bluuebunny/crossref_metadata_2025 huggingface dataset:
“What sceptics believe”: The effects of information and deliberation on climate change scepticism
Authors: Hobson Kersty , Niemeyer Simon
Published: January 2012

Scepticism about climate change now appears a pervasive social phenomenon. Research to date has examined the different forms that scepticism can take, from outright denial to general uncertainty. Less is known about what climate sceptics value and believe beyond their climate change doubt, as well as how “entrenched” such beliefs are. In response, this paper discusses research into public reactions to projected climate change in the Australian Capital Region. Using Q Methodology and qualitative data, it outlines five discourses of scepticism and explores the impact regional-scale climate scenarios and a deliberative forum had on these discourses. Results show that both forms of intervention stimulate “discourse migration” amongst research participants. However, migrations are rarely sustained, and sceptical positions are infrequently dispelled outright, suggesting the relationship between climate scepticism, broader beliefs, and the methods used to inform and debate about climate change, are pivotal to comprehending and addressing this issue.
Economic Evaluation of the National Immunization Program of Rotavirus Vaccination for Children in Korea
Authors: Kang Hye-Young , Kim Ki Hwan , Kim Ji Hong , Kim Hwang Min , Kim Jinkyung , Kim Mi-Sun , El Khoury Antoine C. , Kim Dong Soo
Published: January 2012

The authors assessed the cost-effectiveness of rotavirus vaccination to develop an evidence-based national immunization program in Korea. A Markov model was constructed to compare the costs and clinical outcomes of vaccination versus no vaccination. The birth cohort of 493189 infants in 2007 was followed until the age of 5 years. Korea-specific data for epidemiological characteristics and economic burden of rotavirus diarrhea were used for the modeled estimation. Efficacy of RotaTeq® was based on a recent clinical trial. Rotavirus vaccination would prevent 181238 symptomatic cases (reduction rate = 63.2%) over 5 years after birth. From the societal perspective, at a vaccination cost of 100000 Korean won (KW; 1 US$ ≈ 1200 KW) per dose, universal vaccination would cost 375 620 KW per case averted. The breakeven price of vaccine was 56061 KW. Rotavirus vaccination would reduce the burden of the disease substantially and be a cost-effective strategy to prevent rotavirus diarrhea in Korea.
Domperidone With ORT in the Treatment of Pediatric Acute Gastroenteritis in Japan
Authors: Kita Fumiyo , Hinotsu Shiro , Yorifuji Tohru , Urushihara Hisashi , Shimakawa Tetsuro , Kishida Kenji , Wakazono Yoshihiro , Yamauchi Eiko , Sasaki Hiroshi , Nakahata Tatsutoshi , Kawakami Koji
Published: January 2012

Domperidone is an antiemetic that is often prescribed for children with acute gastroenteritis in Japan. In this study, the authors assessed the efficacy of domperidone prescription in combination with oral rehydration treatment (ORT) in the treatment of vomiting during acute gastroenteritis in children during the early period. They performed a prospective multicenter randomized trial in Japan. Patients received either ORT or ORT and domperidone prescription. The primary outcome was the proportion of patients who had vomiting during the first 2 hours after randomization. A total of 56 children were eligible; 24 received ORT alone, and 32 received ORT and prescribed domperidone suppository. Results showed that 27.3% of children in the ORT group vomited as compared with 20.7% of children in the ORT and domperidone group ( P = .41). In this study, it appears that domperidone in combination with ORT in the treatment of acute gastroenteritis does not reduce vomiting in the early period.
Synchronized switch damping on inductor and negative capacitance
Authors: Mokrani Bilal , Rodrigues Gonçalo , Ioan Burda , Bastaits Renaud , Preumont Andre
Published: January 2012

This article presents a strategy for enhancing the performance of the synchronized switch damping on inductor technique used for the semiactive control of structural vibrations. This enhancement is achieved by adding a negative capacitance to the resonant circuit that dissipates the energy converted by a piezoelectric transducer embedded in the structure. A unidimensional spring-mass system shunted synchronously to a resonant circuit is studied analytically, and the main parameters governing the performances of the system are highlighted. Experimental results obtained with a synthetic negative capacitance demonstrate the enhancement of the performance of synchronized switch damping on inductor and confirm the parametric dependencies identified analytically.
Artificial neural network based proportional plus integral plus derivative controller for a brushless DC position control system
Authors: Ganesh C , Patnaik SK
Published: January 2012

Brushless DC (BLDC) motors are useful in applications such as process control, robotics, industrial automation, aerospace, electric vehicles etc. due to such advantages as the elimination of rotor losses and magnetizing current. Wider usage of BLDC motors demands optimum position control for high efficiency, accuracy and reliability. For an accurate position control, the estimation of moment of inertia and friction coefficient of the motor with load is essential. This paper incorporates the computation of the moment of inertia and friction coefficient of a BLDC motor with load at different load settings and emphasizes that load has an appreciable effect on the dynamic performance of the system. To obtain the optimum position control, a proportional plus integral plus derivative (PID) controller is employed and tuned using the PARR method. Artificial neural networks are used for computing the moment of inertia and friction coefficient of a BLDC motor with load and PID controller parameters at various load settings. Simulation results of the position control system are obtained at different load settings. From the results, it is evident that the PID controlled position control system responds to the desired position with minimum rise time, settling time and peak overshoot and is in dependent of load settings.
A simple and unified displacement field for three-dimensional vibration analysis of prestressed circular plates
Authors: Liu Chorng-Fuh , Chen Ting-Jung
Published: January 2012

