bluuebunny/crossref_metadata_2025 huggingface dataset:
Aging‐Associated Changes in Vascular Activity: A Potential Link to Geriatric Cardiovascular Disease
Authors: Weinsaft Jonathan W. , Edelberg Jay M.
Published: June 2007

Ischemic cardiovascular disease is a common cause of morbidity and mortality in the United States population over the age of 65. Prior clinical studies have demonstrated that the severity of cardiovascular pathophysiology is increased in older individuals. Both in vitro and in vivo experimental studies have shown that age‐associated clinical events parallel changes in vascular function. Aging is associated with systemic as well as cardiac alterations in three basic vascular regulatory functions: vascular tone, hemostasis, and vascular repair/angiogenesis. This article reviews the molecular and cellular events that may contribute to senescent cardiac pathology. Indeed, a better understanding of the biology of aging‐associated vascular dysfunction is fundamental for the development of therapeutics targeted for the treatment of cardiovascular disease in older individuals.
Elderly Patients at Risk for Coronary Heart Disease or Stroke: Selecting an Ideal Product for Lipid Lowering
Authors: Rackley Charles E.
Published: June 2007

Coronary heart disease is an affliction of the elderly: 84% of those who die from the disease are over 65 years of age. In patients over 55 years, the incidence of stroke more than doubles with each decade of life. The 3‐hydroxy‐3‐methylglutaryl coenzyme A reductase inhibitors, or statins, have been shown to lower cholesterol and lipids in both middle‐aged and elderly patients in large clinical trials. Some statins have been shown to improve endothelial function and vasodilation and to normalize thrombin formation, which may be among the mechanisms involved in both coronary event and stroke prevention.
Syncope in the Elderly: New Trends in Diagnostic Approach and Nonpharmacologic Management
Authors: Luria David M. , Shen Win Kaung
Published: June 2007

Syncope in the elderly is an important health care issue because of the large patient population, challenging diagnostic and therapeutic approaches, and potentially devastating consequences. Significant comorbidity and atypical clinical presentations render a precise determination of the cause of syncope difficult. Recent studies suggest that noninvasive tests, such as carotid sinus massage or tilt‐table testing, can be helpful in the diagnostic workup. It has been shown that permanent pacemaker therapy benefits elderly patients with carotid sinus hypersensitivity, and younger patients with recurrent vasovagal syncope. The implantable wireless loop recorder can be effective in documenting transient arrhythmias as causes of syncope in selected patients. Elderly patients with syncope and a low ejection fraction are at increased risk of sudden death due to malignant ventricular arrhythmia. Electrophysiologic study and electrophysiology‐guided therapy should be considered in this segment of the population.
Carotid Sinus Syndrome and Falls in Older Adults
Authors: Kenny Rose Anne , Richardson David A.
Published: June 2007

Retrospective and circumstantial evidence supports an overlap between symptoms of falls and syncope in older adults. Because of this overlap, we undertook a prospective, explanatory, single‐center study of cardiac pacing for falls in patients with carotid sinus syndrome in a consecutive series of over 56,000 adult visitors to an emergency department. One third attended because of a fall; one in five fallers had unexplained falls, and one third of these had carotid sinus hypersensitivity, of whom one half had a cardioinhibitory or mixed response that may be expected to respond to cardiac pacing. In a randomized, controlled trial of a subset of these patients, cardiac pacing was shown to significantly reduce subsequent fall rates by two thirds and syncopal rates during 1‐year follow‐up. The current pacing rate for carotid sinus syndrome is much higher in our practice than in other series because our facility is dedicated to falls and syncope in older subjects who have direct access to referring physicians and family practitioners. Of the implants in our region, 24% are for carotid sinus syndrome, compared with 43% for atrioventricular block, 20% for sick sinus syndrome, and 12% for atrial fibrillation. These rates do not include pacing in patients who fall, but rather reflect pacing rates consistent with American College of Cardiology guidelines for carotid sinus syndrome, such as recurrent syncope. These preliminary results from a local explanatory study are now being tested in a multicenter study entitled Syncope and Falls in the Elderly: Pacing and Carotid Sinus Evaluation (SAFE‐PACE II).
Headache as the Sole Presentation of Acute Myocardial Infarction in Two Elderly Patients
Authors: Amendo Manuel T. , Brown Barbara A. , Kossow Lynne B. , Weinberg Frederick M.
Published: June 2007

Myocardial infarction presenting solely as an acute, severe headache is underdiagnosed in elderly patients. In patients over 80 years of age, myocardial infarction presents more commonly with atypical symptoms than with chest pain. The authors describe two patients who presented with headache as the only sympton of an acute myocardial infarction. The authors recommend that acute myocardial infarction be considered in the differential diagnosis of acute, severe headache in elderly patients.
Stress Testing in the Elderly
Authors: Fleg Jerome L.
Published: June 2007

The ever‐increasing number of older patients requiring diagnostic and prognostic assessment for coronary artery disease has necessitated accurate, noninvasive techniques applicable to this age group. Exercise testing, either alone or with radionuclide or echocardiographic imaging, remains a useful tool in elderly patients capable of performing vigorous treadmill or cycle exercise. Fortunately, for the large elderly subset incapable of such exercise, pharmacologic stress testing with dipyridamole, adenosine, or dobutamine offers an excellent alternative. Choosing the most appropriate stress testing modality for a given patient from among the many choices available remains the clinician's challenge.
Clinical and Echocardiographic Features of Hypertrophic Cardiomyopathy in the Elderly
Authors: Lewis Jannet F.
Published: June 2007

