bluuebunny/crossref_metadata_2025 huggingface dataset:
Bradyarrhythmia and supraventricular tachycardia in a neonate with RSV
Authors: OLESCH CA , BULLOCK AM
Published: November 2003

Respiratory syncytial virus infection is the most common cause of hospital admissions in children under 1 year of age. Various cardiac dysrrhythmias have been reported to be associated with respiratory syncytial virus infection. We report a case where both tachyarrhythmia and bradyarrhythmia occurred within the same illness. Paediatricians need to be aware of this association.
Psychosocial aspects of adolescent cancer survival
Authors: BAULD C , ANDERSON V , ARNOLD J
Published: November 2003

Objective:

The purpose of this research was to examine the psychosocial status of adolescent cancer survivors and compare them with healthy peers. It has been suggested in previous research that the majority of survivors display equivalent levels of psychosocial functioning post‐treatment as compared with healthy controls. However, despite successful treatment, survivors may have to adjust to living with a chronic illness and its associated late effects interspersed across the lifespan (e.g. infertility, cognitive deficits, heart complications). Whilst young people appear to have similar levels of psychosocial functioning, avoidance strategies such as denial may result in previous research findings being confounded and in underestimating the true psychosocial status of survivors. It is important to understand the psychosocial status of survivors in order to optimise their quality of life.

Methodology:

Coping mechanisms, anxiety levels and self‐concepts of 32 adolescent cancer survivors, predominantly Acute Lymphoblastic Leukaemia (ALL) were compared with 34 healthy adolescents (age range 12–17 years), via a mailout.

Results:

Survivors’ self‐reports suggest no overt psychological dysfunctioning. Whilst the two groups shared similar coping strategies, survivors were found to be less anxious than peers, with a tendency to employ avoidance strategies to deal with problems faced in adolescence. Age, gender and specific illness variables, such as age at diagnosis and time since treatment, were strong predictors of psychological outcome.

Conclusions:

Results can be interpreted as suggesting that whilst cancer survivors have a similar psychosocial profile to healthy peers, they are more likely to utilise avoidance strategies to manage problems.
Efficacy and safety of oral desmopressin in the treatment of primary nocturnal enuresis in Asian children
Authors: YAP HK , CHAO SM , TAN AYS , MURUGASU B , ONG EK , LOW EH
Published: November 2003

Objective:

To determine the efficacy and safety of oral desmopressin (DDAVP) treatment in Asian children with nocturnal enuresis.

Methodology:

This was a multicentre randomized placebo‐controlled double‐blind cross‐over study. Patients were randomized to either active treatment with oral 400 mg DDAVP or placebo, with a 2‐week medication‐free period between the cross‐over. Children with primary monosymptomatic nocturnal enuresis, aged between 7 and 18 years, with a minimum frequency of wetting of 6 nights or more during a 2‐week observation period were recruited. Efficacy was measured by reduction in the average number of wet nights per week.

Results:

Of the 37 children initially recruited, the outcomes for 34 children were included in the final cross‐over analysis, as they had complete data for both the treatment periods. Statistical analysis by anova showed that there was no significant difference between the medication‐free period and the pretreatment period. However, the average number of wet nights per week for the DDAVP treatment period (2.5±2.7) was significantly lower than that of the placebo treatment period (4.5±2.1) (P<0.0001). In terms of the safety profile, there was no significant change in bodyweight, blood pressure, serum sodium, serum osmolality, and urine osmolality following DDAVP treatment.

Conclusion:

Oral DDAVP is a safe and efficacious drug for the short‐term treatment of children with primary nocturnal enuresis.
Shortcomings in psychosocial history taking in a paediatric emergency department
Authors: GREEN J , SULLIVAN AL , JUREIDINI And J
Published: November 2003

Objective:

To assess the quality of documentation of the psychosocial history taken from parents who repeatedly bring their infants and young children to an emergency department.

Methodology:

We prepared a list of 26 psychosocial items, indicated by the literature to be important elements of a history taken in this setting. We then reviewed subjects’ casenotes, and compared each history to this ideal list.

Participants/Setting:

Case note review of 104 children under 2 years who had presented to a paediatric emergency department at least five times in 1 year.

Results:

Documentation of psychosocial history for these subjects was very poor, with a mean of only 5 of the 26 possible psychosocial items mentioned per set of casenotes. The majority of records lacked important information, including basic demographic data.

Conclusions:

We canvass possible reasons for poor psychosocial history taking, and argue for changes in medical education, the development of techniques to efficiently identify at risk children and families, and improved resources for referral.
Iron status and dietary iron intake of 6–24‐month‐old children in Adelaide
Authors: OTI‐BOATENG P , SESHADRI R , PETRICK S , GIBSON RA , SIMMER K
Published: November 2003

Objective:

Chronic iron deficiency in children is associated with anaemia and impaired mental and psychomotor development. The aim of this study was to assess the iron status and dietary intake of 6–24‐month‐old Caucasian and Asian children living in metropolitan Adelaide.

Method:

A total of 234 healthy children (82% Caucasian and 18% Asian) aged 6–24 months were studied. Dietary iron intake of children was estimated from semiquantitative diet recall questionnaire administered to their parents. Blood samples for full blood count, serum ferritin (SF), serum iron (SI) and transferrin (TF) level estimations were obtained by venesection. Based on the laboratory test results, infants were classified as iron sufficient (IS) if the haemoglobin (Hb) concentration was >110 g L−1, SF ≥15 μg L−1, TF2 3.0 g L−1, SI ≥8 μmol L−1 and iron saturation (ISAT) ≥12%; or nonanaemic iron deficiency (NAID) if the Hb concentration was >110 g L−1 and SF <15 μg L−1 or SI <8 μmol L−1, TF >3.0 g L−1, and ISAT <12%; or as iron deficiency anaemia (IDA) if the Hb concentration was <110 g L−1 in association with SF <15 μg L−1 or with SI <8 μmol L−1, TF >3.0 g L−1 and ISAT <12%.

