bluuebunny/crossref_metadata_2025 huggingface dataset:
Standing Surety in Europe: Common Core or Tower of Babel?
Authors: Kenny Mel
Published: February 2007

This article analyses the treatment of non‐professional suretyship agreements across the EU in the context provided by Commission initiatives aimed firstly at creating a single market in financial services and secondly at improving the coherence of European private law. Predictably, given their polycontextual function, we are confronted with starkly divergent national approaches towards such agreements: a ‘Tower of Babel’ rather than a ‘common core’. The article proceeds to consider how we may see elements of commonality arising through the tension between the differing national approaches – seen in terms of a Unitary Network. In the course of this analysis the treble paradox of surety protection is described. The article finishes with a prediction of the relevance of a dual‐track strategy in this field: involving measures of sector‐specific, vertical harmonisation, and a programme of common‐law style, non‐legislative harmonisation through judicial convergence.
The Justiciability of Resource Allocation
Authors: King Jeff A.
Published: February 2007

A perennial problem in public law is how courts ought to deal with legal challenges to the allocation of public resources. This article explains and renders more coherent the varied approaches of English courts to the justiciability of resource allocation disputes in administrative and tort law. It draws a distinction between ‘discretionary allocative decision‐making’ and ‘allocative impact.’ The non‐justiciability doctrine in R v Cambridge Health Authority, ex p B is concerned with the former only. By contrast, allocative impact is a justiciable matter, but can still ultimately defeat a claim. This distinction, however, does not guide judicial approaches under the Human Rights Act 1998, where courts have chosen mostly to eschew the non‐justiciability doctrine in favour of more flexibly applied notions of judicial deference. Thus while the non‐justiciability doctrine has a relatively narrow scope in administrative and tort law, it has nearly disappeared under human rights law.
The Case for a Rational Reconstruction of Consent in Criminal Law
Authors: Elliott Catherine , De Than Claire
Published: February 2007

This article argues for consistency in criminal law and the need for ‘rational reconstruction’ of the law where necessary to achieve this. It focuses Parliament's failure to respect the need for consistency by passing a statutory definition of consent in the Sexual Offences Act 2003 which appears to apply only to sexual offences. As a result, the law on consent risks being a patchwork of statute and ad hoc case law, without any overarching principle to deal with new situations and different offences. The consequent lack of certainty, accessibility, predictability and fairness is compared to the standards of the European Convention on Human Rights. The statutory definition of consent in the context of the sexual offences is assessed critically as a model which could be used in offences against the person and property offences. The article concludes that until Parliament responds to the need for certainty and consistency by legislating on consent, there can be no rational reconstruction of consent under the Sexual Offences Act 2003.
Tilting at Windmills? Truth and Illusion in ‘The Political Constitution’
Authors: Poole Thomas
Published: February 2007

This article examines the constitutional scholarship of John Griffith. Centring on Griffith's seminal article ‘The Political Constitution’, the analysis reveals a more complex and pessimistic thinker than the standard image of Benthamite radical would allow. The article then examines the cogency of Griffith's vision – particularly his thesis that rights discourse ‘corrupts’ law and politics – against recent developments. It concludes by reflecting on Griffith's radical debunking style.
New Carrots and Sticks: Proposals for Reform of CPR Part 36
Authors: Ward Daniel L.
Published: February 2007

Part 36 of the Civil Procedure Rules is an important component of English civil procedure's costs apportioning mechanism and its primary means of encouraging early settlement. Two changes to make Part 36 more attractive to defendants have been proposed. Firstly, public and insured defendants would be exempted from the requirement of payment into court. Secondly, the costs protection given to a claimant that betters its Part 36 offer at trial – indemnity costs assessment and enhanced interest – would apply to defendants' offers. It is argued that the payment into court requirement should be abolished. Claimants do not reject settlement offers over doubts as to the defendant's solvency as this risk remains throughout the litigation. The requirement only deters defendants from using Part 36. Awarding indemnity costs under Part 36 creates perverse incentives. Where bettering a Part 36 offer weakens costs scrutiny there is an additional incentive to expend disproportionate resources in achieving a better result.
The Usefulness of Book‐to‐Market and ROE Expectations for Explaining UK Stock Returns
Authors: Clubb Colin , Naffi Mounir
Published: February 2007

