bluuebunny/crossref_metadata_2025 huggingface dataset:
Willingness to Pay for Rural Landscape Improvements: Combining Mixed Logit and Random‐Effects Models
Authors: Campbell Danny
Published: August 2007

This paper reports the findings from a discrete‐choice experiment designed to estimate the economic benefits associated with rural landscape improvements in Ireland. Using a mixed logit model, the panel nature of the dataset is exploited to retrieve willingness‐to‐pay values for every individual in the sample. This departs from customary approaches in which the willingness‐to‐pay estimates are normally expressed as measures of central tendency of an a priori distribution. Random‐effects models for panel data are subsequently used to identify the determinants of the individual‐specific willingness‐to‐pay estimates. In comparison with the standard methods used to incorporate individual‐specific variables into the analysis of discrete‐choice experiments, the analytical approach outlined in this paper is shown to add considerable explanatory power to the welfare estimates.
Segmenting the Wine Market Based on Price: Hedonic Regression when Different Prices mean Different Products
Authors: Costanigro Marco , McCluskey Jill J. , Mittelhammer Ron C.
Published: August 2007

Many economists have estimated hedonic price functions for red and white wine. However, estimating a single hedonic price function imposes the assumption that the implicit prices of the attributes are the same for any red or white wine. We argue that even within these two categories, wines are differentiated, and disregarding this heterogeneity causes an aggregation bias in the estimated implicit prices. By estimating hedonic functions specific to price ranges, we show that the wine market is segmented into several product classes or market segments. We find that a model accounting for the existence of wine classes has greater ability to explain the variability in the data and produces more accurate and interpretable results regarding the implicit prices of the attributes.
Modelling Deforestation and Land‐Use Change: Sparse Data Environments
Authors: Pinto Alessandro De , Nelson Gerald C.
Published: August 2007

Land‐use change in developing countries is of great interest to policy‐makers and researchers with diverse interests. Concerns about consequences of deforestation for global climate change and biodiversity have received the most publicity, but loss of wetlands, declining land productivity and watershed management are also problems facing developing countries. Analyses of these problems are especially constrained by lack of data. This article reviews modelling approaches for data‐constrained environments that involve discrete choice methods including neural nets and dynamic programming, and research results that link individual household survey data with satellite images using geographic positioning systems.
The Governance of Rural Land in a Liberalised World
Authors: Hodge Ian
Published: August 2007

Liberalisation of agricultural policies reduces the influence of policy on land‐use decisions, but environmental policy objectives remain. Governance provides an approach that recognises the role of institutions and collective action. The formulation of environmental policy objectives in terms of the provision of public goods raises questions as to the role of economic valuation and as to whether the definition of ‘goods’ may misdirect policy attention. An alternative approach relates to ecosystem services and sees management issues in terms of ecosystem resilience and the adaptive governance of socio‐ecological systems. Governance involves a mix of regulation, markets, government incentives and collective action. Regulation sets the domain within which markets operate and social judgements as to property rights are required as a basis for exchanges. Depending on commodity prices, agri‐environment schemes may be required either to reduce agricultural production intensity or to keep land under production. The diffuse nature of the environmental benefits and costs of land uses, the complexity of ecosystems and the need to co‐ordinate land management decisions indicate a role for local adaptive co‐management of land resources. Governments play a major role in supporting the institutional framework within which this can take place.
Spatial Econometric Issues for Bio‐Economic and Land‐Use Modelling
Authors: Holloway Garth , Lacombe Donald , LeSage James P.
Published: August 2007

We survey the literature on spatial bio‐economic and land‐use modelling and assess its thematic development. Unobserved site‐specific heterogeneity is a feature of almost all the surveyed works, and this feature, it seems, has stimulated significant methodological innovation. In an attempt to improve the suitability with which the prototype incorporates heterogeneity, we consider modelling alternatives and extensions. We discuss solutions and conjecture others.
Multiculturalism in the Age of Terror: Confronting the Challenges
Authors: Mahajan Gurpreet
Published: August 2007

Multiculturalism appears to be under siege in Western liberal democracies. The encounter with organised terrorism has placed a question mark against the multicultural wisdom of recognising and accommodating cultural differences in the public arena. As concerns of national security dominate the post-9/11 world, distinctions between ‘us’ and ‘them’ are surfacing in a way that has prompted some to say that the present war on terror is actually a war on Islam. Will the multicultural ethic survive in this environment? Will states be willing to accommodate cultural diversity and live with the presence of visible differences? The article explores these questions through the lens of India.

India has been battling with terrorism for more than a decade now. While this has severely strained the capacity of the political community to nurture multiculturalism, it has successfully resisted the challenges posed by an assertive cultural/religious majoritarianism that surfaced in the shadow of terrorism. India has dealt with the schisms produced by terrorism by drawing upon the collective imaginary and past cultural legacies that ensued from its understanding of a ‘situated self’. This was supplemented by a functioning democracy in which significant minorities were able to shape the electoral fate of political parties and reduce the political clout of those who were insensitive to their concerns.