Results:

Sixty‐nine per cent of Caucasian children were classified IS, 25% as NAID and 6% were IDA; while 72% of Asian children were classified IS, 14% as NAID and 14% were IDA. Multivariate analysis demonstrated that factors associated with iron deficiency (SF </5 μg L−1) included age, duration of breast‐feeding and cows’ milk intake.

Conclusion:

Iron deficiency is common in our young population. Additional strategies to prevent IDA need be developed and evaluated in Australian infants.
Annotation Understanding tracheomalacia
Authors: BEASLEY SW , QI BQ
Published: November 2003

Tracheomalacia is an abnormality of the trachea that probably is present to some degree in all infants and children with oesophageal atresia. It causes the trachea to collapse during breathing, leading to obstruction of the upper airway. Our knowledge of the structural abnormalities underlying tracheomalacia is limited, mainly because patients with oesophageal atresia usually survive. Recently, the Adriamycin‐induced rat model of oesophageal atresia and tracheomalacia has clarified some aspects of its pathology and the factors which may influence its development. The rat model suggests that the same detrimental factors that cause oesophageal atresia might also affect the development of the trachea, and that anomalous great vessels may exacerbate the severity of tracheomalacia locally.
Sleep deprivation or postnatal depression in later infancy: Separating the chicken from the egg
Authors: ARMSTRONG KL , HAERINGEN AR VAN , DADDS MR , CASH R
Published: November 2003

Objectives:

To explore the association between maternal distress and depression in the first years of a newborn’s life and the child’s sleeping behaviour and problems associated with this behaviour. To asses the effectiveness of an outpatient‐based individualised behaviour modification programme to modify children’s sleep behaviour and to decrease levels of maternal distress and depression.

Method:

Families were referred to an outpatient childhood sleep problems clinic. Intervention consisted of an individualised management programme including recognised modes of child sleep behaviour management (‘controlled crying’, ‘cold turkey,’ rewards) together with occasional use of short‐term (less than 2 weeks) tapering dose sedating medication for the child. Two months after the initial contact with the clinic, families completed a second questionnaire collating similar data to that collected at time of enrolment.

Results:

A total of 114 consecutive families referred to the clinic provided initial data. Follow‐up questionnaires were returned by 70 (61%). Significant change was recorded in children’s sleep parameters including reduction in mean number of night time awakenings (4.1–1.3, P<0.001), proportion of children requiring longer than 30 min to settle at night (49% to 21%, P<0.01) and in the proportion of children settling after 8 pm (51% to 33%, P<0.01). Sleep problem rating on a 0–10 scale decreased from a mean of 8.1–3.1 (P<0.001). On initial assessment, 40% of mothers had Edinburgh Postnatal Depression Scale (EPNDS) scores greater than 12 (screening cut‐off point). At repeat assessment, 4.3% had scores greater than 12. The mean score on the EPNDS fell from 11.2 to 5.8 (P<0.001).

Conclusions:

An outpatient‐based individualised approach to modifying children’s problematic sleep behaviour using recognised behaviour management techniques is effective.

 Modification of problematic childhood sleep behaviour is associated with significant improvement in maternal mood.

 Given the high incidence of childhood sleep problem and diagnosed postnatal depression, it is likely significant numbers of mothers being diagnosed as having postnatal depression are suffering the effects of chronic sleep deprivation.

 Management of postnatal mood disorder and childhood sleep behaviour must occur with due recognition to their close association.
Massive subdural haematoma: An unusual complication of septicaemia in preterm very low birthweight infants
Authors: NG PC , FOK TF , LEE CH , WONG W , CHEUNG KL
Published: November 2003

Non‐traumatic massive subdural haematoma is a rare condition in newborn infants and is usually associated with hereditary coagulation disorders or congential vascular malformation. Its occurrence in preterm very low birthweight infants secondary to systemic bacterial infection has not been reported. We describe two extremely preterm neonates who developed massive subdural haematoma as a result of Gram‐negative septicaemia and disseminated intravascular coagulation. Both infants suffered severe parenchymal cerebral injury and hydrocephalus. Clinicians should be aware of this unusual and catastrophic complication if a very low birthweight infant with severe sepsis and disseminated intravascular coagulation suddenly deteriorates despite successful treatment with antibiotics. Radiological imaging by cranial ultrasound or computed tomography scanning should be routinely considered in all such infants for the detection of intracranial bleeding.
Review Article Reducing the risk of sudden infant death syndrome: A review of the scientific literature
Authors: HENDERSON‐SMART DJ , PONSONBY A‐L , MURPHY E
Published: November 2003

In March 1997 a multidisciplinary forum was convened by the National SIDS Council of Australia to review recent evidence concerning risk factors of sudden infant death syndrome (SIDS) and to revise and refine the current guidelines for reducing the risk of SIDS. The forum provided an assessment of the evidence for recommendations to reduce the risk of SIDS using an evidence‐based process. Strong evidence has now accumulated that the intervention campaigns to reduce prone sleeping during infancy have been followed by SIDS rate declines. Recent data indicate that the supine position is not associated with an increase in significant morbidity outcomes and provides greater protection for SIDS than the side position, which may be unstable. Covering of the baby’s head by bedding is strongly related to SIDS. The infant’s sleeping environment should be carefully set up to ensure that the baby’s head, including the face, cannot be obstructed during sleep.

