bluuebunny/crossref_metadata_2025 huggingface dataset:
Sex‐biased natal dispersal and inbreeding avoidance in American black bears as revealed by spatial genetic analyses
Authors: COSTELLO CECILY M. , CREEL SCOTT R. , KALINOWSKI STEVEN T. , VU NINH V. , QUIGLEY HOWARD B.
Published: October 2008

We tested the hypothesis that sex‐biased natal dispersal reduces close inbreeding in American black bears, a solitary species that exhibits nearly complete male dispersal and female philopatry. Using microsatellite DNA and spatial data from reproductively mature bears (≥ 4 years old), we examined the spatial genetic structure of two distinct populations in New Mexico from 1993 to 2000. As predicted, relatedness (r) and the frequency of close relationships (parent–offspring or full siblings) decreased with distance among female dyads, but little change was observed among male or opposite‐sex dyads. Neighbouring females were more closely related than neighbouring males. The potential for inbreeding was low. Most opposite‐sex pairs that lived sufficiently close to facilitate mating were unrelated, and few were close relatives. We found no evidence that bears actively avoided inbreeding in their selection of mates from this nearby pool, as mean r and relationship frequencies did not differ between potential and actual mating pairs (determined by parentage analysis). These basic patterns were apparent in both study areas despite a nearly two‐fold difference in density. However, the sex bias in dispersal was less pronounced in the lower‐density area, based on proportions of bears with male and female relatives residing nearby. This result suggests that male bears may respond to reduced competition by decreasing their rate or distance of dispersal. Evidence supports the hypothesis that inbreeding avoidance is achieved by means of male‐biased dispersal but also indicates that competition (for mates or resources) modifies dispersal patterns.
Simple estimates for the magnitude of bedload transport under a turbid surge
Authors: PRITCHARD DAVID
Published: October 2008

Characteristic length and timescales for a turbid surge are used to estimate bedload transport by the surge, deriving estimates for the conditions under which deposited material will be mobilized as bedload, and of the relative importance of bedload in determining the overall deposit geometry. A critique is provided of the common modelling assumptions which underlie these estimates and of how their consistency can be checked. For large turbidity currents, such as those which emplaced the Marnoso Arenacea turbidites in northern Italy, model predictions of overall geometry are not easy to reconcile with the field data: some possible reasons for this are discussed. The estimates obtained from these characteristic scales are consistent with the widespread presence in turbidites of sedimentary structures which indicate bedload transport; some of these structures from the Marnoso Arenacea Formation are reviewed briefly. However, the estimates suggest that bedload transport is not a major factor responsible for the geometry of the large turbidites in this formation, which exhibit a broad thickness maximum in their proximal region that contrasts with the downstream‐thinning geometry of smaller beds. This effect suggests that the explanation for this theoretically unexpected geometry should be sought in other physical mechanisms.
Relative abundance of Δ5‐sterols in plasma membrane lipids of root‐tip cells correlates with aluminum tolerance of rice
Authors: Hossain Khan M. Shahadat , Tawaraya Keitarou , Sekimoto Hiroshi , Koyama Hiroyuki , Kobayashi Yuriko , Murayama Tetsuya , Chuba Masaru , Kambayashi Mihoko , Shiono Yoshihito , Uemura Matsuo , Ishikawa Satoru , Wagatsuma Tadao
Published: October 2008

We investigated variations in aluminum (Al) tolerance among rice plants, using ancestor cultivars from the family line of the Al‐tolerant and widely cultivated Japonica cultivar, Sasanishiki. The cultivar Rikuu‐20 was Al sensitive, whereas a closely related cultivar that is a descendant of Rikuu‐20, Rikuu‐132, was Al tolerant. These two cultivars were compared to determine mechanisms underlying variations in Al tolerance. The sensitive cultivar Rikuu‐20 showed increased permeability of the plasma membrane (PM) and greater Al uptake within 1 h of Al treatment. This could not be explained by organic acid release. Lipid composition of the PM differed between these cultivars, and may account for the difference in Al tolerance. The tolerant cultivar Rikuu‐132 had a lower ratio of phospholipids to Δ5‐sterols than the sensitive cultivar Rikuu‐20, suggesting that the PM of Rikuu‐132 is less negatively charged and less permeabilized than that of Rikuu‐20. We used inhibitors of Δ5‐sterol synthesis to alter the ratio of phospholipids to Δ5‐sterols in both cultivars. These inhibitors reduced Al tolerance in Rikuu‐132 and its Al‐tolerant ancestor cultivars Kamenoo and Kyoku. In addition, Rikuu‐132 showed a similar level of Al sensitivity when the ratio of phospholipids to Δ5‐sterols was increased to match that of Rikuu‐20 after treatment with uniconazole‐P, an inhibitor of obtusifoliol‐14α‐demethylase. These results indicate that PM lipid composition is a factor underlying variations in Al tolerance among rice cultivars.
Lithium‐induced Hashimoto’s encephalopathy: a case report
Authors: Nagamine Masanori , Yoshino Aihide , Ishii Motoyasu , Ogawa Tetsuo , Kurauchi Sachi , Yoshida Takeshi , Shigemura Jun , Kodera Tsutomu , Tanaka Yuji , Nomura Soichiro
Published: October 2008

Objective:  To report on a patient with Hashimoto’s encephalopathy induced by lithium.