The multicultural ethic is far from secure in India, yet it does not, and has not, faced the problems that confront multiculturalism in Western Europe today. The issues before European democracies may have been accentuated by terrorism but they are linked closely to the liberal notion of tolerance. Does a notion of the ‘situated self’ that informs tolerance in India offer a viable alternative? We cannot expect any political community to erase its historically defined identity, yet a reflection on other ways of thinking and living may assuage some of our anxieties and open us to the possibility of redefining our understanding of differences.
Dutch ‘Multiculturalism’ Beyond the Pillarisation Myth
Authors: Vink Maarten P.
Published: August 2007

This article is about the state of multiculturalist politics in the Netherlands. It assesses the popular claim that a paradigmatic change has occurred in the Netherlands due to events such as 9/11 and the murders of Pim Fortuyn and Theo van Gogh. The article argues that although changes are significant, both in discourse and in practice, they must be viewed as part of a process of rethinking the relation between newcomers and the state that goes back as far as the end of the 1980s. Long-standing claims about the exemplary form of multiculturalism in the Netherlands were always ambiguous at least, or even hard to sustain. The article criticises the persistent idea that Dutch accommodating integration policies since the end of the 1970s are an extension of the historical tradition of ‘pillarisation’. Only by going beyond this myth can we understand why recent changes are much less of a break with the past, and why multiculturalism was never accepted or practised as fully as has often been suggested in more stereotypical depictions of Dutch integration policy.
Cellular and molecular pathology of HTS: basis for treatment
Authors: Armour Alexis , Scott Paul G. , Tredget Edward E.
Published: August 2007

Hypertrophic scar and keloids are fibroproliferative disorders of the skin which occur often unpredictably, following trauma and inflammation that compromise cosmesis and function and commonly recur following surgical attempts for improvement. Despite decades of research in these fibrotic conditions, current non‐surgical methods of treatment are slow, inconvenient and often only partially effective. Fibroblasts from these conditions are activated to produce extracellular matrix proteins such as collagen I and III, proteoglycans such as versican and biglycan and growth factors, including transforming growth factor‐β and insulin like growth factor I. However, more consistently these cells produce less remodeling enzymes including collagenase and other matrix metalloproteinases, as well as the small proteoglycan decorin which is important for normal collagen fibrillogenesis. Recently, the systemic response to injury appears to influence the local healing process whereby increases in Th2 and possibly Th3 cytokines such as IL‐2, IL‐4 and IL‐10 and TGF‐β are present in the circulating lymphocytes in these fibrotic conditions. Finally, unique bone marrow derived cells including mesenchymal and endothelial stem cells as well as fibrocytes appear to traffic into healing wounds and influence the healing tissue. On this background, clinicians are faced with patients who require treatment and the pathophysiologic basis as currently understood is reviewed for a number of emerging modalities.
Consequences of excessive scar formation: dealing with the problem and aiming for the future
Authors: Greenhalgh David G.
Published: August 2007

Scarring is the major hindrance to the healing of all tissues. Unfortunately, our knowledge about the factors that regulate scarring is quite limited. Even worse is the fact that there have been few gains in the treatment of pathologic scarring. This review sets the stage for the supplement on scar formation that provides the latest knowledge on the pathophysiology and treatment of scar formation.
Bone marrow‐derived stem cells in wound healing: a review
Authors: Wu Yaojiong , Wang JianFei , Scott Paul G. , Tredget Edward E.
Published: August 2007

Optimum healing of a cutaneous wound requires a well‐orchestrated integration of the complex biological and molecular events of cell migration and proliferation, and of extracellular matrix deposition and remodeling. Several studies in recent years suggest that bone marrow derived stem cells such as mesenchymal stem cells, progenitor cells such as endothelial progenitor cells and fibrocytes may be involved in these processes, contributing to skin cells or releasing regulatory cytokines. Stem/progenitor cells may be mobilized to leave the bone marrow, home to injured tissues and participate in the repair and regeneration. Direct injection of bone marrow derived mesenchymal stem cells or endothelial progenitor cells into injured tissues shows improved repair through mechanisms of differentiation and/or release of paracrine factors. Enhanced understanding of these cells may help develop novel therapies for difficult cutaneous conditions such as non‐healing chronic wounds and hypertrophic scarring as well as engineering cutaneous substitutes.
TGF‐β–induced fibrosis and SMAD signaling: oligo decoys as natural therapeutics for inhibition of tissue fibrosis and scarring
Authors: Cutroneo Kenneth R.
Published: August 2007

Transforming‐growth factor‐β (TGF‐β) is a pleiotrophic growth factor that is synthesized by many cells in the body. This growth factor is chemotactic for fibroblasts, stimulates fibroblast proliferation, and increases the synthesis of a number of extracellular matrix proteins including collagens. The TGF‐β activator protein is a transacting factor, which binds to the TGF‐β element in the distal promoter of the COL1A1 collagen gene and induces transcription of this gene. Although transient TGF‐β1 activity participates in repair and regeneration of tissues, persistent TGF‐β1 function affects excessive fibrosis and ultimately scarring of both skin and internal organs. Scarring of internal organ (e.g., liver and lung) results in a loss of function and ultimately death may occur. The central issue of this review is that phosphorothioate double‐stranded decoys or other decoys decrease procollagen gene expression, procollagen synthesis, and collagen during fibrogenesis. The rationale is that the decoys containing the TGF‐β element or other gene transcription regulatory CIS‐elements bind the transacting proteins preventing the latter from binding to the CIS‐element in the 5′‐flanking region of the natural gene resulting in transcription inhibition. We will, in part, focus on aspects involved in TGF‐β1–induced fibrosis that occur during fibrogenesis and the use of the dsTGF‐β element containing oligodeoxynucleotide decoys to control excessive collagen synthesis, and deposition resulting from persistent TGF‐β. In our model of regulation of collagen synthesis, these double‐stranded oligo decoys act as promoter competitors, binding to the activator protein either in the cytoplasm or in the nucleus. The significance of the proposed studies is that these novel natural antifibrotics will mimic the effect of glucocorticoids on collagen synthesis during fibrogenesis without the unwanted side effects of these steroids. Based on our previous studies on the molecular mechanisms by which glucocorticoids selectively decrease collagen synthesis, designed phosphorothioate oligodeoxynucleotides resistant to nuclease action will mimic the effects of glucocorticoids at the molecular, cellular, and in vivo levels of collagen synthesis. However, the glucocorticoids significantly inhibit noncollagen protein synthesis. Both the single‐stranded and double‐stranded oligodeoxynucleotide specifically decrease collagen synthesis without an inhibitory effect on noncollagen protein synthesis. In this review, we will specifically ask if TGF‐β–induced collagen synthesis is inhibited in cell culture and in vivo by using the double‐stranded oligodeoxynucleotide decoys, will this inhibit fibrogenesis and ultimately scarring?
Empirical Assessment of a Research Advance Directive for Persons with Dementia and Their Proxies
Authors: Stocking Carol B. , Hougham Gavin W. , Danner Deborah D. , Patterson Marian B. , Whitehouse Peter J. , Sachs Greg A.
Published: August 2007

