H.
Published: August 2010

Transmission electron microscopy and scanning electron microscopy were used to investigate the fine structure of Hepatozoon mocassini gamonts and modifications of the infected erythrocyte plasmalemma. Intraerythrocytic gamonts were contained within a parasitophorous vacuole. An electron‐lucid space observed between the gamont pellicle and the membrane of the vacuole corresponded to the unstained space described in light microscopy studies. Gamonts possessed a conoid, polar ring, subpellicular microtubules, four pairs of rhoptries, micronemes, ovoid granules, mitochondria with tubular cristae, and a pellicle composed of three individual unit membranes. The conoid had an anterior diameter of 320 nm, a posterior diameter of 360 nm, and a length of 150 nm. In contrast to a report on Hepatozoon aegypti, no micropore or “canopy‐like structure” was observed. The plasmalemma of infected erythrocytes exhibited two types of modifications: gross membrane deformations and knobs with an electron‐dense central mass. These knobs are structurally distinct from previously described membrane excrescences.
Form and Function of the Dinoflagellate Transverse Flagellum1
Authors: Gaines Gregory , Taylor F. J. R.
Published: August 2010

A reexamination of the dinoflagellate transverse flagellum in relation to swimming in more than 50 species, using a television recording system, has revealed the following new facts: the flagellar beat always proceeds counterclockwise when seen from the cell apex; the cell always rotates in the direction of the flagellar beat, and fluid is propelled in the opposite direction. These observations can be explained by the actions of flagellar mastigonemes not included in previous models. The shape of the flagellar wave is not isotropic. New explanations are offered for other morphological features of the cell as they relate to swimming.
Phagocytized Intracellular Microsporidian Blocks Phagosome Acidification and Phagosome‐Lysosome Fusion
Authors: Weidner Earl , Sibley L. David
Published: August 2010

This study examines the relationship between phagosome acidification and phagosome‐lysosome fusion events using phagocytized Glugea hertwigi spores. The incidence of lysosome fusion with Glugea spores in phagosomes of mouse peritoneal macrophages and of Tetrahymena was monitored using colloidal gold and acridine orange as labels for secondary lysosomes. Over 80% of the Glugea phagosomes remained segregated from the labeled compartments in macrophages after 60 min; this inhibition of fusion was still evident after 4 h. In Tetrahymena, Glugea spores also showed a high capacity to block fusion with secondary lysosomes (67%); however, spores coated with cationized ferritin showed an 80% fusion rate with labeled acidic compartments (i.e. lysosomes) after 60 min with both Tetrahymena and macrophages. The pH of phagosome compartments was monitored by measuring the emissions of fluorescein isothiocyanate (FITQ‐labeled Glugea ingested by Tetrahymena. Tetrahymena phagosomes with FITC‐Glugea did not acidify within the first hour after phagocytosis; however, phagosomes with cationized ferritin‐labeled Glugea underwent acidification during this time period. This acidification took place although the capability of the host cells' lysosomes to fuse was blocked by pretreatment with poly‐D‐glutamic acid. The cationized ferritin bound to Glugea spores was uncoupled from the spore wall prior to fusion with colloidal gold‐labeled compartments. In vitro testing showed that ferritin dissociation requires an acid pH, indicating that phagosomes acidify prior to lysosome fusion.
Interactions of Plasmodium berghei‐Infected Erythrocytes with Complement1
Authors: Schetters Theo P. M. , Lent Peter Van , Zon Adriaan A. J. C. Van , Eling Wijnand M. C.
Published: August 2010

