bluuebunny/crossref_metadata_2025 huggingface dataset:
Focal decreases of cortical GABAA receptor binding remote from the primary seizure focus: What do they indicate?
Authors: Juhász Csaba , Asano Eishi , Shah Aashit , Chugani Diane C. , Batista Carlos E. A. , Muzik Otto , Sood Sandeep , Chugani Harry T.
Published: July 2008

Purpose:  To determine the electroclinical significance and histopathological correlates of cortical γ‐aminobutyric acidA(GABAA) receptor abnormalities detected in and remote from human neocortical epileptic foci.

Methods:  Cortical areas with decreased11C‐flumazenil (FMZ) binding were objectively identified on positron emission tomography (PET) images and correlated to intracranial electroencephalography (EEG) findings, clinical seizure variables, histology findings, and surgical outcome in 20 patients (mean age, 9.9 years) with intractable partial epilepsy of neocortical origin and nonlocalizing magnetic resonance imaging (MRI).

Results:  Focal decrease of cortical FMZ binding was detected in the lobe of seizure onset in 17 (85%) patients. Eleven patients (55%) had 17 remote cortical areas with decreased FMZ binding outside the lobe of seizure onset. Thirteen of those 16 (81%) of the 17 remote cortical regions that were covered by subdural EEG were around cortex showing rapid seizure spread on intracranial EEG. Remote FMZ PET abnormalities were associated with high seizure frequency and, when resected, showed gliosis in all six cases where material was available. Higher number of unresected cortical regions with decreased FMZ binding was associated with poorer surgical outcome.

Conclusions:  Focal decreases of cortical GABAA receptor binding on PET may include cortical regions remote from the primary focus, particularly in patients with high seizure frequency, and these regions are commonly involved in rapid seizure propagation. Although these regions may not always need to be resected to achieve seizure freedom, a careful evaluation of cortex with decreased GABAA receptor binding prior to resection using intracranial EEG may facilitate optimal surgical outcome in patients with intractable neocortical epilepsy.
Eicosapentaenoic and docosahexaenoic acids are not anticonvulsant or neuroprotective in acute mouse seizure models
Authors: Willis Sarah , Samala Ramakrishna , Rosenberger Thad A. , Borges Karin
Published: July 2008

Docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), or vegetable oil (control) were added to standard rodent chow (6 g/kg) and fed to mice ad lib for 4 weeks to determine if polyunsaturated fatty acids (PUFA) are anticonvulsant or neuroprotective in mice. The seizure susceptibility of these mice was compared using the fluorothyl, pentylenetetrazole (PTZ), 6 Hz, and kainate models. We found that PUFA feeding significantly altered the fatty acid profile in both plasma and brain, but did not change seizure thresholds in the fluorothyl, PTZ, or 6 Hz models nor did it significantly alter seizure behavior or hippocampal damage following kainate injection. In conclusion, DHA or EPA feeding did not show anticonvulsant or neuroprotective activity in four acute seizure models. Chronic seizure models remain to be examined.
Validation of an Interdisciplinary Food Safety Curriculum Targeted at Middle School Students and Correlated to State Educational Standards
Authors: Richards Jennifer , Skolits Gary , Burney Janie , Pedigo Ashley , Draughon F. Ann
Published: July 2008

ABSTRACT:  Providing effective food safety education to young consumers is a national health priority to combat the nearly 76 million cases of foodborne illness in the United States annually. With the tremendous pressures on teachers for accountability in core subject areas, the focus of classrooms is on covering concepts that are tested on state performance examinations. As a result, topics such as food safety are rarely addressed in middle school classrooms. Middle school is an ideal time to teach food safety because adolescents are in the process of setting lifelong behaviors; therefore, they are more likely to synthesize new food safety knowledge in a way that will lead to the development of lifelong behaviors. The purpose of this study was to scientifically validate an educational resource that provides a method for classroom teachers to involve young consumers in food safety education while meeting state content area curriculum standards. An interdisciplinary curriculum targeted at middle school students and correlated directly to state content standards was designed to include highly effective instructional strategies that teach food safety concepts through all core subject classes (science, math, social studies, and language arts). The curriculum was pilot tested in 5 schools using a pretest, posttest, and follow‐up test assessment model. The results showed that the curriculum was highly effective at raising student knowledge (21% gain) and improving students' food handling behaviors (8.47% gain) from pretests to posttests. In addition, 6 wk after implementation, students retained 86% of their total knowledge gain as measured by a follow‐up assessment.
Usefulness of Nonlinear Analysis of ECG Signals for Prediction of Inducibility of Sustained Ventricular Tachycardia by Programmed Ventricular Stimulation in Patients with Complex Spontaneous Ventricular Arrhythmias
Authors: Durin Ornella , Pedrinazzi Claudio , Donato Giorgio , Pizzi Rita , Inama Giuseppe
Published: July 2008

Introduction: The aim of our study was to assess the effectiveness of the nonlinear analysis (NLA) of ECG in predicting the results of invasive electrophysiologic study (EPS) in patients with ventricular arrhythmias.

Methods: We evaluated 25 patients with history of cardiac arrest, syncope, sustained, or nonsustained ventricular tachycardia (VT). All patients underwent electrophysiologic study (EPS) and nonlinear analysis (NLA) of ECG. The study group was compared with a control group of 25 healthy subjects, in order to define the normal range of NLA. ECG was processed in order to obtain numerical values, which were analyzed by nonlinear mathematical functions. Patients were classified through the application of a clustering procedure to the whole set of functions, and the correlation between the results of nonlinear analysis of ECG and EPS was tested.