Abstract:  The fundamental valuation perspective on stock returns suggests that book‐to‐market will be positively related to returns if market value of equity equals future expected cash flows discounted at the expected return and book value proxies for future cash flows. Building on this perspective, we develop a log linear model which includes expectations of future BM and ROE in addition to current BM as explanatory variables for future stock returns. We show that these three variables explain a significant part of UK cross‐sectional stock returns and that they remain highly statistically significant after including additional risk proxy variables. This supports relevance of fundamental valuation based firm characteristics for explaining stock returns and indicates their potential usefulness for predicting future stock returns.
Ownership, Investor Protection and Earnings Expectations
Authors: Dargenidou Christina , McLeay Stuart , Raonic Ivana
Published: February 2007

Abstract:  This study examines the interactive influence of corporate ownership, corporate governance and investor protection on the incorporation of current value shocks in the accounting earnings of European companies. This influence is investigated not only by means of the association between current news and current earnings but also with respect to the association of the same news with expected future earnings, and its persistence. Consistent with the contractual explanation of accounting conservatism, it is shown that the accounting behaviour examined is a function of the demand created by shareholders, and that the institutional arrangements in force are of lesser significance in the presence of widely held ownership. On the other hand, greater separation between supervision and management and stronger investor protection are seen to be influential under close ownership, as these are shown to curb aggressive accounting in the form of a persistently lower recognition of bad news in earnings. Evidence is also provided that stricter corporate governance practices in Europe can substitute for weaknesses in investor protection provisions in law.
Preparing for Critical Infrastructure Breakdowns: The Limits of Crisis Management and the Need for Resilience
Authors: Boin Arjen , McConnell Allan
Published: February 2007

Modern societies are widely considered to harbour an increased propensity for breakdowns of their critical infrastructure (CI) systems. While such breakdowns have proven rather rare, Hurricane Katrina has demonstrated the catastrophic consequences of such breakdowns. This article explores how public authorities can effectively prepare to cope with these rare events. Drawing from the literature on crisis and disaster management, we examine the strengths and weaknesses of traditional approaches to crisis preparation and crisis response. We argue that the established ways of organising for critical decision‐making will not suffice in the case of a catastrophic breakdown. In the immediate aftermath of such a breakdown, an effective response will depend on the adaptive behaviour of citizens, front‐line workers and middle managers. In this article, we formulate a set of strategies that enhance societal resilience and identify the strong barriers to their implementation.
Critical Infrastructure in the Face of a Predatory Future: Preparing for Untoward Surprise
Authors: LaPorte Todd R.
Published: February 2007

The editors of this special issue asked Todd LaPorte to reflect on the issues that emerge from the discussions in this special issue and, more in general, from the discussions that have proliferated in the wake of recent crises and disasters. In his contribution, Professor LaPorte contemplates what political leaders can do to prepare for catastrophic surprises. A crucial initiative, he argues, would be the initiation of a public discussion about the level of distress that a society is willing to accept in the pursuit of efficient, reliable critical infrastructures.
The electrophysiological correlate of contour integration is similar for color and luminance mechanisms
Authors: Mathes Birgit , Fahle Manfred
Published: February 2007

Contour integration perceptually links together similarly oriented line elements hidden between randomly oriented distracters. To investigate how contour integration depends on early sensory processing, we compared the electrophysiological correlate of contour integration of elements defined by luminance (black‐and‐white) or isoluminant color (red‐and‐green) contrasts. Detection performance for color‐ and luminance‐defined contours (both open and closed) was matched. Detectable contours elicited a negative shift over posterior electrodes starting 220 ms after stimulus onset. The shift occurred for both color and luminance contrasts, even when possible luminance artifacts in red‐and‐green stimuli were masked. This indicates a common physiological processing stream for orientation‐based contour integration of red‐and‐green and black‐and‐white elements.
A psychological refractory period in access to visual short‐term memory and the deployment of visual–spatial attention: Multitasking processing deficits revealed by event‐related potentials
Authors: Brisson Benoit , Jolicœur Pierre
Published: February 2007