OBJECTIVES: To evaluate a research advance directive for persons with established dementia diagnoses and their family caregivers or proxies.

DESIGN: Prospective randomized, controlled trial.

SETTING: Three clinics, one each in Ohio, Kentucky, and Illinois.

PARTICIPANTS: At the end of separate interviews about enrollment choices in five types of hypothetical research projects, 149 persons with established dementia diagnoses and their family proxies were randomized to jointly complete the Planning Ahead Together (PAT) document, a research advance directive (n=69) or to remain in the control group (n=80).

INTERVENTION: The directive was assessed at two points: immediately after sample members received naturally occurring invitations to participate in other studies and again 2 years after initial enrollment.

MEASUREMENTS: Personal enrollment rates, reported ease of enrollment decision for patients and proxies, and proxy comfort were compared between the experimental and control groups.

RESULTS: Forty‐one dyads were reinterviewed immediately after consent discussions for other trials. Forty‐seven patients and 106 proxies were interviewed at 2‐year follow‐up. There was no evidence immediately after a trial enrollment opportunity or in the follow‐up interview that the research advance directive (PAT) assisted patients or proxies. Enrollment rates, decision ease, and proxy comfort and certainty were similar in the PAT and control groups.

CONCLUSION: Patient and proxy experience making hypothetical decisions in the interview may have affected enrollment decisions by the PAT and control groups. Although the low number of recruitment attempts and the natural attrition of the geriatric population limit conclusions about effectiveness that may be drawn from this unique data set, the feasibility of a research advance directive is clearly demonstrated.
High‐Intensity Environmental Light in Dementia: Effect on Sleep and Activity
Authors: Sloane Philip D. , Williams Christianna S. , Mitchell C. Madeline , Preisser John S. , Wood Wendy , Barrick Ann Louise , Hickman Susan E. , Gill Karminder S. , Connell Bettye Rose , Edinger Jack , Zimmerman Sheryl
Published: August 2007

OBJECTIVES: To determine whether high‐intensity ambient light in public areas of long‐term care facilities will improve sleeping patterns and circadian rhythms of persons with dementia.

DESIGN: A cluster‐unit crossover intervention trial involving four conditions: morning bright light, evening bright light, all‐day bright light, and minimum standard light.

SETTING: The common areas of two geriatric units in a psychiatric hospital and a dementia‐specific residential care facility.

PARTICIPANTS: Sixty‐six older adults with dementia.

INTERVENTION: Ambient bright light of approximately 2,500 lux, delivered through a low‐glare lighting system installed in the dining and activity areas. Participant exposure averaged 2.5 to 3.0 hours for the morning and evening interventions and 8.4 hours for the all‐day intervention.

MEASUREMENTS: Nighttime sleep using wrist actigraphy and daytime activity using nonobtrusive daytime observations.

RESULTS: Night‐time sleep increased significantly in participants exposed to morning and all‐day light, with the increase most prominent in participants with severe or very severe dementia (mean increase 16 minutes (P=.008) for morning, and 14 minutes (P=.01) for all‐day). Morning light produced a mean phase advance of 29 minutes (P=.02) and evening light a mean phase delay of 15 minutes (P=.06). Effects on daytime sleepiness were inconsistent, and the number of sleep bouts, mesor, amplitude, intradaily variability, and interdaily stability were not significantly different, indicating that the overall strength of day and night activity rhythms did not change significantly under any treatment condition.

CONCLUSION: Bright light appears to have a modest but measurable effect on sleep in this population, and ambient light may be preferable to stationary devices such as light boxes.
Psychiatric Comorbidity and Greater Hospitalization Risk, Longer Length of Stay, and Higher Hospitalization Costs in Older Adults with Heart Failure
Authors: Sayers Steven L. , Hanrahan Nancy , Kutney Ann , Clarke Sean P. , Reis Brendali F. , Riegel Barbara
Published: August 2007

OBJECTIVES: To explore associations between psychiatric comorbidity and rehospitalization risk, length of hospitalization, and costs.

DESIGN: Cross‐sectional study of 1‐year hospital administrative data.

SETTING: Claims‐based study of older adults hospitalized in the United States.

PARTICIPANTS: Twenty‐one thousand four hundred twenty‐nine patients from a 5% national random sample of U.S. Medicare beneficiaries aged 65 and older, with at least one acute care hospitalization in 1999 with a Diagnostic‐Related Group of congestive heart failure.

