bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Study of Cryosurgery Efficacy in the Treatment of Skin and Subcutaneous Tumors in Dogs and Cats
Authors: DE QUEIROZ GENILSON FERNANDES , MATERA JULIA MARIA , ZAIDAN DAGLI MARIA LÚCIA
Published: July 2008

Objective— To evaluate the efficacy of cryosurgery for treatment of skin and subcutaneous tumors in dogs and cats.

Study Design— Prospective study.

Animals— Dogs (n=20), cats (10).

Methods— Cutaneous or subcutaneous tumors were treated by liquid nitrogen cryosurgical spray (1 cm from target tissue at 90° until a 5‐mm halo of frozen tissue was achieved) for 15–60 seconds. Malignant lesions had 3 freeze–thaw cycles benign tumors, 2 cycles. The second or third freeze cycle was performed after complete thaw of the preceding freeze. Wounds healed by second intention. Follow‐up was weekly for 1 month and then twice monthly until wounds healed, and final outcome was determined by telephone interview of owners.

Results— Tumor size ranged from 0.3 to 11 cm diameter with 28 (60%) being 0.3–1 cm; 8 (17%) 1.1–3 cm, and 11 (23%) >3.4 cm. Complications included edema, erythema and for extremity lesions, pain and lameness. Treated lesions (n=47) had an overall remission of 98% (mean follow‐up, 345±172.02 days [range, 150–750 days]). One malignant peripheral nerve sheath tumor recurred 7 months after cryosurgical treatment.

Conclusion— Cryosurgery is an efficient method for treatment of skin and subcutaneous tumors in dogs and cats.

Clinical Relevance— Cryosurgical ablation is an effective means of treating small cutaneous or subcutaneous tumors in dogs and cats, especially in older animals where wound closure or cosmetic outcome might limit surgical excision alone.
Oncologic Outcome after Curative‐Intent Treatment in 39 Dogs with Primary Chest Wall Tumors (1992–2005)
Authors: LIPTAK JULIUS M. , KAMSTOCK DEBRA A. , DERNELL WILLIAM S. , MONTEITH GABRIELLE J. , RIZZO SCOTT A. , WITHROW STEPHEN J.
Published: July 2008

Objective— To describe the clinical features and determine oncologic outcome and prognostic factors for dogs with primary tumors of the osseous chest wall.

Study Design— Historical cohort.

Animals— Dogs (n=39) with spontaneous tumors involving the chest wall.

Methods— Medical records were reviewed for dogs with rib and/or sternal tumors treated by chest wall resection and reconstruction. Signalment, preoperative clinical features, reconstruction technique, and oncologic outcome (local tumor recurrence, metastasis, and survival time) were determined from medical records and by telephone contact with owners and referring veterinarians. Oncologic outcome and prognostic factors were determined using Kaplan–Meier survival analysis and Cox proportional hazards. Logistic regression was used to determine if increased serum alkaline phosphatase (ALP) concentration was associated with tumor type.

Results— Of the 39 dogs with tumors arising from the chest wall, 25 had osteosarcoma, 12 had chondrosarcoma, and 2 dogs had hemangiosarcoma. Median survival time (MST) for dogs with rib osteosarcoma was 290 days. Increased activity of total ALP significantly decreased survival in dogs with osteosarcoma (210 days versus 675 days, P=.0035). MST for dogs with rib chondrosarcoma was not reached (mean 1301 days) and survival was significantly greater than all other types of rib tumors (P=.0321).

Conclusion— Rib tumors should be resected with wide margins to decrease the risk of incomplete excision, because local tumor recurrence has a significant impact on the survival time. The prognosis for dogs with rib chondrosarcoma is very good, but guarded for other types of tumors.

Clinical Relevance— Osteosarcoma and chondrosarcoma are the most common primary tumors of the chest wall. Prognosis for dogs with primary rib chondrosarcoma is very good with surgery alone, but surgery and adjunctive chemotherapy is recommended for dogs with primary rib osteosarcoma and the prognosis remains guarded.
A Simulation Study of Quantitative Risk Assessment for Bivariate Continuous Outcomes
Authors: Yu Zi‐Fan , Catzlano Paul J.
Published: July 2008

The neurotoxic effects of chemical agents are often investigated in controlled studies on rodents, with binary and continuous multiple endpoints routinely collected. One goal is to conduct quantitative risk assessment to determine safe dose levels. Yu and Catalano (2005) describe a method for quantitative risk assessment for bivariate continuous outcomes by extending a univariate method of percentile regression. The model is likelihood based and allows for separate dose‐response models for each outcome while accounting for the bivariate correlation. The approach to benchmark dose (BMD) estimation is analogous to that for quantal data without having to specify arbitrary cutoff values. In this article, we evaluate the behavior of the BMD relative to background rates, sample size, level of bivariate correlation, dose‐response trend, and distributional assumptions. Using simulations, we explore the effects of these factors on the resulting BMD and BMDL distributions. In addition, we illustrate our method with data from a neurotoxicity study of parathion exposure in rats.
A Combined Monte Carlo and Possibilistic Approach to Uncertainty Propagation in Event Tree Analysis
Authors: Baraldi Piero , Zio Enrico
Published: July 2008