In this psychological refractory period (PRP) experiment, a tone (T1) was presented, followed by a visual target (T2) embedded in a bilateral display, and a speeded response was required for each target. The T1–T2 stimulus onset asynchrony (SOA) was 300, 650, or 1000 ms. Mean response time to T2 increased as SOA was reduced, replicating the well‐known PRP effect. Importantly, the N2pc component of the event‐related potential was progressively attenuated as SOA was reduced, and the onset latency of the sustained posterior contralateral negativity (SPCN) that follows the N2pc was progressively lengthened. Conditional analysis based on Task1 difficulty corroborated the analyses based on effects of SOA. The results suggest that central processing leading to the PRP effect interferes with the deployment of visual–spatial attention (as indexed by the N2pc) and delays encoding into visual short‐term memory (as indexed by the SPCN onset latency).
Difficulty of discrimination modulates attentional capture for deviant information
Authors: Sawaki Risa , Katayama Jun'ichi
Published: February 2007

It has been reported that an increased difficulty of discrimination between standard and target enhances P3a for typical nontarget. To elucidate the mechanism of this effect on deviant processing, the P300 event‐related brain potential (ERP) was elicited using a visual three‐stimulus oddball paradigm (standard circle, .70, target circle, .15, and nontarget/target square, .15). Four task conditions were defined by a combination of two category types of rare square (nontarget or target) and two levels of discrimination difficulty between standard and target circles (easy or difficult). In the difficult conditions, P3a was elicited by both nontarget and target square. Our findings suggest that the difficulty of discrimination between standard and target enhances attentional capture, rather than inhibition, for deviant information. This study has implications for understanding the attentional mechanisms of deviant processing.
Isolation and characterization of 10 microsatellite loci in the paper wasp Polistes rothneyi (Hymenoptera; Vespidae)
Authors: TAKAHASHI J. , YAMASAKI K.
Published: February 2007

We developed 10 polymorphic microsatellite loci for the Japanese paper wasp Polistes rothneyi using the magnetic particle method. Eight of the 10 loci tested were highly polymorphic, having four to eight alleles in P. rothneyi with an expected heterozygosity of 0.60–0.75. They also appeared to be applicable to other related species such as Polistes jokahamae. These loci can be used to study parameters concerning genetic relatedness such as worker reproduction and kin structure.
EST‐SSR markers from the Pacific oyster, Crassostrea gigas
Authors: YU HONG , LI QI
Published: February 2007

Ten polymorphic microsatellite repeat markers were identified from Crassostrea gigas, expressed sequence tags (EST) deposited in public sequence database. Number of alleles per locus ranged from three to 18, expected and observed heterozygosities ranged from 0.071 to 0.738 and from 0.306 to 0.913, respectively. Marker transferability was tested on other two Crassostrea species and polymorphic products were detected at nine loci. EST‐derived simple sequence repeats provide robust, informative and potentially transferable polymorphic markers suitable for population genetic, parentage, and mapping studies of C. gigas.
Multiplex panels of polymorphic microsatellite loci for two cryptic bat species of the genus Pipistrellus, developed by cross‐species amplification within the family Vespertilionidae
Authors: KAŇUCH P. , FORNŮSKOVÁ A. , BARTONIČKA T. , BRYJA J.
Published: February 2007

The paper presents multiplex panels of polymorphic microsatellites for two closely related cryptic species Pipistrellus pipistrellus and Pipistrellus pygmaeus. We tested the cross‐species amplification of 34 microsatellite loci, originally developed for five vespertilionid bat species. Ten and nine polymorphic loci in P. pipistrellus (mean number of alleles per locus = 10.5) and P. pygmaeus (8.1), respectively, in three multiplex polymerase chain reactions per species were amplified. All loci can be analysed in a single fragment analysis and can be used as markers to the study of evolution and the ecology of structured populations of socially living bats.
Selective alteration at the growth‐hormone‐ releasing‐hormone nerve terminals during aging in GHRH‐green fluorescent protein mice
Authors: Alonso Gérard , Sanchez‐Hormigo Angela , Loudes Catherine , El Yandouzi Taoufik , Carmignac Danielle , Faivre‐Bauman Annie , Recolin Bénédicte , Epelbaum Jacques , Robinson Iain CAF , Mollard Patrice , Méry Pierre‐François
Published: February 2007