MEASUREMENTS: The number of hospitalizations, mean length of hospital stay, and total hospitalization costs in calendar year 1999.

RESULTS: Overall, 15.8% of patients hospitalized for heart failure (HF) had a coded psychiatric comorbidity; the most commonly coded comorbid psychiatric disorder was depression (8.5% of the sample). Most forms of psychiatric comorbidity were associated with greater inpatient utilization, including risk of additional hospitalizations, days of stay, and hospitalization charges. Additional hospitalization costs associated with psychiatric comorbidity ranged up to $7,763, and additional days length of stay ranged up to 1.4 days.

CONCLUSION: Psychiatric comorbidity appears in a significant minority of patients hospitalized for HF and may affect their clinical and economic outcomes. The associations between psychiatric comorbidity and use of inpatient care are likely to be an underestimate, because psychiatric illness is known to be underdetected in older adults and in hospitalized medical patients.
Collaborative Clinical Quality Improvement for Pressure Ulcers in Nursing Homes
Authors: Lynn Joanne , West Jeff , Hausmann Susan , Gifford David , Nelson Rachel , McGann Paul , Bergstrom Nancy , Ryan Judith A.
Published: August 2007

The National Nursing Home Improvement Collaborative aimed to reduce pressure ulcer (PU) incidence and prevalence. Guided by subject matter and process experts, 29 quality improvement organizations and six multistate long‐term care corporations recruited 52 nursing homes in 39 states to implement recommended practices using quality improvement methods. Facilities monitored monthly PU incidence and prevalence, healing, and adoption of key care processes.

In residents at 35 regularly reporting facilities, the total number of new nosocomial Stage III to IV PUs declined 69%. The facility median incidence of Stage III to IV lesions declined from 0.3 per 100 occupied beds per month to 0.0 (P<.001) and the incidence of Stage II to IV lesions declined from 3.2 to 2.3 per 100 occupied beds per month (P=.03). Prevalence of Stage III to IV lesions trended down (from 1.3 to 1.1 residents affected per 100 occupied beds (P=.12). The incidence and prevalence of Stage II lesions and the healing time of Stage II to IV lesions remained unchanged. Improvement teams reported that Stage II lesions usually healed quickly and that new PUs corresponded with hospital transfer, admission, scars, obesity, and immobility and with noncompliant, younger, or newly declining residents. The publicly reported quality measure, prevalence of Stage I to IV lesions, did not improve. Participants documented disseminating methods and tools to more than 5,359 contacts in other facilities.

Results suggest that facilities can reduce incidence of Stage III to IV lesions, that the incidence of Stage II lesions may not correlate with the incidence of Stage III to IV lesions, and that the publicly reported quality measure is insensitive to substantial improvement. The project demonstrated multiple opportunities in collaborative quality improvement, including improving the measurement of quality and identifying research priorities, as well as improving care.
Profound thrombocytopenia and survival of hematopoietic stem cell transplant patients without clinically significant bleeding, using prophylactic platelet transfusion triggers of 10 × 109or 20 × 109per L
Authors: Nevo Shoshan , Fuller Alice K. , Zahurak Marianna L. , Hartley Eric , Borinsky Mark E. , Vogelsang Georgia B.
Published: August 2007

BACKGROUND:A trigger of 10 × 109per L for prophylactic platelet (PLT) transfusions is generally recommended for stable thrombocytopenic patients who receive chemotherapy, based on studies showing similar incidence, severity, and fatality of bleeding compared with the 20 × 109per L trigger. The outcome of thrombocytopenic nonbleeding patients has not been well described. This retrospective analysis evaluates thrombocytopenia and survival of 381 hematopoietic stem cell transplant (HSCT) patients without clinically significant bleeding, with 10 × 109and 20 × 109per L prophylactic triggers.

STUDY DESIGN AND METHODS:A total of 170 patients who received prophylactic PLT transfusions at 20 × 109per L (1997‐1998, SP1) and 211 patients who had prophylaxis at 10 × 109per L (1999‐2001, SP2) were identified as nonbleeding patients. PLT counts and clinical complications were assessed within 100 days from HSCT.

RESULTS:PLT counts less than or equal to 10 × 109per L were found in 69.2 percent of patients in SP2 and 38.3 percent in SP1 (p < 0.001). Profound thrombocytopenia (4+ PLT counts ≤10 × 109/L) was found in 19.0 percent of patients in SP2 and 7.0 percent in SP1 (p = 0.001). Patients with profound thrombocytopenia had significantly increased early mortality (odds ratio [OR], 3.18; 95% confidence interval [CI], 1.25‐8.07) and significantly reduced overall survival (hazard ratio [HR], 1.95; 95% CI, 1.28‐2.97) compared to patients with 0 to 3 PLT counts less than or equal to 10 × 109per L. The association of profound thrombocytopenia with early mortality was more notable in SP2.

CONCLUSION:The 10 × 109per L transfusion trigger is associated with significantly greater exposure to low PLT counts. Nonbleeding patients with profound thrombocytopenia were at significantly greater risk of dying compared with nonthrombocytopenic patients. These results suggest that safety of the 10 × 109per L trigger should be more thoroughly evaluated.
AABB survey of transfusion‐related acute lung injury policies and practices in the United States
Authors: Kopko Patricia , Silva Marianne , Shulman Ira , Kleinman Steven
Published: August 2007

BACKGROUND: Policies and practices with regard to transfusion‐related acute lung injury (TRALI) diagnosis, laboratory investigation of TRALI cases, and donor deferral and donor management are not standardized.