Hypertrophic cardiomyopathy is a familial cardiac disease with exceptionally diverse clinical and morphologic presentations. The influence of age on the disease manifestation has become increasingly clear over the last decade. Most initial reports concentrated on characterization and treatment of the disease in younger individuals, but a better appreciation of hypertrophic cardiomyopathy in elderly patients has yielded important information regarding clinical presentation, morphologic appearance on echocardiography, prognosis, and management. This paper reviews the literature focusing on the age‐related differences in hypertrophic cardiomyopathy.
Efficacy and Safety of Angiotensin II Receptor Blockers in Elderly Patients With Mild to Moderate Hypertension
Authors: Okereke Chika E. , Messerli Franz H.
Published: June 2007

The role of the renin‐angiotensin‐aldosterone system in the pathogenesis of hypertensive disease has long been recognized, and the interruption of this cascade with angiotensin‐converting enzyme‐I has been beneficial in the management of hypertension. Recently, a new class of drugs, the angiotensin receptor blockers, emerged, enlarging the antihypertensive armamentarium. Since elderly patients are more prone to adverse drug reactions, in this paper we review several trials, most of which were of short duration, on the efficacy and safety of angiotensin receptor blockers in the geriatric population with mild to moderate hypertension. These studies established that the drugs are well‐tolerated, safe, and in most instances as efficacious as other classes of antihypertensive medications. Combination therapy with angiotensin receptor blockers and hydrochlorothiazide was additive, without any significant effect on the safety profile.
Effects of Age and Gender on the Pharmacodynamics of Omapatrilat in Healthy Volunteers
Authors: Liao Wei‐chi , Vesterqvist Ole , Manning James , Hammett Janis L. , Ferreira Irene M. , Meier Alan , Davis Kathy D. , Hutman H. Wayne
Published: June 2007

Omapatrilat is the most clinically advanced member of a new class of cardiovascular drugs, vasopeptidase inhibitors. Omapatrilat is a single molecule that simultaneously inhibits neutral endopeptidase and angiotensin‐converting enzyme, thus preserving vasodilator peptides and inhibiting production of the vasoconstrictor angiotensin II. In healthy male volunteers, omapatrilat decreased blood pressure while being generally well tolerated, with no serious adverse events. This study was undertaken to determine the effect of age and gender on the pharmacodynamics of omapatrilat. Healthy male or female volunteers between the ages of 18 and 80 were given a single oral dose of omapatrilat 40 mg. Neither age nor gender affected the vasopeptidase inhibition by omapatrilat. There were no differences between subject groups in the effect of omapatrilat on supine systolic, diastolic, or mean arterial blood pressure. Based on this study of healthy subjects, it can be concluded that it is not necessary to adjust the initial dose of omapatrilat for the treatment of hypertension based solely on age or gender.
Abuse of dosulepin to induce mania
Authors: Lepping Peter , Menkes David B.
Published: June 2007

Background  Tricyclic antidepressants sometimes trigger mania in bipolar patients, but little is known about their potential for abuse in this regard.

Case description  We describe a man with bipolar disorder and alcohol dependency who abused dosulepin repeatedly in order to induce manic episodes. This caused serious problems for treatment and long‐term outcome. We mention two further cases in which dosulepin or clomipramine was used deliberately to induce bipolar mania.

Conclusions  Tricyclic antidepressants can be abused to induce mood elevation in bipolar patients. This should be considered in cases of treatment‐resistant mania.
An examination of main and interactive effects of substance abuse recovery housing on multiple indicators of adjustment
Authors: Jason Leonard A. , Olson Bradley D. , Ferrari Joseph R. , Majer John M. , Alvarez Josefina , Stout Jane
Published: June 2007

Aims  To assess the effectiveness of community‐based supports in promoting abstinence from substance use and related problems.

Design and participants  Individuals (n = 150) discharged from residential substance abuse treatment facilities were assigned randomly to either an Oxford House recovery home or usual after‐care condition and then interviewed every 6 months for a 24‐month period.

Intervention  Oxford Houses are democratic, self‐run recovery homes.

Measurements  Hierarchical linear modeling was used to examine the effect of predictive variables on wave trajectories of substance use, employment, self‐regulation and recent criminal charges. Regressions first examined whether predictor variables modeled wave trajectories by condition (Oxford House versus usual after‐care), psychiatric comorbidity, age and interactions.

Findings  At the 24‐month follow‐up, there was less substance abuse for residents living in Oxford Houses for 6 or more months (15.6%), compared both to participants with less than 6 months (45.7%) or to participants assigned to the usual after‐care condition (64.8%). Results also indicated that older residents and younger members living in a house for 6 or more months experienced better outcomes in terms of substance use, employment and self‐regulation.

Conclusions  Oxford Houses, a type of self‐governed recovery setting, appear to stabilize many individuals who have substance abuse histories.
Improving drug addiction treatment in China
Authors: Tang Yi‐Lang , Hao Wei
Published: June 2007

Aims  To illustrate the current situation and problems of drug addiction in treatment China and propose suggestions.