Growth hormone (GH) secretion decreases spontaneously during lifespan, and the resulting GH deficiency participates in aging‐related morbidity. This deficiency appears to involve a defect in the activity of hypothalamic GH‐releasing hormone (GHRH) neurons. Here, we investigated this hypothesis, as well as the underlying mechanisms, in identified GHRH neurons from adult (∼13 weeks old) and aged (∼100 weeks old) transgenic GHRH‐green fluorescent protein mice, using morphological, biochemical and electrophysiological methods. Surprisingly, the spontaneous action potential frequency was similar in adult and aged GHRH neurons studied in brain slices. This was explained by a lack of change in the intrinsic excitability, and simultaneous increases in both stimulatory glutamatergic‐ and inhibitory GABAergic‐synaptic currents of aged GHRH neurons. Aging did not decrease GHRH and enhanced green fluorescent protein contents, GHRH neuronal number or GHRH‐fibre distribution, but we found a striking enlargement of GHRH‐positive axons, suggesting neuropeptide accumulation. Unlike in adults, autophagic vacuoles were evident in aged GHRH‐axonal profiles using electron microscopy. Thus, GHRH neurons are involved in aging of the GH axis. Aging had a subtle effect at the nerve terminal level in GHRH neurons, contrasting with the view that neuronal aging is accompanied by more widespread damage.
FORCES SHAPING CHINA'S INTERPROVINCIAL INEQUALITY
Authors: Tsui Kai‐yuen
Published: February 2007

This paper explores the forces that shaped China's interprovincial inequality in the last five decades of Communist rule. In so far as the change in interprovincial inequality is the result of differential growth in provincial GDP per capita and provincial economic growth, it may be decomposed into contributions by total factor productivity (TFP) and other factor inputs. A new method is introduced to make this decomposition. Care is exercised in taking into account problems of Chinese official data when implementing the decomposition analysis. The findings suggest that TFP and factor inputs exerted different and sometimes opposing effects on interprovincial inequality in the Maoist and reform era. The increase in inequality from the mid 1960s to the mid 1970s is due to the contribution of TFP overwhelming that of physical capital. The opposite is true for the 1980s. The increase in the 1990s is mainly driven by the skewed distribution of investments in favor of the richer coastal provinces reinforced by the increasing contribution of TFP.
GENDER EARNINGS DIFFERENTIALS AND REGIONAL ECONOMIC DEVELOPMENT IN URBAN CHINA, 1988–97
Authors: Ng Ying Chu
Published: February 2007

Gender earnings differentials in urban China by region and their changes during the first decade of economic reform are examined. It is found that the female–male earnings ratio increased during the early stage of reform. The male earnings premium, overall, showed an increasing trend in the later stage of reform. Decomposition of the gender earnings differential reveals that a relatively lower percentage of the differential could be explained by gender differences in productive characteristics in the fast growing regions and in regions with a rapid pace of reform. The cross‐sectional results highlight the possible existence of gender discrimination, particularly in the later stages of economic reform and development. Both market competition and the effects of wage decentralization play a role in shaping the gender earnings differentials. Gender earnings differentials varied by region and over time, generally in tandem with the pace of economic reform and development. The decomposition of the over time changes in the earnings gap indicated that improvement in the productive characteristics of females during the reform period constantly enhanced the earnings of females relative to those of males. The changes over time in the return to female characteristics, however, work to counter any narrowing of the gender earnings gap.
Reverse Remodeling of the Failing Ventricle: Surgical Intervention With the Acorn Cardiac Support Device
Authors: Oz Mehmet C. , Konertz Wolfgang F. , Raman Jai , Kleber Franz X.
Published: February 2007