Patient and interventions:  A 61‐year‐old woman with a type II bipolar disorder and a history of lithium‐induced thyrotoxicosis associated with silent thyroiditis was hospitalized to treat a severe major depressive episode. Given long‐term treatment with levothyroxine for hypothyroidism that had resulted from silent thyroiditis, endogenous hormone in thyroid follicles was assumed to be minimized by the negative feedback, decreasing risk of recurrent thyrotoxicosis if lithium were restarted.

Results:  Lithium clearly relieved the patient’s depressive symptoms, but after 40 days encephalopathy developed. Thyrotoxicosis was ruled out, and serum antithyroid antibody titers were elevated. In the cerebrospinal fluid, protein content was substantially elevated and antithyroid antibodies were detected. Encephalopathy resolved dramatically after course of intravenous pulse therapy with methylprednisolone.

Conclusions:  We believe that autoantibodies against antigens shared by the thyroid gland and the brain were induced by exposure to lithium, causing the patient to develop Hashimoto’s encephalopathy.
Contributions of spectral frequency analyses to the study of P50 ERP amplitude and suppression in bipolar disorder with or without a history of psychosis
Authors: Carroll Christine A , Kieffaber Paul D , Vohs Jenifer L , O’Donnell Brian F , Shekhar Anantha , Hetrick William P
Published: October 2008

Objective:  The present study investigated event‐related brain potential (ERP) indices of auditory processing and sensory gating in bipolar disorder and subgroups of bipolar patients with or without a history of psychosis using the P50 dual‐click procedure. Auditory‐evoked activity in two discrete frequency bands also was explored to distinguish between sensory registration and selective attention deficits.

Methods:  Thirty‐one individuals with bipolar disorder and 28 non‐psychiatric controls were compared on ERP indices of auditory processing using a dual‐click procedure. In addition to conventional P50 ERP peak‐picking techniques, quantitative frequency analyses were applied to the ERP data to isolate stages of information processing associated with sensory registration (20–50 Hz; gamma band) and selective attention (0–20 Hz; low‐frequency band).

Results:  Compared to the non‐psychiatric control group, patients with bipolar disorder exhibited reduced S1 response magnitudes for the conventional P50 peak‐picking and low‐frequency response analyses. A bipolar subgroup effect suggested that the attenuated S1 magnitudes from the P50 peak‐picking and low‐frequency analyses were largely attributable to patients without a history of psychosis.

Conclusions:  The analysis of distinct frequency bands of the auditory‐evoked response elicited during the dual‐click procedure allowed further specification of the nature of auditory sensory processing and gating deficits in bipolar disorder with or without a history of psychosis. The observed S1 effects in the low‐frequency band suggest selective attention deficits in bipolar patients, especially those patients without a history of psychosis, which may reflect a diminished capacity to selectively attend to salient stimuli as opposed to impairments of inhibitory sensory processes.
The tryptophan hydroxylase gene influences risk for bipolar disorder but not major depressive disorder: results of meta‐analyses
Authors: Chen Christine , Glatt Stephen J , Tsuang Ming T
Published: October 2008

Objective:  Tryptophan hydroxylase is the rate‐limiting enzyme in the synthesis of serotonin, and thus its gene, TPH, has been extensively studied as a risk factor for both bipolar disorder and major depressive disorder. The purpose of the present report is to synthesize the available data on these putative associations and derive best estimates of the nature and magnitude of the influence of TPH on risk for mood disorders.

Methods:  We identified studies that examined the TPH A218C polymorphism in relation to major depressive disorder or bipolar disorder using the PubMed online search engine, ultimately including 10 case‐control studies in two meta‐analyses.

Results:  The AA genotype had a significant effect on risk for bipolar disorder in comparison to either the CC or AC genotypes, suggesting that the A allele may increase risk for bipolar disorder in a recessive manner. None of the three genotypes significantly increased risk for major depressive disorder relative to any of the other genotypes.

Conclusion:  The homozygous recessive genotype of the TPH A218C polymorphism has a significant effect on risk for bipolar disorder but not major depressive disorder. A possible explanation for these results is that the A allele influences mood by permitting or facilitating mania while having no effect on depression. Further replication of these findings in additional large case‐control and family‐based association is needed before TPH can be designated a risk gene for bipolar disorder.
A comparison of cognitive functioning in medicated and unmedicated subjects with bipolar depression
Authors: Holmes M Kathleen , Erickson Kristine , Luckenbaugh David A , Drevets Wayne C , Bain Earle E , Cannon Dara M , Snow Joseph , Sahakian Barbara J , Manji Husseini K , Zarate Carlos A
Published: October 2008

Objective:  Neuropsychological studies of bipolar disorder reveal deficits in a variety of domains, including affective processing, memory, and sustained attention. These findings are difficult to interpret due to the potential confounding effects of mood‐stabilizing medications. The present study aims to compare the cognitive performance of medicated and unmedicated subjects with bipolar depression to healthy control subjects.

Method:  Unmedicated subjects with bipolar depression (UBD, n = 32), subjects with bipolar depression on therapeutic doses of lithium or valproic acid (MBD, n = 33), and healthy control subjects (HC, n = 52) performed neuropsychological tasks measuring affective processing, visual memory, and sustained attention. Performance measures were covaried with age and mood ratings, where applicable.

Results:  With regard to affective processing, the MBD group exhibited greater response latency than the UBD and HC groups. For the same task, the MBD group made more omission errors during the happy condition than in the sad condition. On a task of sustained attention, the MBD group made more errors than the HC group. There were no significant group differences on measures of visual memory.