Methods  A descriptive study based on literature searched from Medline and the China National Knowledge Infrastructure database (1996–2007) and hand‐picked references.

Results  Since the re‐emergence of drug addiction in China in the early 1990s, there has been tremendous progress in drug addiction treatments in China, especially treatments for opiate addiction. However, many problems and challenges remain for improvement, including widespread negative attitudes towards drug abuse and drug‐dependent individuals, the lack of evidence‐based data on the efficacy of Chinese traditional medicine and the lack of a comprehensive and integrated system to organize all treatment resources and monitor treatment progress. The authors discuss the challenges that impede effective treatments of drug addiction and some suggestions are proposed. Implementing these suggestions can improve the outcome of treatment of drug‐dependent individuals and benefit the whole society.

Conclusion  China faces substantial drug addiction problems that appear to be worsening with time. Although much progress in drug addiction treatment has been made, improvement in many aspects is needed urgently.
Brief alcohol intervention and alcohol assessment do not influence alcohol use in injured patients treated in the emergency department: a randomized controlled clinical trial
Authors: Daeppen Jean‐Bernard , Gaume Jacques , Bady Pierre , Yersin Bertrand , Calmes Jean‐Marie , Givel Jean‐Claude , Gmel Gerhard
Published: June 2007

Aims  To evaluate the effectiveness of brief alcohol intervention (BAI) in reducing alcohol use among hazardous drinkers treated in the emergency department (ED) after an injury; in addition it tests whether assessment of alcohol use without BAI is sufficient to reduce hazardous drinking.

Design  Randomized controlled clinical trial with 12‐month follow‐up conducted between January 2003 and June 2005.

Setting  Urban academic emergency department (ED) of the Lausanne University Hospital, Lausanne, Switzerland.

Participants  A total of 5136 consecutive patients attending ED after an injury completed a seven‐item general and a three‐item alcohol screen and 1472 (28.7%) were positive for hazardous drinking according to the National Institute on Alcohol Abuse and Addiction definition; of these 987 (67.1%) were randomized into a BAI group (n = 310) or a control group with screening and assessment (n = 342) or a control group with screening only (n = 335) and then a total of 770 patients (78.0%) completed the 12‐month follow‐up procedures.

Intervention  A single 10–15‐minute session of standardized BAI conducted by a trained research assistant.

Measurements  Percentage of participants who have changed to low‐risk drinking at follow‐up.

Findings  Data obtained at 12 months indicated that similar proportions were low‐risk drinkers in BAI versus control groups with and without assessment (35.6%, 34.0%, 37.0%, respectively, P = 0.71). Data also indicated similar reductions in drinking frequency, quantity, binge drinking frequency and Alcohol Use Disorders Identification Test (AUDIT) scores across groups. All groups reported similar numbers of days hospitalized and numbers of medical consults in the last 12 months. A model including age groups, gender, AUDIT and injury severity scores indicated that BAI had no influence on the main alcohol use outcome.

Conclusions  This study provides the evidence that a 10–15‐minute BAI does not decrease alcohol use and health resource utilization in hazardous drinkers treated in the ED, and demonstrates that commonly found decreases in hazardous alcohol use in control groups cannot be attributed to the baseline alcohol assessment.
Methamphetamine and cardiovascular pathology: a review of the evidence
Authors: Kaye Sharlene , McKetin Rebecca , Duflou Johan , Darke Shane
Published: June 2007

Aims  To examine the literature pertaining to the cardiovascular effects of methamphetamine and discuss the implications for methamphetamine users.

Methods  Relevant literature was identified through comprehensive MEDLINE and EMBASE searches.

Findings and conclusions  There is sufficient clinical and experimental evidence to suggest that methamphetamine can have adverse and potentially fatal effects on the cardiovascular system. The existing literature suggests that: (1) methamphetamine users are at elevated risk of cardiac pathology; (2) risk is not likely to be limited to the duration of their methamphetamine use, because of the chronic pathology associated with methamphetamine use; (3) the risk of cardiac pathology is greatest among chronic methamphetamine users; (4) pre‐existing cardiac pathology, due to methamphetamine use or other factors, increases the risk of an acute cardiac event; and (5) methamphetamine use is likely to exacerbate the risk of cardiac pathology from other causes, and may therefore lead to premature mortality.
Motivational interviewing versus feedback only in emergency care for young adult problem drinking
Authors: Monti Peter M. , Barnett Nancy P. , Colby Suzanne M. , Gwaltney Chad J. , Spirito Anthony , Rohsenow Damaris J. , Woolard Robert
Published: June 2007

Aim  To establish the efficacy of a brief motivational intervention compared to feedback only when delivered in an emergency department for reducing alcohol use and problems among young adults.

Design  Two‐group randomized controlled trial with follow‐up assessments at 6 and 12 months.

Setting  Level I Trauma Center.

Participants  A total of 198 18–24‐year‐old patients who were either alcohol positive upon hospital admission or met screening criteria for alcohol problems.

Intervention  Participants were assigned randomly to receive a one‐session motivational intervention (MI) that included personalized feedback, or the personalized feedback report only (FO). All participants received additional telephone contact 1 month and 3 months after baseline.

