bluuebunny/crossref_metadata_2025 huggingface dataset:
Graded Blood Pressure Reduction in Hypertensive Outpatients Associated With Use of a Device to Assist With Slow Breathing
Authors: Elliott William J. , Izzo Joseph L. , White William B. , Rosing Douglas R. , Snyder Christopher S. , Alter Ariela , Gavish Benjamin , Black Henry R.
Published: May 2007

To study the effects of device‐guided breathing on office systolic blood pressure (SBP), five centers randomized 149 untrained hypertensives (50% male, age 59±10 years, baseline blood pressure 150±9/86±9 mm Hg, 77% taking drug therapy). One half received a device to guide slow breathing; all received a home blood pressure monitor and only simple, written instructions. The changes in office SBP (adjusted for office‐to‐home difference in baseline SBP and accumulated time spent in slow breathing, guided and measured by the device) were significantly (p<0.001 for trend) correlated with accumulated time spent in slow breathing. Greater decreases in SBP (−15.0±1.8 vs. −7.3±1.9 mm Hg) were observed for those who spent more (vs. less) than 180 minutes over 8 weeks in slow breathing, as well as those who just monitored their blood pressure at home (−9.2±1.6 mm Hg). Thus, even without training, hypertensive patients who receive a device to guide slow breathing significantly lowered their office SBP if the total time spent in slow breathing over 8 weeks exceeded a "threshold" value of 180 minutes.
Elevation of C‐Reactive Protein in People With Prehypertension
Authors: King Dana E. , Egan Brent M. , Mainous Arch G. , Geesey Mark E.
Published: May 2007

The objective of this study was to determine the relationship of C‐reactive protein (CRP) and blood pressure (BP) across the range of BP categories including prehypertension. The Third National Health and Nutrition Examination Survey (NHANES III) data collected from 1988 to 1994 were analyzed. In unadjusted analyses, there was a step‐wise increase in the probability of elevated CRP across a wide range of BP categories. Prehypertensive participants had a higher prevalence of elevated CRP than normotensive people (27.4% vs. 19.8%; p<05). After adjustment for age, gender, race, smoking, body mass index, exercise, diabetes, and medication usage, participants with systolic BP 120–139 mm Hg or diastolic BP 80–89 mm Hg were more likely to have elevated CRP than people with systolic BP <120 (odds ratio, 1.36; 95% confidence interval, 1.14–1.62; odds ratio, 1.20; 95% confidence interval, 1.02–1.41, respectively). CRP and BP are positively related across a wide range of BP categories. A substantial proportion of prehypertensive individuals have elevated CRP independent of multiple confounders.
Minoxidil: An Underused Vasodilator for Resistant or Severe Hypertension
Authors: Sica Domenic A.
Published: May 2007

Minoxidil is a direct vasodilator introduced in the early 1970s for the treatment of hypertension. It is capable of reducing blood pressure in most persons with resistant hypertension where therapy has failed with multidrug regimens. Minoxidil's effect can be limited because of an increase in pulse rate and/or sodium (and water) retention. The latter May prove quite debilitating in some patients. Thus, minoxidil is generally administered with both a diuretic and an agent that can keep pulse rate in check, such as a β blocker or a combined α‐β blocker. The prominent tachycardia with minoxidil can aggravate myocardial ischemia and, if long‐standing, leads to left ventricular hypertrophy. Minoxidil has a particularly annoying side effect of hypertrichosis that May limit its use, particularly among women. Minoxidil use is infrequently associated with the idiosyncratic onset of a pericardial effusion. If a patient's hypertension is severe enough to warrant minoxidil therapy, a hypertension specialist should probably become involved in the patient's care. The use of this medicaion should be limited in view of the availability of effective agents with fewer side effects. There is, however, a place for minoxidil in the treatment of resistant hypertension especially in patients with advanced renal disease.
The Role of Existing and Newer Calcium Channel Blockers in the Treatment of Hypertension
Authors: Basile Jan
Published: May 2007

Calcium channel blockers (CCBs), which include both dihydropyridines such as nifedipine and amlodipine and non‐dihydropyridines (verapamil and diltiazem), are among the most widely prescribed agents for the management of essential hypertension. Several large outcome risk trials and comprehensive meta‐analyses have found that CCBs reduce the cardiovascular morbidity and mortality associated with uncontrolled hypertension, including stroke. CCBs, however, appear less effective than angiotensin‐converting enzyme inhibitors and diuretics for preventing heart failure and myocardial infarction. CCBs are among the agents listed as potential first‐line therapy, either alone or in combination with other agents in hypertension management guidelines. Furthermore, CCBs are suitable for add‐on therapy in combination with diuretics, angiotensin‐converting enzyme inhibitors, and angiotensin‐II receptor blockers. CCBs may be partially suitable for patients with comorbid Raynaud's syndrome, isolated systolic hypertension (dihydropyridine), or angina pectoris (non‐dihydropyridine). The newer inherently long‐acting dihydropyridine agents (e.g., lacidipine, lercanidipine), which are not currently available in the United States, appear to have comparable efficacy to older agents of the dihydropyridine class but may have an improved tolerability profile, especially with regard to peripheral edema.
Different Effects of Losartan and Moxonidine on Endothelial Function During Sympathetic Activation in Essential Hypertension
Authors: Doumas Michael N. , Douma Stella N. , Petidis Kostas M. , Vogiatzis Kostas V. , Bassagiannis Ilias C. , Zamboulis Chris X.
Published: May 2007