 Parental smoking is strongly associated with SIDS. Structural supportive interventions for parental smoking cessation are required. Bedsharing increases the risk of SIDS amongst smokers and the data are currently not sufficient to provide complete reassurance to nonsmoking parents that bedsharing is safe. Infants should be maintained in a comfortable temperature zone. The evidence for a protective effect of breast‐feeding is conflicting, so breast‐feeding cannot be promoted strongly as reducing the risk of SIDS. Immunisation has not been associated with SIDS.

 Parents and carers should be aware of the current guidelines. Health professionals should also be aware of the evidence on which the current recommendations are based. Effective health education programmes should lead to a further decline in SIDS mortality in Australia.
Postural drainage in cystic fibrosis: Is there a link with gastro‐oesophageal reflux?
Authors: BUTTON BM , HEINE RG , CATTO‐SMITH AG , PHELAN PD
Published: November 2003

Objectives:

To determine the clinical effects of a change from postural drainage (PD) to positive expiratory pressure chest physiotherapy (PEP) in children with cystic fibrosis (CF) and symptoms of gastro‐oesophageal reflux (GOR). To measure the effects of PD on GOR in children with CF.

Methods:

Study 1: Six adolescents with CF and symptoms of GOR during PD were changed to upright PEP physiotherapy. The effects on lung function, reflux symptom scores and annual hospital days were measured. Study 2: Twenty‐four children with CF (mean age 11 years) and symptoms suggestive of GOR underwent 24‐h pH monitoring, including periods of chest physiotherapy.

Results:

Study 1: All six patients reported a reduction in reflux symptoms during PEP therapy (P<0.001). Lung function parameters improved during the first 6 months of PEP (P<0.001). This improvement was sustained for a further 18 months. Annual hospital days decreased significantly (P<0.0005). Study 2: Nine of 24 patients (37.5%) had pathological GOR. Reflux episodes were significantly increased during PD (P<0.0001), as was fractional reflux time (P<0.01).

Conclusions:

Upright PEP physiotherapy may be more appropriate than PD in selected patients with CF and symptomatic GOR. The role of GOR as a cofactor in the progression of pulmonary disease in CF needs further evaluation.
Hospitalisation for pneumonia in children in Auckland, New Zealand
Authors: GRANT CC , SCRAGG R , TAN D , PATI A , AICKIN R , YEE RL
Published: November 2003

Objective:

To describe the epidemiology of hospitalisations for pneumonia in children in Auckland, New Zealand.

Methods:

A consecutive sample of children hospitalised with pneumonia at the Starship Childrens Hospital from 1 July 1993 to 30 June 1996. Subjects were Pacific Island, Maori, and European/other children aged 0–14 years resident in north, west and central Auckland who were hospitalised with pneumonia. Comparisons were made of the number of hospitalisations by year, ethnicity, age and season; and of the hospitalisation rates by year, ethnicity and age.

Results:

There were 681 children who were hospitalised with pneumonia during 1993–94, 731 during 1994–95 and 630 during 1995–96. The average annual hospitalisation rate was 5.0 per 1000 children aged 0–14 years (95% CI 4.8–5.2). The average annual hospitalisation rate for Pacific Island children was 14.0 per 1000 (95% CI 13.0–14.9), for Maori children 6.7 per 1000 (95% CI 6.0–7.4) and for European/other children was 2.7 per 1000 (95% CI 2.6–2.9). Fifty‐three per cent of the hospitalised children were less than 2 years of age. A larger percentage of Pacific Island (61%) and Maori (60%) children were aged less than 2 years compared to European/other (42%) children (P<0.001). There was marked seasonal variability in the number of hospitalisations, with peaks in hospitalisations corresponding to peaks in positive respiratory viral isolates.

Conclusions:

Pneumonia was a consistent cause of hospitalisation for a large number of Auckland children during this 3‐year period. Hospitalisation rates and age distribution varied with ethnicity. Hospitalisation rates were highest for Pacific Island, intermediate for Maori and lowest for European/other children. Based on these hospitalisation data, pneumonia is a significant cause of morbidity for children in Auckland, New Zealand.
Transcatheter occlusion of atrial septal defects: An initial experience with the Amplatzer septal occluder
Authors: CHAN KY , YIP WCL , GODMAN MJ
Published: November 2003

Objective:

To discuss the initial experience with the use of a new double disc occluding device, the Amplatzer septal occluder in transcatheter occlusion of secundum atrial septal defects (ASD).

Methods:

Transvenous sizing of secundum ASD was performed in five children under general anaesthesia using transoesophageal echocardiographic and fluoroscopic guidance. An Amplatzer septal occluder equal to or minimally larger than the stretched diameter of the ASD was used for transcatheter occlusion of the defect in three suitable patients. Pulmonary balloon valvuloplasty with a 18 mm×3 cm Mansfield balloon catheter was carried out in one patient with associated pulmonary valvar stenosis in the same procedure setting.