Results: NLA assigned all patients with negative EPS to the same class of healthy subjects, whereas the patients in whom VT was inducible had been correctly and clearly isolated into a separate cluster. In our study, the result of NLA with application of the clustering technique was significantly correlated to that of EPS (P < 0.001), and was able to predict the result of EPS, with a negative predictive value of 100% and a positive predictive value of 100%.

Conclusions: NLA can predict the results of EPS with good negative and positive predictive value. However, further studies are needed in order to verify the usefulness of this noninvasive tool for sudden death risk stratification in patients with ventricular arrhythmias.
Beat‐to‐Beat QT Interval Variability Is Primarily Affected by the Autonomic Nervous System
Authors: Mine Takanao , Shimizu Hiroki , Hiromoto Kenji , Furukawa Yoshio , Kanemori Tetsuzou , Nakamura Hiroaki , Masuyama Tohru , Ohyanagi Mitsumasa
Published: July 2008

Background: Beat‐to‐beat QT interval variability is associated with life‐threatening arrhythmias and sudden death, however, its precious mechanism and the autonomic modulation on it remains unclear. The purpose of this study was to determine the effect of drugs that modulate the autonomic nervous system on beat‐to‐beat QT interval.

Method: RR and QT intervals were determined for 512 consecutive beats during fixed atrial pacing with and without propranolol and automatic blockade (propranolol plus atropine) in 11 patients without structural heart disease. Studied parameters included: RR, QTpeak (QRS onset to the peak of T wave), QTend (QRS onset to the end of T wave) interval, standard deviation (SD) of the RR, QTpeak, and QTend (RR‐SD, QTpeak‐SD, and QTend‐SD), coefficients of variation (RR‐ CV, QTpeak‐CV, and QTend‐CV) from time domain analysis, total power (TP; RR‐TP, QTpeak‐TP, and QTend‐TP), and power spectral density of the low‐frequency band (LF; RR‐LF, QTpeak‐LF, and QTend‐LF) and the high‐frequency band (HF; RR‐HF, QTpeak‐HF and QTend‐HF).

Results: Administration of propranolol and infusion of atropine resulted in the reduction of SD, CV, TP, and HF of the QTend interval when compared to controlled atrial pacing (3.7 ± 0.6 and 3.5 ± 0.5 vs 4.8 ± 1.4 ms, 0.9 ± 0.1 and 0.9 ± 0.1 vs 1.2 ± 0.3%, 7.0 ± 2.2 and 7.0 ± 2.2 vs 13.4 ± 8.1 ms2, 4.2 ± 1.4 and 4.2 ± 1.2 vs 8.4 ± 4.9 ms2, respectively). Administration of propranolol and atropine did not affect RR interval or QTpeak interval indices during controlled atrial pacing.

Conclusions: Beat‐to‐beat QT interval variability is affected by drugs that modulate the autonomic nervous system.
Phenotypic Variability in Caucasian and Japanese Patients with Matched LQT1 Mutations
Authors: Liu Judy F. , Goldenberg Ilan , Moss Arthur J. , Shimizu Wataru , Wilde Arthur A. , Hofman Nynke , McNitt Scott , Zareba Wojciech , Miyamato Yoshihiro , Robinson Jennifer L. , Andrews Mark L.
Published: July 2008

Background: Ethnic differences may affect the phenotypic expression of genetic disorders. However, data regarding the effect of ethnicity on outcome in patients with genetic cardiac disorders are limited. We compared the clinical course of Caucasian and Japanese long QT type‐1 (LQT1) patients who were matched for mutations in the KCNQ1 gene.

Methods: The study population comprised 62 Caucasian and 38 Japanese LQT1 patients from the International LQTS Registry who were identified as having six identical KCNQ1 mutations. The biophysical function of the mutations was categorized into dominant‐negative (>50%) or haploinsufficiency (≤50%) reduction in cardiac repolarizing IKs potassium channel current. The primary end point of the study was the occurrence of a first cardiac event from birth through age 40 years.

Results: Japanese patients had a significantly higher cumulative rate of cardiac events (67%) than Caucasian patients (39%; P = 0.01). The respective frequencies of dominant negative mutations in the two ethnic groups were 63% and 28% (P < 0.001). In multivariate analysis, Japanese patients had an 81% increase in the risk of cardiac events (P = 0.06) as compared with Caucasians. However, when the biophysical function of the mutations was included in the multivariate model, the risk associated with Japanese ethnicity was no longer evident (HR = 1.05; P = 0.89). Harboring a dominant negative mutation was shown to be the most powerful and significant predictor of outcome (HR = 3.78; P < 0.001).

Conclusions: Our data indicate that ethnic differences in the clinical expression of LQTS can be attributed to the differences in frequencies of the specific mutations within the two populations.
Sympathetic Overactivity in Patients with Pulmonary Stenosis and Improvement after Percutaneous Balloon Valvuloplasty
Authors: Alyan Omer , Ozdemir Ozcan , Kacmaz Fehmi , Topaloglu Serkan , Ozbakir Cemal , Gozu Ayfer , Korkmaz Sule , Toprak Nizamettin
Published: July 2008

Objective: Percutaneous balloon valvulotomy (PBV) is the procedure of choice for the treatment of valvular pulmonary stenosis (PS) with similar results comparable to surgical valvotomy but less invasive. .