The aim of this study was to investigate: 1) the effects of treadmill exercise on plasma catecholamines and endothelin‐1 (ET‐1, a potent vasoconstrictor) levels in hypertensive patients; and 2) the impact of 1‐month therapy with losartan as compared with moxonidine on catecholamine and ET‐1 changes during exercise. Twenty‐eight patients with essential hypertension were randomized in two groups: group A received losartan and group B received moxonidine for 1 month. Plasma catecholamines exhibited an almost 10‐fold increase during exercise (p<0.00001) before treatment. Moxonidine significantly decreased catecholamine levels (p<0.05), while losartan reduction was nonsignificant (p<0.36). Plasma ET‐1 increased significantly during exercise before treatment (p<0.00005). Moxonidine therapy did not affect ET‐1 levels (p<0.88), while losartan resulted in a significant decrease of ET‐1 levels both at baseline and during exercise (p<0.007). These findings suggest a mechanism for the reduced cardiovascular mortality noted with an angiotensin receptor blocker as compared with a sympatholytic agent.
Combination Angiotensin Receptor Blocker/Hydrochlorothiazide as Initial Therapy in the Treatment of Patients With Severe Hypertension
Authors: Salerno Christina M. , Demopoulos Laura , Mukherjee Robin , Gradman Alan H.
Published: May 2007

Patients with severe hypertension are at high risk for cardiovascular events. The authors hypothesized that initial treatment with a combination angiotensin receptor blocker/diuretic agent would be safe and more effective than initial treatment with a single agent for these patients. In this 6‐week, double‐blind trial, 585 patients were randomized to losartan/hydrochlorothiazide or losartan as monotherapy and titrated as needed at 2‐week intervals to reach goal blood pressure (<90 mm Hg). Almost twice as many patients achieved goal at the primary end point of 4 weeks on 50 mg losartan/12.5 mg hydrochlorothiazide vs. the losartan regimen (50–100 mg; p=0.002). Additionally, almost three times as many patients achieved goal blood pressures at 6 weeks (p<0.001). Adverse experiences on losartan/hydrochlorothiazide (43%) were significantly less than with the angiotensin receptor blocker alone (52.6%). This study confirmed the efficacy and tolerability of initial use of a fixed combination of losartan/hydrochlorothiazide vs. losartan without a thiazide.
Update on the Management of Hypertension: Recent Clinical Trials and the JNC 7
Authors: Moser Marvin
Published: May 2007

The following issues are highlighted: Emphasis is placed on the importance of systolic blood pressure elevations in estimating risk and in determining prognosis. A review of placebo‐controlled clinical trials indicates that cardiovascular events are statistically significantly reduced with diuretic‐ or β blocker‐based treatment regimens. The question of whether blood pressure lowering alone or specific medications make the difference in outcome is discussed. Based on the results of numerous trials, it is apparent that blood pressure lowering itself is probably of greater importance in reducing cardiovascular events than the specific medication used. Meta‐analyses suggest, however, that the use of an agent that blocks the renin‐angiotensin aldosterone system is probably more effective in diabetics and in patients with nephropathy than a regimen based on calcium channel blocker therapy. The Antihypertensive and Lipid‐Lowering treatment to Prevent Heart Attack Trial (ALLHAT) reported no overall difference in coronary heart disease outcome among patients treated with a diuretic‐based compared to a calcium channel blocker‐ or an angiotensin‐converting enzyme inhibitor‐based treatment program. However, patients in the diuretic group experienced fewer episodes of heart failure than in the calcium channel blocker group and fewer episodes of heart failure and strokes than those in the angiotensin‐converting enzyme inhibitor group. Results were similar in diabetics and nondiabetics. Possible reasons for this outcome are discussed. The Australian National Blood Pressure 2 study, which was unblinded, reported a marginally significantly better outcome only in male patients receiving an angiotensin‐converting enzyme inhibitor‐based regimen compared to those receiving a diuretic‐based program. Finally, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) is reviewed. Highlights of this report include the new designation of prehypertension, i.e., blood pressures of 120–139 mm Hg/80–89 mm Hg. The JNC 7 suggested that diuretics should be the first‐step drug of choice in most patients, but listed numerous specific reasons why other agents should be used in special situations. The report stressed that the majority of patients will require two or more medications to achieve goal blood pressure.
Cardiovascular Implications of Albuminuria
Authors: Tuttle Katherine R.
Published: May 2007

Microalbuminuria is a major independent risk factor for cardiovascular disease (CVD) events in persons with diabetes or hypertension, the general population, and persons with known CVD. Although microalbuminuria is a stronger risk factor in men, women with increased albuminuria levels are also at a higher risk of CVD. Microalbuminuria is an indicator of generalized endothelial injury, a hallmark of systemic atherosclerosis. Treatments that decrease albuminuria, particularly agents that inhibit the renin‐angiotensin system, reduce CVD risk in various populations, including those with and without diabetes or hypertension. Whether albuminuria should be a treatment target for CVD is not yet proven. Nevertheless, the measurement of albuminuria is clinically useful to identify high‐risk individuals who should receive intensive risk factor management based on current treatment guidelines.
Management of Hypertensive Chronic Kidney Disease: Role of Calcium Channel Blockers
Authors: Toto Robert D.
Published: May 2007