In this study a simple displacement field is proposed for finite element vibration analysis of circular plates. The displacement field is a combination of a conventional field, which is very popular for three-dimensional vibration analysis of circular plates or cylinders, and another field, which is most general for axisymmetric vibration. The investigation here is intended, through mathematical formulation and examples, to verify the existence of coupled axisymmetric vibration modes. These modes cannot be found by conventional displacement field, but can easily be revealed by the present model. Validity and accuracy of the proposed displacement field to show all the prominent vibration modes of circular plates or cylinder-like structures is also demonstrated by comparing results using the present method with those of a three-dimensional finite element analysis and experiments.
Dispersion of horizontally polarized shear waves in an irregular non-homogeneous self-reinforced crustal layer over a semi-infinite self-reinforced medium
Authors: Chattopadhyay Amares , Gupta Shishir , Sahu Sanjeev Anand , Singh Abhishek Kumar
Published: January 2012

The present paper discusses the dispersion equation for horizontally polarized shear waves (SH waves) in a non-homogeneous self-reinforced layer over a semi infinite self-reinforced medium with an irregularity. The dispersion equation has been obtained in closed form. In the isotropic case, when non homogeneity and irregularity are absent, the dispersion equation reduces to standard SH wave equation. The dispersion curves have been presented by means of graphs for different sizes of irregularity and different values of non-homogeneity parameters. The influence of depth of irregularity and non-homogeneity parameters on phase velocity has been studied.
Suspected serotonin syndrome in a patient being treated with methylene blue for ifosfamide encephalopathy
Authors: McDonnell AM , Rybak I , Wadleigh M , Fisher DC
Published: January 2012

Methylene blue has been used not only as a diagnostic agent, but also as an agent in the treatment of ifosfamide-induced encephalopathy (IIE) for several years. Recently, several cases of suspected serotonin syndrome have been reported in patients who received methylene blue in combination with serotonin active agents. Rodent models have revealed that methylene blue is a potent, reversible inhibitor of monoamine oxidase A. It is well known that serotonin active drugs, in combination with monoamine oxidase inhibitors can produce profound serotonin syndrome. To date, cases of serotonin syndrome, which resulted from concurrent methylene blue and serotonin active agents, have been published in the anesthesia literature. We report the first known case of serotonin syndrome in a patient receiving methylene blue for IIE.
Doppler echocardiographic diagnosis and surgical therapy of constrictive pericarditis in a cat
Authors: Thomason Justin D , Radlinsky MaryAnn G , Rapoport Gregg , Howerth Elizabeth W , Acevedo Karelma Frontera , Fallaw Tiffany L , Calvert Clay A
Published: January 2012

A 4-year-old Ragdoll cat presented for dyspnea secondary to chylous pleural effusion to the University of Georgia Veterinary Teaching Hospital. Physical examination, complete blood count, serum chemistries, urinalysis, thoracic radiographs, abdominal radiographs, and thoracic fluid cytology and culture failed to identify an etiology for the chylous effusion. The patient tested negative for feline leukemia virus, feline immunodeficiency virus and heartworm disease. Respiration phasic influences on early diastolic trans-mitral, trans-tricuspid and pulmonary vein blood flow velocities during Doppler echocardiography were consistent with constrictive pericarditis. The cat underwent subtotal pericardectomy. The patient recovered without complication and is overtly healthy without radiographic or echocardiographic abnormalities 6-months post-surgery. Constrictive pericarditis should be considered in cats with idiopathic pleural effusion, with or without ascites, in which standard echocardiographic assessment is not suggestive of structural heart disease. If constrictive pericarditis is present, the Doppler characteristics outlined here may allow for this diagnosis to be made. Pericardectomy may be highly rewarding, although the specific etiology of the constrictive pericarditis may remain unknown.
Negatively shaping the asylum agenda? The representational strategy and impact of a tabloid news campaign
Authors: Matthews Julian , Brown Andy R
Published: January 2012

This article examines coverage presented in a news campaign (on asylum and immigration) by the UK tabloid newspaper, the Sun, from January to March 2003. The analysis reveals how tabloid news conventions rather than government definitions or viewpoints frame the character and contours of campaign representations, an observation that throws into sharp relief existing explanations of elite influence or authority skew. This campaign includes portrayals of the asylum seeker as ‘the other’ or ‘folk devil’, a moral framework explaining their deviant intentions and actions, as well as expressions of irreverence at elite decision-making and government UK asylum policy. Yet it is striking how accompanying tabloid representations of public opinion, featuring consistently through the coverage, offer additional hostility to asylum policy and government officials. The article outlines how such representations and appeals garner the attention of the political elite and elite media on this occasion and develop new concerns over the newspaper’s role in negatively shaping the asylum agenda.
Sadly missed: The death knock news story as a personal narrative of grief
Authors: Duncan Sallyanne
Published: January 2012