Preclincial studies have shown that an innovative meshlike cardiac support device (CorCap, Acorn Cardiovascular, Inc., St. Paul, MN) can provide end diastolic support to reduce mechanical stress, improve function, and reverse cardiac remodeling. The CorCap device has been implanted worldwide in more than 130 patients with dilated cardiomyopathy (idiopathic or ischemic), with or without concomitant cardiac surgery. A series of 48 patients was implanted in initial safety and feasibility studies (33 received concomitant cardiac surgery, 15 patients received the CorCap device only). At implant, 33 patients were in New York Heart Association functional class III, 11 in class II, and four in class IV. There were no device‐related intraoperative complications, deaths, or adverse events. Eight early and nine late deaths occurred during follow‐up extending to 18–24 months. During follow‐up, chamber dimensions decreased, and ejection fraction and New York Heart Association functional class improved. The CorCap device is correlated with improvements in patient functional status. Randomized clinical trials are underway in Europe, Australia, and North America.
The Role of Angiotensin‐Converting Enzyme Polymorphism in Congestive Heart Failure
Authors: Pilati Mara , Cicoira Mariantonietta , Zanolla Luisa , Nicoletti Ilaria , Muraglia Simone , Zardini Piero
Published: February 2007

Angiotensin‐converting enzyme (ACE) is a zinc metallopeptidase, with primary known functions of converting angiotensin I into the vasoactive and aldosterone‐stimulating peptide angiotensin II and inactivating bradykinin. There is high variability among individuals in ACE concentrations, mainly due to the presence of a genetic polymorphism. The ACE gene has, in fact, insertion/deletion polymorphism in intron 16, consisting of a 287‐base pair Alu repeat sequence, with three genotypes: insertion polymorphism, insertion/deletion polymorphism, and deletion polymorphism. The genetic effect accounts for 47% of the total variance of serum ACE. The determination of this polymorphism has allowed researchers to study the implications of the ACE gene in many case‐control studies of cardiovascular disease, including myocardial infarction and hypertrophic and dilated cardiomyopathy. We review the current knowledge about the ACE gene polymorphism and its implications in heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Interpretation of the results of studies about the role of this polymorphism are controversial. The repetition of epidemio‐genetic studies and the creation of adequate experimental studies will help to definitively establish the pathogenetic role of the permanent increase in ACE expression associated with the deletion polymorphism genotype.
Differences in Hospital Length‐of‐Stay, Charges, and Mortality in Congestive Heart Failure Patients
Authors: Joshi Ashish V. , D'Souza Anna O. , Madhavan S. Suresh
Published: February 2007

The aim of this study was to demonstrate differences in hospitalization outcomes including length‐of‐stay (LOS), charges, and mortality in congestive heart failure patients using the Healthcare Cost and Utilization Project dataset. Hospitalizations with International Classification of Diseases, Ninth Revision, clinical modification (ICD‐9‐CM) codes for congestive heart failure were extracted from a 10% random Healthcare Cost and Utilization Project sample to yield 19,693 hospitalizations between January 1 and December 31, 1997. Mean hospital charges were $11,688 and mean LOS was 5.83 days. The overall in‐hospital mortality rate was 4.7%. Both LOS and hospital charges were higher in urban compared with rural hospitals (p≤0.05). LOS and charges also increased with hospital size (p≤0.05). Among patient characteristics, patient health status significantly affected LOS, charges, and mortality. Privately insured/health maintenance organization patients had 9% shorter LOS than Medicare patients, and Medicaid patients had 6.6% lower charges and 42% lower mortality than Medicare patients (p≤0.05). Other significant predictors of study outcome variables included age, gender, race, hospital region, and hospital experience.
A Polymorphism of the Gene Encoding AMPD1: Clinical Impact and Proposed Mechanisms in Congestive Heart Failure
Authors: Binkley Philip F. , Auseon Alex , Cooke Glen
Published: February 2007

A vast array of gene polymorphisms have been described, and further discovery of these gene variants will continue as the human genome is defined. Therefore, selection of a single polymorphism to investigate in relation to disease evolution or outcome must be motivated by specific physiologic, pathophysiologic, or epidemiologic associations. A significant gene polymorphism may result in an alteration of protein function, or be associated with disease incidence or outcome. Prevalence of the polymorphism in the general population is of extreme importance, as it must be common enough to warrant interest in its clinical impact. The polymorphism of the gene encoding for the enzyme adenosine monophosphate deaminase 1 results in an abnormal protein necessary in skeletal muscle metabolism. While its physiologic effects are not completely understood, it has been associated with improved morbidity and mortality in patients with cardiovascular disease.
The Emerging Pharmacogenomics of the β‐Adrenergic Receptors
Authors: Taylor Matthew R. G. , Bristow Michael R.
Published: February 2007