Both the prevalence and incidence of end‐stage renal disease have been increasing in the United States over the past two decades. Diabetes and hypertension are the attributable causes for more than three fourths of all new cases of end‐stage renal disease. The overwhelming majority of diabetics with nephropathy are hypertensive, and lowering blood pressure is indicated in all patients with chronic kidney disease because of the increased risk for cardiovascular morbidity and mortality. Multiple studies indicate that reaching goal systolic blood pressure in patients with chronic kidney disease generally requires three to four antihypertensive agents. A number of medication combinations can effectively reduce blood pressure in the chronic kidney disease patient. In this regard, adding a calcium channel blocker to an angiotensin‐converting enzyme inhibitor or an angiotensin receptor blocker helps in reaching goal blood pressure while preserving renal function in both diabetics and nondiabetics with proteinuria.
A Comparison of Morning Blood Pressure Surge in African Americans and Whites
Authors: Haas Donald C. , Gerber Linda M. , Shimbo Daichi , Warren Katherine , Pickering Thomas G. , Schwartz Joseph E.
Published: May 2007

African Americans have twice the risk of suffering a stroke compared to whites, but the reasons for this disparity have yet to be elucidated. Recent data suggest that the morning blood pressure (BP) surge is an independent predictor of strokes. Whether African Americans and whites differ with respect to morning BP surge is unknown. African‐American (n=183) and white (n=139) participants, age 18‐65, were studied with 24‐hour ambulatory BP monitoring. Morning surge was defined as morning BP minus the trough BP during sleep. The morning surge was significantly lower in African Americans than in whites (23 mm Hg vs. 27 mm Hg; both SEM=1.0; p=0.009). This relationship was no longer evident after adjusting for gender, age, and body mass index (23 mm Hg vs. 26 mm Hg; SE=1.0 and 1.1; p=nonsignificant). Morning BP surge is unlikely to account for differences in stroke incidence between African Americans and whites.
Dietary Influences on Blood Pressure: The Effect of the Mediterranean Diet on the Prevalence of Hypertension
Authors: Kokkinos Peter , Panagiotakos Demosthenes B , Polychronopoulos Evangelos
Published: May 2007

Hypertension has long been recognized as a major risk factor for several common cardiovascular diseases. The World Health Organization reports that the number of people with hypertension worldwide is estimated at 600 million, while 3 million will die annually as a result of hypertension. There is evidence to support that several factors related to lifestyle habits may influence blood pressure levels. Among these, the beneficial effect of diet on human health, as well as on the control of hypertension, has been underlined in several studies. Moreover, adherence to a Mediterranean diet has been associated with reduced all‐cause mortality and, especially, coronary heart disease. The effect of this traditional diet on blood pressure levels has not been well understood and appreciated. This review summarizes the current understanding of the dietary influences on blood pressure control and the findings of observational and clinical studies that have evaluated the effect of the Mediterranean dietary pattern on the prevalence of chronic essential hypertension.
Polycystic Kidney Disease
Authors: Fall Pamela J. , Prisant L. Michael
Published: May 2007

Polycystic kidney disease, an inherited systemic disorder, is characterized by the development of multiple cysts in the kidneys and other organs. Patients can present at any age, but more often come to clinical attention (unless there is a family history) after age 30. Patients who are diagnosed before age 30 have a worse renal survival. Although palpation of the abdomen occasionally provides a clue to the presence of polycystic kidney disease, radiographic procedures most often suggest the diagnosis. Mutations in the PKD1 or PKD2 genes give rise to cyst formation. Flank pain, hematuria, polyuria, nephrolithiasis, urinary tract infections, and hypertension may be part of the syndrome of polycystic kidney disease. It is the fourth most common cause of end‐stage renal disease. Blood pressure treatment goals are less than 130/80 mm Hg. Treatment should include the use of angiotensinconverting enzyme inhibitors.
Secondary Hypertension—Whom and How Do You Study? What Type of Therapy Is Appropriate?
Authors: Moser Marvin , Victor Ronald , Handler Joel
Published: May 2007

Following a hypertension symposium in Los Angeles, CA on October 20, 2004, a roundtable was convened to discuss secondary or treatable forms of high blood pressure, when and whom should be studied, and treatment methods. Dr. Marvin Moser, Clinical Professor of Medicine at Yale University School of Medicine, New Haven, CT, moderated the panel discussion. Participants included Dr. Ron Victor, from the Southwestern Medical Center, Dallas, TX and Dr. Joel Handler of the Orange County Kaiser Permanente Hypertension Clinic, Anaheim, CA.
Systemic Hypertension Among Women With Uterine Leiomyomata: Potential Final Common Pathways of Target End‐Organ Remodeling
Authors: Silver Marc A. , Raghuvir Rashmi , Fedirko Bohdan , Elser Denise
Published: May 2007

The uterus and the heart share a common structure and may remodel in a similar fashion, albeit temporally distinct. The authors investigated the prevalence of systemic hypertension in women with uterine leiomyomata (fibroids) and compared the prevalence in women undergoing hysterectomy for other reasons as well as in age‐matched women from the National Health and Nutrition Examination Survey III (NHANES III). A total of 584 women, 205 with leiomyomata in 1999 (group A) and 379 who underwent hysterectomy for a variety of reasons in 2000 (group B) at Advocate Christ Medical Center were included. Presence of leiomyomata was confirmed by pathology. Hypertension was defined as blood pressure ≥140/90 mm Hg or history of hypertension with or without medication use. The prevalence of hypertension in group A and B patients with leiomyomata compared with NHANES III overall was 48.6% vs. 24% (p<0.001), in African Americans 55.5% vs. 32.4% (p<0.001), and in Caucasians 51.1% vs. 23.3% (p<0.001). Leiomyomata were more frequent among hypertensive than normotensive women (57% vs. 27%). Caucasian and African‐American women with leiomyomata were significantly younger and more likely to use hormone replacement therapy than others. Thus there appears to be an association between leiomyomata and hypertension, which needs to be explored in future prospective trials.
Single‐Pill Therapy in the Treatment of Concomitant Hypertension and Dyslipidemia (The Amlodipine/Atorvastatin Gemini Study)
Authors: Blank Roy , LaSalle James , Reeves Russell , Maroni Jaman , Tarasenko Lisa , Sun Franklin
Published: May 2007