This article examines the manner in which journalists write news stories based on the ‘death knock’ interview where they gather reaction from the recently bereaved about their loss. The death knock news story with its emphasis on the first-hand testimony of the bereaved in certain respects can be perceived as a personal narrative of grief. This research studies the types of narratives used to tell these personal stories and applies Labov and Waletzky’s personal narrative model in order to determine what the bereaved tell us about grief and how the journalist interprets it. Statements from the bereaved contained in such stories are examined to identify emergent grief themes across the genre. The research found that, despite the adoption of a more positive mood in the later stages of reporting a family’s grief, the coherent narrative was one of unyielding anguish, emptiness and continuing loss.
Election news in Sweden and the United States: A comparative study of sources and media frames
Authors: Dimitrova Daniela V , Strömbäck Jesper
Published: January 2012

This study compares election news coverage in two different countries – Sweden and the United States, focusing on the use of the strategic game frame and the conflict frame and the association between these two frames and different types of news sources. The content analysis includes early evening newscasts from CBS Evening News, NBC Nightly News and ABC World News in the USA and Rapport, Aktuellt and TV4 Nyheterna in Sweden. The findings show that the strategic game frame is used more frequently in the US coverage and is correlated with the use of media analysts and campaign operatives in both countries. Ordinary citizens as sources contribute to issue framing while domestic political actors tend to be associated with conflict framing. Differences in media framing between public and private media are also identified and discussed in the context of national political and media systems.
An experimental investigation of exhaust emissions of a 1999 Cummins ISM370 diesel engine supplemented with H2
Authors: Liew C , Li H , Gatts T , Liu S , Xu S , Rapp B , Ralston B , Clark N , Huang Y
Published: January 2012

This paper investigates the effect of hydrogen (H2) addition on the exhaust emissions of a 1999 Cummins ISM370 heavy-duty diesel engine with H2 continuously supplemented to intake air. Using the 13-mode European Stationary Cycle (ESC), the addition of 2 per cent H2 by volume increased the emissions of oxides of nitrogen (NO x) and nitrogen dioxide (NO2), but reduced nitric oxide (NO) emissions. The addition of 4 per cent H2 increased the emissions of NO, NO2, and NO x. When examined under constant load, the addition of H2 reduced the emissions of particulate matter (PM) and carbon monoxide (CO), but had very mild effects on hydrocarbon (HC) emissions. It was also shown that the reduction in PM emissions was due to the reduced diesel fuel flowrate rather than the improvement to the combustion efficiency of diesel fuel. However, the addition of a relatively large amount of H2 at medium to high (30–70 per cent) load substantially increased the emissions of NO x. This was due to an increase in maximum local combustion temperature resulting from the enhanced heat release rate, advanced combustion phasing, and reduced combustion duration. In comparison, the addition of a small amount of H2 had a very mild effect on NO x emissions. However, a substantial reduction in NO x emissions was observed with the addition of large amounts of H2 at 10–15 per cent load, which was due to deteriorated peak heat release rate observed at premixed combustion process and elongated diffusion combustion process, which reduced the peak local combustion temperature and retarded the combustion phasing. It was also noted that the addition of H2 substantially increased the emissions of NO2, indicating the significant effect of H2 addition in enhancing the conversion of NO to NO2. When measured using the 13-mode ESC, the addition of 2 per cent and 4 per cent H2 increased NO2 emissions by 300 per cent and 221 per cent, respectively. When measured under constant load, a maximum NO2/NO x ratio of 62.2 per cent was obtained with the addition of 4 per cent H2 at 10 per cent load.
Peoples, political liberalism and religious diversity
Authors: Seymour Michel
Published: January 2012

In this article I first develop a particular definition of misrecognition understood as a particular kind of political resistance to formally institutionalized rights of persons and peoples. It is exemplified in the refusal to move from moral rights to legal rights. I therefore provide an institutional and not a psychological account of misrecognition. In the second part of the article, I present political liberalism and I show how it is able to accommodate the rights of persons and peoples. In the third and last part of the article, I examine one particular argument that affects ethno-religious groups in particular. With the help of the theoretical resources of political liberalism, I am in a position to achieve a delicate balance between the recognition of the individual rights of persons and the collective rights of peoples.
Immigration control in Italian political elite debates: Changing policy frames in Italy, 1980s–2000s
Authors: Magnani Natalia
Published: January 2012

This work provides an analysis of the structure and transformations of the official political debate over immigration control within the Italian political elite over the last three decades. Through a close historical reading of the Italian political scene based primarily on parliamentary debates, this article charts the key policy frames articulated in different periods of Italian immigration history in relation to the nature of the immigration control problem (cognitive dimension) and the suggested policy solutions (normative dimension). Moreover, it highlights the various factors – from party competition and political ideologies to the pressure of interest groups, the characteristics of national political institutions and the normative pressure from Europe and European institutions – that have influenced immigration policy frames and have interacted with them in shaping policy goals.
Hydroelastic analysis and model tests on the structural responses and fatigue behaviours of an ultra-large ore carrier in waves
Authors: Hu Jia-Jun , Wu You-Sheng , Tian Chao , Wang Xue-Liang , Zhang Fan
Published: January 2012