Beta‐adrenergic signaling mechanisms are of central importance to cardiovascular health and disease. Modulation of these pathways represents an important pharmacologic approach to the treatment of heart failure and hypertension. Advances in molecular genetics have identified genetic polymorphisms in the human β‐adrenergic receptor genes; some of this variation predicts changes in protein sequence/structure, and potentially changes in function, of the β‐adrenergic receptors. This article reviews the current state of knowledge and understanding of the genetic variation present in the three human β‐adrenergic receptor genes. Already, variation in these genes has been associated with observed differences in several cardiovascular phenotypes. This work has led to the demonstration of functional differences in activity between receptors with certain known polymorphisms and “wild‐type” receptors. An understanding of these polymorphisms is key to the development of studies of how differences in drug response/effects may be mediated by these polymorphisms. Such studies are anticipated to provide a foundation for the development of novel pharmacologic approaches where selection of and dosing of cardiovascular therapy is tailored to individuals on the basis of each patient's specific genetic makeup.
Tumor Necrosis Factor α Polymorphism in Heart Failure/Cardiomyopathy
Authors: Vadlamani Lou , Iyengar Srinivas
Published: February 2007

Tumor necrosis factor α (TNF‐α) is a proinflammatory cytokine that is produced by activated macrophages. It has been shown to stimulate the release of endothelial cytokines and NO, increase vascular permeability, decrease contractility, and induce a prothrombotic state. The most studied TNF‐α gene mutation in heart disease is a γ to α substitution, which occurs when 308 nucleotides move upstream from the transcription initiation site in the TNF promoter and has been associated with elevated levels of TNF‐α. The TNF1 allele (wild type) contains γ at this site, while the TNF2 allele has an α substitution at the site. The TNF2 allele is a more powerful transcriptional activator, therefore leading to higher TNF‐α levels. Most of the studies to date have failed to conclusively show any link between the polymorphism and heart disease, both coronary artery disease and cardiomyopathy/heart failure.
Pathogenesis of Hypertension in African Americans
Authors: Nesbitt Shawna , Victor Ronald G.
Published: February 2007

Hypertension is a compelling disease process that disproportionately affects African Americans. It is the single largest risk factor for cardiovascular disease in African Americans. The end organ manifestations of hypertension are striking and include higher rates of stroke, significantly increased renal disease including end‐stage renal disease requiring dialysis, higher risk of left ventricular hypertrophy, and an associated higher risk of heart failure. The cause of these more aggressive end organ phenomena is likely multifactorial and includes a mix of genetic and environmental influences. Intriguing polymorphisms of the epithelial sodium channel are consistent with patterns of hypertension seen in African Americans. Obesity, especially in African‐American women, may be closely related to hypertension as a result of sympathetic nervous system stimulation.
Racial Response to Angiotensin‐Converting Enzyme Therapy in Systolic Heart Failure
Authors: Dries Daniel L. , Yancy Clyde W. , Strong Mark A. , Drazner Mark H.
Published: February 2007

The treatment of heart failure with angiotensin‐converting enzyme inhibitors has resulted in substantial improvements in morbidity and mortality due to heart failure. Varying reports in the literature have suggested that African Americans respond less well to angiotensin‐converting enzyme inhibitors, but careful reanalysis of major clinical trials in heart failure, especially the Studies of Left Ventricular Dysfunction (SOLVD), demonstrates a similar mortality benefit for African Americans as for whites. Morbidity, measured as hospitalizations, may not be as favorably impacted. African Americans do respond to angiotensin‐converting enzyme inhibitors as a preemptive strategy to prevent heart failure, but the incidence of heart failure is still higher in this population. Mechanisms for these potential nuances in the response to angiotensin‐converting enzyme inhibitors are not yet clear. The exaggerated benefit of nitrates and hydralazine implicates alterations in nitric oxide homeostasis. Race is an inadequate model to explain the observed differences. Careful translational research focusing on genetic patterns of disease may help resolve these outstanding questions.
The Use of Beta‐Adrenergic Receptor Antagonists in the Treatment of African Americans With Heart Failure
Authors: Yancy Clyde W. , Laskar Sonjay , Erichhom Eric
Published: February 2007