Conclusions:  Deficits in affective processing were found in the medicated group, while unmedicated subjects appear to be unaffected. In particular, the MBD group made more errors during happy conditions, indicating a potential attentional bias in subjects with bipolar depression on mood‐stabilizing medications. The present study also implicates impairment in sustained attention for medicated subjects with bipolar disorder, particularly those with the type II variety.
Dopamine D3 receptor‐preferring agonists increase dendrite arborization of mesencephalic dopaminergic neurons via extracellular signal‐regulated kinase phosphorylation
Authors: Collo Ginetta , Zanetti Silvia , Missale Cristina , Spano PierFranco
Published: October 2008

Clinical improvements in Parkinson’s disease produced by dopamine D3 receptor‐preferring agonists have been related to their neuroprotective actions and, more recently, to their neuroregenerative properties. However, it is unclear whether dopamine agonists produce their neurotrophic effects by acting directly on receptors expressed by the mesencephalic dopaminergic neurons or indirectly on receptors expressed by astrocytes, via release of neurotrophic factors. In this study, we investigated the effects of the dopamine D3 receptor‐preferring agonists quinpirole and 7‐hydroxy‐N,N‐di‐propyl‐2‐aminotetralin (7‐OH‐DPAT), as well as of the indirect agonist amphetamine, on dopaminergic neurons identified by tyrosine hydroxylase immunoreactivity (TH‐IR). Experiments were performed on neuronal‐enriched primary cultures containing less than 0.5% of astrocytes prepared from the mouse embryo mesencephalon. After 3 days of incubation, both quinpirole (1–10 μm) and 7‐OH‐DPAT (5–500 nm) dose‐dependently increased the maximal dendrite length (P < 0.001), number of primary dendrites (P < 0.01) and [3H]dopamine uptake (P < 0.01) of TH‐IR‐positive mesencephalic neurons. Similar effects were observed with 10 μmamphetamine. All neurotrophic effects were blocked by the unselective D2/D3 receptor antagonist sulpiride (5 μm) and by the selective D3 receptor antagonist SB‐277011‐A at a low dose (50 nm). Quinpirole and 7‐OH‐DPAT also increased the phosphorylation of extracellular signal‐regulated kinase (ERK) within minutes, an effect blocked by pretreatment with SB‐277011‐A. Inhibition of the D2/D3 receptor signalling pathway to ERK was obtained with PD98059, GF109203 or LY294002, resulting in blockade of neurotrophic effects. These data suggest that dopamine agonists increase dendritic arborizations of mesencephalic dopaminergic neurons via a direct effect on D2/D3 receptors, preferentially involving D3 receptor‐dependent neurotransmission.
Short‐lived brain state after cued motor imagery in naive subjects
Authors: Pfurtscheller G. , Scherer R. , Müller‐Putz G. R. , Lopes da Silva F. H.
Published: October 2008

Multi‐channel electroencephalography recordings have shown that a visual cue, indicating right hand, left hand or foot motor imagery, can induce a short‐lived brain state in the order of about 500 ms. In the present study, 10 able‐bodied subjects without any motor imagery experience (naive subjects) were asked to imagine the indicated limb movement for some seconds. Common spatial filtering and linear single‐trial classification was applied to discriminate between two conditions (two brain states: right hand vs. left hand, left hand vs. foot and right hand vs. foot). The corresponding classification accuracies (mean ± SD) were 80.0 ± 10.6%, 83.3 ± 10.2% and 83.6 ± 8.8%, respectively. Inspection of central mu and beta rhythms revealed a short‐lasting somatotopically specific event‐related desynchronization (ERD) in the upper mu and/or beta bands starting ∼300 ms after the cue onset and lasting for less than 1 s.
Mortality risk analysis following routine vs selective defunctioning stoma formation after total mesorectal excision for rectal cancer
Authors: Pata G. , D’Hoore A. , Fieuws S. , Penninckx F.
Published: October 2008

Objective  To answer the question whether a defunctioning stoma (DS) should be constructed routinely after total mesorectal excision or whether it could be used selectively to ensure patient safety.

Method  A PubMed search was performed. All randomized trials on the role of a DS were included. Also, observational articles published between January 1997 and August 2007 were reviewed. Sensitivity analysis of the mortality risk was performed.

Results  The clinical anastamotic leak (CAL) rate was 17% in 358 patients from four randomized trials and 9.6% in 4059 patients from 39 observational studies. The CAL rate increased significantly from 9.6% with DS to 24.4% without DS in four randomized trials, and from 7.9% with DS to 13.2% without DS in 17 observational studies. The re‐operation rate as a result of anastomotic leakage was lower in patients with DS than in patients without DS in both study types. Leak‐related mortality was not significantly different: 7.2% with vs 7.7% without DS in observational studies, and 0% with vs 4.6% without DS in randomized trials. Sensitivity analysis indicated that a selective DS strategy is acceptable if the CAL rate without DS is less than 16.6% with a CAL‐related mortality of no more than 4.6%.

Conclusion  The results of this review support the routine construction of a protective stoma. However, selective use of a DS is justified from a patient safety point of view if the CAL‐rate and its related mortality are limited. Each unit should audit its performance.
How much might cardiovascular disease risk be reduced by intensive therapy in people with screen‐detected diabetes?
Authors: Echouffo‐Tcheugui J. B. , Sargeant L. A. , Prevost A. T. , Williams K. M. , Barling R. S. , Butler R. , Fanshawe T. , Kinmonth A. L. , Wareham N. J. , Griffin S. J.
Published: October 2008

Aims  To assess the cardiovascular disease (CVD) risk of people with screen‐detected Type 2 diabetes and to estimate the risk reduction achievable through early intensive pharmacological intervention.