To provide guidance on structural design for the life cycle safety of an ultra-large 500,000 deadweight tonnage ore carrier, the springing-induced high-frequency responses in waves, the resultant structural loads and their influences on the structural fatigue damage were investigated by employing the three-dimensional linear and second-order non-linear hydroelasticity theories of ships and the corresponding numerical methods. The theoretical predictions of the structural loads and responses and the comparisons with the model tests carried out in the towing tank of the China Ship Scientific Research Center are presented in this paper. The results for the hydroelastic responses of the ship at a forward speed and at zero forward speed in regular and irregular waves are illustrated, which provide the quantitative relations for the wave-motion-induced and the springing-induced structural loads, and their linear and non-linear components of the ship in different sea states, especially when the first flexible body resonant frequency is in the wave frequency region. The results show that the springing responses may occur in waves with any significant wave heights for such a large ship when the characteristic wave periods are less than a certain amount. The short-term and long-term distributions of the wave-induced and rigid-body-motion-induced structural loads and the springing-induced high-frequency loads are predicted. Based on the hydroelastic predictions of the structural loads, the accumulated fatigue theory is applied to assess the fatigue damage of the typical deck and bottom structural components of a ship serving in three shipping lines.
Waist circumference is a strong and independent determinant of the distribution of HDL subfractions in overweight patients with cardiovascular risk factors
Authors: Rosenbaum David , Hansel Boris , Bonnefont-Rousselot Dominique , Bittar Randa , Girerd Xavier , Giral Philippe , Bruckert Eric
Published: January 2012

Purpose: Our aim was to determine the influence of waist circumference on the repartition of high-density lipoprotein (HDL) and low-density lipoprotein (LDL) subfractions in patients with increased waist perimeter and one or more cardiovascular risk factor.

Methods: All 117 patients without lipid-lowering therapy underwent routine clinical, biological evaluation and isolation of the following lipid subfractions: HDL2b, HDL2a, HDL3a, HDL3b, HDL3c and LDL1, LDL2, LDL3, LDL4.

Results: Mean waist circumference was 102.9 cm for women and 109.4 cm for men, and 92 patients presented with metabolic syndrome. In the highest waist circumference tertile, when compared with the lowest one, an increased HDL3c (7.7% vs. 5.7% p=0.02) and a non-significant decrease of HDL2b percentages were observed with no difference in other subfractions. In multivariate analysis, only plasma triglycerides and waist circumference remained independent predictors of HDL3c percentage.

Conclusion: In our population, waist circumference was a strong and independent determinant of a shift in the distribution of HDL toward denser particles.
Clinical Relevance of Action Observation in Upper-Limb Stroke Rehabilitation
Authors: Franceschini Marco , Ceravolo Maria Gabriella , Agosti Maurizio , Cavallini Paola , Bonassi Stefano , Dall’Armi Valentina , Massucci Maurizio , Schifini Francesca , Sale Patrizio
Published: January 2012

Objective. A randomized controlled observer-blind trial was designed to evaluate the effectiveness of action observation as an add-on treatment to the standard rehabilitation of upper-limb function, early after stroke. Methods. Stroke survivors (N = 102) were consecutively recruited from 13 centers 30 days (±7) after a first-ever stroke and randomly assigned to the experimental (EG) or control group (CG). EG participants watched video footage of daily routine tasks (actions) carried out with the upper limb in order to prepare to imitate the presented action. At the end of each sequence, a therapist prompted the patient to perform the same movement for 2 minutes, providing help when needed. Static images without animals or human beings were shown to the CG. At the end of each sequence, the CG executed movements that simulated the shoulder and elbow joint mobilization activities performed by the EG. Results for the Fugl-Meyer test, Frenchay Arm test, Box and Block test (BBT), Modified Ashworth Scale, and Functional Independence Measure Motor items were recorded before treatment (T0), after 4 weeks of treatment (T1), and at the follow-up visit 4 to 5 months after the conclusion of treatment (T2). Results. An improvement over time was appreciated on all measures of impairment and functional ability with both treatment programs. A Time × Treatment interaction emerged from the generalized estimating equations analysis of BBT, showing significant T0–T1 and T0–T2 differences in favor of EG. Conclusion. This multicenter trial endorses the use of action observation in upper-extremity rehabilitation, along with a role for the mirror neuron system in poststroke recovery.
Playing catch-up? Recent reform of New Zealand’s youth justice system
Authors: Lynch Nessa
Published: January 2012

The New Zealand youth justice system emerged as a ‘new paradigm’ in the early 1990s. This model of reintegration, restorativeness, diversion and family empowerment has been highly influential worldwide. The New Zealand system has remained stable and non-punitive in the context of a volatile and punitive adult criminal justice system and the ‘punitive turn’ in the youth justice systems of similar jurisdictions. Significant reforms have been made through amending legislation in 2010. Here, three significant conceptual shifts underpinning the recent reforms are discussed. It is suggested that the New Zealand youth justice system is ‘playing catch-up’ both with the adult system, and with comparable jurisdictions. Nevertheless, those factors which allowed the youth justice system to remain non-punitive up to now may act to mitigate the potentially harsh effects of the legislative changes.
‘I am the person now I was always meant to be’: Identity reconstruction and narrative reframing in therapeutic community prisons
Authors: Stevens Alisa
Published: January 2012