Results:

Stretched diameters of the defects in the three patients ranged from 14 to 17 mm. Devices of sizes 14, 17 and 17 were deployed through 7F and 8F sheaths, respectively. The upper and lower rims of interatrial septum were more than 8 mm in all patients. All patients had successful occlusion with complete obliteration of the atrial left to right shunting. Simultaneous pulmonary balloon valvuloplasty for the valvar stenosis reduced pressure gradient from 53 mmHg to 22 mmHg across the valve prior to septal occlusion in one patient. No intraprocedural or short‐term complication was encountered.

Conclusions:

The design of the Amplatzer septal occluder permits ease in loading, delivery, deployment and stable seating of the device. This initial experience shows that Amplatzer device occlusion is feasible, relatively safe and effective and appears to be a viable alternative to surgical closure of secundum atrial septal defects in properly selected patients.
Immunisation has no effect on arousal from sleep in the newborn infant
Authors: LOY CS , HORNE RSC , READ PA , CRANAGE SM , CHAU B , ADAMSON TM
Published: November 2003

Objective:

To investigate arousal from sleep in infants before and after triple antigen immunisation (DTP).

Methodology:

Arousal thresholds were determined in both active sleep (AS) and quiet sleep (QS) the day before and the day following the first DTP immunisation in 14 infants. Arousal was induced using a pulsatile puff of air delivered alternately to the nostrils of the infant.

Results:

Arousal threshold was significantly higher in QS compared to AS in both studies (P<0.001). Mean arousal threshold in the pre immunisation study was not different from that in the post immunisation study in either sleep state. Core temperature and heart rate measured at the time of stimulus delivery were both significantly elevated in the post immunisation study (P<0.001). Sleep duration and number of awakenings from sleep were unaffected by immunisation.

Conclusion:

The first triple antigen immunisation has no effect on arousal from sleep in either AS or QS in this group of infants.
Use of aciclovir in herpes simplex virus infections
Authors: KESSON AM
Published: November 2003

Herpes simplex virus type 1 and type 2 cause a wide range of illnesses ranging from minor cold sores to severe necrotising encephalitis or disseminated systemic infections seen in immunocompromised patients including neonates. Following primary infection, the virus is not eradicated from the body but is latent in sensory nerve ganglia where it can reactivate and cause recurrent disease. Aciclovir is the most studied and used antiviral agent with activity against herpes simplex virus infections. In most situations the use of aciclovir shortens the duration of clinical illness and viral shedding and reduces morbidity and mortality. All life‐ or sight‐threatening infections should be managed in an inpatient hospital setting with intravenous therapy. The use of oral aciclovir is recommended in patients with non‐life‐threatening illness who may still have significant symptoms.
Histomorphometric analysis of aplastic bone disease in chronic renal failure at initiation of haemodialysis: Relation to aluminum and parathormone
Authors: EI Isei , MARUYAMA Hiroki , GEJYO Fumitake , OKADA Masami , AOYAGI Ryuji , SATO Takashi , OHARA Kazuhiko , TANIZAWA Tatsuhiko , TAKAHASHI Hideaki E , ARAKAWA Masaaki
Published: November 2003

SUMMARY: We studied bone histology of 134 uraemic patients without a history of vitamin D administration at the start of haemodialysis. Patients were categorized according to bone histology as follows: aplastic bone disease (ABD), ostitis fibrosa, mixed type, mild hyperparathyroidism and osteomalacia. On initiation of haemodialysis, ABD was observed in 48.5% of patients. the average age of the ABD group (50.8 ± 12.5 years) was significantly higher than that of patients with other histologies (P<0.01). Serum parathyroid hormone (PTH) and alkaline phosphatase (ALP) concentrations were lower (P<0.01) in the ABD group, especially in patients with diabetes mellitus. Patients with diabetes mellitus and ABD had lower serum concentrations of PTH and ALP than non‐diabetic patients, suggesting that depressed PTH may be related to ABD. Eleven (55%) of the 20 patients who were receiving A1(OH)3 also had ABD. A direct relationship was observed between serum aluminum concentration and aluminum‐positive bone surface (r=0.60; P<0.01). Aluminum staining was more frequently observed in the ABD group than in the non‐ABD group (P<0.01). Because serum intact‐PTH concentrations correlate with osteoid surface area, fibrosis volume and bone formation rate, it may be a useful marker of bone histology in renal osteodystrophy. These results suggest that, in addition to conservative treatment with A1(OH)3, other factors may be involved in the formation of ABD which is often present at the start of haemodialysis.
Planning for the restoration of native biodiversity within the Goulburn Broken Catchment, Victoria, using spatial modelling
Authors: Wilson Jenny A. , Lowe Kim W.
Published: November 2003

Summary  Conservation planning aims to ensure the protection and continuation of biodiversity. In rural landscapes in Victoria, this will require the restoration of habitat and biophysical processes to levels that can sustain the majority of species. Planning is required at scales large enough to have ecological relevance. In this study, a land‐use change scenario that plans for the conservation of native biodiversity within the Goulburn Broken Catchment was developed using simple ecological principles. A set of indicative rules for restoring remnant native vegetation was modelled within a geographical information system. The modelling of the rules resulted in a change in rural landscapes from highly fragmented (with few large remnants) to highly connected. Future applications of this approach include incorporating the biodiversity rules into a biophysical model to assess the effect of planning landscapes for the conservation of biodiversity on hydrological and economic outcomes for the region. In addition, the rules are to be refined so that the priority landscapes for biodiversity planning can be identified.
Treatment and outcome of 104 hospitalized patients with legionnaires’ disease
Authors: Howden B. P. , Stuart R. L. , Tallis G. , Bailey M. , Johnson P. D. R.
Published: November 2003

Abstract

Background:  Large outbreaks of Legionella pneumonia are rare, but when they occur provide an opportunity to assess predictors of mortality and efficacy of drug therapy. Although erythromycin has been the treatment of choice for many years, newer antimicrobials with increased activity against Legionella are available. A large outbreak of legionnaires’ disease associated with the Melbourne Aquarium occurred in April 2000.