STUDY DESIGN AND METHODS: A Web‐based survey was designed and administered to participating AABB member institutions in July 2006.

RESULTS: The survey response rate was highest for donor centers, followed by larger hospital blood banks and transfusion services. Laboratory case workups regularly included HLA Class I and II antibody testing of donors followed less frequently by HNA antibody testing; recipient specimens for leukocyte antigen typing were usually not obtained, even if indicated as part of the planned workup. Several different criteria (i.e., all donors, female donors only, case by case determination) were used to select which donors should be tested. There was agreement that donors should be deferred if implicated in a TRALI case (i.e., antibody‐cognate antigen match); however, donor management policies varied in other scenarios. The final diagnosis of TRALI was often (45%‐66% depending on institutional type) based on a combination of clinical and serologic findings rather than on adherence to the clinical definition recommended by the Canadian Consensus Conference. Many TRALI policies appeared to be decided on a case‐by‐case basis at the discretion of the institution's medical director.

CONCLUSIONS: There is wide variability in procedures and policies related to the diagnosis of and donor investigation and/or management of TRALI cases. Lack of a consensus approach may partly reflect limitations in understanding of TRALI pathogenesis. The survey suggests that increased education of transfusion medicine practitioners is needed.
How we treat: management of life‐threatening primary postpartum hemorrhage with a standardized massive transfusion protocol
Authors: Burtelow Matthew , Riley Ed , Druzin Maurice , Fontaine Magali , Viele Maurene , Goodnough Lawrence Tim
Published: August 2007

Management of massive, life‐threatening primary postpartum hemorrhage in the labor and delivery service is a challenge for the clinical team and hospital transfusion service. Because severe postpartum obstetrical hemorrhage is uncommon, its occurrence can result in emergent but variable and nonstandard requests for blood products. The implementation of a standardized massive transfusion protocol for the labor and delivery department at our institution after a maternal death caused by amniotic fluid embolism is described. This guideline was modeled on a existing protocol used by the trauma service mandating emergency release of 6 units of group O D– red cells (RBCs), 4 units of fresh frozen or liquid plasma, and 1 apheresis unit of platelets (PLTs). The 6:4:1 fixed ratio of uncrossmatched RBCs, plasma, and PLTs allows the transfusion service to quickly provide blood products during the acute phase of resuscitation and allows the clinical team to anticipate and prevent dilutional coagulopathy. The successful management of three cases of massive primary postpartum hemorrhage after the implementation of our new massive transfusion protocol in the maternal and fetal medicine service is described.
Peripheral blood progenitor uncontrolled‐rate freezing: a single pediatric center experience
Authors: Iannalfi Alberto , Bambi Franco , Tintori Veronica , Lacitignola Laura , Bernini Gabriella , Mariani Maria Pia , Sanvito Maria Chiara , Pagliai Francesca , Brandigi Francesco , Muscarella Elisa , Tapinassi Francesca , Faulkner Lawrence
Published: August 2007

BACKGROUND: Controlled‐rate freezing (CRF) followed by storage in liquid nitrogen is employed by most centers as the standard procedure for peripheral blood progenitor cell (PBPC) cryopreservation. Uncontrolled‐rate freezing (URF) at −80°C is more simple, time‐saving, less expensive, and, possibly, as effective as CRF. The aim of this retrospective analysis was to compare CRF and URF in childhood transplantation.

STUDY DESIGN AND METHODS: A total of 54 PBPC transplants performed in 39 children aged 3 to 16 years (median, 9.5 years) were analyzed: 23 transplants in 16 children with CRF versus 31 transplants performed in 23 children with −80°C URF. All grafts contained at least 2 × 106 per kg unselected CD34+ cells, enumerated before freezing. Nucleated cells infused ranged from 1.32 × 108 to 4.3 × 108 per mL with a median of 3.1 × 108 per mL. Cryoprotectant solution consisted of a final dimethyl sulfoxide (DMSO) concentration of 10 percent DMSO with autologous plasma.

RESULTS: The two study groups did not differ in terms of timing of neutrophil and platelet recovery or transfusion requirements. Adverse events related to graft infusion, severe complications, and transplant‐related mortality were not significantly different between CRF and URF groups. In both groups only mild adverse events were observed during graft administration. URF procedures, however, were simpler and less expensive. At a median follow‐up of 72 months, no secondary myelodysplasia was observed in either group.

CONCLUSION: Our analysis suggests that URF is safe and effective in the pediatric population.
The alloimmune response to the human platelet antigen‐1a is not related to maternal‐fetal killer immunoglobulinlike receptor/HLA‐Cw combinations
Authors: Valentin Nathalie , Gagne Katia , Kerdudou Nolwenn , Hallé Liliane , Kaplan Cécile , Killie Mette Kjaer , Skogen Bjorn , Muller Jean‐Yves , Bignon Jean‐Denis
Published: August 2007

BACKGROUND: Human platelet antigen (HPA)‐1a fetomaternal alloimmune thrombocytopenia, responsible in the most severe cases for fetal or neonatal intracranial hemorrhages leading to death or survival with neurologic sequelae, was shown to be restricted to the human leukocyte antigen (HLA) Class II DRB3*0101‐encoded molecule. Whereas more than 90 percent of alloimmunized mothers display the DRB3*0101 allele, the positive predictive value of the presence of DRB3*0101 is only 35 percent. Additional genetic risk factors may exist of which elucidation could improve the undertaking of incompatible pregnancies in at‐risk families, encouraging an antenatal screening. Interactions of killer immunoglobulinlike receptors (KIRs) on maternal decidual NK cells with HLA‐Cw molecules on fetal trophoblasts were reported as one of the mechanisms involved in the fetomaternal tolerance during pregnancy.