Methods and Results: Twenty‐seven consecutive patients with PS being evaluated for PBV were enrolled in the study. Peak instantaneous transvalvular gradient, right ventricle (RV) diameter, mean atrial pressures, RV systolic pressure (RVSP), pro‐brain natriuretic peptide (proBNP) levels significantly decreased immediately after PBV. Regarding heart rate variability (HRV) parameters, mean HR (heart rate), LF (low frequency) day and night, LF/HF day and night significantly decreased and standard deviation of all NN intervals (SDNN), root mean square of successive differences (RMSSD), P number of NN intervals that differed by more than 50 ms from adjacent interval divided by the total number of all NN intervals (PNN50), HF (High frequency) day and night significantly increased 1 day after PBV and these changes were shown to be preserved at the first month. The increase in SDNN was correlated with the decrease in right atrial pressure (RAP) (r =−0.5, P = 0.04); the increase in standard deviation of the 5‐minute mean RR intervals (SDANN) was correlated with the decrease in proBNP (r =−0.4, P = 0.03).

Conclusions: Sympathetic overactivity and increased proBNP levels were associated with the symptomatic status of patients with PS. Associated with a decrease in atrial pressures and proBNP levels, PBV yielded a decrease in adrenergic overactivity in the patients with PS.
Reproducibility and Gender‐Related Differences of Heart Rate Variability during All‐Day Activity in Young Men and Women
Authors: Sztajzel Juan , Jung Michel , Bayes de Luna Antonio
Published: July 2008

Background: Only few data are available on reproducibility over time in healthy young men and women and the corresponding gender‐related changes of heart rate variability (HRV) measurements.

Methods: We studied temporal and spectral HRV indices obtained from 24‐hour Holter recordings in 32 healthy volunteers (14 men and 18 women, mean age 29 ± 3 years) during 2 days of their usual all‐day activity.

Results: Time‐domain measures and the spectral low‐frequency (LF) and high‐frequency (HF) components as well as the LF/HF ratio were comparable on both test days. Significantly higher values on test day 2 were observed only for the spectral very‐low‐frequency (VLF) component and for the resulting total power. Compared to men, women had higher day‐ and nighttime vagus‐associated HRV indices, including root mean square of successive differences (RMSSD), pNN50 (NN50 count divided by the total number of all NN intervals), and HF power, and lower day‐ and nighttime VLF and LF power with lower LF/HF ratio and total power.

Conclusions: Temporal indices and the LF and HF spectral HRV measures are reproducible over usual all‐day activity in young healthy subjects. Young women have higher day‐and nighttime vagal tone than men with similar age range.
The Impact of Preinfarction Angina on Electrocardiographic Ischemia Grades in Patients with Acute Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention
Authors: Celik Turgay , Yuksel U. Cagdas , Iyisoy Atila , Kilic Selim , Kardesoglu Ejder , Bugan Baris , Isik Ersoy
Published: July 2008

Objective: Grade 3 ischemia (G3I) is defined as ST elevation with distortion of the terminal portion of the QRS (emergence of the J point >50% of the R wave in leads with qR configuration, or disappearance of the S wave in leads with an Rs configuration). Patients with G3I on the presenting electrocardiogram (ECG) had worse prognosis than the patients with lesser (grade 2‐G2I) ischemia. The aim of this study is to examine the effects of preinfarct angina (PIA) on electrocardiographic ischemia grades.

Methods: One hundred forty‐eight consecutive patients with ST‐segment myocardial infarction (STEMI) were included in this study. All patients underwent primary percutaneous coronary intervention. The admission ECGs was analyzed retrospectively for electrocardiographic ischemia grades and compared with the presence of PIA.

Results: Study population consisted of 110 patients with G2I (88 men, mean age = 63 ± 6 years) and 38 patients with G3I (32 men, mean age = 61 ± 8 years). Baseline characteristics of the groups were the same except for patients with G3I had significantly longer pain to balloon time and higher admission creatine kinase MB isoenzyme (CK‐MB) levels. Tissue myocardial perfusion grade (TMPG) was better in patients with G2I. While 18 patients (47%) with G3I had PIA, 81 patients (70%) with G2I had PIA (P = 0.005). Although pain to balloon time and admission CK‐MB were independent predictor of worse electrocardiographic ischemia grade (OR 1.69, 95% CI 1.09–2.62; P = 0.01; OR 1.01, 1.00–286

Conclusion: PIA is one of the most important clinical predictors of better ischemia grades especially when combined with the pain to balloon time, LVEF, and admission CK‐MB levels in patients with STEMI. This study provided another evidence for the protective effects of PIA.
Electrocardiographic Transmural Dispersion of Repolarization in Patients with Inherited Short QT Syndrome
Authors: Anttonen Olli , Väänänen Heikki , Junttila Juhani , Huikuri Heikki V. , Viitasalo Matti
Published: July 2008

Background: Short QT syndrome (SQTS) carries an increased risk for sudden cardiac death. However, only a short QT interval does not express the risk of ventricular arrhythmias. Thus, additional evaluation of the repolarization abnormality in SQTS patients is essential. In experimental models of SQTS, increased transmural dispersion of repolarization (TDR) and its electrocardiographic counterpart T‐wave peak to T‐wave end interval (TPE) appeared critical for induction of polymorphic ventricular tachycardia (PMVT). In a clinical study with acquired long QT syndrome patients, TPE/QT ratio > 0.28 indicated arrhythmia risk. We hypothesized that the TPE/QT ratio would be greater in SQTS patients than in control subjects.