Aim:  To describe the patterns and impact of Legionella therapy, and predictors of outcome in a large group of hospitalized patients with legionnaires’ disease.

Methods:  A 6‐month retrospective audit of hospitalized patients with proven legionnaires’ disease around the time of the Melbourne Aquarium outbreak was conducted. Statistical analysis was performed using SAS version 8.0 (SAS Institute Inc., NC, USA).

Results:  Data were obtained on 104 patients (71 aquarium related, 33 not related). There were six deaths (mortality rate 5.8%), three of which were attributable directly to progressive legionnaires’ disease. The major predictors of death were pre‐existing cardiac failure (P = 0.0035) and renal disease (P = 0.026). Erythro­mycin is still the most commonly used antibiotic (80% received i.v. erythromycin) with clinicians prescribing more than one active Legionella drug in the majority of cases (76%). Choice of initial antibiotic therapy did not statistically affect outcome as measured by death, length of hospital stay or time to defervescence, although there was a trend towards improved survival with i.v. erythromycin (P = 0.063). Intravenous erythromycin was associated with a 19% rate of phlebitis, whereas side‐effects from other antibiotics were uncommon.

Conclusion:  The most commonly used Legionella therapy in Australia remains erythromycin. This continues to be an effective agent, however, side‐effects are common. (Intern Med J 2003; 33: 484−488)
Reduction of medical error at the point‐of‐care using electronic clinical information delivery
Authors: Wilcox R. A. , Whitham E. M.
Published: November 2003

Abstract

There is accumulating evidence that point‐of‐care delivery of clinical information such as evidence‐based medicine, practice guidelines and drug information can streamline clinical practice and reduce preventable errors. In Australia, hospital‐based physicians have ­generally been slow to fully use these resources to enhance their clinical practice. Here we provide an introduction to the practical application of several hand‐held and electronic information systems available to Australian physicians. (Intern Med J 2003; 33: 537−540)
Secondary screening for osteoporosis in patients admitted with minimal‐trauma fracture to a major teaching hospital
Authors: Wong P. K. K. , Spencer D. G. , McElduff P. , Manolios N. , Larcos G. , Howe G. B.
Published: November 2003

Abstract

Aims:  The aim of the present study was to determine: (i) the prevalence of the investigation and treatment of osteoporosis in patients admitted to hospital with a minimal‐trauma fracture, (ii) the prevalence of osteo­porosis using bone mineral density assessment by dual X‐ray absorptiometry (DEXA) in such patients and (iii) a clinical pathway for the management of osteo­porosis in such patients.

Methods:  A cross‐sectional study was undertaken involving all patients admitted with a fracture to Westmead Hospital, Sydney, Australia, between January 1999 and June 2000 (n = 327). Of these, 264 were excluded because of: (i) the fracture following significant trauma (n = 83), (ii) unavailability of medical records for review (n = 38), (iii) nursing home status (n = 37), (iv) previous malignancy (n = 18), (v) deceased (n = 11), (vi) recent osteoporosis screening and/or treatment (n = 18), (vii) refusal to participate (n = 37), (viii) uncontactable (n = 16) and (ix) inadequate English (n = 6). The remaining 63 patients underwent DEXA assessment and the following laboratory investigations: (i) liver function tests, (ii) urea, (iii) electrolytes, (iv) calcium, (v) phosphate, (vi) full blood count, (v) 25‐hydroxyvitamin D level and (vi) thyroid‐function tests. In men, levels of serum free testosterone, luteinizing hormone, follicle‐stimulating hormone and prolactin were also obtained.

Results:  Of the 63 study participants, 87% of the 47 women were either osteoporotic (T <−2.5) or osteopenic (−2.5 <T <−1) at a mean of 12.7 ± 5.4 months post‐fracture. Of the 16 men screened, 75% had a T‐score ≤−1. Forty‐four per cent of the study sample had a low 25‐hydroxyvitamin D level, 6% were biochemically hyperthyroid and 40% of the men had a low serum free testosterone. Only 16% had an effective anti‐­osteoporotic medication added following the fracture.

Conclusions:  Secondary screening and treatment of osteo­porosis in patients following minimal‐trauma fracture are low. The implementation of a clinical pathway for osteoporosis management in these patients may be useful. (Intern Med J 2003; 33: 505−510)
Automatic Beat‐to‐Beat Left Heart AV Normalization:
Authors: CHIRIFE RAÚL , TENTORI MARÍA CRISTINA , MAZZETTI HÉCTOR , DASSO DANIEL
Published: November 2003