The Gemini Study was a 14‐week, open‐label, noncomparative, office‐based, multicenter trial to evaluate single‐pill therapy in the treatment of concomitant hypertension and dyslipidemia. In addition to recommending lifestyle modifications, eight dosage strengths of amlodipine/atorvastatin single pill (5/10, 5/20, 5/40, 5/80,10/10,10/20,10/40, and 10/80 mg) were electively titrated to improve blood pressure and lipid control. A total of 1220 patients with uncontrolled hypertension at baseline received study medication. At baseline, mean blood pressure was 146.6/87.9 mm Hg and mean low‐density lipoprotein cholesterol concentration was 152.9 mg/dL. At study end, 57.7% of patients had achieved both their blood pressure and low‐density lipoprotein cholesterol goals (51.9% of patients with uncontrolled low‐density lipoprotein cholesterol at baseline). The mean dose of study medication at end point was amlodipine component 7.1 mg and atorvastatin component 26.2 mg. Fifty‐eight patients (4.8%) discontinued therapy due to adverse events. Single‐pill therapy is effective in reducing both blood pressure and lipid levels and in helping patients achieve goals for both hypertension and dyslipidemia.
Conflicting and Confusing Data From the Hypertension Treatment Trials: Whom and What Should You Believe?
Authors: Moser Marvin , Giles Thomas , Oparil Suzanne
Published: May 2007

Following a hypertension symposium in Atlanta, GA on March 30, 2005, a roundtable was convened to discuss a confusing topic: “Conflicting Information from the Hypertension Treatment Trials: Whom and What Should You Believe?” Dr. Marvin Moser, Clinical Professor of Medicine at the Yale University School of Medicine, New Haven, CT, moderated the panel discussion. Participants included Dr. Thomas Giles, Professor of Medicine at Louisiana State University Health Sciences Center, New Orleans, LA and President of the American Society of Hypertension, and Dr. Suzanne Oparil, Professor of Medicine at the University of Alabama at Birmingham, Birmingham, AL.
Hypertension and the Cardiometabolic Syndrome
Authors: Manrique Camila , Lastra Guido , Whaley‐Connell Adam , Sowers James R.
Published: May 2007

Hypertension and cardiovascular disease are leading causes of morbidity and mortality. Accumulating data demonstrate a relationship between hypertension and several vascular and metabolic abnormalities that are components of the cardiometabolic syndrome. The components of the cardiometabolic syndrome include insulin resistance/hyperinsulinemia, central obesity, dyslipidemia, hypertension, microalbuminuria, increased inflammation, and oxidative stress. There is growing evidence that tissue activation of the renin‐angiotensin‐aldosterone system participates in endothelial dysfunction, microalbuminuria, insulin resistance, and subsequent cardiovascular and chronic kidney disease. The notion that hypertension is a metabolic as well as a vascular disease opens a new paradigm for the treatment of this disorder.
Interview With Edward Frohlich, MD
Authors: Moser Marvin
Published: May 2007

Dr. Edward Frohlich has been involved in research and treatment activities in hypertension for many years. His career has included working with some of the most important researchers in the field of hypertension—Ed Freis, Harriet Dustan, Irving Page, and Raymond Gifford among many others. He served as Editor in Chief of the journal Hypertension and continues as an active, productive researcher. He is most worthy of the designation Hypertension Icon.
Adiponectin and Resistin Plasma Levels in Healthy Individuals With Prehypertension
Authors: Papadopoulos Dimitrios P. , Makris Thomas K. , Krespi Panagiota G. , Poulakou Maria , Stavroulakis Georgios , Hatzizacharias Antonios N. , Perrea Despina , Votteas Vasilios V.
Published: May 2007

Prehypertension seems to be related to increased cardiovascular risk in healthy subjects, while hypoadiponectinemia and hyperresistinemia may contribute to insulin resistance and accelerated atherogenesis. This study investigated whether plasma levels of adiponectin (known to increase insulin sensitivity) and resistin (a protein possibly involved in inflammatory activities) are affected in healthy individuals with prehypertension, and to compare the findings to those of healthy normotensives matched for age, gender, and body mass index. Twenty‐six (14 men and 12 women) healthy individuals with prehypertension (mean age, 52±5 years; mean body mass index, 23±1.5 kg/m2) and 24 healthy normotensives (13 men and 11 women; mean age 53±6 years; body mass index 23.2±1.4 kg/m2) were studied. The adiponectin and resistin plasma levels were determined by the enzyme‐linked immunosorbent assay method. Plasma resistin levels were significantly higher, while adiponectin plasma levels were significantly lower, in prehypertensive subjects compared with normotensive subjects (10.62?3.17 ng/mL vs. 6.72±3.15 ng/mL and 6.26±2.18 μg/mL vs. 12.12±4.8 μg/mL; p<0.01, respectively). The findings suggest that healthy individuals with prehypertension have significantly higher resistin plasma levels and significantly lower adiponectin plasma levels compared with healthy normotensives. These findings may represent another possible mechanism that may increase the cardiovascular risk in this special group of patients, needing further investigation.
Alpha1‐Adrenergic Blockers: Current Usage Considerations
Authors: Sica Domenic A.
Published: May 2007