Methods and Results: We compared the behavior of the electrocardiographic TDR in three seriously symptomatic SQTS patients of unknown genotype presenting baseline QTc values <320 ms and in nine healthy age‐matched control subjects. We determined QT and TPE intervals as well as TPE/QT ratio from 24‐hour ECG recordings using a computer‐assisted program. Diurnal average of TPE/QT ratio was 0.28 ± 0.03 in SQTS patients and 0.21 ± 0.02 in control subjects (P = 0.01). SQTS patients had also lesser capacity to change TPE intervals from steady‐state conditions to abrupt maximal values than control subjects.

Conclusion: SQTS patients have increased and autonomically uncontrolled electrocardiographic TDR. According to experimental SQTS models, the present results may in part explain increased vulnerability of SQTS patients to ventricular arrhythmias.
Ultrasonic Dispersion of TiO2Nanoparticles in Aqueous Suspension
Authors: Sato Kimitoshi , Li Ji‐Guang , Kamiya Hidehiro , Ishigaki Takamasa
Published: July 2008

Aggregation and dispersion behavior of nanometer and submicrometer scale TiO2particles in aqueous suspension were investigated using three kinds of mechanical dispersion methods: ultrasonic irradiation, milling with 5‐mm‐diameter balls, and milling with 50 μm beads. Polyacrylic acids with molecular weights ranging from 1200 to 30 000 g/mol were used as a dispersant, and the molecular weight for each dispersion condition was optimized. Viscosities and aggregate sizes of the submicrometer powder suspensions were not appreciably changed in the ultrasonic irradiation and 5‐mm‐ball milling trials. In contrast, in the trials in which nanoparticle suspension was used, ultrasonic irradiation produced better results than 5‐mm‐ball milling. Use of ultrasonication enabled dispersion of aggregates to primary particle sizes, which was determined based on the specific surface area of the starting TiO2powders, even for relatively high solid content suspensions of up to 15 vol%. Fifty‐micrometer‐bead milling was also able to disperse aggregates to the same sizes as the ultrasonic irradiation method, but 50‐μm‐bead milling can be used only in relatively low solid content suspensions. It was concluded that the ultrasonic dispersion method was a useful way to prepare concentrated and highly dispersed nanoparticle suspensions.
Preparation and Characterization of Aluminum‐Doped Silicon Carbide by Combustion Synthesis
Authors: Li Zhimin , Zhou Wancheng , Su Xiaolei , Luo Fa , Zhu Dongmei , Liu Pengle
Published: July 2008

Al‐doped β‐SiC powders were synthesized via combustion reaction of the Si/C system in a 0.1 MPa nitrogen atmosphere, using polytetrafluoroethylene as the chemical activator and Al as the dopant. The β‐SiC powders produced have fine spherical particles and narrow particle size distribution. The impurity phase of Al2O3 is generated and the doped β‐SiC contains N component when Al content is up to 10%. The electric permittivities of β‐SiC samples were determined in the frequency range of 8.2–12.4 GHz. Results show that the β‐SiC doped with 10% Al has the highest real part ɛ′ and imaginary part ɛ″ of permittivity. The mechanism of dielectric loss by doping has been discussed.
Synthesis and Photovoltaic Application of High Aspect‐Ratio TiO2 Nanotube Arrays by Anodization
Authors: Yang Yang , Wang Xiaohui , Li Longtu
Published: July 2008

The anodic formation of high‐aspect‐ratio titanium oxides (TiO2) nanotube arrays on titanium foils were investigated in N, N‐dimethyl formamide electrolyte. The influences of reaction time and applied voltage on the formation of TiO2 nanotube arrays were examined. By tailoring the anodization conditions, high‐aspect‐ratio TiO2 nanotube arrays with a length of 22 μm were obtained. The current work indicates that a protecting layer formed during the anodization is responsible for the formation of long TiO2 nanotubes. A light‐to‐energy conversion efficiency of 3.4% was obtained by using dye D102. This kind of high‐aspect‐ratio TiO2 nanotube arrays has potential applications in photovoltaic cells.
Fabrication of UHTCs by Conversion of Dynamically Consolidated Zr+B and Hf+B Powder Mixtures
Authors: Brochu Mathieu , Gauntt Bryan , Zimmerly Tony , Ayala Alicia , Loehman Ronald
Published: July 2008

Mixtures of Zr+B and Hf+B were shock compacted into bulk samples possessing relative densities above 95.5% and were subsequently converted to ZrB2 and HfB2 ceramic components by a heat treatment. The conversion temperature was varied between 1600° and 2000°C. The conversion temperature was found to have no effect on the final density of the ceramics. Theoretical densities of 72% and 62% were obtained for the converted ZrB2 and HfB2 ceramics, respectively. Increasing the heat‐treatment temperature promoted grain growth rather than densification for the ZrB2 samples. The grain size increased from 1.8±0.6 to 5.6±1.3 to 8.5±3.3 μm, for heat treatments at 1600°, 1800°, and 2000°C, respectively. No grain growth was observed for the HfB2 system, which exhibited a grain structure of 5.0±1.6, 3.3±1.5, and 4.4±2.2 μm for the same temperature range studied. Microhardness values for the ZrB2 decreased from 19.4±0.4 to 17.2±0.6 down to 13.7±0.6 GPa, while similar hardness results of 19.1±0.8, 17.1±1.0, and 17.8±0.5 GPa were observed for the HfB2 samples.
Cellular Ceramics by Direct Foaming of Emulsified Ceramic Powder Suspensions
Authors: Barg Suelen , Soltmann Christian , Andrade Miria , Koch Dietmar , Grathwohl Georg
Published: July 2008