STUDY DESIGN AND METHODS: Genotyping was performed of 16 KIR genes in HPA‐1a–negative/DRB3*0101‐positive alloimmunized mothers and in HPA‐1a–negative/DRB3*0101‐positive nonimmunized mothers as well as HLA‐Cw genotyping in thrombocytopenic children and their nonaffected siblings.

RESULTS: No particular KIR genes or KIR genotypes were observed in the alloimmunized or nonimmunized mothers. Distribution of HLA‐Cw genes in affected infants and nonaffected siblings did not reveal any HLA‐Cw specificity associated with triggering or modulation of the HPA‐1a alloimmunization. No maternal KIR/fetal HLA‐Cw combinations were demonstrated in association with a detrimental or a protective effect on the HPA‐1a alloimmunization.

CONCLUSION: Maternal KIR/fetal HLA‐Cw gene combinations that are involved in the fetomaternal tolerance do not appear to play a role in the HPA‐1a alloimmunization.
Leukoreduction filtration of whole‐blood units from sickle trait donors: effects of a metered citrate anticoagulant system
Authors: Bryant Barbara J. , Bianchi Maria , Wesley Robert A. , Stroncek David F. , Leitman Susan F.
Published: August 2007

BACKGROUND: Polymerization of hemoglobin (Hb) S is exacerbated by acidic and hyperosmotic citrate anticoagulant solutions and often results in occlusion of leukoreduction filters by red blood cells (RBCs) from sickle cell trait (Hb AS) donors. This study evaluates a blood collection instrument that adds citrate anticoagulant in a metered fashion, thus mitigating adverse citrate effects.

STUDY DESIGN AND METHODS: Collection of whole blood by a metered anticoagulant system was compared to traditional phlebotomy in 12 Hb AS and 12 non–sickle trait (Hb AA) donors. Each donated twice; on one occasion, units were filtered after 4‐hour storage at 20 to 24°C, and on the other, units were stored at 1 to 6°C for 24 hours before filtration.

RESULTS: Filtration times, RBC recoveries, and residual white blood cell (WBC) counts met defined criteria more often in Hb AS units collected by a metered anticoagulant system (9 of 12, 8 of 12, and 4 of 12, respectively) compared to traditional phlebotomy (1 of 12, 2 of 12, and 0 of 12, respectively). Overall, Hb AS units filtered better after storage at 1 to 6°C for 24 hours, with units collected by a metered anticoagulant system undergoing filtration most effectively (5 of 6 had >85% RBC recovery, 3 of 6 had <5 × 106 residual WBC). Units exhibited similar changes in RBC storage parameters.

CONCLUSION: Use of a metered anticoagulation instrument demonstrates potential for successful leukoreduction and acceptable storage of Hb AS units; however, the system needs further modifications and improvements before it can be utilized to collect and leukoreduce Hb AS blood.
Quality and stability of red cells derived from gravity‐separated placental blood with a hollow‐fiber system
Authors: Brune Thomas , Fill Sara , Heim Gerd , Rabsilber Angelika , Wohlfarth Kathrin , Garritsen Henk S.P.
Published: August 2007

BACKGROUND: Several studies show that donor red blood cells (RBCs) can be processed by gravity separation with a hollow‐fiber filtration system. This study investigated whether fetal blood could be filtered in the same way.

STUDY DESIGN AND METHODS: Twelve newborns born after healthy pregnancies were included in the study. Placental blood was sampled with standard procedures. The sampled blood was separated with a specially designed hollow‐fiber filtration system (Sangofer neonatal, Heim Group). The RBC bag contained 10 mL of saline, adenine, glucose–mannitol (SAG‐M) for stabilization. After processing, the resulting RBC volume was estimated. Quality variables (blood counts, hemolysis rate) were measured before and after 35 days of storage at +4°C.

RESULTS: The 12 processed RBC units had a mean volume of 62.3 ± 13.5 mL and a mean hematocrit level of 0.56 ± 0.06. No white blood cell contamination could be detected in any of the RBC units tested. After 35 days of storage, the hemolysis was 0.1 ± 0.07 and the amount of free hemoglobin was 0.28 ± 0.017 mmol per L.

CONCLUSIONS: This study shows that it is possible to process placental blood to RBCs by gravity separation with a hollow‐fiber system. The quality of the RBCs thus processed was suitable for 35 days storage. The use of placental blood in the treatment of children with anemia (e.g., malaria) in the underresourced world is widely discussed. Because the separation device used here needs no additional equipment or electrical devices, it is considered to be an ideal method for use in these countries.
Sustained Polymorphic Arrhythmias Induced by Programmed Ventricular Stimulation have Prognostic Value in Patients Receiving Defibrillators
Authors: GREENBERG SCOTT L. , MAURICIO SÁNCHEZ J. , COOPER JONAS A. , CAIN MICHAEL E. , CHEN JANE , GLEVA MARYE J. , LINDSAY BRUCE D. , SMITH TIMOTHY W. , FADDIS MITCHELL N.
Published: August 2007

Background:Patients with ischemic cardiomyopathy (ICM) who have monomorphic ventricular tachycardia (VT) induced by programmed ventricular stimulation (PVS) are at increased risk of sudden cardiac death (SCD). Among a primary prevention population, the prognostic significance of induced polymorphic ventricular arrhythmias is unknown.