Measurements  Demographic information, alcohol use, alcohol problems and treatment seeking.

Findings  Six months after the intervention MI participants drank on fewer days, had fewer heavy drinking days and drank fewer drinks per week in the past month than did FO patients. These effects were maintained at 12 months. Clinical significance evaluation indicated that twice as many MI participants as FO participants reliably reduced their volume of alcohol consumption from baseline to 12 months. Reductions in alcohol‐related injuries and moving violations, and increases in alcohol treatment‐seeking were observed across both conditions at both follow‐ups with no differences between conditions.

Conclusions  This study provides new data supporting the potential of the motivational intervention tested to reduce alcohol consumption among high‐risk youth.
Drug‐induced methaemoglobinaemia following elective coronary artery bypass grafting
Authors: Choi A. , Sarang A.
Published: June 2007

Dapsone can alter the oxygen carrying capacity of haemoglobin. Some patients are more susceptible to these effects because of genetic factors, comorbidities or peri‐operative factors such as anaemia. We present a 57‐year‐old lady who underwent elective coronary artery bypass grafting. Deterioration in neurological and respiratory condition prompted a review of her drug treatment. A combination of long‐term dapsone therapy, co‐existing cardiac and respiratory disease, postoperative anaemia and renal impairment contributed to her decompensation, despite a relatively low level of methaemoglobin. Successful management included stopping dapsone therapy, supportive care and administration of ascorbic acid.
Propofol infusion syndrome
Authors: Kam P. C. A. , Cardone D.
Published: June 2007

The clinical features of propofol infusion syndrome (PRIS) are acute refractory bradycardia leading to asystole, in the presence of one or more of the following: metabolic acidosis (base deficit > 10 mmol.l−1), rhabdomyolysis, hyperlipidaemia, and enlarged or fatty liver. There is an association between PRIS and propofol infusions at doses higher than 4 mg.kg−1.h−1 for greater than 48 h duration. Sixty‐one patients with PRIS have been recorded in the literature, with deaths in 20 paediatric and 18 adult patients. Seven of these patients (four paediatric and three adult patients) developed PRIS during anaesthesia. It is proposed that the syndrome may be caused by either a direct mitochondrial respiratory chain inhibition or impaired mitochondrial fatty acid metabolism mediated by propofol. An early sign of cardiac instability associated with the syndrome is the development of right bundle branch block with convex‐curved (‘coved type’) ST elevation in the right praecordial leads (V1 to V3) of the electrocardiogram. Predisposing factors include young age, severe critical illness of central nervous system or respiratory origin, exogenous catecholamine or glucocorticoid administration, inadequate carbohydrate intake and subclinical mitochondrial disease. Treatment options are limited. Haemodialysis or haemoperfusion with cardiorespiratory support has been the most successful treatment.
The effect of local cooling on pain perception during infiltration of local anaesthetic agents, a prospective randomised controlled trial*
Authors: Leff D. R. , Nortley M. , Dang Van , Bhutiani R. P.
Published: June 2007

The effect of pre‐infiltration local cooling of the site of inguinal herniorrhaphy on pain perception during infiltration of local anaesthetic was studied in a prospective randomised controlled trial. One hundred patients were randomly allocated to receive topical application of either a cooled saline bag (study group) or a saline bag at room temperature (control group) prior to injection of local anaesthetic. Pain scores were recorded using a visual analogue scale following application of the saline bags and again on completion of infiltration with local anaesthetic. There was no significant difference in pain scores following topical saline bag application. However, a highly significant difference (p = 0.0001, Mann–Whitney U) was observed between post‐infiltration pain scores of the study group (median = 2) and the control group (median = 6).
Fentanyl dose–response curves when inserting the LMA Classic™ laryngeal mask airway*
Authors: Wong C. M. , Critchley L. A. , Lee A. , Khaw K. S. , Kee W. D. Ngan
Published: June 2007

Probit analysis was used to predict an optimal dose of fentanyl, co‐administered with propofol 2.5 mg.kg−1, when inserting the laryngeal mask airway. In all, 21 male and 54 female healthy Chinese patients, aged 18–63 years, requiring anaesthesia for minor surgery were recruited. They were assigned to one of five groups: placebo, 0.5, 1.0, 1.5 and 2.0 μg.kg−1. Insertion was performed 90 s after administration and insertion conditions assessed using a six‐category score. Dose–response curves could only be drawn for swallowing and movement categories, and only the ED50 could be predicted with certainty. To provide optimal conditions in over 95% of patients, fentanyl doses well above the clinical range were required. A standard fentanyl dose of 1 μg.kg−1, co‐administered with propofol 2.5 mg.kg−1, provided optimal conditions in 65% of cases. Ninety seconds may have been insufficient time for fentanyl to reach its peak effect.
Estimation of pulmonary oxygen consumption in the early postoperative period after thoracic surgery
Authors: Saito H. , Minamiya Y. , Kawai H. , Motoyama S. , Katayose Y. , Kimura K. , Saito R. , Ogawa J.‐I.
Published: June 2007