The addition of β‐adrenergic antagonists to the treatment regimen for heart failure has validated the neurohormonal hypothesis and provided much‐improved outcomes. This benefit had been in question for African Americans based on past experiences in the field of hypertension and worrisome data reported from the Beta Blocker Evaluation of Survival Trial. However, the totality of data now demonstrate that African Americans respond favorably to β blockers and are capable of having the same outcomes in response to medical therapy for heart failure. There should be no reluctance, nor is there an appropriate rationale, to withhold β‐blocker therapy for heart failure to any patient with left ventricular dysfunction without an overt contraindication. The first prospective trial in African Americans with heart failure, the African American Heart Failure Trial (A‐HeFT), is ongoing and provides additional insight into the best treatment strategies for this patient population.
Therapy of Heart Failure in African Americans: Lessons From an Urban Public Hospital
Authors: Mehta Sameer K. , Toto Kathleen H. , Nelson Lauren L. , Drazner Mark H.
Published: February 2007

African‐American patients with heart failure treated at urban public hospitals are at high risk for adverse outcomes likely due to complex socioeconomic factors. While establishing a heart failure disease management program at Parkland Memorial Hospital in Dallas, TX, the authors completed two studies that address the high rates of heart failure hospitalizations seen in this population. The first study found high rates of adverse outcomes following emergency department discharge for heart failure. The second identified important deficiencies in dietary sodium knowledge. Both 90‐day outcomes (return emergency department visit or heart failure hospitalization) following an index emergency department discharge and dietary sodium knowledge represent new potential measures of quality of care of heart failure. Studies of this high‐risk population of heart failure patients may offer insights that lead to improved outcomes both in the urban setting and elsewhere.
The Natural History, Epidemiology, and Prognosis of Heart Failure in African Americans
Authors: Yancy Clyde W. , Strong Mark
Published: February 2007

Heart failure is more common in African Americans and appears to be of worse severity. At the time of diagnosis, left ventricular function is more severely impaired and the clinical class is more advanced. The strongest risk factor for heart failure in African Americans appears to be hypertension, which is both more prevalent and more pathologic in African Americans. It is likely that heart failure represents an important end organ effect of hypertension. When affected by heart failure, African Americans experience a greater rate of hospitalization and may be exposed to a higher mortality risk as well. Genomic medicine has yielded a number of candidate single nucleotide polymorphisms that might contribute to the excess pathogenicity of heart failure in African Americans, but much more work needs to be done in larger cohorts. Effective therapy of heart failure must start with the recognition of the different manifestations of heart failure in African Americans. An increased awareness of the risk of hypertension followed by early and effective intervention may reduce the risk of heart failure in this population.
β‐Adrenoceptor Blockers as Agonists: Coupling of β2‐Adrenoceptors to Multiple G‐Proteins in the Failing Human Heart
Authors: Harding Sian E. , Gong Haibin
Published: February 2007

Beta blockers have been shown in clinical trials to improve cardiac function and reduce mortality of heart failure patients. However, these agents require careful titration since they can produce an initial decrease in cardiac output. The authors have recently shown that β blockers, including some used clinically, can directly depress contraction of myocardium from the failing (but not nonfailing) human heart. This occurs on single ventricular myocytes and is therefore completely independent of any inhibition of endogenous catecholamines. The effect appears to be mediated primarily by the β2‐adrenoceptor (AR) and is dependent on the inhibitory guanine nucleotide binding protein, Gi. Using a transgenic mouse model, as well as adenoviral vectors to overexpress Gi or the human β2AR in adult myocytes of various species, the authors demonstrate that agents that are blockers for βAR/Gs coupling can be agonists at a β2AR/Gi‐coupled form of the receptor. The negative effect of β blockers could contribute to the initial cardiodepression that is observed when introducing these agents in heart failure patients. However, in the long term, β2AR/Gi coupling may enhance the ability of β blockers to protect and improve the function of the failing heart.
Use of a Biventricular Assist Device in the Treatment of Acute Doxorubicin‐Induced Cardiotoxicity
Authors: Swartz Michael F. , Fink Gregory W. , Carhart Robert L.
Published: February 2007