Methods:A total of 105 consecutive patients who received an implantable cardioverter‐defibrillator (ICD) for primary prevention of SCD in the setting of ICM and non‐sustained VT were retrospectively evaluated. Seventy‐five patients (group I) had induction of monomorphic VT and 30 patients (group II) had a sustained ventricular arrhythmia other than monomorphic VT (ventricular flutter, ventricular fibrillation, and polymorphic VT) induced during PVS.

Results:Baseline characteristics were similar between group I and group II except for ejection fraction (25% vs. 31%, P = 0.0001) and QRS duration (123 milliseconds vs. 109 milliseconds, P = 0.04). Sixteen of 75 (21.3%) patients in group I and 6 of 30 (20%) patients in group II received appropriate ICD therapy (P = 0.88). Survival free from ICD therapy was similar between groups (P = 0.54). There was a trend toward increased all‐cause mortality among patients in group I by Kaplan‐Meier analysis (P = 0.08). However, when adjusted for age, EF, and QRS duration mortality was similar (P = 0.45).

Conclusions:There is no difference in rates of appropriate ICD discharge or mortality between patients dichotomized by type of rhythm induced during PVS. These results suggest that patients in this population who have inducible VF or sustained polymorphic VT have similar rates of subsequent clinical ventricular tachyarrhythmias as those with inducible monomorphic VT.
Variation in Pacing Impedance: Impact of Implant Site and Measurement Method
Authors: ANDERSON SARA E. , SKADSBERG NICHOLAS D. , LASKE TIMOTHY G. , BENDITT DAVID G. , IAIZZO PAUL A.
Published: August 2007

Background:

Variations in pacing impedance may be observed during implantation of various active fixation pacing leads. However, these variations can be influenced by the nature of the fixation, the implant site, or the measurement method. Here we describe implant dynamics for a 4.1F, catheter‐delivered pacemaker lead.

Methods:

Endocardial active fixation leads were implanted under direct intracardiac visualization in two right atrial sites and three right ventricular sites in isolated swine (n = 6) and human (n = 4) hearts. Impedance measurements were recorded at each site employing three different measurement techniques—Pacing System Analyzer (PSA) 5311, PSA 2090, and the Impedance Tone Box (Medtronic, Inc., Minneapolis, MN, USA)—with four different degrees of lead fixation: helix touching, one turn fixed (1 TF), two turns fixed (2 TF), and overtorqued.

Results:

Pacing impedances increased from touching to 1 TF to 2 TF at all implant sites in both swine and human hearts. Overtorquing applied to leads was associated with visible distortion at the endocardial tissue‐lead interface in at least 60% of swine (18 of 30 implants) and human hearts (nine of 14 implants). Impedance values in the right atrial high septum were significantly larger than in any other implant site (P < 0.05). The three measurement methods did not yield significantly different impedance measurements.

Conclusions:

Variations in measured impedances were associated with the nature of implant fixation at all sites in both swine and human hearts.
Biventricular Upgrading in Patients with Conventional Pacing System and Congestive Heart Failure:Results and Response Predictors
Authors: LAURENZI FRANCESCO , ACHILLI AUGUSTO , AVELLA ANDREA , PERALDO CARLO , ORAZI SERAFINO , PEREGO GIOVANNI B. , CESARIO ANTONIO , VALSECCHI SERGIO , DE SANTO TIZIANA , PUGLISI ANDREA , TONDO CLAUDIO
Published: August 2007

Background: There are few studies on cardiac resynchronization therapy (CRT) in heart failure (HF) patients with preexisting right ventricular (RV) pacing. The purpose of this study was to determine the efficacy of CRT upgrading in RV‐paced patients and the predictivity of electromechanical dyssynchrony parameters (EDP) evaluated by standard echocardiography (ECHO) and tissue Doppler imaging (TDI).

Methods: Thirty‐eight consecutive patients with HF [New York Heart Association (NYHA) class III or IV, LVEF < 35%], prior continuous RV pacing, and absence of atrial fibrillation were enrolled in the presence of a paced QRS ≥ 150 ms and evaluated by ECHO and TDI. A responder was defined as a patient with a favorable change in NYHA class and neither HF hospitalization nor death, plus an absolute increase of LVEF ≥ 10 units.

Results: At six‐months follow‐up, the whole study population had significant improvement in symptoms, systolic function, and QRS duration (P < 0.001); 32 (84%) patients had a favorable clinical outcome, 25 (66%) were considered responders according to the previous definition. Postimplant QRS was similarly reduced in both responders and nonresponders, whereas EDP had a significant improvement only in responders (P < 0.05). Using EDP, 23 (79%) patients were responders compared with 2 (22%) patients without mechanical dyssynchrony (P = 0.002).

Conclusions: In HF patients with previous RV pacing, CRT is effective to improve clinical, functional outcome, and LV performance and to reduce electromechanical dyssynchrony in a large proportion of patients. Dyssynchrony evaluated by standard and TDI ECHO can be useful for CRT selection of paced patients.
Patient Evaluation of ICD Recall Communication Strategies:A Vignette Study
Authors: STUTTS LAUREN A. , CONTI JAMIE B. , ARANDA JUAN M. , MILES WILLIAM M. , BURKART THOMAS A. , SEARS SAMUEL F.
Published: August 2007

Introduction: Communication about the unprecedented number of implantable cardioverter defibrillator (ICD) recalls has proved challenging. While initial studies have explored the psychological impact of recalls on patients, the optimal way to communicate recalls is not currently known. This study investigated the way communication of a recall can affect patients' responses.