Programming the right heart AV interval to a normal value may cause a nonphysiological left heart AV due to interatrial and interventricular conduction delays, thus affecting cardiac performance. Since AV normalization at rest and exercise may be invalidated by pacing or sensing (mode) changes, the aim of this study was to (1) study the feasibility of a mode independent pacemaker (PM) algorithm for automatic beat‐to‐beat left AV normalization, (2) establish normal values for the time between mitral flow A wave (Af) and ventricular activation (Va), the AfVa interval, the mechanical surrogate of left AV, and (C) determine the range of values of the interatrial electromechanical delays (IAEMDs) and the effect of RA pacing. To pace with the proper right AV, the previously reported RV‐paced interventricular electromechanical delay and the interatrial electromechanical delay, either P‐sensed (IAEMDs) or atrial‐paced (IAEMDp) are required inputs. Data were collected during diagnostic echo Doppler studies in 84 subjects divided in three groups: (1) control with narrow QRS and no structural heart disease (n = 33, age 50 ± 21 years, 42% men); (2) patients in sinus rhythm with diverse cardiac pathologies except LBBB (n = 39, age 69 ± 14 years, 56% men), and (3) DDD‐paced patients (n = 12, mean age 71 ± 6 years). Normal values of AfVa were established from the control group, while IAEMDs and IAEMDp and active atrial flow time (A‐peak), in all subjects. The algorithm was tested by computer simulation under all possible modes with the following calculation: RAV = N + IAEMD − IVD, where RAV is the right AV, N is the desired normal AfVa value, IAEMD is either P‐sensed or A‐paced, and IVD is close to zero for intrinsic narrow QRS and biventricular pacing, or 79 ms for RV pacing. The results demonstrated (1) Normal (controls) AfVa: 85 ± 15 ms (range 52–110 ms); (2) IAEMDs (All): 84 ± 16 ms; (3) atrial pacing prolonged IAEMDs by 57 ± 18 ms (from 93 ± 15 to 150 ± 25 ms, P < 0.0001); and (4) Computer simulation of rate and mode changes validated the normalization algorithm. An automatic, beat‐to‐beat left AV normalization algorithm to preserve a normal AfVa without a hemodynamic sensor is feasible. The normal value of AfVa is 85 ± 15 ms. (PACE 2003; 26:2103–2110)
The Annular Fat Stripe as a Fluoroscopic Guide to Anatomic Sites During Diagnostic and Interventional Electrophysiology Studies
Authors: MOULTON KRIEGH P.
Published: November 2003

Few radiographic landmarks are visible during electrophysiology procedures to aid in catheter positioning other than the catheters themselves. In the 35°‐45° RAO projection, a linear radio‐opacity corresponding to the rings of fat surrounding both annuli can be easily identified. This “fat stripe” can serve as a useful landmark for several important anatomic sites. Intracardiac catheters positioned left of (posterior) the fat stripe lie within an atrial cavity while those positioned to the right (anterior) lie within a ventricular cavity. The superior third of the stripe corresponds to the region of the right and left atrial appendages while the inferior end identifies the site of the coronary sinus os. The middle third serves as a reference for the fast AV nodal pathway and compact AV node. The region corresponding to the slow AV nodal pathway superimposes on the lower third of the fat stripe. Electrophysiological recordings from catheters positioned along the fat stripe always exhibit both an atrial and ventricular component consistent with an annular recording, whether the catheter is septal or free wall in its location. Coronary sinus os engagement and catheterization can be simplified by using the fat stripe as an anatomic guide. In addition to facilitating catheter positioning for evaluating normal AV conduction, the fat stripe can serve as an excellent guide for targeting the majority of structures intended for ablation because of their annular location. These include the compact AV node, the slow AV nodal pathway, the subeustachian isthmus and any accessory pathway. Good ablation catheter tip contact with annular structures is confirmed by observing its movement in unison with the fat stripe. (PACE 2003; 26:2151–2156)
Sudden Cardiac Death with Left Main Coronary Artery Occlusion in a Patient Whose Presenting ECG Suggested Brugada Syndrome
Authors: HATA TADAYOSHI , WATANABE YOSHIO , HATA YOKO , FUKAMI HATSUE , KURODA MAKOTO
Published: November 2003

This article describes a patient who died suddenly during Holter ECG monitoring. A ventricular premature systole with an extremely short coupling interval of 240 ms was immediately followed by torsades de pointes, soon degenerating into ventricular fibrillation. Retrospective survey of the patient's medical records revealed an incomplete right bundle branch block (iRBBB) configuration with fluctuating saddle back‐type ST elevation in leads V1 and V2, these suggesting Brugada syndrome. Autopsy showed complete thrombotic occlusion of the left main coronary artery. (PACE 2003; 26:2175–2177)
Complete Atrioventricular Block Induced by Alcohol Abuse
Authors: LETONJA MITJA , PETROVIČ DANIEL
Published: November 2003

A patient with a history of chronic alcoholism and a reversible complete AV block due to excessive alcohol abuse is reported. The conduction disorder gradually improved after the complete cessation of alcohol consumption as the only means of therapy. During 6 month follow‐up he continued to abstain from alcohol and had intact AV conduction. (PACE 2003; 26:2192–2193)
Perceived temperature effects on microwave heated meals and meal components
Authors: Ryynänen Suvi , Tuorila Hely , Hyvönen Lea
Published: November 2003

Two experiments were carried out to evaluate the effect of serving temperature on the pleasantness of microwave heated ready meals and meal components. Serving temperature clearly affected sensory attributes and the pleasantness of the meal components. However, while instrumental measurements had indicated large differences in temperatures between two microwave heated ready meals with different arrangement of meal components, the consumer panel perceived only small differences in some sensory attributes. Regardless of temperature differences, the overall pleasantness of the two microwave heated meals was judged to be similar. We concluded that serving temperature is critical for the pleasantness of food but, to the extent that it varied in microwave heating, it did not have a major impact on the overall pleasantness of the meal. Possibly in long‐term use, very uneven temperature distribution may become a nuisance and therefore, the arrangement of meal components with a more uniform temperature distribution is recommended.
Active skarn formation beneath Lascar Volcano, northern Chile: a petrographic and geochemical study of xenoliths in eruption products
Authors: MATTHEWS S. J. , MARQUILLAS R. A. , KEMP A. J. , GRANGE F. K. , GARDEWEG M. C.
Published: November 2003