In risk analysis, the treatment of the epistemic uncertainty associated to the probability of occurrence of an event is fundamental. Traditionally, probabilistic distributions have been used to characterize the epistemic uncertainty due to imprecise knowledge of the parameters in risk models. On the other hand, it has been argued that in certain instances such uncertainty may be best accounted for by fuzzy or possibilistic distributions. This seems the case in particular for parameters for which the information available is scarce and of qualitative nature. In practice, it is to be expected that a risk model contains some parameters affected by uncertainties that may be best represented by probability distributions and some other parameters that may be more properly described in terms of fuzzy or possibilistic distributions. In this article, a hybrid method that jointly propagates probabilistic and possibilistic uncertainties is considered and compared with pure probabilistic and pure fuzzy methods for uncertainty propagation. The analyses are carried out on a case study concerning the uncertainties in the probabilities of occurrence of accident sequences in an event tree analysis of a nuclear power plant.
An Integrated Approach to Oversight Assessment for Emerging Technologies
Authors: Kuzma Jennifer , Paradise Jordan , Ramachandran Gurumurthy , Kim Jee‐Ae , Kokotovich Adam , Wolf Susan M.
Published: July 2008

Analysis of oversight systems is often conducted from a single disciplinary perspective and by using a limited set of criteria for evaluation. In this article, we develop an approach that blends risk analysis, social science, public administration, legal, public policy, and ethical perspectives to develop a broad set of criteria for assessing oversight systems. Multiple methods, including historical analysis, expert elicitation, and behavioral consensus, were employed to develop multidisciplinary criteria for evaluating oversight of emerging technologies. Sixty‐six initial criteria were identified from extensive literature reviews and input from our Working Group. Criteria were placed in four categories reflecting the development, attributes, evolution, and outcomes of oversight systems. Expert elicitation, consensus methods, and multidisciplinary review of the literature were used to refine a condensed, operative set of criteria. Twenty‐eight criteria resulted spanning four categories: seven development criteria, 15 attribute criteria, five outcome criteria, and one evolution criterion. These criteria illuminate how oversight systems develop, operate, change, and affect society. We term our approach “integrated oversight assessment” and propose its use as a tool for analyzing relationships among features, outcomes, and tradeoffs of oversight systems. Comparisons among historical case studies of oversight using a consistent set of criteria should result in defensible and evidence‐supported lessons to guide the development of oversight systems for emerging technologies, such as nanotechnology.
Modeling Cholinesterase Activity for Human Dietary Risk Assessment of Carbamate Insecticides
Authors: Williams Rick L. , Mihlan Gary J. , Tobia Abraham J.
Published: July 2008

This article demonstrates statistical models to quantify the interaction between a carbamate insecticide and acetylcholinesterase. Carbamates are a class of chemicals that inhibit the activity of acetylcholinesterase in humans, an enzyme involved in the regulation of the neurotransmitter acetylcholine. Following exposure to a carbamate insecticide, we specifically address (1) if acetylcholinesterase activity recovers to its level of preexposure activity; (2) the level of inhibition of acetylcholinesterase activity; (3) the recovery time of acetylcholinesterase activity to its preexposure level for a typical individual; and (4) the upper percentiles of the recovery time of acetycholinesterase activity across individuals. A nonlinear mixed‐effects model is fitted to data from a repeated measures experiment conducted with human volunteers randomly assigned to a control and four dose groups. Repeated measurements were taken prior to exposure and at 1, 2, 4, 6, 8, and 21 hours after exposure to the carbamate aldicarb. It was found that full recovery did occur. Inhibition at 1 hour was estimated with maximum inhibition most likely occurring prior to 1‐hour postexposure. In addition, recovery was rapid even for sensitive individuals. Given this information, the potential effect from exposure to a carbamate consumed in the diet during a day can be quantitatively assessed.
Efficiency of Even Separation of Parallel Elements with Variable Contest Intensity
Authors: Hausken Kjell , Levitin Gregory
Published: July 2008

The article considers strategic defense and attack of a system that can be separated into parallel elements. The defender distributes its resource between separation and protecting the elements from outside attacks. The vulnerability of each element is determined by an attacker‐defender contest success function, which depends on a contest intensity that may increase or decrease through the separation process. The article determines criteria of separation efficiency for systems without performance redundancy and 1‐out‐of‐N and Q‐out‐of‐N systems with performance redundancy. For the systems with performance redundancy the cases of expected damage proportional to the probability that the demand is not met, and expected damage proportional to the unsupplied demand, are considered.
Change over Tenure: Voting, Variance, and Decision Making on the U.S. Courts of Appeals
Authors: Kaheny Erin B. , Haire Susan Brodie , Benesh Sara C.
Published: July 2008

Existing scholarship on the voting behavior of U.S. Courts of Appeals judges finds that their decisions are best understood as a function of law, policy preferences, and factors relating to the institutional context of the circuit court. What previous studies have failed to consider, however, is that the ability to predict circuit judge decisions can vary in substantively important ways and that judges, in different stages of their careers, may behave distinctively. This article develops a theoretical framework which conceptualizes career stage to account for variability in voting by circuit judges and tests hypotheses by modeling the error variance in a vote choice model. The findings indicate that judges are more predictable in their voting during their early and late career stages. Case characteristics and institutional features of the circuit also affect voting consistency.
The Context Matters: The Effects of Single‐Member versus At‐Large Districts on City Council Diversity
Authors: Trounstine Jessica , Valdini Melody E.
Published: July 2008