Drawing upon semi-ethnographic research, this article explores desistance in process among serious offenders residing in democratic therapeutic communities. It is argued that offender rehabilitation in therapeutic communities involves a process of purposive and agentic reconstruction of identity and narrative reframing, so that a ‘new’ and ‘better’ person emerges whose attitudes and behaviours cohere with long-term desistance from crime. This is possible because the prison-based therapeutic community, with its commitment to a radically ‘different’ culture and mode of rehabilitation, socially enables, produces and reinforces the emergence of someone ‘different’. The article therefore develops existing understandings of change in forensic therapeutic communities, and reaffirms theories of desistance which emphasize the importance of pro-social changes to the offender’s personal identity and self-narrative.
Use of twin dorsal middle phalangeal finger flaps for thumb or index finger reconstruction
Authors: Qi W. , Chen K. J.
Published: January 2012

Amputation or degloving injuries of the thumb or index finger are highly disabling. We describe the use of twin dorsal middle finger flaps harvested from the dorsal aspects of the middle and ring fingers, and based on one palmar proper digital artery, its venae comitantes, and the dorsal branches of the palmar digital nerves of the middle and ring fingers, respectively. These flaps offer advantages when large soft tissue defects of the thumb or index finger are present. In this study, twin dorsal middle finger flaps were used in nine patients (six thumbs, three index fingers). All flaps completely survived. At the mean follow-up of 20 months, the appearance of the reconstructed thumbs or index fingers was acceptable, the length was maintained, and the mean static 2-point discrimination values were 10 mm in the palmar flap and 13 mm in the dorsal flap of the reconstructed digit. All patients were satisfied with the appearance and mobility of the donor fingers. All but one donor finger showed normal finger pulp sensibility, with a static 2-point discrimination between 3 and 6 mm.
Rehabilitation of Concussion and Post-concussion Syndrome
Authors: Leddy John J. , Sandhu Harkeet , Sodhi Vikram , Baker John G. , Willer Barry
Published: January 2012

Context: Prolonged symptoms after concussion are called post-concussion syndrome (PCS), which is a controversial disorder with a wide differential diagnosis.

Evidence Acquisition: MEDLINE and PubMed searches were conducted for the years 1966 to 2011 using the search terms brain concussion/ complications OR brain concussion/ diagnosis OR brain concussion/ therapy AND sports OR athletic injuries. Secondary search terms included post-concussion syndrome, trauma, symptoms, metabolic, sports medicine, cognitive behavioral therapy, treatment and rehabilitation. Additional articles were identified from the bibliographies of recent reviews.

Results: Of 564 studies that fulfilled preliminary search criteria, 119 focused on the diagnosis, pathophysiology, and treatment/rehabilitation of concussion and PCS and formed the basis of this review. Rest is the primary treatment for the acute symptoms of concussion. Ongoing symptoms are either a prolonged version of the concussion pathophysiology or a manifestation of other processes, such as cervical injury, migraine headaches, depression, chronic pain, vestibular dysfunction, visual dysfunction, or some combination of conditions. The pathophysiology of ongoing symptoms from the original concussion injury may reflect multiple causes: anatomic, neurometabolic, and physiologic.

Conclusions: Treatment approaches depend on the clinician’s ability to differentiate among the various conditions associated with PCS. Early education, cognitive behavioral therapy, and aerobic exercise therapy have shown efficacy in certain patients but have limitations of study design. An algorithm is presented to aid clinicians in the evaluation and treatment of concussion and PCS and in the return-to-activity decision.
Public relations and philosophy: Parsing paradigms
Authors: Curtin Patricia A.
Published: January 2012

This philosophical article examines how public relations researchers have engaged with Kuhn’s concept of a paradigm and have used it to set a research agenda for the field. I argue that Kuhn believed the social sciences to be inherently multi-paradigmatic, making the quest for a single, overarching paradigm for public relations research misguided. Instead, I lay out a four-paradigm schematic for the field, examining issues of semantic and cultural incommensurability and consequences for language use and research method and values. The article questions the definition of a mature discipline as often found in public relations literature and proposes that we might be more mature than we think if we are willing to accept a diversity of perspectives and their concomitant research values.
Breast and Cervical Cancer Screening Among Rural Midwestern Latina Migrant and Seasonal Farmworkers
Authors: Castañeda Sheila F. , Rosenbaum Rene Perez , Gonzalez Patricia , Holscher Jessica T.
Published: January 2012