Methods  In ADDITION‐Cambridge, diabetic patients were identified among people aged 40–69 years through a stepwise screening procedure including a risk score, random and fasting capillary blood glucose, HbA1c and oral glucose tolerance test. In those without prior macrovascular disease, 10‐year CVD risk was computed using UK Prospective Diabetes Study (UKPDS) and Framingham engines. The absolute risk reduction achievable and its plausible range were predicted using relative risk reductions for individual therapies from published trials and sensitivity analysis.

Results  Of the 867 individuals with undiagnosed diabetes, 19% had pre‐existing CVD, 97% were overweight or obese, 86% had hypertension, 75% had dyslipidaemia, 20% had microalbuminuria and 18% were smokers. Of those with hypertension, 35% were not prescribed drugs and 42% were suboptimally treated. Of participants with dyslipidaemia, 68% were not prescribed medications and 22% were poorly controlled. Median 10‐year CVD risk was 34.0%[interquartile range (IQR) 26.2–44.6] in men and 21.5% (IQR 15.7–28.7) in women using the UKPDS engine; 38.6% (IQR 27.8–53.0) in men and 24.6% (IQR 17.2–32.9) in women using Framingham equations. In the most conservative scenario (no additive effect of therapies), the absolute risk reduction achievable through multifactorial therapy ranged from 4.9 to 9.5% (UKPDS) and from 5.4 to 10.5% (Framingham). The corresponding ranges of numbers needed to treat were 11–20 and 10–19.

Conclusions  People with screen‐detected diabetes have an adverse cardiovascular risk profile, which is potentially modifiable through application of existing treatment recommendations.
Mathematical Analysis of a Soccer Game. Part II: Energy, Spectral, and Correlation Analyses
Authors: Yue Zengyuan , Broich Holger , Seifriz Florian , Mester Joachim
Published: October 2008

Following the calculations on the individual and collective behaviors of players and the ball in Part I, further calculations are carried out in Part II concerning (i) the specific kinetic energy of each player, (ii) the power densities of various quantities for different groups of players (forwards, defenders) and for the geometrical centers of the two teams, as well as for the ball, and (iii) the correlations of various quantities among different groups of players and the ball, as well as among the geometrical centers and the ball. Some parameters are compared between the two teams. The relation between these parameters and the potential indicators and all the influencing factors to the final result of a soccer match are discussed. Advantages and limitations of the present approach and some ideas for the future research are outlined.
The Klein–Gordon Equation in a Domain with Time‐Dependent Boundary
Authors: Pelloni B. , Pinotsis D. A.
Published: October 2008

We solve a Dirichlet boundary value problem for the Klein–Gordon equation posed in a time‐dependent domain. Our approach is based on a general transform method for solving boundary value problems for linear and integrable nonlinear PDE in two variables. Our results consist of the inversion formula for a generalized Fourier transform, and of the application of this generalized transform to the solution of the boundary value problem.
Clinical features and natural history of acquired cold urticaria in a tertiary referral hospital: a 10‐year prospective study
Authors: Katsarou‐Katsari A , Makris M , Lagogianni E , Gregoriou S , Theoharides T , Kalogeromitros D
Published: October 2008

Background  Acquired cold urticaria (ACU) represents a heterogeneous group of disorders that share a common clinical feature: the development of urticaria or angioedema after cold exposure. We present epidemiological and clinical data of subjects with ACU, natural progression and we examine possible parameters that could correlate with disease severity.

Methods  During a 10‐year period in all subjects with ACU, detailed record of personal history, laboratory testing, cold stimulation testing (CST), atopy assessment and disease severity took place. In a re‐evaluation visit at the end of the surveillance period, ACU progression was assessed from patients in a subjective way.

Results  Four thousand one hundred fifty‐seven individuals with chronic urticaria were referred, and 352 (198 males, 154 females, 8.47% of patients with chronic urticaria) presented definite symptoms of physical urticarias, while 95 individuals (49 males, 46 females, 27% of patients with physical urticarias) were detected with ACU. Sixty‐two participants were included in study analysis. Thirty‐two patients (51.6%) were female; the mean age was 41.5 ± 15.6 years, while the mean age at disease onset was 32.5 ± 15.6 years; half were ≤ 30 years old at disease onset. The mean duration of surveillance was 9.0 ± 6.9 years. During this time interval, 18 patients (29.0%) showed the same or even worse symptomatology, 26 patients reported some improvement (41.9%), while in 18 patients, symptoms resolved completely (29.0%); the mean time to resolution was 5.6 ± 3.5 years. Disease severity was the only variable statistically significantly related to disease progression (P = 0.004).

Conclusions  Cold urticaria is a chronic persistent disorder with occasional severe clinical manifestations.
What Can the FOCUS E‐mail Discussion Group Tell Us About the Issues Facing CAMH Professionals?
Authors: Low Jessica , Dugmore Ottilie
Published: October 2008

Background:  The FOCUS e‐mail discussion group was established in 1998 with the aim of facilitating information‐sharing between professionals working in child and adolescent mental health services (CAMHS).

Method:  A content analysis was carried out on messages sent to the FOCUS e‐mail discussion group between September 2004 and August 2005.

Results:  Discussion topics were widely distributed across twelve main themes, reflecting the breadth of issues discussed by CAMH professionals. The five most frequently discussed were: clinical cases; workforce issues; interventions; service policy; and service organisation.