Methods: Sixty‐six ICD patients read one of six vignettes that detailed a hypothetical device recall. Vignette variables included the source of recall dissemination (physician vs. media vs. device manufacturer) and the personal relevance (own brand is recalled vs. different brand is recalled). Subsequently, patients rated their agreement to 12 statements concerning their response to the recall on a scale from 1 (Strongly Disagree) to 5 (Strongly Agree).

Results: Patients were significantly more confident in the accuracy of recall information from both their physician and their manufacturer compared with the media, F (2, 63) = 36.10, P < 0.01, η2= 0.53. Interestingly, patients were concerned about the recall regardless of whether their brand of ICD was recalled. Survey results indicated that 78.6% of patients reported learning about recalls from the media. In stark contrast, 77.0% of patients asserted preferring to learn about recalls from their physician.

Conclusions: ICD patients report increased confidence in the accuracy of the recall information from physicians and manufacturers compared with the media in reporting recalls. Because it seems that most ICD patients learn about recalls from the media, these results demonstrate a disconnect between the initial source of recall information and the patients' desired sources.
Evaluating Patients with Acute Ischemic Stroke with Special Reference to Newly Developed Atrial Fibrillation in Cerebral Embolism
Authors: TAGAWA MINORU , TAKEUCHI SHIGEKAZU , CHINUSHI MASAOMI , SAEKI MAKIHIKO , TANIGUCHI YOSHINORI , NAKAMURA YUICHI , OHNO HIDEKO , KITAZAWA KEIKO , AIZAWA YOSHIFUSA
Published: August 2007

Background:

Cardioembolic strokes are extensive and have a poor prognosis. To identify the cardiovascular risk factors of cardioembolic stroke, we evaluated the cardiovascular status with special reference to persistent atrial fibrillation (AF) and paroxysmal atrial fibrillation (PAF) combined with the type of acute ischemic stroke.

Methods:

We divided 315 consecutive patients admitted to our Department of Neurosurgery with an acute ischemic stroke into four types of brain infarction using clinical history, onset pattern of stroke, and brain imaging: cardioembolic (group E, n = 105), lacunar (group L, n = 92), atherothrombotic (group T, n = 111), and unclassified (n = 7). All patients underwent standard electrocardiography (ECG), a 24‐hour ECG recording (Holter ECG) and transthoracic echocardiography (UCG).

Results:

Persistent AF or PAF was detected in 97 patients (31.5%) using Holter ECG: more frequently in group E (67.6%) than in groups L (15.2%) or T (9.2%). Persistent AF or PAF was first diagnosed on admission using a standard ECG in 16 patients (5.2%) with no previous history and 14 of these patients belonged to group E (13.3%). PAF was newly detected on Holter ECG in another 26 patients (8.4%) and 13 of these patients (12.4%) belonged to group E. Concerning UCG, left atrial enlargement and mitral regurgitation were more frequent in group E than in group L or T.

Conclusion:

Holter ECG in addition to ECG on admission is important for detecting persistent AF or PAF in patients with ischemic stroke, especially with cardioembolism as diagnosed by neuroimaging.
Cryoablation of Accessory Pathways in Children
Authors: TUZCU VOLKAN
Published: August 2007

Background: Cryoablation is utilized for septal tachycardia substrates due its safety. Considering the recent studies which reveal coronary artery stenosis related to radiofrequency ablation (RFA) in children, cryoablation may offer advantages for nonseptal accessory pathways (APs) as well. The aim of this study was to investigate the efficacy and safety of cryoablation of APs in children.

Methods: A total of 39 patients (median age = 9.3 years, range 4.8 to 17.2 years) underwent cryoablation of APs. A three‐dimensional, surface electrode‐based navigation system (EnSite NavX™, St.Jude Medical Inc., St. Paul, MN, USA) is used to decrease the fluoroscopy exposure.

Results: A total of 45 APs were identified. Of these APs, 23 were septal (anteroseptal, midseptal, posteroseptal) and 22 were nonseptal. Acute success rate with cryoablation was 73%. RFA was used when cryoablation failed and overall acute success rate was 84%. To assess for the effect of institutional experience, the initial 23 APs were compared to the recent 22 APs and acute success rate revealed significant improvement (57% vs. 91%). Recurrence rate was 24% during a median follow‐up of 282 days.

Conclusion: Cryoablation of APs is safe and yields to high acute success rates in children. It can potentially be used as the first ablation option for all APs in children. However, recurrence rate is higher compared to the RFA and there is a need for prospective comparative studies.
Shocking Truths about Implantable Cardioverter Defibrillator Monitoring Zones
Authors: MANSOUR FADI , THIBAULT BERNARD , DUBUC MARC , GUERRA PETER G. , MACLE LAURENT , BRUGADA RAMON , ROY DENIS , TALAJIC MARIO , KHAIRY PAUL
Published: August 2007

A 36 year‐old man with hypertrophic cardiomyopathy and an ATLAS + DR implantable cardioverter defibrillator (ICD) (St. Jude Medical, Inc., St. Paul, MN, USA) for primary prevention received a shock while cycling. The ventricular fibrillation detection threshold was 182 beats/min. An additional monitoring zone was programmed to 156 beats/min with all discriminators “on” except morphology. On interrogation, the ICD shock followed sinus tachycardia. In the absence of a monitoring zone, device therapy would not have been expected. We explore the mechanisms by which monitoring zones could potentially contribute to inappropriate ICD therapy and offer trouble‐shooting tips.