Scholars continue to debate the degree to which electoral institutions matter for representation. The literature predicts that minorities benefit from districts while women benefit from at‐large elections. The mechanisms by which institutions affect the ability of traditionally underrepresented groups to win seats have been understudied. Using an analysis of over 7,000 cities and interviews with city councilors, we find that compared to at‐large systems, district systems can increase diversity only when underrepresented groups are highly concentrated and compose a substantial portion of the population. In addition, we find that the electoral system has a significant effect on representation only for African American male and white female councilors; the proportion of African American women and Latina councilors is not affected by the use of either district or at‐large systems.
Church Engagement, Religious Values, and Mass‐Elite Policy Agenda Agreement in Local Communities
Authors: Hill Kim Quaile , Matsubayashi Tetsuya
Published: July 2008

We provide evidence on two prominent but heretofore untested expectations about the relevance of religion for the democratic process: (1) that greater engagement in churches or comparable religious institutions and their organizational life enhances representational processes; and (2) that religious values in a community have greater influence on the latter processes, with more liberal religious values expected to enhance the responsiveness of community leaders to general public preferences. Using data on local communities in the United States in the late 1960s, we find strong support for the expected relevance of religious liberalism for representation, but none for the expected effect of church engagement. We provide evidence, too, that our findings about religious values are generalizable to present‐day politics.
Beliefs and Voting Decisions: A Test of the Pivotal Voter Model
Authors: Duffy John , Tavits Margit
Published: July 2008

We report results from a laboratory experiment testing the basic hypothesis embedded in various rational voter models that there is a direct correlation between the strength of an individual's belief that his or her vote will be pivotal and the likelihood that individual incurs the cost to vote. This belief is typically unobservable. In one of our experimental treatments we elicit these subjective beliefs using a proper scoring rule that induces truthful revelation of beliefs. This allows us to directly test the pivotal voter model. We find that a higher subjective probability of being pivotal increases the likelihood that an individual votes, but the probability thresholds used by subjects are not as crisp as the theory would predict. There is some evidence that individuals learn over time to adjust their beliefs to be more consistent with the historical frequency of pivotality. However, many subjects keep substantially overestimating their probability of being pivotal.
Aristotle's Introduction to the Problem of Happiness: On Book I of the Nicomachean Ethics
Authors: Bartlett Robert C.
Published: July 2008

The study of Book I of the Nicomachean Ethics is useful today in part because it deals with a question—the nature of human happiness—whose relevance is obvious. But in dealing with that question, Book I compels us to raise difficulties for ourselves that, far from being obvious, are in danger of being forgotten. Chief among these difficulties are, first, the true character of our hope for happiness and, ultimately, the necessity of there being a kind of divine providence if that hope is to be realized. Inasmuch as we still long for happiness, we must still undergo the pull of that necessity, however distant it may appear to us to be. In bringing out our deepest concern in this way, the study of the first book of the Ethics also prepares us to become serious students of Aristotle's “philosophy of human matters” as a whole, which is concerned with the reality of providence because it is concerned with the possibility of philosophy as a way of life.
A Scaling Model for Estimating Time‐Series Party Positions from Texts
Authors: Slapin Jonathan B. , Proksch Sven‐Oliver
Published: July 2008

Recent advances in computational content analysis have provided scholars promising new ways for estimating party positions. However, existing text‐based methods face challenges in producing valid and reliable time‐series data. This article proposes a scaling algorithm called WORDFISH to estimate policy positions based on word frequencies in texts. The technique allows researchers to locate parties in one or multiple elections. We demonstrate the algorithm by estimating the positions of German political parties from 1990 to 2005 using word frequencies in party manifestos. The extracted positions reflect changes in the party system more accurately than existing time‐series estimates. In addition, the method allows researchers to examine which words are important for placing parties on the left and on the right. We find that words with strong political connotations are the best discriminators between parties. Finally, a series of robustness checks demonstrate that the estimated positions are insensitive to distributional assumptions and document selection.
Video‐Assisted Thoracoscopic Implantation of the Left Ventricular Pacing Lead for Cardiac Resynchronization Therapy
Authors: JUTLEY RAJWINDER S. , WALLER DAVID A. , LOKE IAN , SKEHAN DOUGLAS , NG ANDRE , STAFFORD PETER , CHIN DEREK , SPYT T. J.
Published: July 2008

Background: To study the feasibility and efficacy of video‐assisted thoracoscopic (VAT) placement of the left ventricular pacing lead for cardiac resynchronization therapy (CRT) where the conventional transvenous coronary sinus approach has failed.

Methods: Seventeen patients underwent the VAT procedure. Indications for CRT were ischemic cardiomyopathy in six patients and nonischemic cardiomyopathy in 11. The procedure was performed under general anesthesia with single‐lung ventilation. Three 2‐cm incisions were used on the left chest wall to place the screw‐in lead near the obtuse marginal arteries high on the lateral wall of the left ventricle (LV).

Results: The VATS approach was successful in 13/17 (76%) patients. Median procedure time was 75 minutes (range 55–135). A learning curve was observed that appeared to plateau at 75 minutes procedure time after four cases. Median length of hospital stay was 2 days (range 2–8) with one patient requiring intensive care. Satisfactory thresholds and impedances of 2.3 ± 0.9 V/0.5 ms and 560 ohms, respectively, were achieved at mean follow‐up of 226 days. All patients reported symptomatic benefit with reduction in New York Heart Association score from III preoperatively to II postoperatively.