Alpha1‐adrenergic‐blocking drugs are effective in reducing blood pressure and do so in a fashion comparable to most other antihypertensive drug classes. These compounds are most effective in patients in the upright position, reducing systolic and diastolic pressures by 8%–10%. Alpha1‐adrenergic‐blocking drugs incrementally reduce blood pressure when combined with most drug classes and are the only antihypertensive drug class to improve plasma lipid profiles. Alpha1‐adrenergic‐blocking drugs are also accepted as important elements of the treatment plan for symptomatic benign prostatic hypertrophy. Dose escalation of an α1‐adrenergic‐blocking drug can trigger renal Na+ retention, and the ensuing volume expansion can attenuate its blood pressure‐lowering effect. Orthostatic hypotension can occur with these compounds, particularly when a patient is volume‐contracted. Dizziness, headache, and drowsiness are common side effects with α2‐adrenergic blockers. A modest decline in the use of doxazosin and other α1‐adrenergic‐blocking drugs has occurred coincident to the early termination of the doxazosin treatment arm in the Antihypertensive and Lipid‐Lowering Treatment to Prevent Heart Attack Trial.
Conduction Properties of the Inferior Vena Cava‐Tricuspid Annular Isthmus in Patients with Typical Atrial Flutter
Authors: KINDER CHARLES , KALL JOHN , KOPP DOUGLAS , RUBENSTEIN DONALD , BURKE MARTIN , WILBER DAVID
Published: May 2007

Conduction Properties of the Annular Isthmus. Introduction: A functional region of slow conduction located in the inferior right atrium has been postulated to be critical to the induction and maintenance of typical human atrial flutter. We reexamined the potential role of functional conduction delay in the annular isthmus between the tricuspid valve and the inferior vena cava; it is within this region that such delays have been postulated to occur, and where interruption of conduction by radiofrequency energy application has been shown to eliminate typical flutter.

Methods and Results: Thirty patients with type I atrial flutter (30 counterclockwise, 14 clockwise) were studied. Counterclockwise and clockwise isthmus activation times adjacent and parallel to the tricuspid valve were measured during three conditions: (1) atrial pacing in sinus rhythm, (2) atrial flutter, and (3) entrainment of atrial flutter. During pacing in sinus rhythm at progressively shorter cycle lengths, both counterclockwise and clockwise isthmus activation times remained unchanged; decremental conduction prior to flutter induction or loss of capture was not observed. Counterclockwise isthmus activation time did not significantly differ during flutter (68 ± 23 msec), inferolateral tricuspid annulus pacing (71 ± 23 msec), or entrainment of flutter (72 ± 23 msec). Similarly, clockwise isthmus activation times did not significantly differ between flutter (65 ± 22 msec), proximal coronary sinus pacing (73 ± 21 msec), or entrainment of flutter (64 ± 15 msec).

Conclusion: Decremental conduction is not characteristic of activation through the isthmus when activation is assessed parallel and adjacent to the tricuspid annulus. Functional slowing or conduction delay does not develop in this region during typical atrial flutter.
Membrane Refractoriness and Excitation Induced in Cardiac Fibers by Monophasic and Biphasic Shocks
Authors: TRAYANOVA NATALIA , BRAY MARK‐ANTHONY
Published: May 2007

Cardiac Fiber Responses to Defibrillation Shocks. Introduction: This modeling study examines the effect of low‐intensity monophasic and biphasic waveforms on the response of a refractory cardiac fiber to the defibrillation shock.

Methods and Results: Two cardiac fiber representations are considered in this study: a continuous fiber and a discrete fiber that incorporates gap junctions. Each fiber is undergoing a propagating action potential. Shocks of various strengths and coupling intervals are delivered extracellularly at fiber ends during the relative refractory period. In a continuous fiber, monophasic shock strengths of three times the diastolic threshold either elicit no response or, for coupling intervals above 380 msec, reinitiate propagation. In contrast, biphasic shocks of same strength are capable of terminating the existing wavefronts by either invoking a non‐propagating response (coupling intervals 370 to 382 msec) that prolongs the refractory period or inducing wavefront collision (coupling intervals above 400 msec). The fiber response is similar for other shock strengths and when cellular discontinuity is accounted for. Thus, for a refractory fiber, biphasic shocks have only a small “vulnerable” window of coupling intervals over which propagation is reinitiated.

Conclusion: At short coupling intervals, a significant extension of refractoriness is generated at regions where the biphasic shock induced hyperpolarization followed by depolarization. At large coupling intervals, the enhanced efficacy of biphasic shocks is associated with their ability to induce wavefront collision, thus decreasing the probability of reinitiating fibrillation. Overall, the defibrillation shock affects the tissue through the induced large‐scale hyperpolarization and depolarization, and not through the small‐scale transmembrane potential oscillations at cell ends.
Predictors of Maternal Responsiveness
Authors: Drake Emily E. , Humenick Sharron S. , Amankwaa Linda , Younger Janet , Roux Gayle
Published: May 2007

Purpose

: To explore maternal responsiveness in the first 2 to 4 months after delivery and to evaluate potential predictors of maternal responsiveness, including infant feeding, maternal characteristics, and demographic factors such as age, socioeconomic status, and educational level.