Lung injury, including pneumonia, can occur in the early postoperative period following thoracic surgery. Pulmonary oxygen consumption is thought to increase in patients with pulmonary infection. This study measured oxygen consumption in relationship to lung injury in the early postoperative period after thoracic surgery. Thirty‐five patients who underwent thoraco‐abdominal oesophagectomy for oesophageal cancer were studied. Measured oxygen‐consumption was obtained by indirect calorimetry and calculated oxygen‐consumption was simultaneously determined by the reverse Fick method. The difference in oxygen consumption was attributed to pulmonary oxygen consumption. The difference in oxygen consumption increased to 23.1 ml.min−1.m−2 on postoperative day 2. In patients with pneumonia the difference in oxygen consumption increased significantly to 39.0 ml.min−1.m−2 the day before clinical onset of pneumonia, and it increased further to 65.7 ml.min−1.m−2 on the day that pneumonia became clinically apparent. These findings suggest that the difference in oxygen consumption may be useful for estimating the extent of lung injury and for predicting pulmonary complications in the postoperative period.
Effect site concentration during propofol TCI sedation: a comparison of sedation score with two pharmacokinetic models
Authors: Barakat A. R. , Sutcliffe N. , Schwab M.
Published: June 2007

Target controlled infusion (TCI) pumps function using a programme based on a pharmacokinetic/pharmacodynamic model. We compared the Marsh and Schnider models to find out which better correlates with the clinically observed effect of propofol as assessed by the Observer Assessment of Alertness/Sedation (OAAS) score and the Bispectral index. We assessed the sedation score and Bispectral index score in 40 un‐premedicated patients undergoing surgical procedures under spinal anaesthesia with propofol sedation to a target concentration of 2 μg.ml−1. Half of the patients received TCI propofol driven by the Schnider model in effect site control, the other half were sedated with TCI propofol driven by the Marsh model in plasma control. We calculated the effect site concentration predicted by both models for all the patients. Changes in the sedation score and Bispectral index correlated better with the Marsh than with the Schnider effect site prediction in both study groups.
Evaluation of four airway training manikins as patient simulators for the insertion of single use laryngeal mask airways*
Authors: Cook T. M. , Green C. , McGrath J. , Srivastava R.
Published: June 2007

We evaluated the performance of four manikins: Airsim™, Bill 1™, Airway Management TrainerTM and Airway TrainerTM, as simulators for insertion of single‐use laryngeal mask airways and the reusable LMA Classic™. Sixteen volunteer anaesthetists inserted each laryngeal mask airway into each manikin twice. Insertions were scored for ease of insertion, clinical and fibreoptic position, and lung ventilation (maximum score 10). Scores < 7 were classified ‘poor’ and < 5 ‘failure’. We analysed manikin and laryngeal mask airway performance. Poor insertion rate was 15% (range 9–21%) and was lowest for the VBM manikin (p = 0.02). Insertion failure rate was 2.6% and did not differ significantly between manikins (p = 0.2). Overall manikin performance was significantly different (p < 0.0001). The VBM manikin scored best, with all other manikins equivalent. The VBM manikin performed significantly better for three individual laryngeal mask airways. Overall performance differences of laryngeal mask airways were statistically significant (p < 0.001) but individual comparisons were not. Silicone devices performed better than PVC devices (p < 0.05) Devices with and without grilles performed similarly. All manikins were adequate. The VBM manikin performed best overall and for several individual laryngeal mask airways. The methodology is useful for future evaluations of devices, both manikins and supraglottic airways. Further human clinical research is required.
Successful use of pharyngeal pulse oximetry with the oropharyngeal airway in severely shocked patients
Authors: Yu H. , Liu B.
Published: June 2007

We describe the successful use of pharyngeal oximetry with the oropharyngeal airway in two patients with severe shock in whom finger pulse oximetry failed. One patient was a 50‐year‐old man with septic shock and the other a 32‐year‐old woman with haemorrhagic shock. In both patients, an oropharyngeal airway with a paediatric pulse oximeter probe was inserted adjacent to the tracheal tube. A good waveform was obtained and oxygen saturation was 0–2% lower than arterial samples whereas finger pulse oximetry saturation was unobtainable or much lower than arterial oxygen saturation. Pharyngeal oxygen saturation with the oropharyngeal airway is feasible and more accurate than finger oximetry in low perfusion states.
A comparison of the clinical use of the Laryngeal Tube S™ and the ProSeal® Laryngeal Mask Airway by first‐month anaesthesia residents in anaesthetised patients*
Authors: Klaver N. S. , Kuizenga K. , Ballast A. , Fidler V.
Published: June 2007

The Laryngeal Tube S™ and the LMA‐ProSeal® are supraglottic instruments with an improved airway seal and a drainage tube to protect against regurgitation and to facilitate passage of a gastric tube. We compared the feasibility of these two instruments in a randomised, controlled clinical trial. One hundred and sixty patients were randomly allocated to undergo insertion of a Laryngeal Tube S (n = 82) or an LMA‐ProSeal (n = 78). All insertions were carried out by first‐month anaesthesia residents. Success rates were not significantly different: Laryngeal Tube S 89%, LMA‐ProSeal 95%. There was also no significant difference in leak pressure or insertion time. Insertion time decreased significantly when we compared the first with the last 10 insertions. Gastric tube placement was successful in all patients in the Laryngeal Tube S group, but failed in 12 patients in the LMA‐ProSeal group (p < 0.001). Dysphagia was reported by 22% of Laryngeal Tube S group and 3% of LMA‐ProSeal group (p = 0.001). These findings demonstrate the applicability of the devices and a learning effect in the hands of anaesthesia residents with limited experience.
The development and validation of the Pre‐operative Intrusive Thoughts Inventory (PITI)
Authors: Crockett J. K. , Gumley A. , Longmate A.
Published: June 2007