Conclusions: VAT placement of the epicardial pacing lead is feasible, safe, and efficacious. It should be considered in cases where the transvenous route has failed or as an alternative in prolonged or hazardous transvenous procedures.
Steerable Sheath Catheter Navigation for Ablation of Atrial Fibrillation: A Case‐Control Study
Authors: PIORKOWSKI CHRISTOPHER , KOTTKAMP HANS , GERDS‐LI JIN‐HONG , ARYA ARASH , SOMMER PHILIPP , DAGRES NICOS , ESATO MASAHIRO , RIAHI SAM , WEISS SEBASTIAN , KIRCHER SIMON , HINDRICKS GERHARD
Published: July 2008

Background: Lack of stable access to all desired ablation target sites is one of the limitations for efficacious circumferential left atrial (LA) pulmonary vein (PV) ablation. Targeting that, new catheter navigation technologies have been developed. The aim of this study was to describe atrial fibrillation (AF) mapping and ablation using manually controlled steerable sheath catheter navigation and to compare it against an ablation approach with a nonsteerable sheath.

Methods and Results: In this case‐control‐analysis 245 consecutive patients (controls) treated with circumferential left atrial PV ablation were matched with 105 subsequently consecutive patients (cases) ablated with a similar line concept but mapping and ablation performed with a manually controlled steerable sheath. One hundred sixty‐six patients were selected to be included into 83 matched patient pairs. Ablation success was measured with serial 7‐day Holter electrocardiograms. Patients ablated with the steerable sheath showed an increase in the success rate (freedom from AF) from 56% to 77% (P = 0.009) after a single procedure and 6 months of follow‐up. With respect to procedural data no difference could be found for procedure time, fluoroscopy time, irradiation dose, and radiofrequency (RF) burning time. With the steerable sheath mean procedural RF power (33 ± 9 vs 41 ± 4 W; P < 0.0005) and total RF energy delivery (97,498 vs 111,864 J; P < 0.005) were significantly lower and the rate of complete PV isolation significantly increased from 10% to 52% (P < 0.0005). The complication rate was the same in both groups. Among different arrhythmia, procedure, and patient characteristics, the lack of early postinterventional arrhythmia recurrences was the only but powerful predictor for long‐term ablation success.

Conclusions: An AF mapping and ablation approach solely using a manually controlled steerable sheath for catheter navigation improved the outcome of circumferential left atrial PV ablation at similar intervention times and similar complication rates. The 6‐month success rate after a single LA intervention increased from 56% to 77%.
New‐Onset Orthostatic Intolerance Following Bariatric Surgery
Authors: BILLAKANTY SREEDHAR R. , KLIGMAN MARK D. , KANJWAL YOUSUF M. , KOSINSKI DANIEL J. , MALY GEORGE T. , KARABIN BEVERLY , GRUBB BLAIR P.
Published: July 2008

Background: As bariatric surgery has become an increasingly popular treatment for obesity, we have seen an increasing number of patients present after bariatric surgery with new‐onset syncope, near‐syncope, and lightheadedness.

Methods: We retrospectively reviewed patients who had had bariatric surgery referred to our institution for evaluation of orthostatic intolerance. We reviewed history, physical examination, type of bariatric surgery procedure, and tilt table test results in these patients. There were 14 women and one man with mean age 42 ± 6 years, preoperative body mass index was 49.3 ± 6.0 kg/m2, and mean postoperative weight loss was 55.9 kg. Mean onset of symptoms was 5.2 ± 3.9 months after surgery. Presenting symptoms were lightheadedness in 15 (100%), near‐syncope in 11 (73%), and syncope in nine (60%). All but one patient had a positive tilt table test with eight (53%) having a neurocardiogenic response, three (20%) having a dysautonomic response, and (20%) having a postural tachycardia response. The likely mechanism of orthostatic intolerance is autonomic insufficiency in combination with reverse course of obesity‐related hypertension. The majority of the patients (12 out of 15) responded to standard therapy for autonomic insufficiency.

Conclusion: Some patients may develop significant orthostatic intolerance due to autonomic insufficiency following bariatric surgery, and awareness of the potential association between bariatric surgery and new orthostatic intolerance is important for providing timely care.
Remote Magnetic Navigation‐Assisted Catheter Ablation Enhances Catheter Stability and Ablation Success with Lower Catheter Temperatures
Authors: DAVIS DARRYL R. , TANG ANTHONY S.L. , GOLLOB MICHAEL H. , LEMERY ROBERT , GREEN MARTIN S. , BIRNIE DAVID H.
Published: July 2008

Background: It has been suggested that remote magnetic navigation (RMN) may provide enhanced catheter stability and substrate contact to aid in ablation. To date, no study has examined this claim. Accordingly, we compared the characteristics of the successful ablation of atrioventricular reentry tachycardia (AVNRT) using RMN with a matched population ablated using a conventional (CON) manual approach.

Methods: Sixteen patients who underwent RMN‐assisted ablation of typical AVNRT were matched with 16 patients who had a CON‐AVNRT ablation.