Incubation of radioactively labeled parasitized (Plasmodium berghei) erythrocytes (PE) with adherent peritoneal exudate cells in the presence of 10% (v/v) fresh mouse serum (NMS) resulted in the uptake of a proportion of radioactive material (PE). Inactivation of the added serum by heat or zymosan treatment resulted in diminished uptake of radioactivity. These results suggest that PE activated complement. Incubation of fresh NMS with PE reduced the hemolytic complement level of the serum as shown by its subsequent decreased ability to lyse antibody‐coated rabbit red blood cells. No such effect was found when uninfected erythrocytes from either infected or uninfected blood were preincubated with fresh NMS. Thus, PE or PE‐derived material activated complement. Addition of EGTA during incubation of fresh NMS with PE did not inhibit the decrease in complement level. This indicated that complement was activated by the alternative pathway. Complement levels decreased even when fresh NMS and PE were incubated in the presence of EDTA (which inhibits both classical and alternative pathway activation), suggesting that a complement activating factor (or a complement inhibitor) was released from the PE. However, lysis of PE after incubation with either fresh rabbit or guinea pig serum did not occur unless anti‐mouse erythrocyte antibody was added. The production of a complement‐activating factor by PE might explain part of the decreasing complement levels during infection and might enable the parasite to escape from a complement‐mediated defense mechanism of the host.
Oxidative Metabolism Associated with Phagocytosis in Acanthamoeba castellanii1
Authors: Brooks Steven E. , Schneider Donald L.
Published: August 2010

When amebae were incubated with latex beads, cyanide‐insensitive oxygen consumption increased nearly two‐fold. This cyanide‐insensitive respiration was inhibited by salicylhydroxamate. Furthermore, cell fractionation studies revealed a localization for a portion of the NAD(P)H oxidase activity in phagolysosomes. The presence of low concentrations of divalent metal during fractionation resulted in an increased yield of oxidative activity in the phagolysosome fraction. In addition, the phagolysosome membrane was enriched about two‐fold in a b‐type cytochrome. These results show that oxidative metabolism in amebae has some striking similarities to the respiratory burst oxidase of neutrophils.
Incorporation and Toxicity of 32P‐Orthophosphate and Occurrence of Poly phosphate in Entamoeba Trophozoites1
Authors: López‐Revilla Rubén , Gómez‐Domínguez Rodolfo
Published: August 2010

We explored the requirements of inorganic phosphate (Pi), the incorporation of 32P‐orthophosphate (32Pi), and the occurrence of inorganic polyphosphate (polyP) in axenic Entamoeba cultures. Maximal population densities and growth rates of Entamoeba histolytica trophozoites were attained in complete TP‐S‐1 medium. As 32Pi concentration was increased in the medium, its own incorporation and the culture growth rate were progressively inhibited, especially in Pi‐deficient medium. PolyP grains were found in the cytoplasm and occasionally in the nuclear membrane of E. histolytica, E. histolytica‐like, E. invadens, and E. moshkovskii trophozoites.
A Comparison of Spore Polypeptides in Microsporidia from a Grasshopper Control Program1
Authors: Streett D. A. , Henry J. E.
Published: August 2010

Spore polypeptide profiles of Nosema locustae and an unidentified microsporidium infecting Aulocara elliotti and Psoloessa delicatula are compared with sodium dodecyl sulfate (SDS) polyacrylamide gel electrophoresis (PAGE). Unique spore polypeptide profiles are not detected for the unknown microsporidium from A. elliotti and P. delicatula whereas these profiles are distinctly different from N. locustae spore polypeptide profiles. These results indicate that the microsporidium is not a polymorphic form of N. locustae but a separate species.
Evidence Supporting the Existence of a Host Cell Surface Receptor for Trypanosoma cruzi1
Authors: KIERSZENBAUM FELIPE , STILES BRAD
Published: August 2010

Membrane fragments from trypomastigote forms of Trypanosoma cruzi inhibited the association of intact trypomas‐ tigotes with rat heart myoblasts whereas a similar preparation from non‐invasive epimastigotes did not. Furthermore, killed trypo‐ mastigotes bound to the host cell surface and prevented the attachment of living organisms. Conversely, the extent of association of killed parasites with the host cells was reduced by the presence of living flagellates. These results suggest the presence of a distinct structure(s) on the surface of rat heart myoblasts to which infective forms of T. cruzi can bind.
A Fifteen‐Year Perspective on the In Vitro Culture of Pneumocystis carinii
Authors: PIFER LINDA L.
Published: August 2010

The in vitro cultivation of Pneumocystis carinii in chick lung cell culture made it possible to observe the organism proceeding through its life cycle It provided the foundation for extensive scrocpidcmiologic studies, for in vitro drug screening, and for essential biological, metabolic, and morphologic research, in vitro culture made possible the discovery of P. carinii antigencmia, its biochemical nature, and its relevance to subclinical and clinical infection. Its utility in the presumptive diagnosis of P. carinii pneumonia and in monitoring responses to drug therapy illustrate the value and clinical application of basic research.
Propagation and Purification of Rat Pneumocystis carinii in Short‐Term Cell
Authors: ARMSTRONG MARTINE V.K. , RICHARDS FRANK F.
Published: August 2010