A new direct foaming method to produce macroporous cellular ceramics using surfactants as foam stabilizers is presented. The technology relies on the transition of a stabilized aqueous ceramic powder suspension containing a homogeneously dispersed alkane or air–alkane phase into cellular ceramics. The stabilization of the powder suspension and the emulsion is realized with particular emphasis on the interaction of both mechanisms providing enduring stability of the system up to high foaming degrees. Anionic, cationic, and nonionic surfactants were studied with their stabilization and foaming effects. The presence and influence of air bubbles was proved to be of negligible importance. Foaming is then provided by the evaporation of the emulsified alkane droplets, leading to the expansion of the emerging foam and giving rise to solids foams with cell sizes from 0.5 to 3 mm and porosities up to 97.5% after sintering. The microstructures of these filigree ceramics are stable and rigid with dense struts and uniform distributions of the solid phase and the porosity.
Dielectric and Structural Properties of Layer‐Structured Sr1−xCaxBi2Nb2O9
Authors: Huang Shiming , Li Yuchen , Feng Chude , Gu Mu , Liu Xiaolin
Published: July 2008

Sr1−xCaxBi2Nb2O9 (x=0, 0.2, 0.4, 0.6, 0.8 and 1) ceramics were prepared by a conventional solid‐state reaction method. Their dielectric and structural properties were investigated. X‐ray diffraction analysis indicated that single‐phase layered perovskites were obtained. For Ca‐substituted specimens, a dielectric relaxation peak is observed in the temperature range of 30°–150°C, and there is a broader para‐ferroelectric phase transition peak. The temperature of the maximum dielectric constant Tm increases linearly with increasing Ca content. Raman spectra indicate that a small amount of Ca2+ is incorporated into Bi sites in the Bi2O2 layers, and an increase in the degree of distortion of NbO6 octahedra for Ca‐substituted specimens should be one of the reasons for the increase in Tm compared with SrBi2Nb2O9.
Enhanced Dielectric and Piezoelectric Properties of Aurivillius‐Type Potassium Bismuth Titanate Ceramics by Cerium Modification
Authors: Wang Chun‐Ming , Wang Jin‐Feng , Mao Chaoliang , Chen Xuefeng , Dong Xianlin , Gai Zhi‐Gang , Zhao Ming‐Lei
Published: July 2008

The microstructure, and dielectric and piezoelectric properties of the CeO2‐modified potassium bismuth titanate K0.5Bi4.5Ti4O15 (KBT) piezoelectric ceramics were investigated. X‐ray diffraction analysis revealed that the cerium‐modified KBT ceramics have a pure four‐layer Aurivillius‐type structure. The piezoelectric properties of KBT ceramics were significantly enhanced and the dielectric loss decreased by cerium doping. The Curie temperature Tc and piezoelectric coefficient d33 for the KBT ceramics with 0.50 wt% cerium modification were found to be 550°C and 28 pC/N, respectively. The Curie temperature was found to decrease gradually from 555° to 541°C with cerium modification up to 1.00 wt%. Dielectric and annealing spectroscopy showed that the materials possess stable piezoelectric properties.
MgTiO3 and Ba0.60Sr0.40Mg0.15Ti0.85O3 Composite Thin Films with Promising Dielectric Properties for Tunable Applications
Authors: Gao Lina , Zhai Jiwei , Yao Xi , Xu Zhengkui
Published: July 2008

Mg2TiO4‐doped Ba0.60Sr0.40Mg0.15Ti0.85O3 (BSTM) thin films with different Mg2TiO4 concentrations were deposited on a polycrystalline alumina substrate via the sol–gel method. With the addition of Mg2TiO4, MgTiO3, MgAl2O4, and BSTM phases were formed in these composite thin films. The dielectric loss of the composite thin films decreased about one order of magnitude and the tunability still remained above 15% at a DC‐applied electric field of 80 kV/cm. The dielectric constant decreased from 1040 to 388. The low dielectric constant, high tunability, and figure of merit of these composite thin films can be useful for potential tunable devices.
Success of Ultrasound‐guided Peripheral Intravenous Access with Skin Marking
Authors: Resnick Jessica R. , Cydulka Rita K. , Donato Jessica , Jones Robert A. , Werner Sandra L.
Published: July 2008

Objectives:  The most effective technique for ultrasound‐guided peripheral intravenous access (USGPIVA) is unknown. In the traditional short‐axis technique (locate, align, puncture [LAP]), the target vessel is aligned in short axis with the center of the transducer. The needle is then directed toward the target under real‐time ultrasound (US) guidance. Locate, align, mark, puncture (LAMP) requires the extra step of marking the skin at two points over the path of the vein and proceeding with direct visualization as in LAP. The difference in success between these two techniques was compared among variably experienced emergency physician and emergency nurse operators.

Methods:  Subjects in an urban academic emergency department (ED) were randomized to obtain intravenous (IV) access using either LAP or LAMP after two failed blind attempts. Primary outcomes were success of the procedure and time to complete the procedure in variably experienced operators.

Results:  A total of 101 patients were enrolled. There was no difference in success between LAP and LAMP, even among the least experienced operators. Of successful attempts, LAMP took longer than LAP (median 4 minutes, interquartile range [IQR] 4–10.5 vs. median 2.9 minutes, IQR 1.6–7; p = 0.004). Only the most experienced operators were associated with higher levels of success (first attempt odds ratio [OR] 6.64; 95% confidence interval [CI] = 2 to 22). Overall success with up to two attempts was 73%. Complications included a 2.8% arterial puncture rate and 12% infiltration rate.