Pre‐operative anxiety is common and influences postoperative pain, hospital stay and patient satisfaction. We set out to explore anxiety content and develop a tool to evaluate patient anxiety at the pre‐operative assessment clinic. We recruited 128 day surgery patients. Pre‐operative anxiety content was explored and six factors (themes) were identified: ‘preoccupation’, ‘outcome concerns’, ‘being unconscious’, ‘loss of control’, ‘dependence on others’ and ‘pain/discomfort’. The Pre‐operative Intrusive Thoughts Inventory (PITI) was constructed and evaluated using exploratory and confirmatory factor analysis. The PITI demonstrated internal consistency for the full scale (Cronbach's α = 0.91) and for the subscales (Cronbach's α 0.74–0.85) as well as sensitivity (0.88) and specificity (0.60) to clinically significant anxiety assessed using the Hospital Anxiety and Depression Scale. The properties of the PITI suggest that it has potential as an additional tool for the evaluation of pre‐operative anxiety.
Subcutaneous naloxone for the prevention of intrathecal morphine induced pruritus in elective Caesarean delivery*
Authors: Lockington P. F. , Fa'aea P.
Published: June 2007

The aim of this study was to assess the antipruritic efficacy of subcutaneous naloxone following intrathecal morphine administration. Fifty women undergoing elective Caesarean section using spinal anaesthesia were randomly allocated, in a double‐

blind study design, to receive either naloxone 400 μg or placebo as a subcutaneous injection at the end of surgery. Spinal anaesthesia was performed using 0.5% hyperbaric bupivacaine, 25 μg fentanyl and 150 μg of preservative‐free morphine sulphate.

The primary outcome measures were: incidence of pruritus, nausea and vomiting, and quality of analgesia. The incidence of pruritus and nausea and vomiting was not significantly different between the two groups. There was also no significant difference in postoperative analgesia between the two groups. We conclude that pruritus, following intrathecal fentanyl 25 μg and preservative‐free morphine sulphate 150 μg, is not reduced by the addition of naloxone 400 μg administered subcutaneously on the completion of surgery.
Modern treatment of thalassaemia intermedia
Authors: Borgna‐Pignatti Caterina
Published: June 2007

The term thalassaemia intermedia includes a large spectrum of conditions of varying severity. Blood transfusion and chelation are necessary in some patients, especially during childhood, in order to promote growth and prevent bone deformities. Alloimunisation, however, is frequent and can be difficult to control. Splenectomy is usually needed at some time because of hypersplenism and mechanical encumbrance. Reactivation of HbF is possible only in a small proportion of patients: hydroxycarbamide (also known as hydroxyurea) appears to be the most effective drug for this purpose. Antioxidant agents, although theoretically useful, do not improve haemoglobin levels. Stem cell transplantation is an option limited to the severe forms. Gene therapy and other molecular approaches are subjects of intense study. Numerous complications, including pulmonary hypertension, thrombotic events, pseudoxanthoma elasticum and osteoporosis, have been described and all contribute to complicate the treatment of a disease that represents a significant burden for the patients and their families.
Research Review: Sibling placement in foster care: a review of the evidence
Authors: Washington Karla
Published: June 2007

This research review was undertaken to explore the current evidence pertaining to sibling placement in the foster care system. The review specifically addresses the following questions: (1) Which theories inform research on siblings in foster care? (2) Which designs and methodology are used to study brothers and sisters in out of home placement? (3) How do researchers define ‘siblings’ when investigating child placement? and (4) What are the findings of studies pertaining to siblings in the foster care system? This review suggests that incorporation of theory into research regarding siblings in foster care is quite limited. Additionally, few studies clearly state how siblings were identified and defined. A major strength of the research, however, is the diversity of design and methodology used. Overall, the evidence presented in this review strongly supports keeping sibling groups intact unless there is a compelling reason for separate placements.
Children and firearms in Turkish homes
Authors: Hızel S. , Özcebe H. , Şanlı C. , Albayrak M. , Uner S.
Published: June 2007

Background  Unintentional firearm injuries are an important cause of preventable deaths and disabilities among children. Keeping firearms at home and letting children to see or touch them increases the risk of injury.

Methods  This cross‐sectional study was conducted to estimate the extent of the firearm problem in an Anatolian province in Turkey. A random sample of families were approached and were asked to answer a series of questions completed by research assistants.

Results  In 974 randomly selected households, there were 2129 children aged less than 18 years, 11.1% of the fathers have a job in the firearms industry or in the security sector, and 12.3% of the households kept a firearm at home. Only 25.6% of the firearms were kept in a safe place, and 29.3% of the firearms and ammunition were kept separately. Overall, 70.9% of the children whose parents have firearms saw the firearm and 27.2% had handled it.