Calcsilicate xenoliths occur in large numbers in some lavas and pyroclastic flows of Lascar Volcano. Their whole‐rock major element and REE compositions indicate that the protolith was the Upper Cretaceous Yacoraite Formation, which crops out extensively in NW Argentina. The whole‐rock major element compositions of the xenoliths fall into specific groups suggesting a strong geochemical zonation in the skarn zone. Three geochemical zones have been identified; (1) an outer metamorphic zone rich in wollastonite; (2) a middle zone rich in pyroxene and garnet; (3) an inner zone rich in pyroxene and magnetite. The two innermost zones have developed from the wollastonite zone by infiltration of metasomatic fluids rich in Fe, Mn, Mg, Ti and Al. Whole‐rock REE patterns have not changed significantly during prograde metamorphism and metasomatism, indicating REE immobility in the altering fluids. Retrograde alteration by acid‐sulphate fluids produced anhydrite skarns and secondary calcite and wilkeite veins in the wollastonite zone. The carbon and oxygen isotopic compositions of this calcite indicate that it formed by Rayleigh crystallization from a low‐temperature (<200 °C) fluid containing dissolved H2CO3. The calculated δ18O of the water in this fluid suggests a magmatic origin whereas the calculated δ13C of the dissolved carbonate is consistent with derivation from rocks of the Yacoraite Formation at 350 °C. It is suggested that the magmatic acid‐sulphate fluid was responsible for leaching carbonate from the surrounding carbonate rocks and redepositing it in the skarn zone. REEs were mobilized during the retrograde acid‐sulphate and acid‐carbonate alteration. A negative Ce anomaly associated with this carbonate and sulphate indicates high oxygen fugacities in the mineralizing fluids.
Interaction of aqueous fluids with calcareous metasediments during high‐T, low‐P regional metamorphism in the Qadda area, southern Arabian Shield
Authors: DROOP G. T. R. , AL‐FILALI I. Y.
Published: November 2003

The S.W. Nabitah Mobile Belt, Saudi Arabia, contains a Proterozoic island‐arc complex. In the Qadda area, the metavolcanic‐dominated supracrustal sequence records amphibolite facies regional metamorphism of high‐T , low‐P type. Calcsilicate rocks and aluminous dolomitic marbles within the supracrustal sequence have been studied in detail to refine estimates of peak metamorphic P–T  conditions and assess the role of fluids during prograde and retrograde metamorphism.

Fluid‐independent thermobarometers (including the calcite–dolomite thermometer and P‐sensitive equilibria involving grossular, wollastonite, anorthite, meionite, quartz and calcite) yield peak P–T  conditions of c. 650–660 °C, 4 kbar, both higher than previous estimates, giving a revised average thermal gradient of c. 45 °C km–1.

The close match between the peak temperatures implied by calcite–dolomite thermometry and those recorded by univariant devolatilization equilibria suggests that the calcareous rocks were fluid‐bearing during late‐prograde and peak metamorphic stages. These fluids were essentially binary H2O–CO2 mixtures with low NaCl and HF concentrations. Most were H2O‐rich, with XCO2 between 0.02 and 0.2, but values of c. 0.6 are recorded by two samples. High modal abundances of the solid products of decarbonation reactions (e.g. c. 10–50% wollastonite) in many of the rocks that record low‐XCO2 equilibrium fluids implies infiltration of significant quantities of externally derived aqueous fluid during late‐prograde metamorphism, but not enough to exhaust the buffering capacity of the rocks. Calculated minimum time‐integrated fluid‐to‐rock ratios of five wollastonite‐bearing calcsilicate rocks range from 0.7±0.22 to 1.39±0.46 (1σ); those of six marbles range from c. 0 to 4±1.4. The latter variation occurs on a metre‐scale, implying focusing of fluid flow. Diopside‐rich rocks record fluid‐to‐rock ratios of up to 88±48. Penetrative wollastonite lineations indicate a temporal link between infiltration and distributed ductile deformation. Infiltrating fluids were probably derived both from the prograde dehydration of adjacent metabasalts and metatuffs and from crystallization of voluminous pretectonic granitoid intrusions. In general, fluid‐to‐rock ratios deduced for the metavolcanic‐dominated Qadda area are similar to those recorded by rocks in the metasediment‐dominated terrane of N. New England.

The occurrence of post‐tectonic retrograde hydration textures in both carbonate‐bearing and carbonate‐free rocks otherwise lacking hydrous minerals testifies to infiltration of aqueous fluids during retrograde metamorphism in the absence of penetrative deformation. Minimum fluid‐to‐rock ratios calculated for secondary grossular reaction rims in some calcsilicates are c. 0.04. Later patchy hydration of scapolite probably utilized static, pore‐filling fluids remaining after the early retrograde infiltration.
Raman spectrum of carbonaceous material: a possible metamorphic grade indicator for low‐grade metamorphic rocks
Authors: YUI T.‐F. , HUANG E. , XU J.
Published: November 2003