Conclusion:  The findings demonstrate the usefulness of the FOCUS e‐mail discussion group as a means of identifying the key issues facing CAMH professionals and consequently its potential to inform healthcare practice and policy.
REVIEW OF EXHIBITION
Authors: RUBIN PATRICIA
Published: October 2008

Leonardo da Vinci, The Hayward Gallery, London, 26 January – 16 April 1989, with a fully illustrated catalogue by Martin Kemp, Jane Roberts and Philip Steadman, introduction by E. H. Gombrich
Alcohol Withdrawal‐Induced Hippocampal Neurotoxicity In Vitro and Seizures In Vivo are Both Reduced by Memantine
Authors: Stepanyan Tracy D. , Farook Justin M. , Kowalski Alexandra , Kaplan Eva , Barron Susan , Littleton John M.
Published: October 2008

Background: The ethanol withdrawal (EWD) syndrome is typically treated using benzodiazepines such as diazepam. However there is concern that benzodiazepines may not prevent neurotoxicity associated with EWD. Antagonists of glutamate/N‐Methyl‐D‐Aspartate receptors (NMDARs) such as MK801 have been shown to be effective against both EWD‐induced neurotoxicity in vitro and seizures in vivo. However, most of these agents have adverse side effects. An exception is the moderate affinity NMDAR channel blocker memantine, used in Alzheimer’s dementia. The present studies examined the ability of memantine to protect against EWD‐related toxicity in vitro and seizures in vivo.

Methods: Organotypic hippocampal slice cultures from neonatal rat pups were treated starting at 15 days in vitro with 100 mM ethanol for 10 days followed by a 24‐hour EWD period. During the 24‐hour EWD period cultures were treated with memantine (15 or 30 μM). MK801 (10 μM) was utilized as a positive control. For the in vivo studies, the ability of memantine (2, 5, 10, and 15 mg/kg) to reduce convulsions was analyzed in Swiss‐Webster mice using the handling induced convulsion test paradigm.

Results: In vitro studies demonstrated that memantine is effective at blocking EWD‐induced neurotoxicity. In vivo experiments showed that memantine also significantly reduced convulsions induced by EWD in mice.

Conclusions: Memantine may be of therapeutic value during alcohol detoxification by virtue of its having neuroprotective effects in addition to anti‐seizure activity. The potential role of memantine in treatment of alcoholism is deserving of further study.
Variable Judgments of Decisional Capacity in Cognitively Impaired Research Subjects
Authors: Stocking Carol B. , Hougham Gavin W. , Danner Deborah D. , Patterson Marion B. , Whitehouse Peter J. , Sachs Greg A.
Published: October 2008

OBJECTIVES:To compare assessments of the decisional capacity of cognitively impaired patients by research assistants (RAs) and by family caregiver/proxies and to determine whether either or both groups judge capacity differently depending on the specific (hypothetical) research enrollment decision being made.

DESIGN:Cross‐sectional.

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

PARTICIPANTS:One hundred forty‐nine patients with established dementia diagnoses and their caregiver/proxies.

MEASUREMENTS:As part of a longer interview, patients were asked about future enrollment in five hypothetical research projects with varying risks and benefits. After patients reported each decision and reasons for that decision, RAs (using Applebaum and Grisso's four standards) indicated whether the patients were competent to make that decision on their own. In separate interviews, caregiver/proxies were asked for a similar appraisal based on life experience with the patient. RA and proxy judgments were compared.

RESULTS:Capacity judgments by RAs and by caregiver/proxies differed according to specific project for most patients. Agreement between RA and caregiver/proxy judgments varied according to project, but agreement was only fair when tested using kappa (range in data 0.21–0.39). Caregiver/proxies appraised 50 patients as competent for all decisions, and RAs assessed 47 as so. Of these, only 24 were the same patients.

CONCLUSION:If capacity were assessed anew for each enrollment decision, more potential participants could maintain authority in making those decisions.
A Comprehensive Hip Fracture Program Reduces Complication Rates and Mortality
Authors: Pedersen Susanne J. , Borgbjerg Finn M. , Schousboe Birgitte , Pedersen Bente D. , Jørgensen Henrik L. , Duus Benn R. , Lauritzen Jes B. ,   Hip Fracture Group of Bispebjerg Hospital
Published: October 2008

OBJECTIVES: To evaluate the rate of postoperative complications, length of stay, and 1‐year mortality before and after introduction of a comprehensive multidisciplinary fast‐track treatment and care program for hip fracture patients (the optimized program).

DESIGN: Retrospective chart review with historical control.

SETTING: Orthopedic ward (110 beds) at a university hospital (700 beds).

PARTICIPANTS: Five hundred thirty‐five consecutive patients aged 40 and older (94%≥60) hospitalized for hip fracture between January 1, 2003, and March 31, 2004. Three hundred and thirty‐six patients (70.3%) were community dwellers before the fracture and 159 (29.7%) were admitted from nursing homes.

INTERVENTION: The fast‐track treatment and care program included a switch from systemic opiates to a local femoral nerve catheter block; an earlier assessment by the anesthesiologist; and a more‐systematic approach to nutrition, fluid and oxygen therapy, and urinary retention.