Conclusions  Results of this study pointed to the urgent need for preventive measures for the physical separation of guns from children. The establishment of effective firearms safety programmes requires an understanding of the culture and routine behaviours of the target population.
Pictorial and verbal category‐ratio scales for effort estimation in children
Authors: Marinov B. , Mandadjieva S. , Kostianev S.
Published: June 2007

Background  Research on the diverse aspects of exercise performance in childhood in the past 20 years has included an increase in the study of perceived exertion.

Objective  The aim of this study was to compare children's ratings of effort perception by means of the Borg Category‐Ratio Perceived Exertion (CR‐10) Scale and a pictorial version of the Children's Effort Rating Table (Pictorial‐CERT) scale, and to assess the long‐term repeatability of the two scales.

Methods  Fifty healthy children (25 girls and 25 boys; initially aged 10.4 ± 0.5 years) participated in three incremental treadmill tests until volitional exhaustion or a maximal gradient of 22% at 5.4 km/h was attained. The first two tests (T1 and T2) were at an interval of 1 month. The third test (T3) took place 3 years later and utilized exactly the same protocol.

Results  Perceived exertion correlated significantly with measures of exercise intensity – minute ventilation, heart rate and oxygen uptake for the whole group. The range of correlations for all tests was significantly higher for the Pictorial‐CERT (r = 0.62–0.88 and r = 0.59–0.71 for the Pictorial‐CERT and CR‐10 respectively). Intraclass correlation coefficients between T1 and T2 were significantly higher for the Pictorial‐CERT in comparison with the CR‐10 (0.77 vs. 0.54, respectively; z = −2.07; P = 0.038).

Conclusion  The Pictorial‐CERT is more appropriate for use with children of this age range and appears to be more reproducible than the Borg CR‐10 Scale. Concurrent and construct validity evidence promotes the use of the Pictorial‐CERT by junior children.
Behavioural, developmental and child protection outcomes following exposure to Class A drugs in pregnancy
Authors: Topley J. , Windsor D. , Williams R.
Published: June 2007

Background  The long‐term consequences of intrauterine exposure to Class A drugs are still relatively undocumented, and much of the literature relates to the North American experience, where cocaine use predominates. In Britain, heroin and amphetamine use is more common and, within Britain, patterns of drug use vary. Clearly the long‐term educational and welfare needs of these children will be enhanced if the behavioural, developmental and child‐care outcomes are known. This study attempts to explore some of these issues.

Methods  The developmental, behavioural and child protection outcomes in a group of 62 children exposed to Class A drugs in utero were investigated when the children were in full‐time schooling.

Results  Seventy‐four per cent (46/62) of the children at the time of the study had no educational or behavioural problems, and 11 (17.7%) were receiving extra support in school. No child had a statement of special educational need. Twelve (19.3%) were reported to have behaviour and concentration problems, and in four cases, this was attributed to poor‐quality parenting at the time of the study. Three of the 12 children had fetal alcohol syndrome. Twenty‐six (42%) children were placed on the Child Protection Register, and care orders or residence orders were granted for 22 (35.5%) of those who were placed on the register. All of the 22 children went into substitute care at some stage. Of these children, nine were adopted and 10 were placed permanently with other family members. Ten of the 62 (16.1%) children at the time of the study were of concern to professionals for child protection reasons, and four of them were on the Child Protection Register.

Conclusions  This study suggests we can be reasonably optimistic about the developmental and behavioural outcomes for children exposed to Class A drugs in utero. Over 50% required an intervention by social services, and 31% were in substitute care at the time of the study. There were continuing child protection concerns in 16% at school entry.
A qualitative study of parents' perceptions of a behavioural sleep intervention
Authors: Tse L. , Hall W.
Published: June 2007

Background  A study, entitled Evaluation of an Intervention Aimed at Resolving Behavioural Sleep Problems in 6‐ to 12‐month‐old Infants: A Pilot Study, was undertaken to evaluate the efficacy of a behavioural sleep intervention. This descriptive qualitative study aimed to describe parents' perceptions of the sleep intervention and any burden associated with participating in the study.

Methods  Fourteen of the 35 families who had participated in the quantitative study were interviewed. Respondents comprised well‐educated, middle‐class and mixed‐ethnicity families. Data were collected through semi‐structured interviews, with open‐ended trigger questions, and were analysed using inductive content analysis.

Result  Nine themes, which subsumed a number of categories, were constructed. Parents changed their perspectives about sleep and parenting styles; they experienced many challenges and inadvertent benefits; and they welcomed a structured framework for assisting with sleep problems. The parents fitted intervention strategies into their realities; many factors interfered with their success; and their support systems and their expectations of the study varied.

Conclusion  These parents' previous education about normal infant sleep cycles and behavioural sleep problems was inadequate. The parents who were able to use the structured framework, flexible strategies and access to healthcare professionals for problem solving not only excelled in resolving their infants' sleep problems, but also gained confidence about their parenting skills and success.
Predictors of late menarche and adult height in children with anorexia nervosa
Authors: Rozé Catherine , Doyen Catherine , Le Heuzey Marie‐France , Armoogum Priscilla , Mouren Marie‐Christine , Léger Juliane
Published: June 2007

Objectives  The onset of anorexia nervosa (AN) during childhood can affect the timing of puberty and adult height. The aim of the study was to evaluate the determinants of late menarche and adult height in children with AN.