Results: All patients had successful slow pathway modification without complication. The mean catheter temperature achieved with the successful ablation was significantly lower with RMN than with CON (42 ± 7°C vs 47 ± 3°C, P ≤ 0.05). Time to junctional tachycardia (JT) was significantly earlier (5.7 ± 4.1 s vs 11.2 ± 8.9 s, P ≤ 0.05) and variation in catheter temperature with the successful ablation (0.89 ± 0.45 vs 1.45 ± 0.49, P < 0.01) was significantly reduced in the RMN group than in the CON group. There was no significant difference between RMN and CON in terms of the total number of lesions and the mean power achieved during the successful lesion.

Conclusions: Although the construction of the ablation catheters is similar, ablations with RMN catheters resulted in a lower mean temperature, earlier time to JT, and less variability of temperature during ablation, suggesting greater catheter stability. This study indicates that ablation with RMN can achieve success with lower catheter temperatures.
Biventricular Implantable Cardioverter Defibrillator Right Ventricle Pace‐Sense Ring Electrode Failure: Lead Switch Fix
Authors: VENKATARAMAN GANESH , MOORE HANS , KARASIK PAMELA , SINGH STEVE , FLETCHER ROSS
Published: July 2008

This is the case of a 77‐year‐old man with hypertension, diabetes, ischemic cardiomyopathy, heart failure, and an extensive device history. In May 2005, he underwent implantation of a right‐sided biventricular implantable cardioverter defibrillator (ICD) system (Medtronic Insync Maximo 7303), Capsure Fix Novus 4076 atrial lead (Medtronic), Sprint Fidelis 6949 right ventricular (RV) dual coil ICD lead (Medtronic), and Attain OTW Bipolar 4194 left ventricular (LV) lead (Medtronic). In September 2007, he was using his right arm to dig a ditch and lay bricks. The next day while holding up a newspaper to read, he received multiple shocks. He was taken to a local emergency room where his ICD was reprogrammed to prevent shocks, and he was transferred to our facility for management.
Cardiac Resynchronization after Left Ventricular Lead Extraction: Usefulness of Angioplasty in Coronary Sinus Stenosis
Authors: ZUCCHELLI GIULIO , SOLDATI EZIO , SEGRETI LUCA , DI CORI ANDREA , ARENA GIUSEPPE , DE LUCIA RAFFAELE , BONGIORNI MARIA G.
Published: July 2008

A 68‐year‐old man, 54 months after having been implanted with a biventricular device, underwent successful extraction of the malfunctioning left ventricular (LV) lead using mechanical dilation. During LV lead reimplantation, venography documented stenosis of the coronary sinus (CS). To overcome the obstacle, balloon angioplasty was performed and a LV lead was then inserted into a lateral tributary of the CS. The procedure was complicated by local infection and, after 2 months, removal of the entire unit became necessary. During controlateral device implantation, a second angioplasty was carried before insertion of the new LV lead because, in the meantime, restenosis had developed in the CS.
A Fatal Device‐Device Interaction between a Wearable Automated Defibrillator and a Unipolar Ventricular Pacemaker
Authors: LAPAGE MARTIN J. , CANTER CHARLES E. , RHEE EDWARD K.
Published: July 2008

We report a fatal device‐device interaction between a wearable automated defibrillator (WAD; LifeVest ‐ LifeCor, Inc., Pittsburgh, PA, USA) and a unipolar pacemaker that occurred in an 18‐year‐old patient listed for cardiac transplantation due to his failing Fontan. The patient developed ventricular tachycardia that was initially detected by the WAD. However, large unipolar pacing artifacts and specific WAD arrhythmia detection algorithms caused the WAD to revert to nonrecognition of the arrhythmia, which lead to the patient's death. We identify likely causes of the failure and suggest methods of preventing such occurrences in the future.
The Dormant Epicardial Reconnection of Pulmonary Vein: An Unusual Cause of Recurrent Atrial Fibrillation After Pulmonary Vein Isolation
Authors: MATSUO SEIICHIRO , YAMANE TEIICHI , TOKUDA MICHIFUMI , KANZAKI YASUKO , INADA KEIICHI , SHIBAYAMA KENRI , MIYANAGA SATORU , DATE TARO , MIYAZAKI HIDEKAZU , ABE KUNIHIKO , SUGIMOTO KEN‐ICHI , YOSHIMURA MICHIHIRO
Published: July 2008

The case of a 65‐year‐old man with recurrent atrial fibrillation after undergoing segmental pulmonary vein isolation caused by the reconnection of previously isolated pulmonary veins is herein reported. Interestingly, frequent ectopic firings in the left superior pulmonary vein conducted to the left atrium, not through its ostium but through the supposed epicardial pathway at the region of the Marshall ligament, which had been absent during the first treatment session. The reisolation of the left superior pulmonary vein by radiofrequency application in the left atrial appendage thus successfully eliminated the occurrence of atrial fibrillation.
Mapping of Intraatrial Reentrant Tachycardias by Remote Magnetic Navigation in Patients with d‐Transposition of the Great Arteries After Mustard or Senning Procedure
Authors: WU JINJIN , PFLAUMER ANDREAS , DEISENHOFER ISABEL , ÜCER EKREM , HESS JOHN , ZRENNER BERNHARD , HESSLING GABRIELE
Published: July 2008

Introduction: Mapping of intraatrial reentrant tachycardia (IART) still presents a challenge in complex congenital heart disease. The goal of this work was to present our initial experience with remote magnetic navigation (RMN) for mapping of IART in four patients after the atrial switch procedure (Mustard n = 1, Senning n = 3) for d‐transposition of the great arteries.