Design and Methods

: A cross‐sectional survey design was used to assess the variables of maternal responsiveness, feeding patterns, and maternal characteristics in a convenience sample of 177 mothers in the first 2 to 4 months after delivery. The 60‐item self‐report instrument included scales to measure maternal responsiveness, self‐esteem, and satisfaction with life as well as infant feeding questions and sociodemographic items. An online data‐collection strategy was used, resulting in participants from 41 U.S. states.

Findings

: Multiple regression analysis showed that satisfaction with life, self‐esteem, and number of children, but not breastfeeding, explained a significant portion of the variance in self‐reported maternal responsiveness scores. In this analysis, sociodemographic variables such as age, education, income, and work status showed little or no relationship to maternal responsiveness scores.

Conclusions

: This study provides additional information about patterns of maternal behavior in the transition to motherhood and some of the variables that influence that transition. Satisfaction with life was a new predictor of maternal responsiveness. However, with only 15% of the variance explained by the predictors in this study, a large portion of the variance in maternal responsiveness remains unexplained. Further research in this area is needed.
Delirium in Older Patients in Surgical Intensive Care Units
Authors: Balas Michele C. , Deutschman Clifford S. , Sullivan‐Marx Eileen M. , Strumpf Neville E. , Alston Robert P. , Richmond Therese S.
Published: May 2007

Purpose: To examine the frequency and course of delirium in older adults admitted to a surgical intensive care unit (SICU).

Design and Methods: Prospective, observational cohort study of 114 English‐speaking participants and their surrogates, aged 65 and older, admitted to an SICU, and managed by a surgical critical care service. Chart reviews and surrogate interviews were conducted within 24 hours of SICU admission to collect information regarding evidence of dementia using the short form of the Informant Questionnaire on Cognitive Decline in the Elderly. Participants were also screened for delirium daily throughout their hospitalization with either the Confusion Assessment Method‐ICU (CAM‐ICU) while in the SICU or the CAM while on medical/surgical units.

Results: In this population of older adults, 18.4% had evidence of dementia on admission to the SICU. Few older adults (2.6%) were admitted to the hospital with evidence of preexisting delirium, but 28.3% developed delirium in the SICU and 22.7% during the post‐SICU period. A total of 52 of 114 (45.6%) participants were delirious sometime during their hospital stay or 24 hours before hospital admission. Episodes of deep sedation and nonarousal were uncommon, occurring in only 9.7% of the sample.

Conclusions: Older adults admitted to SICUs were at high risk for developing delirium during hospitalization. Further research is needed to elucidate the risk factors for, and outcomes of, delirium in this uniquely vulnerable population.
A Psychometric Toolbox for Testing Validity and Reliability
Authors: DeVon Holli A. , Block Michelle E. , Moyle‐Wright Patricia , Ernst Diane M. , Hayden Susan J. , Lazzara Deborah J. , Savoy Suzanne M. , Kostas‐Polston Elizabeth
Published: May 2007

Purpose: To review the concepts of reliability and validity, provide examples of how the concepts have been used in nursing research, provide guidance for improving the psychometric soundness of instruments, and report suggestions from editors of nursing journals for incorporating psychometric data into manuscripts.

Methods: CINAHL, MEDLINE, and PsycINFO databases were searched using key words: validity, reliability, and psychometrics. Nursing research articles were eligible for inclusion if they were published in the last 5 years, quantitative methods were used, and statistical evidence of psychometric properties were reported. Reports of strong psychometric properties of instruments were identified as well as those with little supporting evidence of psychometric soundness.

Findings: Reports frequently indicated content validity but sometimes the studies had fewer than five experts for review. Criterion validity was rarely reported and errors in the measurement of the criterion were identified. Construct validity remains underreported. Most reports indicated internal consistency reliability (α) but few reports included reliability testing for stability. When retest reliability was asserted, time intervals and correlations were frequently not included.

Conclusions: Planning for psychometric testing through design and reducing nonrandom error in measurement will add to the reliability and validity of instruments and increase the strength of study findings. Underreporting of validity might occur because of small sample size, poor design, or lack of resources. Lack of information on psychometric properties and misapplication of psychometric testing is common in the literature.
Fourier‐Transformed Infrared Breath Testing After Ingestion of Technical Alcohol*
Authors: Laakso Olli , Haapala Matti , Pennanen Teemu , Kuitunen Tapio , Himberg Jaakko‐Juhani
Published: May 2007

Abstract: The study aim was to evaluate the feasibility of a Fourier‐transformed infrared (FT‐IR) analyzer for out‐of‐laboratory use by screening the exhalations of inebriated individuals, and to determine analysis quality using common breath components and solvents. Each of the 35 inebriated participants gave an acceptable sample. Because of the metabolism of 2‐propanol, the subjects exhaled high concentrations of acetone in addition to ethanol. Other volatile ingredients of technical ethanol products (methyl ethyl ketone, methyl isobutyl ketone, and 2‐propanol) were also detected. The lower limits of quantification for the analyzed components ranged from 1.7 to 12 μg/L in simulated breath samples. The bias was ±2% for ethanol and −11% for methanol. Within‐day and between‐day coefficients of variation were <1% for ethanol and <4% for methanol. The bias of ethanol and methanol analyses due to coexisting solvents ranged from −0.8 to +2.2% and from −5.6 to +2.9%, respectively. The FT‐IR method proved suitable for use outside the laboratory and fulfilled the quality criteria for analysis of solvents in breath.
Sudden Cardiac Death due to Giant Cell Inflammatory Processes*
Authors: Hamilton Rebecca A. , Sullivan Linda , Wolf Barbara C
Published: May 2007