RESULTS: In the intervention group, the rate of any in‐hospital postoperative complication was reduced from 33% to 20% (odds ratio=0.61, 95% confidence interval=0.4–0.9; P=.002). Rates of confusion (P=.02), pneumonia (P=.03), and urinary tract infection (P<.001) were lower in the intervention group than in the control group, and length of stay was 15.8 days in the control group, versus 9.7 days in the intervention group (P<.001). For community dwellers, 12‐month mortality was 23% in the control group versus 12% in the intervention group (P=.02). Overall 12‐month mortality was 29% in the control group and 23% in the intervention group (P=.2).

CONCLUSION: The optimized hip fracture program reduced the rate of in‐hospital postoperative complications and mortality. Randomized clinical trials are needed to confirm these results and elucidate the elements of the program that have the greatest effect on clinical outcomes and mortality.
Image Integration‐Guided Catheter Ablation of Atrial Fibrillation: A Prospective Randomized Study
Authors: DELLA BELLA PAOLO , FASSINI GAETANO , CIREDDU MANUELA , RIVA STEFANIA , CARBUCICCHIO CORRADO , GIRALDI FRANCESCO , MACCABELLI GIUSEPPE , TREVISI NICOLA , MOLTRASIO MASSIMO , PEPI MAURO , GALLI CLAUDIA A. , ANDREINI DANIELE , BALLERINI GIOVANNI , PONTONE GIANLUCA
Published: October 2008

Image Integration for Catheter Ablation of Atrial Fibrillation. Background: Several studies have provided details of left atrial anatomy by means of the image integration techniques, particularly focusing on the atypical patterns of the pulmonary veins.

Objective:
To compare, in a prospective, randomized fashion, the conventional method of pulmonary vein disconnection and the image integration‐guided approach.

Methods:
Two hundred and ninety consecutive patients (290 patients, mean age 55 ± 11 years) with drug‐refractory paroxysmal or persistent atrial fibrillation were enrolled in the study and were divided into two treatment groups: group 1 (145 patients) undergoing an imaging integration‐guided (CartoMerge TM) ablation; group 2 (145 patients) treated by a conventional radiofrequency catheter ablation procedure. The arrhythmia was refractory to at least two antiarrhythmic drugs (IC, amiodarone).

Results:
Electrical disconnection of all identified pulmonary veins was obtained in all patients of both groups. Bidirectional block of the cavotricuspid isthmus was achieved in 34 group 1 patients and in 40 group 2 patients. Left mitral isthmus ablation was attempted in 52 group 1 patients and in 56 group 2 patients. At a mean follow‐up of 14 ± 12 months, the atrial fibrillation‐free survival rate was significantly higher in group 1 patients compared with group 2 patients (88% vs 69%, P = 0.017). The analysis for the subset of patients with previously ineffective ablation (98 patients: 52 group 1 patients and 46 group 2 patients) showed a significantly lower recurrence rate in group 1 versus group 2 (19% vs 48%, P < 0.01).

Conclusions:
Our data indicate a superior efficacy of the image‐integration guided catheter ablation of atrial fibrillation over the long term. (J Cardiovasc Electrophysiol, Vol. 20, pp. 258‐265, March 2009)
Percutaneous coronary intervention and the use of glycoprotein IIb/IIIa inhibitors in patients with chronic kidney disease on dialysis: A single center experience
Authors: KHAJA Azam , GARG Rajeev , GOVINDARAJAN Gurushanker , MADSEN Richard , AGGARWAL Kul
Published: October 2008

Patients on dialysis constitute a major healthcare burden with high prevalence of coronary artery disease frequently requiring coronary revascularization. Prior studies have reported high complications rates with revascularization in patients on dialysis. However, information on the use glycoprotein and direct thrombin inhibitors in this patient population undergoing percutaneous revascularization is limited. We retrospectively analyzed the procedural success and in‐hospital outcomes of percutaneous coronary revascularization in 56 consecutive patients on dialysis compared with 524 patients without renal failure, between January 2001 and August 2007 at our facility. Additionally, we also analyzed the off‐label use of glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors during revascularization in this high‐risk group of patients to evaluate for possible increased bleeding complications. In the study group, 7 interventions were performed on peritoneal dialysis and 49 on hemodialysis patients. Sixty‐one percent of these patients had diabetes mellitus. A total of 72 lesions were intervened upon; 12 underwent angioplasty and 60 underwent stenting. Four of 72 interventions were not successful, giving a procedural success rate of 94%. There were 6 immediate complications (10.7%), but no deaths. Thirty‐two patients (57%) received GP IIb/IIIa inhibitors while direct thrombin inhibitors were used during percutaneous coronary intervention in 11(20%) patients. There were no bleeding complications with use of either GP IIb/IIIa inhibitors or direct thrombin inhibitors. In our experience, percutaneous coronary intervention has high procedural success in dialysis patients and concomitant use of GP IIb/IIIa inhibitors is not associated with any major bleeding complications, making this a feasible, safe and effective revascularization option for patients on dialysis; however, this merits further study in a randomized prospective trial.
Orally administrated Juzen‐taiho‐to/TJ‐48 ameliorates erythropoietin (rHuEPO)‐resistant anemia in patients on hemodialysis
Authors: NAKAMOTO Hidetomo , MIMURA Taku , HONDA Nobuko
Published: October 2008