Conclusions:  LAMP did not improve success of USGPIVA in variably experienced operators. Experience was associated with higher rates of success for USGPIVA.
Relapse after Emergency Department Discharge for Acute Asthma
Authors: Rowe Brian H. , Villa‐Roel Cristina , Sivilotti Marco L.A. , Lang Eddy , Borgundvaag Bjug , Worster Andrew , Walker Allan , Ross Scott
Published: July 2008

Objectives:  The objectives were to determine patient and treatment‐response factors associated with relapse after emergency department (ED) treatment for acute asthma.

Methods:  Subjects aged 18–55 years who were treated for acute asthma in 20 Canadian EDs prospectively underwent a structured ED interview and telephone contact 2 weeks later.

Results:  Of 695 enrolled patients, 604 (86.9%) were discharged from the ED; follow‐up was available in 529 (87.5%); 63% were female and the median age was 29 years. Most patients were discharged on oral (70.8%) and inhaled (60.1%) corticosteroids (CS); 2‐week treatment adherences were 93.3 and 80.9%, respectively. Relapse occurred in 9.2% at 1 week (95% confidence interval [CI] = 7.1% to 12.0%) and 13.9% (95% CI = 11% to 17%) at 2 weeks. In multivariable modeling, factors associated with relapse were ethnicity (risk ratio [RR] white = 0.66; 95% CI = 0.52 to 0.83); female gender (RR = 1.57; 95% CI = 1.14 to 2.09); any ED visits in the past 2 years (RR = 1.47; 95% CI = 1.18 to 1.80); ever admitted for asthma treatment (RR = 1.83; 95% CI = 1.09 to 2.84); use of combined inhaled CS plus long‐acting β2‐agonists (RR = 1.39; 95% CI = 1.07 to 1.78) and of oral CS (RR = 1.35; 95% CI = 1.12 to 1.59) at the time of ED presentation.

Conclusions:  Ethnicity (white), female gender, prior ED visits and admissions for asthma, and recent treatments (especially oral CS) were associated with asthma relapse, which remains relatively common. Future research is required to target this high‐risk group.
Educational and Research Implications of Portable Human Patient Simulation in Acute Care Medicine
Authors: Kobayashi Leo , Patterson Mary D. , Overly Frank L. , Shapiro Marc J. , Williams Kenneth A. , Jay Gregory D.
Published: July 2008

Advanced medical simulation has become widespread. One development, the adaptation of simulation techniques and manikin technologies for portable operation, is starting to impact the training of personnel in acute care fields such as emergency medicine (EM) and trauma surgery. Unencumbered by cables and wires, portable simulation programs mitigate several limitations of traditional (nonportable) simulation and introduce new approaches to acute care education and research.

Portable simulation is already conducted across multiple specialties and disciplines. In situ medical simulations are those carried out within actual clinical environments, while off‐site portable simulations take place outside of clinical practice settings. Mobile simulation systems feature functionality while moving between locations; progressive simulations are longer‐duration events using mobile simulations that follow a simulated patient through sequential care environments. All of these variants have direct applications for acute care medicine.

Unique training and investigative opportunities are created by portable simulation through four characteristics: 1) enhancement of experiential learning by reframing training inside clinical care environments, 2) improving simulation accessibility through delivery of training to learner locations, 3) capitalizing on existing care environments to maximize simulation realism, and 4) provision of improved training capabilities for providers in specialized fields. Research agendas in acute care medicine are expanded via portable simulation’s introduction of novel topics, new perspectives, and innovative methodologies.

Presenting opportunities and challenges, portable simulation represents an evolutionary progression in medical simulation. The use of portable manikins and associated techniques may increasingly complement established instructional measures and research programs at acute care institutions and simulation centers.
Promoting Teamwork: An Event‐based Approach to Simulation‐based Teamwork Training for Emergency Medicine Residents
Authors: Rosen Michael A. , Salas Eduardo , Wu Teresa S. , Silvestri Salvatore , Lazzara Elizabeth H. , Lyons Rebecca , Weaver Sallie J. , King Heidi B.
Published: July 2008

The growing complexity of patient care requires that emergency physicians (EPs) master not only knowledge and procedural skills, but also the ability to effectively communicate with patients and other care providers and to coordinate patient care activities. EPs must become good team players, and consequently an emergency medicine (EM) residency program must systematically train these skills. However, because teamwork‐related competencies are relatively new considerations in health care, there is a gap in the methods available to accomplish this goal. This article outlines how teamwork training for residents can be accomplished by employing simulation‐based training (SBT) techniques and contributes tools and strategies for designing structured learning experiences and measurement tools that are explicitly linked to targeted teamwork competencies and learning objectives. An event‐based method is described and illustrative examples of scenario design and measurement tools are provided.
Dizziness Presentations in U.S. Emergency Departments, 1995–2004
Authors: Kerber Kevin A. , Meurer William J. , West Brady T. , Mark Fendrick A.
Published: July 2008

Objectives:  The objectives were to describe presentation characteristics and health care utilization information pertaining to dizziness presentations in U.S. emergency departments (EDs) from 1995 through 2004.

Methods:  From the National Hospital Ambulatory Medical Care Survey (NHAMCS), patient visits to EDs for “vertigo‐dizziness” were identified. Sample data were weighted to produce nationally representative estimates. Patient characteristics, diagnoses, and health care utilization information were obtained. Trends over time were assessed using weighted least squares regression analysis. Multivariable logistic regression analysis was used to control for the influence of age on the probability of a vertigo‐dizziness visit during the study time period.