Abstract:  Granulomatous inflammation of the myocardium may occur in a number of systemic disease processes including those with infectious etiologies such as fungal, mycobacterial and parasitic infections, as well as hypersensitivity reactions, and rarely autoimmune disorders. In many of these disorders, giant cells are components of the inflammatory infiltrate. Systemic granulomatous processes of unknown pathogenesis, most notably sarcoidosis, may also be associated with involvement of the myocardium. Occasionally, these disorders are associated with sudden death due to pathologic involvement of the heart. In contrast, giant cell myocarditis, also known as idiopathic myocarditis, a rare, frequently fulminant and fatal disorder of unknown etiology, is isolated to the heart and lacks systemic involvement. This disorder is most commonly diagnosed at autopsy. We present two cases in which sudden death resulted from a giant cell inflammatory process affecting the myocardium. Both individuals lacked antemortem diagnoses and collapsed at their respective places of employment. These cases compare and contrast the clinical and pathologic issues involved in the differential diagnoses of the subgroup of sudden cardiac deaths resulting from giant cell inflammatory processes that affect the myocardium, as well as the value of histologic examination and immunohistochemical studies.
Bioinformatics and Human Identification in Mass Fatality Incidents: The World Trade Center Disaster*
Authors: Leclair Benoît , Shaler Robert , Carmody George R. , Eliason Kristilyn , Hendrickson Brant C. , Judkins Thad , Norton Michael J. , Sears Christopher , Scholl Tom
Published: May 2007

Abstract:  Victim identification initiatives undertaken in the wake of Mass Fatality Incidents (MFIs) where high‐body fragmentation has been sustained are often dependent on DNA typing technologies to complete their mandate. The success of these endeavors is linked to the choice of DNA typing methods and the bioinformatic tools required to make the necessary associations. Several bioinformatic tools were developed to assist with the identification of the victims of the World Trade Center attacks, one of the most complex incidents to date. This report describes one of these tools, the Mass Disaster Kinship Analysis Program (MDKAP), a pair‐wise comparison software designed to handle large numbers of complete or partial Short Tandem Repeats (STR) genotypes, and infer identity of, or biological relationships between tested samples. The software performs all functions required to take full advantage of the information content of processed genotypic data sets from large‐scale MFIs, including the collapse of victims data sets, remains re‐association, virtual genotype generation through gap‐filling, parentage trio searching, and a consistency check of reported/inferred biological relationships within families. Although very few WTC victims were genetically related, the software can detect parentage trios from within a victim’s genotype data set through a nontriangulated approach that screens all possible parentage trios. All software‐inferred relationships from WTC data were confirmed by independent statistical analysis. With a 13 STR loci complement, a fortuitous parentage trio (FPT) involving nonrelated individuals was detected. Additional STR loci would be required to reduce the risk of an FPT going undetected in large‐scale MFIs involving related individuals among the victims. Kinship analysis has proven successful in this incident but its continued success in larger scale MFIs is contingent on the use of a sufficient number of STR loci to reduce the risk of undetected FPTs, the use of mtDNA and Y‐STRs to confirm parentage and of bioinformatics that can support large‐scale comparative genotyping schemes capable of detecting parentage trios from within a group of related victims.
A Case of Fatal Intoxication from Metformin*
Authors: Gambaro Veniero , Dell’Acqua Lucia , Farè Fiorenza , Fidani Marco , Froldi Rino , Saligari Elisa
Published: May 2007

A case of fatal intoxication from metformin is presented. The decedent was an obese 58‐year‐old‐woman with type II diabetes, in whom severe lactic acidosis secondary to metformin accumulation was precipitated by acute renal failure. She had been on metformin 500 mg twice a day. Postmortem blood was deproteinated with acetonitrile, washed with dichloromethane, and the resulting supernatant injected into high‐performance liquid chromatography system. Separation was performed on a analytical 125 × 4 mm i.d. RP‐8 column. The wavelength was set at 235 nm. The mobile phase was acetonitrile (40%), sodium lauryl sulfate, and sodium dihydrogen phosphate adjusted to pH 5.1 (60%) at a flow rate of 1.0 mL/min. The concentration of metformin in postmortem blood was 77.3 μg/mL. The qualitative result was also confirmed by LC/APCI/MS/MS analysis.
Effect of Bat Exclusion on Patterns of Seed Rain in Tropical Rain Forest in French Guiana
Authors: Henry Mickaël , Jouard Sylvie
Published: May 2007

To assess the impact of bats on seed dispersal in a tropical mature forest (Nouragues, French Guiana), we conducted a bat exclusion experiment and tested the hypotheses that an artificial reduction in the abundance of bats would result in: (1) a decrease in seed species diversity, at the community level; and (2) an increase in seed limitation (a failure of seeds to reach all suitable sites for germination) at the species level. Seed rain was sampled in two contiguous forest plots for a total of 120 d, using 49 seed traps (1 m2) arranged in 7 × 7 grids and spaced at 5‐m intervals. Using mist nets, bat activity was reduced in one forest plot for a total of 60 nights. Thirty‐nine plant species, or species groups, likely to be consumed and dispersed by bats, were collected within a total sample of 50,063 seeds. The overall seed rain was dominated by epiphytic Araceae and Cyclanthaceae (83.3%) and tree species within the genera Cecropia and Ficus (16.0%). Seeds from bat‐dispersed shrubs and treelets (Piper, Solanum, and Vismia) were relatively rare (0.7%). The bat exclusion resulted in a 30.5 percent reduction in seed species richness and increased seed limitation for most of the species sampled. Seed limitation was caused mainly by a reduced seed rain (seed source limitation) rather than a decrease in seed dispersal uniformity (seed dispersal limitation). Therefore, bat‐dispersed plants with low seed production are likely to be particularly affected by a decline in bat abundance, as a result of anthropogenic change.
Diploid Male Frequencies in Colombian Populations of Euglossine Bees
Authors: López‐Uribe Margarita M. , Almanza Maria T. , Ordoñez Marina
Published: May 2007