Background: While cancer control and prevention efforts are well documented, limited information on this topic exists for Latina farmworkers in the rural Midwest. This study sought to examine correlates of breast cancer and cervical cancer screening practices of English- and Spanish-speaking Latina farmworkers in Michigan. Methods: Survey and anthropometric data were collected from a community-based cross-sectional sample of 173 Latina agricultural laborers in Michigan. Psychosocial-cultural and socioeconomic variables were examined as predictors of mammography and Papanicolaou screening. Findings: Results showed that individual characteristics that were significantly associated with having a Papanicolaou examination in the last 12 months included having higher language-based acculturation (odds ratio = 3.81), having ever done a breast self-examination (odds ratio = 2.82), and having health insurance (odds ratio = 5.58). Conclusions: Acculturation, insurance, and performance of breast self-examination were key correlates of recent cervical cancer screening among Midwest Latina farmworkers. Findings suggest that education and targeted outreach strategies for Spanish-speaking Latina farmworker women in rural settings are urgently needed.
Use and Quality of Care at a VA Outreach Clinic in Northern Maine
Authors: Lee Pamela W. , Markle Penelope S. , West Alan N. , Lee Richard E.
Published: January 2012

Objective: To assess use and quality of care at a new 1-day-per-week Veterans Administration Outreach Clinic in remote northern Maine. Methods: Veterans Administration electronic medical records were abstracted to compare outreach clinic patients seen in its first year to patients seen at the nearest outpatient treatment sites, a small-staff, full-time VA clinic 81 miles away and a community-based outpatient clinic 55 miles away. Chart abstractions (N = 1251) yielded counts of visits, patients newly enrolled in VA care, patients transferring to the outreach clinic, and patients who had and maintained a local non-VA primary care physician, as well as multiple quality of care performance measures using standard VA criteria. Results: The outreach clinic enrolled very few patients new to VA; 96% of its patients were transfers from other sites. For transfers, the average one-way driving burden to reach primary care was reduced by 52.9 miles and 58.1 minutes to reach. Compared to community-based outpatient clinic patients, outreach clinic patients were more likely to have three or more provider visits during the year. Some quality of care measures were lower at the outreach clinic: obesity screenings, referrals to smoking cessation services, diabetes management, and hypertension control. At all three sites, most patients had health insurance coverage and kept a local, non-VA doctor throughout the year. Conclusions: A part-time outreach clinic improved the convenience of primary care for rural VA outpatients, though quality of care was reduced for some measures related to equipment and staffing limitations. Most patients at any VA site had a local, non-VA medical doctor with whom they remained in care while using VA services.
Dexmedetomidine-Ketamine Sedation in a Child With a Mediastinal Mass
Authors: Corridore Marco , Phillips Alistair , Rabe Andrew J. , Tobias Joseph D.
Published: January 2012

Sedation during invasive procedures provides appropriate humanitarian care as well as facilitates the completion of procedures. Although generally safe and effective, adverse effects may occur especially in patients with comorbid diseases. One particularly challenging situation is the child with an anterior mediastinal mass who requires sedation during performance of a biopsy to obtain a tissue diagnosis. When there is evidence of airway compromise, it is generally accepted that the maintenance of spontaneous ventilation is necessary as complete airway obstruction may occur, if positive pressure ventilation is chosen. We present the use of a dexmedetomidine–ketamine combination for procedural sedation in a three-year-old child who presented with a large mediastinal mass and respiratory compromise. Previous reports regarding the use of dexmedetomidine and ketamine for procedural sedation are reviewed and the potential efficacy of this combination is discussed.
Safety of Long-Term Mechanical Support With Berlin Heart EXCOR in Pediatric Patients
Authors: Sandica Eugen , Knyphausen Edzard Zu , Blanz Ute , Röfe Daniela , Morshuis Michiel
Published: January 2012

Background. The Berlin Heart EXCOR Pediatrics is utilized at our center as a bridge to transplantation or bridge to recovery. This retrospective study reviews our results regarding the safety of long-term support and outcome. Methods. Between January 2008 and December 2010, 12 patients (6 females and 6 males) underwent implantation of a ventricular assist device. The median weight was 14.2 kg (range 4.2-51.6 kg) and the median age was 4.12 years (range 0.25-11.83 years). All patients were on inotropes, five patients required mechanical ventilation and three patients experienced cardiopulmonary resuscitation. Results. Eight patients received a left ventricular assist device and four patients received a biventricular assist device. Of the 12 patients, 8 were bridge to heart transplantation, in 2 patients explantation was possible, and 1 patient died on support. The median support time for these 11 patients was 151 days (range 4-488 days), with 2124 days of cardiac support. One patient is on support. Survival rate was 91.6%. Seven patients had a blood pump change once. Four patients had local signs of infection. There was no mediastinitis and thromboembolism. One patient had intracerebral hemorrhage. There was no death after heart transplantation or after explantation of the device. Conclusions. The Berlin Heart EXCOR is effective in bridging children of almost all ages and sizes to cardiac transplantation or myocardial recovery. Our experience proved that long-term support is possible with a low rate of adverse events.
To Cool or Not to Cool During Cardiopulmonary Resuscitation
Authors: Topjian Alexis A. , Naim Maryam Y. , Nadkarni Vinay
Published: January 2012