Results:  Vertigo‐dizziness presentations accounted for 2.5% (95% confidence interval [CI] = 2.4% to 2.6%) of all ED presentations during this 10‐year period. From 1995 to 2004, the rate of visits for vertigo‐dizziness increased by 37% and demonstrated a significant linear trend (p < 0.001). Even after adjusting for age (and other covariates), every increase in year was associated with increased odds of a vertigo‐dizziness visit. At each visit, a median of 3.6 diagnostic or screening tests (95% CI = 3.2 to 4.1) were performed. Utilization of many tests increased over time (p < 0.01). The utilization of computerized tomography and magnetic resonance imaging (CT/MRI) increased 169% from 1995 to 2004, which was more than any other test. The rate of central nervous system diagnoses (e.g., cerebrovascular disease or brain tumor) did not increase over time.

Conclusions:  In terms of number of visits and important utilization measures, the impact of dizziness presentations on EDs is substantial and increasing. CT/MRI utilization rates have increased more than any other test.
Palynology: Its Position in the Field of Forensic Science
Authors: Walsh Kevan A.J. , Horrocks Mark
Published: July 2008

Abstract: Here we examine the current state of palynology in the field of forensic science. Forensic palynology is discussed with reference to other forensic disciplines to help understand what is required for its progress. Emerging developments are also discussed. Palynomorphs potentially deliver excellent trace evidence, fulfilling the requirements relating to the transfer, persistence, and detection of such evidence. Palynological evidence can provide very powerful investigative and associative evidence. Despite this, the application of palynology to forensic science has had mixed success. There are many anecdotal stories where pollen evidence has had spectacular successes. But it is extremely underutilized in most countries because it is labor‐intensive and requires considerable expertise and experience, there is a lack of control over sample collection and inadequate resourcing and funding, and its crime‐solving power is not well known. Palynology has been applied to forensic problems in an unstructured way, resulting in a lack of formalized discussion of the underlying principles. As there is renewed questioning of the acceptability of most evidence types in the current legal environment, there is a need for the establishment of palynological evidence through validation‐type studies and experimentation, and the implementation of independent proficiency testing.
A Middle‐Aged Female Serial Killer
Authors: Ostrosky‐Solís Feggy , Vélez‐García Alicia , Santana‐Vargas Daniel , Pérez Martha , Ardila Alfredo
Published: July 2008

Abstract:  The case of a 48‐year‐old woman accused of killing at least 12 elderly women and attempting to kill another one during the last 3 years is presented. Extensive neuropsychological, electrophysiological, and neuropsychiatric testing showed no evidence of a DSM‐IV‐TR Axis I diagnosis, but a decrease in executive functions and abnormalities in the processing of affective stimuli were found. Behavioral and psychophysiological studies revealed dissociation between knowing how to behave and actually behaving in socially acceptable ways. According to the woman, killing was just her response to “humiliating situations.” Two potentially significant conditions in her past history are found: (i) childhood abuse; and (ii) multiple head injuries. It is conjectured that the nature of her crimes, paranoid and personality traits, a probable frontal brain dysfunction, as well as a specific demographic and social context represent unusual factors accounting for her violent behavior.
Pacemaker/Defibrillator Evaluation at Los Angeles County Department of Coroner*
Authors: Saint‐Martin Pauline , Rogers Christopher , Muto Joseph , Boyle Noel G. , Rieders Daniel , Sathyavagiswaran Lakshmanan
Published: July 2008

Abstract:  Pacemakers and implantable cardioverter‐defibrillators (ICDs) are implanted medical devices for the treatment of cardiac arrhythmias. These devices are now commonly encountered in the postmortem situation. The Los Angeles County Department of the Coroner uses the services of a cardiac electrophysiology consultant to interrogate pacemakers and ICDs, producing a detailed picture of the cardiac events recorded by the device. We have used this method to evaluate 20 cases where the ICD or pacemaker provided significant information. We report four forensic cases to illustrate the different applications of pacemaker interrogation and its contribution in forensic investigation. This technique was used to establish identification of the decedent, to determine the cause and time of death, and to determine whether device malfunction could have played a role in the death. We conclude that detailed evaluation of the pacemaker or ICD in selected cases may provide essential information to the forensic pathologist.
Gait Analysis in Forensic Medicine*
Authors: Larsen Peter K. , Simonsen Erik B. , Lynnerup Niels
Published: July 2008

Abstract:  Recordings from video surveillance systems are used as evidence from crime scenes. It would be useful to perform comparisons between disguised perpetrators and suspects based on their gait. We applied functional anatomical and biomechanical knowledge to analyze the gait of perpetrators, as recorded on surveillance video. Using a structured checklist, which addresses the single body segments during gait, we were able to give a statement concerning the gait patterns. Characteristic parameters were, e.g., varus instability in the knee at heel strike, and larger lateral flexion of the spinal column to one side than the other. Based on these characteristic features, we are able to state with reasonable certainty whether the suspect could be the perpetrator, but it is not possible to identify the perpetrator positively. Nevertheless, we have been involved in several cases where the court has found that this type of gait analysis was a valuable tool.
Comamonas Testosteroni Meningitis in a Homeless Man
Authors: Jin Long , Perper Joshua A. , Cina Stephen J.
Published: July 2008

Abstract:  We report a case of meningitis caused by Comamonas testosteroni in a 54‐year‐old, alcoholic, homeless man. He, as a pedestrian, was struck by a car and suffered multiple fractures of the facial bones including the left frontal sinus. Over the course of 2‐week hospitalization, he was clinically diagnosed with multiple cerebral and cerebellar infarcts resulting in altered mental status. He was pronounced dead 15 days after the injury. At the time of autopsy, diffuse purulent meningitis was found on gross examination. A swab culture of the brain surface was positive for C. Testosteroni, a saprophytic organism commonly found in soil and water. This is the first reported case of fatal meningitis caused by this micro‐organism.
Age Estimation from the Human Os Coxa: A Test on a Documented Italian Collection*
Authors: Hens Samantha M. , Rastelli Elisa , Belcastro Giovanna
Published: July 2008