Methods: Three‐dimensional (3D) mapping of the systemic venous atrium and the pulmonary venous atrium (PVA) was performed using RMN (Niobe) in conjunction with 3D mapping (CartoRMT). The maps were fused with a CT‐based 3D anatomy.

Results: All patients had cavotricuspid isthmus‐dependent IART with a mean atrial cycle length of 305 ms. Mapping of both atria (PVA retrogradely by passing the aortic and tricuspid valve) was feasible and safe. The procedure time for IART mapping ranged from 210 to 320 minutes with a mean of 251 minutes. The fluoroscopy time for IART mapping ranged from 15.8 to 45.0 minutes (mean 31.6 minutes) for patients, and ranged from 12.3 to 24.3 minutes with a mean of 19.5 minutes for physicians. No procedural complications occurred.

Conclusion: Precise mapping of IART in the complex anatomical structures after an atrial switch procedure was feasible and safe using RMN. The maneuverability of the catheter was possible even with a retrograde access crossing two valves. Further reduction of procedural and fluoroscopy times for both patients and physicians seems possible
Novel Measures of Heart Rate Variability Predict Cardiovascular Mortality in Older Adults Independent of Traditional Cardiovascular Risk Factors: The Cardiovascular Health Study (CHS)
Authors: STEIN PHYLLIS K. , BARZILAY JOSHUA I. , CHAVES PAULO H.M. , MISTRETTA STEPHANIE Q. , DOMITROVICH PETER P. , GOTTDIENER JOHN S. , RICH MICHAEL W. , KLEIGER ROBERT E.
Published: July 2008

Background: It is unknown whether abnormal heart rate turbulence (HRT) and abnormal fractal properties of heart rate variability identify older adults at increased risk of cardiovascular death (CVdth).

Methods: Data from 1,172 community‐dwelling adults, ages 72 ± 5 (65–93) years, who participated in the Cardiovascular Health Study (CHS), a study of risk factors for CV disease in people ≥65 years. HRT and the short‐term fractal scaling exponent (DFA1) derived from 24‐hour Holter recordings. HRT categorized as: normal (turbulence slope [TS] and turbulence onset [TO] normal) or abnormal (TS and/or TO abnormal). DFA1 categorized as low (≤1) or high (>1). Cox regression analyses stratified by Framingham Risk Score (FRS) strata (low = <10, mid = 10–20, and high >20) and adjusted for prevalent clinical cardiovascular disease (CVD), diabetes, and quartiles of ventricular premature beat counts (VPCs).

Results: CVdths (N = 172) occurred over a median follow‐up of 12.3 years. Within each FRS stratum, low DFA1 + abnormal HRT predicted risk of CVdth (RR = 7.7 for low FRS; 3.6, mid FRS; 2.8, high FRS). Among high FRS stratum participants, low DFA1 alone also predicted CVdth (RR = 2.0). VPCs in the highest quartile predicted CVdth, but only in the high FRS group. Clinical CV disease predicted CVdth at each FRS stratum (RR = 2.9, low; 2.6, mid; and 1.9, high). Diabetes predicted CVdth in the highest FRS group only (RR = 2.2).

Conclusions: The combination of low DFA1 + abnormal HRT is a strong risk factor for CVdth among older adults even after adjustment for conventional CVD risk measures and the presence of CVD.
Newly Diagnosed Arrhythmogenic Right Ventricular Dysplasia in an Octogenarian
Authors: AKAR JOSEPH G. , SINGH MADHURMEET , AUSEON ALEX J. , WILBER DAVID J.
Published: July 2008

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is thought to be a disease of the young, with the majority of newly diagnosed patients under 40 years of age. Establishing this diagnosis in elderly patients may be challenging, and a few reports exist of patients older than 70 years diagnosed with ARVD/C at autopsy. We report the case of an octogenarian with antemortem newly diagnosed ARVD/C. This case report represents the oldest patient to date to have a newly established diagnosis of ARVD/C and highlights the difficulty in making the diagnosis in the elderly.
The Political Impact of Labor Migration in Bahrain
Authors: LOUËR LAURENCE
Published: July 2008

This paper shows that, in Bahrain, the main political consequence of migration has been the deepening of state/society conflict. While having old historical roots, this conflict has been fostered in the recent period by the collapse of the “caste system” that, since the 1970s, used to regulate the relations between foreigners and nationals in the labor market by preventing the two groups from being in competition for jobs. I conclude that in order to evaluate the possible political impact of migration in the Gulf States, one has to look first at the structure of the relation between the national population and the migrants, rather than focus on the number of foreigners.
Fluid City, Solid State: Urban Environmental Territory in a State of Emergency, Kathmandu
Authors: RADEMACHER ANNE M.
Published: July 2008

This paper addresses the relationship between contemporary territorial processes of statemaking and the fluidity associated with globalizing cities. Focused on the remaking of urban environmental space during a period of political emergency in Kathmandu, the paper examines how state power was sustained and articulated through the production of urban environmental forms, and shows how particular modes of violence and governance were enabled in urban environmental territory. Through an analysis of beautification initiatives undertaken in concert with preparations for a major regional trade conference, I argue that urban environmental productions are critical for understanding the semiotics, multiple scales, and materialities of statemaking in twenty‐first century cities.
A Matter of “Co‐opportunism”: (In)Alienability in London Social Housing
Authors: LAVIOLETTE PATRICK
Published: July 2008