A short‐term cell culture is used to propagate and purify rat‐derived Pneumocystis carinii (Pc). An aliquot of pelleted material washed out of the lungs of rats with moderate to severe Pc pneumonia is cultured for 7 to 10 days on the adherent mink lung cell line Mv 1 Lu, and the rest of the material is frozen down in medium with 10% glycerol. Although it has not been established that substantial multiplication of Pc occurs in culture, the Pc organisms harvested from the supernatant at the end of the culture period arc relatively free of both host and feeder cells. This is in marked contrast with the lung wash inoculum in which the Pc organisms arc heavily contaminated with rat cells and enmeshed in a highly sticky material. Lung wash preparations frozen down in glycerol and stored at −70.°C for as long as 6 months or more can be successfully cultured upon thawing with no apparent loss of viability of the Pc organisms.
Binary Fission of Pneumocystis carinii Trophozoites Grown in Vitro
Authors: RICHARDSON J.D. , QUEENER S.F. , BARTLETT M. , SMITH J.
Published: August 2010

Trophozoites grown in vitro were shown to undergo binary fission by transmission electron microscopy (TEM). Standard fixation with subsequent embedding in Spurr was employed using 3% gluuraldehydc and 1% osmium tetroxide with 5% sucrose added to bom fixatives and 0.1 M cacodylate buffer washes. Trophozoites were grown on WI‐38 cells in vitro. Trophozoites were found in various stages of fission. The dividing trophozoite has daughter cells that arc rounder than the pleomorphic, non‐dividing trophozoites. Tubular forms external to the dividing trophozoites were decreased in number; tubular forms when present were concentrated around the forming septa. Nuclear material was sometimes, but not always, well defined in both daughter cells. There was no concentration of nuclear material at the poles. Vacuoles without membrane were present in the dividing forms. Separate nuclear regions were sometimes found in the dividing trophozoites. These observations suggest that binary fission does occur in culture; however, the significance of binary fission to the life cycle of Pneumocystis carinii (Pc) is not yet clear.
Codon Usage in Tetrahymena and Other Ciliates
Authors: MARTINDALE DUANE W.
Published: August 2010

Codon usage in ciliates was examined by analyzing the coding regions of 22 ciliate genes corresponding to a total of 26, 142 nucleotides (8, 714 codons). It was found that Tetrahymena, Paramecium and the hypotrichs (Oxytricha and Stylonychia) differed in which synonymous codons were used most frequently by their genes. In fact, the codon choices in highly expressed Tetrahymena genes were more similar to those of yeast genes than those of Paramecium genes. The ciliates do not appear to have unusually strong biases in codon usage frequency when compared to other protists such as yeast. The analysis of the Tetrahymena genes indicated that genes which are highly expressed during normal cell growth have a stronger bias towards using the “preferred” codons than those expressed at lower levels during growth or for brief periods during processes such as conjugation. This conforms to what is found in other protists.
Pneumocystis Antigen Appearance during Immunosuppression
Authors: TVEY M.H. , DOWNS T.A. , HART M.C. , GRAVES D.C.
Published: August 2010

The sequential appearance of Pneumocystis carinii (Pc) antigens during the progression of immunosuppression in rats was studied using the immunobloiting technique and specific immunologic probes. Putative Pc soluble antigens, with molecular weights of approximately 70 and 90 kd. were delected as early as 2 wk after initiation of immunosuppression in rats using a pool of monoclonal antibodies produced to I c isolated from lungs using enzymatic digestion. Monoclonal antibodies produced to Pc isolated by massaging the lung tissue using a Stomacher apparatus and infection‐derived sera did not detect soluble antigens until at least the 6th wk of immunosuppression. Analysis of Pc pellets obtained from Stomacher‐ and lavage‐processcd lungs revealed that the lower molecular weight antigens (≤ 40, 45 and possibly 55–60 kd) were recognized early during the immunosuppression process.