Therapeutic hypothermia following cardiac arrest improves neurologic outcome following adult ventricular fibrillation (VF) cardiac arrest and perinatal hypoxic ischemic encephalopathy. Evaluation of therapeutic hypothermia in the pediatric cardiac arrest population has been limited thus far to retrospective evaluations and to date there have been no published prospective efficacy trials. Two retrospective pediatric cohort studies showed no benefit from hypothermia compared to usual care. The timing (intra-arrest or post-arrest) and duration of hypothermia may impact patient outcome. While overshoot hypothermia <32°C, hypokalemia, and bradycardia are commonly associated with induced hypothermia, the risks of severe arrhythmia and bleeding are no worse than in normothermic controls. Despite this, rewarming has been identified as a vulnerable time for hypotension and seizure activity and may attribute to worse outcome. The American Heart Association’s current recommendation is “therapeutic hypothermia (32-34°C) may be considered for children who remain comatose after resuscitation from cardiac arrest. It is reasonable for adolescents resuscitated from sudden, witnessed, out-of-hospital VF cardiac arrest.” Ongoing research will help delineate whether induced hypothermia following pediatric cardiac arrest improves neurologic outcome.
Multimodality Neuromonitoring for Pediatric Cardiac Surgery
Authors: Clark Joseph B. , Barnes Mollie L. , Undar Akif , Myers John L.
Published: January 2012

Brain injury remains a source of morbidity associated with congenital heart surgery. Intraoperative neuromonitoring is used by many centers to help minimize neurologic injury and improve outcomes. Neuromonitoring at our institution is performed using a combination of near-infrared spectroscopy, transcranial Doppler ultrasound, electroencephalography, and somatosensory evoked potentials. Adverse or concerning parameters instigate attempts at corrective intervention. A review of the literature regarding neuromonitoring studies in pediatric cardiac surgery shows that evidence is limited to demonstrate that intraoperative neuromonitoring is associated with improved neurologic outcomes. Further clinical research is needed to assess the utility and cost-effectiveness of intraoperative neuromonitoring for pediatric heart surgery.
Intensive Care of the Pediatric Ventricular Assist Device Patient
Authors: Hehir David A. , Niebler Robert A. , Brabant Christopher C. , Tweddell James S. , Ghanayem Nancy S.
Published: January 2012

Utilization of ventricular assist devices (VADs) in children is increasing, as is the complexity of patients supported. We review the intensive care management of pediatric patients with VAD in the perioperative and rehabilitation phases, highlighting the technical aspects and physiology of VADs which impact care. Indications for VAD placement and the preoperative assessment of risk are discussed. Specific aspects of postoperative and long-term care including device troubleshooting, hemostasis and anticoagulation, support of the right ventricle, incidence and prevention of neurologic injury, and other complications are reviewed.
Right Coronary Sinus of Valsalva Aneurysm With Rupture Into the Right Ventricle
Authors: Bakhtiary Farhad , Hani Amjad Bani , Mohr Friedrich Wilhelm , Kostelka Martin
Published: January 2012

We report a case of right coronary sinus of Valsalva aneurysm (SVA) with rupture into the right ventricle in a 23-year-old man. The problem was successfully managed with surgical closure of both ruptured SVA and the ventricular defect with cardiopulmonary bypass through median sternotomy.
Unoperated Congenitally Corrected Transposition of the Great Arteries, Nonrestrictive Ventricular Septal Defect, and Pulmonary Stenosis in Middle Adulthood
Authors: Shinbane Jerold S. , Shriki Jabi , Hindoyan Antereas , Ghosh Bobby , Chang Philip , Farvid Ali , Saxon Leslie A. , Cao Michael , Cesario David , Takahashi Masato , Colletti Patrick M. , Wilcox Alison , Baker Craig , Starnes Vaughn
Published: January 2012

Submitted May 6, 2011; Accepted August 3, 2011. The survival into adulthood of patients with unoperated complex congenital heart disease with anomalies often considered life threatening in infancy and childhood requires a complex interplay of “balanced” defects allowing for cardiovascular physiology compatible with long-term survival. We report on a series of three cases from our advanced imaging database of middle-aged adults presenting with multiple similar defects providing a hemodynamically balanced circulation. The constellation of defects seen in each of these patients included congenitally corrected transposition of the great arteries, a large nonrestrictive ventricular septal defect, valvular pulmonary stenosis, and in two cases anomalous coronary arteries. Cardiovascular computed tomographic angiography (CCTA) and cardiovascular magnetic resonance imaging (CMR) were important to the characterization of the multiple defects and their three-dimensional relationships in these cases. Treatment decisions in patients with this constellation of findings are challenging, given the limited data due to the rarity of survival of patients with these defects into middle adulthood and the paucity of data related to decisions and approaches to medical management, surgical correction, or transplantation.
An Uncommon Course of the Right Superior Vena Cava in a Patient With Heterotaxy Syndrome
Authors: Chenu Caroline , Fouilloux Virginie , Kreitmann Bernard , Metras Dominique
Published: January 2012