Patients and methods  We carried out a retrospective, longitudinal, university hospital‐based study. All prepubertal or early pubertal girls diagnosed with AN between 1998 and 2002 were selected for the study. Participants (n = 33) were studied at a median age of 21 (19·8–24·3) years. AN was diagnosed at 11·8 (10·7–12·3) years.

Results  Patients with AN reached menarche at significantly greater ages than their mothers [15·4 (13·5–16·8) vs. 13·2 (12·0–14·5) years, P < 0·01]. Chronological age at onset of AN and lowest body mass index (BMI) were important independent predictive factors for delayed menarche (P < 0·01). Adult height was 165·0 (163·0–172·0) cm, 2·5 (–1·5 to 5·0) cm above target height. Twelve patients (36%) did not reach their target height and had a median height deficit of –3·9 cm with respect to their target height. The duration of hospitalization, a marker of disease severity and chronicity, was an independent predictor of the difference between adult height and target height for a given individual (β coefficient = –0·07; P = 0·01). The other factors studied (i.e. age at onset of AN, pubertal stage at diagnosis of AN, lowest BMI reached, associated comorbidity if any, type of AN, age at menarche) had no significant effect on adult height.

Conclusion  The intensity of the disease affects the timing of menarche but not adult height in most patients. Hospitalization, despite often being an effective means of managing AN, does not reduce the impact of AN on growth.
Can we measure terrestrial photosynthesis from space directly, using spectral reflectance and fluorescence?
Authors: GRACE J. , NICHOL C. , DISNEY M. , LEWIS P. , QUAIFE T. , BOWYER P.
Published: June 2007

Attempts to estimate photosynthetic rate or gross primary productivity from remotely sensed absorbed solar radiation depend on knowledge of the light use efficiency (LUE). Early models assumed LUE to be constant, but now most researchers try to adjust it for variations in temperature and moisture stress. However, more exact methods are now required. Hyperspectral remote sensing offers the possibility of sensing the changes in the xanthophyll cycle, which is closely coupled to photosynthesis. Several studies have shown that an index (the photochemical reflectance index) based on the reflectance at 531 nm is strongly correlated with the LUE over hours, days and months. A second hyperspectral approach relies on the remote detection of fluorescence, which is a directly related to the efficiency of photosynthesis. We discuss the state of the art of the two approaches. Both have been demonstrated to be effective, but we specify seven conditions required before the methods can become operational.
Hierarchical saturation of soil carbon pools near a natural CO2 spring
Authors: KOOL DORIEN M. , CHUNG HAEGEUN , TATE KEVIN R. , ROSS DES J. , NEWTON PAUL C. D. , SIX JOHAN
Published: June 2007

Soil has been identified as a possible carbon (C) sink to mitigate increasing atmospheric CO2 concentration. However, several recent studies have suggested that the potential of soil to sequester C is limited and that soil may become saturated with C under increasing CO2 levels. To test this concept of soil C saturation, we studied a gley and organic soil at a grassland site near a natural CO2 spring. Total and aggregate‐associated soil organic C (SOC) concentration showed a significant increase with atmospheric CO2 concentration. An asymptotic function showed a better fit of SOC and aggregation with CO2 level than a linear model. There was a shift in allocation of total C from smaller size fractions to the largest aggregate fraction with increasing CO2 concentration. Litter inputs appeared to be positively related to CO2 concentration. Based on modeled function parameters and the observed shift in the allocation of the soil C from small to large aggregate‐size classes, we postulate that there is a hierarchy in C saturation across different SOC pools. We conclude that the asymptotic response of SOC concentration at higher CO2 levels indicates saturation of soil C pools, likely because of a limit to physical protection of SOC.
Large losses of soil C and N from soil profiles under pasture in New Zealand during the past 20 years
Authors: SCHIPPER L. A. , BAISDEN W. T. , PARFITT R. L. , ROSS C. , CLAYDON J. J. , ARNOLD G.
Published: June 2007

The conversion of two‐thirds of New Zealand's native forests and grasslands to agriculture has followed trends in other developed nations, except that pastoral grazing rather than cropping dominates agriculture. The initial conversion of land to pasture decreased soil acidity and elevated N and P stocks, but caused little change in soil organic C stocks. However, less is known about C and nutrient stock changes during the last two decades under long‐term pastoral management. We resampled 31 whole soil profiles in pastures spanning seven soil orders with a latitudinal range of 36–46°S, which had originally been sampled 17–30 years ago. We measured total C, total N, and bulk density for each horizon (generally to 1 m) and also reanalyzed archived soil samples of the same horizons for C and N. On average, profiles had lost significant amounts of C (− 2.1 kg C m−2) and N (− 0.18 kg N m−2) since initial sampling. Assuming a continuous linear decline in organic matter between sampling dates, significant losses averaged 106 g C m−2 yr−1 (P=0.01) and 9.1 g N m−2 yr−1 (P=0.002). Removal of C through leaching and erosion appears too small to explain these losses, suggesting losses from respiration exceed the inputs of photosynthate in the soil profile. These results emphasize that resampling soil profiles provide a robust method for detecting soil C changes, and add credence to the suggestion that soil C losses may be occurring in some temperate soil profiles. Further work is required to determine whether these losses are continuing and how losses might be extrapolated across landscapes to determine the implications for New Zealand's national CO2 emissions and the sustainability of the implied rates of soil N loss.