This paper explores the dynamics of temporary urban residency. It looks at the relationships between domesticity, mobility and improvisational housing – all relevant to Britain's housing crisis. Hence, I offer a reflexive ethnographic description of ‘short‐life’ co‐op living based on a five year account of managing vacant properties that await refurbishment or re‐development by two major Charitable Housing Trusts based in West London. In questioning how tenants deal with the constant threat of having to move, I ask how members of a short‐life housing co‐op create their own sense of self and stability through a temporary form of accommodation. My goal is thus to investigate how these co‐op tenants appropriate space, relocate themselves and cope with transient domestic alienability. The creative formulation of individual and community identities are central to the wider understanding and implications of residential instability, alternative lifestyles and the general underlying ethos of co‐operative organizations.
Preparation and Electrical Properties of an Anodized Al2O3–BaTiO3 Composite Film
Authors: Du Xianfeng , Xu Youlong
Published: July 2008

A highly stable, water‐based barium titanate BaTiO3, BT, sol was synthesized using a sol–gel route through a chelate lactate technique. Dried BT precursor powders were measured by thermal gravimetry–differential thermal analysis and X‐ray diffraction. It was found that BT powders first converted into barium carbonate BaCO3, Ti complex, and intermediate phase Ba2Ti2O5CO3, and then transformed into perovskite phase BaTiO3. The crystallization temperature was about 550°C. The low‐voltage etched aluminum foils were covered with BT sol by dip coating, and then annealed at 600°C for 30 min in air. After that, the samples were anodized in a 15 wt% aqueous solution of ammonium adipate. The voltage–time variations during anodizing were monitored, and the electrical properties of the anodic oxide film were examined. It was shown that the specific capacitance, the product of specific capacitance and withstanding voltage, and leakage current of samples with a BT coating were about 48.93%, 38.50%, and 167% larger than that without a BT coating, respectively.
Characterization of Lanthanum Zirconate Formation at the A‐Site‐Deficient Strontium‐Doped Lanthanum Manganite Cathode/Yttrium‐Stabilized Zirconia Electrolyte Interface of Solid Oxide Fuel Cells
Authors: Chen Aijie , Bourne Gerald , Siebein Kerry , DeHoff Robert , Wachsman Eric , Jones Kevin
Published: July 2008

Lanthanum zirconate (LZO) formation and growth kinetics between 1273–1673 K at the A‐site (La, Sr)‐deficient Sr‐doped lanthanum manganite (LSM)/yttrium‐stabilized zirconia (YSZ) interface were studied using high‐resolution transmission electron microscopy–energy‐dispersive X‐ray spectrometry (HRTEM–EDS). A cross‐section TEM sample preparation technique was developed using a dual‐beam focused ion beam and an in situ Omniprobe manipulator. The LZO pyrochlore phase was identified at the LSM/YSZ interface by TEM. The LZO is epitaxial with respect to the YSZ phase but not to the LSM phase. EDS results coupled with structural analysis suggest that La diffusion is a critical step in LZO formation. This study shows that LZO formation can occur even for A‐site‐deficient LSM with a La composition of 78 mol% (<86 mol%). The activation energy for LZO formation was found to be 168±8 KJ/mol.
The 3‐Minute Emergency Medicine Medical Student Presentation: A Variation on a Theme
Authors: Davenport Chip , Honigman Benjamin , Druck Jeff
Published: July 2008

Oral presentations are a critical element in the communication of medical knowledge between students and faculty, but in most locations, the amount of time spent on teaching the oral presentation is minimal. Furthermore, the standard oral presentation does not work well within the emergency medicine (EM) setting, due to time constraints and the different principles that make EM a unique specialty. This article provides a suggested approach on how to educate students on optimal oral presentations in EM, as well as providing a link to an online guide instructing medical students how to give oral presentations.

ACADEMIC EMERGENCY MEDICINE 2008; 15:683–687 © 2008 by the Society for Academic Emergency Medicine
Providers Do Not Verify Patient Identity during Computer Order Entry
Authors: Henneman Philip L. , Fisher Donald L. , Henneman Elizabeth A. , Pham Tuan A. , Mei Yi Y. , Talati Rakesh , Nathanson Brian H. , Roche Joan
Published: July 2008

Introduction:  Improving patient identification (ID), by using two identifiers, is a Joint Commission safety goal. Appropriate identifiers include name, date of birth (DOB), or medical record number (MRN).

Objectives:  The objectives were to determine the frequency of verifying patient ID during computerized provider order entry (CPOE).

Methods:  This was a prospective study using simulated scenarios with an eye‐tracking device. Medical providers were asked to review 10 charts (scenarios), select the patient from a computer alphabetical list, and order tests. Two scenarios had embedded ID errors compared to the computer (incorrect DOB or misspelled last name), and a third had a potential error (second patient on alphabetical list with same last name). Providers were not aware the focus was patient ID. Verifying patient ID was defined as looking at name and either DOB or MRN on the computer.

Results:  Twenty‐five of 25 providers (100%; 95% confidence interval [CI] = 86% to 100%) selected the correct patient when there was a second patient with the same last name. Two of 25 (8%; 95% CI = 1% to 26%) noted the DOB error; the remaining 23 ordered tests on an incorrect patient. One of 25 (4%, 95% CI = 0% to 20%) noted the last name error; 12 ordered tests on an incorrect patient. No participant (0%, 0/107; 95% CI = 0% to 3%) verified patient ID by looking at MRN prior to selecting a patient from the alphabetical list. Twenty‐three percent (45/200; 95% CI = 17% to 29%) verified patient ID prior to ordering tests.