Raman spectral analyses of carbonaceous material (CM) extracted from pelitic samples along two sections traversing the metamorphic belt of Taiwan were carried out in the present study. The results show similar spectral variations of CM with metamorphic grade as those documented in the literature. However, continuous sampling from zeolite facies through prehnite–pumpellyite facies to greenschist facies metamorphic rocks in the present study does reveal some interesting features on the Raman spectra of CM that were not noted before. Both the Raman D (disordered‐)/O (ordered‐) peak area (i.e. integrated intensity) ratio and the D/O peak width (i.e. full width at half maximum, FWHM) ratio of the CM decrease with progressive metamorphism, but the most prominent change in the D/O peak area ratio occurs in samples of lower greenschist facies metamorphic grade, while the most significant decrease in the D/O peak width ratio occurs in samples near the boundary of prehnite–pumpellyite facies and greenschist facies. This phenomenon is interpreted as a result of the decoupling of the changing rates of in‐plane crystallite size and degree of defects of CM with progressive metamorphism. It is postulated that the Raman spectrum of CM can serve as a metamorphic grade indicator to distinguish samples of prehnite–pumpellyite facies metamorphic grade from those of greenschist facies metamorphic grade.
The effect of second‐phase particles on stable grain size in regionally metamorphosed polyphase calcite marbles
Authors: MAS D. L. , CROWLEY P. D.
Published: November 2003

Samples of the calcite‐rich Shelburne Marble collected at the Pfizer Quarry in Adams, Massachusetts, show an order of magnitude variation in grain size. Calcite grain size ranges from 94 to 1101 μm. Because these calcite marbles share the same pressure, temperature and strain histories, some other factor must be responsible for the grain size variation.

Grain size appears to be controlled by the concentration of impurity or second‐phase particles. Large calcite grain size occurs where the volume fraction of second‐phase particles is low and grain size decreases as second‐phase volume fraction increases. The relationship between calcite grain size (D), second‐phase grain size (d ) and second‐phase volume fraction ( f ) can be described by the power law D/d=1.4/f  0.36, a result that is consistent with models based upon short‐term (hours or days) laboratory experiments with metals and ceramics and computer simulations of grain growth. Grain growth appears to be greatly restricted by as little as a few per cent of second‐phase particles, with a transition from highly restricted to almost unrestricted grain growth occurring at ≈5% volume of second‐phase particles. These results indicate that second‐phase particles exercise an important control on grain size and can effectively inhibit grain growth in metamorphic rocks. The behaviour of second‐phases in short‐term laboratory experiments may closely approximate the behaviour of second‐phases in grain growth lasting several orders of magnitude longer in the metamorphic environment.
Retinal and Optic Nerve Diseases
Authors: Margalit Eyal , Sadda Srinivas R.
Published: November 2003

Abstract:  A variety of disease processes can affect the retina and/or the optic nerve, including vascular or ischemic disease, inflammatory or infectious disease, and degenerative disease. These disease processes may selectively damage certain parts of the retina or optic nerve, and the specific areas that are damaged may have implications for the design of potential therapeutic visual prosthetic devices. Outer retinal diseases include age‐related macular degeneration, pathologic myopia, and retinitis pigmentosa. Although the retinal photoreceptors may be lost, the inner retina is relatively well‐preserved in these diseases and may be a target for retinal prosthetic devices. Inner retinal diseases include retinal vascular diseases such as diabetic retinopathy, retinal venous occlusive disease, and retinopathy of prematurity. Other retinal diseases such as ocular infections (retinitis, endophthalmitis) may affect all retinal layers. Because the inner retinal cells, including the retinal ganglion cells, may be destroyed in these diseases (inner retinal or whole retinal), prosthetic devices that stimulate the inner retina may not be effective. Common optic nerve diseases include glaucoma, optic neuritis, and ischemic optic neuropathy. Because the ganglion cell nerve fibers themselves are damaged, visual prosthetics for these diseases will need to target more distal portions of the visual pathway, such as the visual cortex. Clearly, a sound understanding of retinal and optic nerve disease pathophysiology is critical for designing and choosing the optimal visual prosthetic device.
Visually Guided Performance of Simple Tasks Using Simulated Prosthetic Vision
Authors: Hayes Jasmine S. , Yin Vivian T. , Piyathaisere Duke , Weiland James D. , Humayun Mark S. , Dagnelie Gislin
Published: November 2003

Abstract:  Loss of photoreceptor cells is one of the major causes of blindness. Several groups are exploring the functional replacement of photoreceptors by a retinal prosthesis. The goal of this study was to simulate the vision levels that recipients of retinal prostheses with 4 × 4, 6 × 10, and 16 × 16 electrode arrays may experience, and to test the functionality of this vision. A PC video camera captured images that were converted in real time into dots (“pixels”). The PC monitor and a head‐mounted display worn by test subjects displayed the pixelized images. To assess performance of normally sighted individuals with each array, we designed a set of tasks including: four‐choice orientation discrimination of a Sloan letter E, object recognition and discrimination, a cutting task, a pouring task, symbol recognition, and two reading tasks. In the letter E task, subjects were found to have visual acuities of 20/1,810, 20/1,330, and 20/420 with the 4 × 4, 6 × 10, and 16 × 16 arrays, respectively. Most subjects were able to read fonts as small as 36 point with the 16 × 16 array, corresponding with a visual acuity of 20/600 in our system. The test subjects partially overcame the visual limitation of the system by scanning the video camera over the letters allowing spatial and temporal integration of visual information. In all categories, subjects performed best with the 16 × 16 array and least well with the 4 × 4 array. Even with the lowest resolution array, however, some subjects could recognize  simple   objects   and   symbols.