Maintenance of the red blood cell volume is a fundamental aspect of ensuring oxygen supply to the tissue. Recombinant human erythropoietin (rHuEPO) was approved for marketing in Japan in 1990 for the treatment of anemia in patients on dialysis. Recombinant human erythropoietin caused a significant increase in hemoglobin (Hb) levels in patients on dialysis. However, not all have a good response to rHuEPO therapy; the causes of rHuEPO failure include iron deficiency, infection, uremia, and interaction of some drugs. Juzen‐taiho‐to (TJ‐48), a mixture of extracts from 10 medicinal herbs, has been used traditionally to treat patients with anemia, anorexia, or fatigue. To clarify the effect of TJ‐48 on erythropoietin‐resistant anemia, we studied the effect of TJ‐48 in patients on hemodialysis with erythropoietin‐resistant anemia. We divided 42 end‐stage renal disease patients on hemodialysis with erythropoietin‐resistant anemia (Hb<10.0 g/dL with rHuEPO 9000 U/wk or 15 U/kg/wk treatment) into 2 groups as follows: a TJ‐48‐treated group (TJ‐48 group, 7.5 g/d, n=22) and a TJ‐48 nontreated (control group, n=20). At the beginning of this study, there was no significant difference between the groups in age, sex, serum creatinine, blood urea nitrogen, serum iron, and ferritin. After 12 weeks of treatment, the Hb level had significantly increased from 8.4 ± 1.1 to 9.5 ± 1.3 g/dL (P=0.0272) in the TJ‐48 group. C‐reactive protein (CRP) had significantly decreased from 1.4 ± 1.7 to 0.6 ± 0.8 mg/dL (P=0.0438). There was a significant negative correlation between Hb and CRP in the TJ‐48 group (r2=0.121, P=0.0066). In contrast, in the control group, Hb and CRP showed no significant changes throughout this study. Nor was there a significant correlation between Hb and CRP in the control group. In conclusion, TJ‐48 was effective in improving erythropoietin‐resistant anemia in end‐stage renal disease patients. This effect was, at least in part, due to the anti‐inflammatory effect of TJ‐48 in patients on hemodialysis.
Hemodialysis access‐related survival and morbidity in an elderly population in South West Thames, UK
Authors: EKBAL Nasirul J. , SWIFT Pauline A. , CHALISEY Anil , STEELE Maggi , MAKANJUOLA David , CHEMLA Eric
Published: October 2008

Elderly patients form the most rapidly expanding group of hemodialysis (HD) patients in Europe and the United States. There are initiatives to promote an increase in arteriovenous fistula (AVF) formation. There are concerns that elderly patients may have lower rates of surgical vascular access compared with younger patients due to risks of higher co‐morbidities, surgical complications, and higher AVF nonuse rates. The aim of this study was to compare access‐related survival and morbidity for dialysis catheters and AVFs and to evaluate the AVF nonuse rate in an elderly population. We have performed a retrospective analysis of access survival and morbidity in patients ≥70 years of age, either on maintenance HD or predialysis with preemptive formation of surgical access. One hundred and forty‐six patients had permanent HD access created during the 18‐month study period, from 1 January 2006 to June 2007. There were 89 male and 57 female patients in whom 78 AVFs and 137 tunneled venous catheters were inserted. There was a significantly greater loss of vascular access due to infection in the catheter group compared with the AVF group (P<0.016). Access survival was also significantly prolonged in the AVF group (446 days, 95% confidence interval 405–487) compared with the catheter group (276 days, 95% confidence interval 240–313), P=0.001. The rate of nonuse of AVFs was low (16%). We conclude that an AVF is the preferred form of vascular access in elderly HD patients.
Correlation between physical functioning and sleep disturbances in hemodialysis patients
Authors: SABBAGH Ramsey , IQBAL Sameena , VASILEVSKY Murray , BARRÉ Paul
Published: October 2008

The study set out to investigate the relationship between physical functioning, inflammatory status, and sleep disturbance in a chronic hemodialysis (HD) population. Forty‐six maintenance HD patients from the McGill University Health Centre were enrolled in this study between October 2005 and 2006. The well‐validated Human Activity Profile (HAP) questionnaire and the RAND 36‐item survey were used to assess physical functioning. Subjects were given the Pittsburgh Sleep Quality Index (PSQI) survey to evaluate the degree of sleep disturbance. Inflammatory status was assessed with the average value of serial C‐reactive protein (CRP) levels for each patient, over a period of 12 months before their enrollment in the study. A multivariate logistic regression model was created for these analyses to control for potential confounders, including dialysis adequacy, inflammation, and hemoglobin. Seventy‐six percent of the study population had poor sleep as per the Pittsburgh Sleep Quality Index (PSQI score ≥5). In addition, 65% of subjects had high CRP values (>5 mg/L). On univariate analysis, both a CRP >5 mg/L and a lower adjusted activity score (AAS) on the HAP were significantly associated with poor sleep (PSQI score ≥5). Multivariate logistic analysis demonstrated that the AAS remained significantly associated with poor sleep, with a 6% decrease in the odds of poor sleep for each score increase in the AAS of the HAP. Poor physical functioning in chronic HD patients, as measured by the HAP, is associated with sleep disturbance, after controlling for inflammation and dialysis adequacy.
Low‐molecular‐weight heparin for routine hemodialysis
Authors: DAVENPORT Andrew
Published: October 2008