We present the case of an infant with congenital heart disease which includes a partial atrioventricular canal defect with the absence of the atrial septum (common atrium) and an extremely uncommon course of the right-sided superior vena cava (SVC) including an intra-atrial segment coursing intramurally along the right posterolateral atrial wall, with an intracardiac orifice situated low within the right side of the atrium, close to the atrial orifice of the right hepatic veins. This feature of the anatomy was discovered intraoperatively at the time of surgical repair. Systemic venous anatomy also included interrupted inferior vena cava (IVC) with azygos continuation to a left-sided SVC draining directly into the left side of the atrium. The successful surgical procedure included tunneling of the left-sided SVC to the right side of the common atrium and atrial septation with a patch.
Pediatric Ventricular Assist Devices
Authors: Jaquiss Robert D. B. , Lodge Andrew J.
Published: January 2012

In the last decade, there have been enormous advances in the field of pediatric-specific mechanical circulatory support. In the past, small children requiring bridge to transplant or recovery were limited to extracorporeal membrane oxygenation. Now, in various stages of development, there are several devices that offer the promise of the same quality of support enjoyed by older teenagers and adolescents, with the potential to substantially reduce transplant waiting list mortality and optimize transplant outcomes. Advances have been driven by both industry and, for the first time, by funding from the US National Institutes of Health.
The Walter Sisulu Paediatric Cardiac Centre for Africa
Authors: Kinsley Robin H. , Edwin Frank
Published: January 2012

The 2011 symposium opened with a consideration of the challenges in the management of children undergoing the Fontan operation. Management options for patients with congenitally corrected transposition were then discussed, using several illustrative case examples and a review of the results from the Texas Children’s Hospital. There was a session dedicated to borderline hypoplastic left heart syndrome, concluding with a review of the results of the Single Ventricle Reconstruction (SVR) Trial in North America. Results of pediatric mechanical circulatory support were considered in the context of surgery for anomalous left coronary artery from the pulmonary artery after a more general overview of pediatric applications of extracorporeal membrane oxygenation and ventricular assist devices. Problems of monitoring in the intensive care unit, quality assurance, feeding algorithms for children, and morbidity associated with mechanical ventilation occupied most of the second day’s sessions. Results of the arterial switch operation for transposition, issues related to neonatal brain protection during open cardiac procedures, and, finally, training paradigms for congenital heart surgeons concluded the symposium’s talks.
Inhaled Nitric Oxide for Elevated Cavopulmonary Pressure and Hypoxemia After Cavopulmonary Operations
Authors: Georgiev Stanimir G. , Latcheva Alexandra Z. , Pilossoff Vladimir B. , Lazarov Stojan D. , Mitev Plamen D.
Published: January 2012

Background. Elevated cavopulmonary pressure early after surgical creation of cavopulmonary connections is an important hemodynamic problem with grave prognostic significance. We examined the effect of administration of inhaled nitric oxide (iNO) to patients with elevated cavopulmonary pressure in the early postoperative period. Methods. We retrospectively reviewed data pertaining to all 14 patients with superior (n = 6) and total (n = 8) cavopulmonary connections who were treated with iNO in the early postoperative period during an interval of six years. Changes in the cavopulmonary pressure, the transpulmonary gradient, and the oxygen saturation after the institution of iNO were evaluated. The preoperative characteristics of the patients were compared to those of a control group of patients with cavopulmonary operations not treated with iNO postoperatively. Results. Twelve hours after the initiation of iNO therapy, significant reduction in the cavopulmonary pressure (16.6 ± 3.5 mm Hg vs 18.1 ± 2.3 mm Hg, P = .006), reduction in the cavopulmonary gradient (7.0 ± 3.5 mm Hg vs 9.8 ± 3.7 mm Hg, P = .009), and elevation of the arterial oxygen saturation (84.5% ± 6.0% vs 78.7% ± 5.9%, P = .001) were observed. Linear correlation analysis confirmed tendencies for reduction in the cavopulmonary pressure ( P = .13), reduction in the cavopulmonary gradient ( P = .02), and elevation of the oxygen saturation ( P = .10). Compared to the control group, the treated patients tended to have higher preoperative pulmonary arterial pressures (PAPs) 17 (11-30) mm Hg versus 12 (10-25) mm Hg, P = .10; higher pulmonary vascular resistance (PVR) 2.04 (0.27-6.94) Wood units versus 1.02 (0.49-5.20) Wood units, P = .37; and longer bypass times 154 (41-218) versus 91 (15-276) minutes, P = .13. Conclusions. Administration of iNO was associated with diminuition of cavopulmonary pressure and transpulmonary gradient and increasing oxygen saturation in our small group of patients. In our experience selected patients with preoperatively elevated PAP above 17 mm and PVR above 2 Wood units can undergo cavopulmonary operations with iNO treatment early postoperatively.
Successful Hybrid Stage I Palliation for Hypoplastic Left Heart Syndrome in a Developing Nation
Authors: Cuaso Charles C. , Cheng Dexter D. , Rosario Jonas del , Plucena Leah Patricia A. , Pasimio Raquel , Reyes Karl G.
Published: January 2012

The first successful stage I palliation for hypoplastic left heart syndrome (HLHS) in a four-day-old female in the Philippines is reported, along with a discussion of the particular dynamics and challenges of performing this kind of surgery in a developing nation. Challenges met were not limited to the preoperative and perioperative period but involved the interstage period as well. In the face of such challenges, our experience, reported here, is the cause for cautious optimism.