Some studies have recently reported high diploid male frequencies in euglossine bees indicating possible population declines. We estimated the genetic variability and frequency of males that are diploid in five Colombian species of euglossine bees using allozyme markers. Expected heterozygosities ranged from 0.10 to 0.23. Diploid males were found in three species with frequencies ranging from 8 to 32 percent. Our results suggest that some species are more susceptible to environmental changes and anthropogenic pressure.
Disturbance‐Mediated Drift in Tree Functional Groups in Amazonian Forest Fragments
Authors: Michalski Fernanda , Nishi Ivone , Peres Carlos A.
Published: May 2007

The interactive effects of forest disturbance and fragmentation on tropical tree assemblages remain poorly understood. We examined the effects of forest patch and landscape metrics, and levels of forest disturbance on the patterns of floristic composition and abundance of tree functional groups within 21 forest fragments and two continuous forest sites in southern Brazilian Amazonia. Trees were sampled within 60 (10 × 250 m) plots placed in the core areas of the fragments. Tree assemblage composition and abundance were summarized using nonmetric multidimensional scaling (NMDS). Forest patch size explained 36.2 percent and 30 percent of the variance in the proportion of small‐seeded softwood and hardwood stems in the 21 forest patches, respectively. Large fragments retained a higher abundance of hardwood tree species whereas small‐seeded softwood trees appear to proliferate rapidly in small disturbed fragments. Generalized linear mixed models showed that time since fragmentation had both positive and negative effects on the density of different functional groups of trees and on the ordination axes describing tree abundance. The composition and abundance of different tree genera were also related to time since fragmentation, distance to the nearest edge, and fire severity, despite the recent post‐isolation history of the forest patches surveyed. Both the proliferation of fast‐growing pioneer trees and the decline of hardwood trees found in our forest plots have profound consequences on the floristic composition, forest dynamics, carbon storage, and nutrient cycling in Amazonian forest fragments.
EFFECT OF ADJUNCTS ON THE COLOR STABILITY OF BOLOGNA AND FRESH BEEF SAUSAGES
Authors: FAROUK M. M. , BOLES J. A. , MIKKELSEN V. L. , McBETH E. E. , DeMANSER G. C. , SWAN J. E.
Published: May 2007

Alpha tocopherol (a‐T), sodium tripolyphosphate (STPP), ascorbic acid (AA), copper gluconate (CG), sodium suljite (SS), sodium erythorbate (SE), citric acid (CA) and tetrasodium pyrophosphate (TS) were added in various combinations to formulations of fresh beef sausage and bologna. Fresh beef sausages containing SS had higher (P < 0.05) Hunter a* values during storage under light at 4C. Bologna containing AA + CG had higher (P < 0.05) Hunter a* values, lower (P < 0.05) Hunter L* and b* values and hue angle, and a slower (P < 0.05) decline in a* and increase in b* values and hue angle during storage. Bologna containing AA + CG had a lower (P < 0.001) cook yield and higher (P < 0.05) compressive strength. Bologna containing phosphates had a higher cook yield and pH, and lower (P < 0.05) compressive strength.
CHEMICAL AND COLOR CHARACTERISTICS OF “LOMO EMBUCHADO” DURING SALTING SEASONING
Authors: PEREZ‐ALVAREZ J. A. , SANCHEZ‐RODRÍGUEZ E. , FERNANDEZ‐LOPEZ J. , GAGO‐GAGO M. ASUNCIÓN , RUÍZ‐PELUFFO C. , ROSINI M. , PAGAN‐MORENO M. J. , LOPEZ‐SANTOVENA F. , ARANDA‐CATALÁ V.
Published: May 2007

“Lomo embuchado” is a traditional Spanish dry‐cured meat product with two principal stages (salting‐seasoning and dry‐maturation) in its process. The evolution of chemical (moisture, nitrite, pH and lactic acid) and physical parameters: (CIELAB color space, chroma and hue, a*/b*, ΔE* and reflectance ratios R560/R500, R650/R570 and R630/RS80), during the salting‐seasoning stage were measured. Three zones in the salted‐seasoned loins were identified, and all parameters in each zone were analyzed. ANOVA and regression analyses were conducted. Moisture, pH and residual nitrite decreased with time (P<0.01), and lactic acid increased (P<0.05). Only moisture showed differences between zones (P<0.05). Color parameters changed during the salting‐seasoning stage. Lightness (P<0.01), redness (only during the first 24 h (P<0.05)), and a*/b* ratio (P<0.01) increased. Yellowness (P<0.01), hue (P<0.01) and chroma (P<0.05) decreased during the process. The only parameter that was not affected by time and zone was reflectance ratio R630/R580 (P>0.05). Moisture and reflectance ratio R560/R500 were affected by zones (PCO.05). An excellent cured color was obtained during salting and seasoning.