Unfractionated heparin (UFH) is a series of molecules, and as such has variable pharmacodynamics. Low‐molecular‐weight heparins were developed to improve both drug pharmacokinetics and dynamics, so as to provide a reliable clinical effect. These are potent agents, but have an increased half‐life compared with UFH in dialysis patients, and also require special laboratory monitoring. We switched our chronic hemodialysis patients from unfractionated to low‐molecular‐weight heparins. Low‐molecular‐weight heparins proved to be effective in preventing extracorporeal circuit clotting, and safe with fewer bleeding episodes and heparin‐induced thrombocytopenia than standard UFH. Indeed, we stopped routine laboratory monitoring because of the lack of side effects, and simply dosed by clinical inspection of the extracorporeal circuit for thrombus, and the time for fistula needle sites to stop bleeding. These agents have become the anticoagulants of choice in Europe for routine outpatient hemodialysis sessions, not only due to reduced drug costs but also due to the reliability of their clinical effect and ease of administration.
Oxygen‐Enhanced Crystallization of Solution‐Derived 12CaO·7Al2O3
Authors: Sakamoto Naonori , Hori Masahito , Matsuyama Yuki , Wakiya Naoki , Suzuki Hisao
Published: October 2008

12CaO·7Al2O3 (C12A7) composed of nanosize cage structure can clathrate oxygen radicals (O−) and has a high potential to application of strong oxidizing catalysis. In the present report, we demonstrate a fabrication route to C12A7 fine powders by Chemical Solution Deposition method in order to enhance the catalytic reactivity. Aluminum sec‐butoxide, calcium nitrate tetrahydrate, acetylacetone, 2‐methoxyethanol, and nitric acid were used as raw materials. Precursor solution was dried and annealed at 800°–900°C in air or O2 atmosphere. Crystalline C12A7 powders were obtained by annealing at 900°C in O2 atmosphere. Scanning electron microscope and transmission electron microscope images of the obtained powders revealed C12A7 particles were sintered and formed several micrometer particles with many pores. BET specific surface area of the powders was 4.2 m2/g. Possibility for synthesizing C12A7 powder with higher specific surface area by the solution process was indicated.
High‐Thermal‐Conductivity AlN Filler for Polymer/Ceramics Composites
Authors: Kume Shoichi , Yamada Ikuko , Watari Koji , Harada Isao , Mitsuishi Kenshi
Published: October 2008

To increase the thermal conductivity of polymer/ceramic composites, aluminum nitride (AlN) granules were added as a ceramic filler. Granules, sintered at 1850°C for 24 h, showed a very high conductivity of 266±26 W (m·°C)−1, as measured by a thermal microscope equipped with thermoreflectant and periodic heating techniques. This conductivity exceeds 80% of the theoretical value of AlN. Ceramic fillers consisting of the obtained AlN granules and commercially available hexagonal boron nitride particles (h‐BN) powder plus polyimide resins were mixed and then molded at 100 MPa and 420°C in a vacuum. The resultant composite showed a high conductivity of 9.3 W (m·°C)−1. This study demonstrates that a high‐thermal‐conductivity filler effectively enhances the conductivity of polymer/ceramic composites.
Synthesis of ZnO Microtubes by a Facile Aqueous Solution Process
Authors: Lin Liwei , Watanabe Hideo , Fuji Masayoshi , Endo Takeshi , Yamashita Seiji , Takahashi Minoru
Published: October 2008

Zinc oxide (ZnO) microtubes 1.0–2.5 μm in length, 300–500 nm in outer diameter, and 50–80 nm in wall thickness have been synthesized by a facile aqueous solution process, by simply dropping ammonia water into zinc chloride aqueous solution. This new method shows some advantages, such as synthesis under atmospheric pressure at a glass flask, low cost and easy control. The growth mechanism of ZnO microtubes is discussed in this paper. The different growth rates of ZnO crystal facets create the different crystallographic facets of hexagonal microtubes. And the polar structure results in the formation of ZnO microtubes for minimizing the spontaneous polarization energy. The dependence of morphologies of ZnO particles on the reaction temperature is also investigated. The scanning electron microscopy results show that the reaction temperature plays an important role in the morphologies of ZnO particles.
Defining Team Performance for Simulation‐based Training: Methodology, Metrics, and Opportunities for Emergency Medicine
Authors: Shapiro Marc J. , Gardner Roxane , Godwin Steven A , Jay Gregory D. , Lindquist David G. , Salisbury Mary L. , Salas Eduardo
Published: October 2008

Across health care, teamwork is a critical element for effective patient care. Yet, numerous well‐intentioned training programs may fail to achieve the desired outcomes in team performance. Hope for the improvement of teamwork in health care is provided by the success of the aviation and military communities in utilizing simulation‐based training (SBT) for training and evaluating teams. This consensus paper 1) proposes a scientifically based methodology for SBT design and evaluation, 2) reviews existing team performance metrics in health care along with recommendations, and 3) focuses on leadership as a target for SBT because it has a high likelihood to improve many team processes and ultimately performance. It is hoped that this discussion will assist those in emergency medicine (EM) and the larger health care field in the design and delivery of SBT for training and evaluating teamwork.
Maintaining Naval Combatants in ABS Classification In‐Service
Authors: ASHE GLENN M.
Published: October 2008

The American Bureau of Shipping and the Naval Sea Systems Command have been working together over the last several years in a measured initiative to develop and apply classification Rules for naval vessels, and currently both littoral combat ship (LCS) programs and the DDG‐1000 program require that the vessels be built and delivered in class to the Naval Vessel Rules. In addition, the JHSV platform will be delivered in class with ABS. It has been decided that the LCS platforms will be retained in class as a part of their maintenance philosophy. If this is successful, then DD‐1000 will also be retained in class. The JHSV, as are all Military Sealift Command ships, will be retained in class in‐service. This paper reviews the background supporting this initiative, describes the concept of retention in class, outlines the approach adopted, and reviews the current status of application.