Abstract:  Current standards for age at death estimation from the pelvis are based on Americans of European and African ancestry. Our limited understanding of population variability hampers our efforts to apply these techniques to the various skeletal populations around the world, especially in global forensic contexts. However, documented skeletal samples are rare, limiting our ability to test our techniques. This study tested the Suchey‐Brooks pubic symphysis aging method and the auricular surface method originally developed by Lovejoy et al. on a large sample (n = 404) of known sex and age from the Sassari Collection, housed at the Museum of Anthropology at the University of Bologna, Italy. The results indicate that for both methods, bias and inaccuracy increased with age and actual age tended to be underestimated over the age of 40. The auricular surface method performed slightly better, exhibiting slightly lower levels of bias and inaccuracy, especially for males.
Claims of Amnesia for Criminal Offenses: Psychopathology, Substance Abuse, and Malingering
Authors: Stout Ronnie G. , Farooque Rokeya S.
Published: July 2008

Abstract: The forensic psychiatric examiner often encounters defendants who deny memory for their offense. Past research proposes a variety of factors to account for offense amnesia. To date there have been few systematic studies of offense amnesia in relation to psychiatric diagnosis, either alone or in combination with other known factors such as substance use and malingering. We studied 53 pretrial felony defendants who had been referred for psychiatric examination; 40% claimed amnesia for their offense. Examinees with psychotic disorders in general, and schizophrenia in particular, were relatively less likely to claim amnesia than were examinees with other diagnoses. Substance use at the time of the offense and associated substance use disorder diagnoses were positively associated with offense amnesia. Malingering diagnosed by general clinical criteria was a poor predictor of amnesia claims. These data suggests that two prominent reasons for referral for forensic psychiatric evaluation include the presence of psychotic symptoms and claims of amnesia for the offense.
Development of Microplitis croceipes as a biological sensor
Authors: Tomberlin J. K. , Rains G. C. , Sanford M. R.
Published: July 2008

Classical conditioning, a form of associative learning, was first described in the vertebrate literature by Pavlov, but has since been documented for a wide variety of insects. Our knowledge of associative learning by insects began with Karl vonFrisch explaining communication among honeybees, Apis mellifera L. (Hymenoptera: Apidae). Since then, the honey bee has provided us with much of what we understand about associative learning in insects and how we relate the theories of learning in vertebrates to insects. Fruit flies, moths, and parasitic wasps are just a few examples of other insects that have been documented with the ability to learn. A novel direction in research on this topic attempts to harness the ability of insects to learn for the development of biological sensors. Parasitic wasps, especially Microplitis croceipes (Cresson) (Hymenoptera: Braconidae), have been conditioned to detect the odors associated with explosives, food toxins, and cadavers. Honeybees and moths have also been associatively conditioned to several volatiles of interest in forensics and national security. In some cases, handheld devices have been developed to harness the insects and observe conditioned behavioral responses to air samples in an attempt to detect target volatiles. Current research on the development of biological sensors with insects is focusing on factors that influence the learning and memory ability of arthropods as well as potential mathematical techniques for improving the interpretation of the behavioral responses to conditioned stimuli. Chemical detection devices using arthropod‐based sensing could be used in situations where trained canines cannot be used (such as toxic environments) or are unavailable, electronic devices are too expensive and/or not of sufficient sensitivity, and when conditioning to target chemicals must be done within minutes of detection. The purpose of this article is to provide a brief review of the development of M. croceipes as a model system for exploring associative learning for the development of biological sensors.
Efficacy of an oral health promotion intervention in the prevention of early childhood caries
Authors: Plutzer Kamila , Spencer A. John
Published: July 2008

Abstract –  Objective:  Despite a marked improvement in oral health of Australian children over the last 30 years, severe early childhood caries (S‐ECC) affects up to 17% of 2‐ to 3‐year‐old children with some requiring hospitalization and invasive treatment. This provided a compelling rationale to develop and test an oral health promotion programme which aimed to reduce this unnecessary suffering. The purpose of this study was to test the efficacy of an oral health promotion programme for the parents of infants, starting during the pregnancy, using a randomized controlled trial.

Methods:  A programme was developed around the provision of anticipatory guidance to nulliparous women (women expecting their first child) in Adelaide. Mothers in the test group received oral health promotion information during pregnancy, and later when the child reached 6 and 12 months of age. After the second round of information the test group mothers were randomized again. The information was reinforced in one of the test subgroups through a telephone consultation. There was no contact with mothers in the control group after enrolment. At the age of 20 ± 2.5 months all test and control group children were examined by a dentist. The case definition of an incidence of S‐ECC was one or more upper incisor teeth being carious at the level of a cavitated or noncavitated lesion. The differences in S‐ECC incidence between the test and control groups, and the test subgroups were analysed.

Results:  Of 649 women enroled in the programme (test group 327, control group 322), 441 had their child examined at follow‐up. The incidence of S‐ECC in the test group was 1.7% and in the control group 9.6% (P < 0.001).

Conclusion:  An oral health promotion programme based on repeated rounds of anticipatory guidance initiated during the mother’s pregnancy was successful in reducing the incidence of S‐ECC in these very young children.