Conclusions:  Medical providers often miss ID errors and infrequently verify patient ID with two identifiers during CPOE.

ACADEMIC EMERGENCY MEDICINE 2008; 15:1–8 © 2008 by the Society for Academic Emergency Medicine
The Eight Cs: A Guide to Success in an International Emergency Medicine Educational Collaboration
Authors: Weiner Scott G. , Kelly Sean P. , Rosen Peter , Ban Kevin M.
Published: July 2008

The Tuscan Emergency Medicine Initiative (TEMI) is a comprehensive emergency medicine (EM) training program designed to build an EM training infrastructure in Tuscany, Italy. The program has successfully trained a team of instructors using a train‐the‐trainers model, certified 350 physicians who are already practicing in emergency departments (EDs), and established a master’s program as a bridge to specialty training at the region’s three universities. Using lessons learned from this program, the authors identify eight factors (The Eight Cs) that can serve as a guide to implementing a collaborative EM program in other environments: collaboration, context, culture, credibility, consulting, consistency, critique, and conclusion. Each of these topics is described in detail and may be useful to other international interventions.

ACADEMIC EMERGENCY MEDICINE 2008; 15:1–5 © 2008 by the Society for Academic Emergency Medicine
An Assessment of the Faculty Development Needs of Junior Clinical Faculty in Emergency Medicine
Authors: Farley Heather , Casaletto Jennifer , Ankel Felix , Young Kelly D. , Hockberger Robert
Published: July 2008

Objectives:  Academic physicians must be able to access the resources necessary to support their ongoing professional development and meet requirements for continued academic advancement. The authors sought to determine the self‐perceived career development needs of junior clinical faculty in emergency medicine (EM) and the availability of educational resources to meet those needs.

Methods:  An educational “needs assessment” survey was distributed to 954 American College of Emergency Physicians (ACEP) members listed in the ACEP database as being faculty at EM residency programs in the United States and having graduated from an EM residency within the past 7 years. Respondents were asked to rank the importance of 22 areas of faculty development to their own professional growth and then to indicate whether educational resources in each area were available to them. Respondents were also asked to note the educational formats they prefer. A search for currently available resources in each topic area was undertaken and compared to the survey results.

Results:  A total of 240 responses were received. Self‐perceived career development needs were identified in the following areas: bedside teaching, lecture development, business skills, managerial skills, educational research, mentorship and career counseling, interpersonal skills, leadership skills, scholarly writing skills, physician wellness, and knowledge of the faculty development process. While a review of currently available educational resources revealed lectures, conferences, and online materials pertinent to most of these topics, a relative lack of resources in the areas of mentorship and physician wellness was identified.

Conclusions:  Junior clinical faculty in EM perceive a lack of educational resources in a number of areas of faculty development. The academic community of EM should strive to improve awareness of and access to currently existing resources and to develop additional resources to address the area of physician wellness. The lack of mentorship in academic EM continues to be a problem in search of a solution.

ACADEMIC EMERGENCY MEDICINE 2008; 15:1–5 © 2008 by the Society for Academic Emergency Medicine
Emergency Department Case‐finding for High‐risk Older Adults: The Brief Risk Identification for Geriatric Health Tool (BRIGHT)
Authors: Boyd Michal , Koziol‐McLain Jane , Yates Kim , Kerse Ngaire , McLean Chris , Pilcher Carole , Robb Gillian
Published: July 2008

Objective:  The objective was to test the ability of the Brief Risk Identification for Geriatric Health Tool (BRIGHT) to identify older emergency department (ED) patients with functional and physical impairment.

Methods:  This was a cross‐sectional study in which 139 persons ≥75 years, who presented to an urban New Zealand ED over a 12‐week period, completed the 11‐item BRIGHT case‐finding tool. Then, within 10 days of their index ED visit, 114 persons completed a comprehensive geriatric assessment. A “yes” response to at least 3 of the 11 BRIGHT items was considered “positive.” Primary outcome measures were instrumental activities of daily living (IADL), cognitive performance scale (CPS), and activities of daily living (ADL).

Results:  The BRIGHT‐identified IADL deficit (64% prevalence) with a sensitivity of 0.76, specificity of 0.79, and receiver operating characteristic (ROC) of 0.83 (95% confidence interval [CI] = 0.74 to 0.91, p < 0.01); cognitive deficit (35% prevalence) sensitivity of 0.78, specificity of 0.54, and ROC of 0.66 (95% CI = 0.55 to 0.76, p = 0.006); and ADL deficit (29% prevalence) sensitivity of 0.83, specificity of 0.53, and ROC of 0.64 (95% CI = 0.53 to 0.75, p = 0.020). Positive likelihood ratios (LR+) for the three outcomes of interest were 3.6, 1.7, and 1.8, respectively. Negative likelihood ratios (LR−) were 0.3, 0.4, and 0.3.

Conclusions:  The 11‐item BRIGHT successfully identifies older adults in the ED with decreased function and may be useful in differentiating elder patients in need of comprehensive assessment.

ACADEMIC EMERGENCY MEDICINE 2008; 15:598–606 © 2008 by the Society for Academic Emergency Medicine