This report describes a patient treated for metastatic leiomyosarcoma, who acutely developed doxorubicin‐induced cardiotoxicity, and consequently developed heart failure. Medical therapy was initiated; however, her condition deteriorated and a surgical alternative was proposed. A biventricular assist device was implanted, allowing her multisystem organ failure to improve. During the next 9 days while on the assist device, her heart failure resolved, her organs were well perfused, and her heart entered a recovery period. After 9 days of mechanical support with the biventricular assist device, she was explanted from the assist device, and with inotropic support and an intra‐aortic balloon pump, she maintained adequate hemodynamics. Eighteen days after implantation of the assist device, she was discharged from the hospital with hospice care, where she later died. Although the patient's cardiac function did not have long‐term recovery, short‐term recovery after doxorubicin toxicity was achieved. The authors maintain that the use of a biventricular assist device in the treatment of acute heart failure resulting from doxorubicin‐induced cardiomyopathy is an effective way to manage this patient population.
ACE Inhibitor Intolerance and Lessons Learned From the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) Trials
Authors: Sica Domenic A.
Published: February 2007

The Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) trials looked at the effects of candesartan in addition to best possible treatment for heart failure in 7601 patients. CHARM encompassed three studies in discrete populations, including patients with left ventricular dysfunction taking angiotensin‐converting enzyme (ACE) inhibitors (CHARM‐Added), patients with maintained left ventricular function (CHARM‐Preserved), and patients with left ventricular dysfunction and an intolerance to ACE inhibitors (CHARM‐Alternative). CHARM‐Alternative was considered a success in that its participants experienced a significant reduction in each component of the study's primary end point, which was a composite of cardiovascular death or hospitalization for heart failure, over a median follow‐up of 34 months. Candesartan was by and large well tolerated in these ACE‐inhibitor intolerant patients; thus, the findings of this study provide additional support for the effectiveness of angiotensin receptor blocker therapy in heart failure patients poorly tolerant of an ACE inhibitor; however, candesartan was not convincingly shown to improve the incidence/severity of hypotension, hyperkalemia, and glomerular filtration rate reductions that were the basis for ACE inhibitor intolerance in approximately 25% of the study population.
CHF: “Compressive” Heart Failure?
Authors: Nachimuthu Senthil , Uber Patricia A. , Balasundaram Priyankha , Mehra Mandeep R.
Published: February 2007

Nearly 10% of patients with malignant neoplasms are found to have cardiac metastasis. Metastatic disease is much more common than primary cardiac tumors and is also associated with a worse prognosis. The authors describe a case of mitral inflow obstruction due to metastatic malignancy to the left atrium which led to “compressive” heart failure. They further provide a clinical review of malignant metastatic heart disease.
Aldosterone Receptor Antagonism: Interface With Hyperkalemia in Heart Failure
Authors: Sica Domenic A. , Hess Michael
Published: February 2007

Aldosterone receptor antagonism (ARA) is an increasingly well‐accepted element of heart failure therapy. The experimental underpinnings for the use of ARA in heart failure are strong being linked to a variety of tissue‐based cardiac effects characteristic of drugs in this class. However, the benefits of ARA therapy do not come without some risk since drugs in this class are potent inhibitors of renal potassium (K+) elimination. Thus, some increment in serum K+, up to and including the development of overt hyperkalemia (typically defined as a serum K+ value in excess of 6.0 mEq/L), is to be expected whenever they are used. Hyperkalemia attributable to ARA relates to several factors including ARA dose, patient predisposition to hyperkalemia, as in the case of renal failure, and dietary intake of K+. The risk of some change in serum K+ with ARA should not be a deterrent to use of drugs in this class but, rather should prompt careful surveillance for the onset of this potentially life‐threatening electrolyte disturbance. The frequency of such scrutiny should be patient‐specific and based on the constellation of risk factors for hyperkalemia.
Is It Constrictive Pericarditis or Restrictive Cardiomyopathy? A Systematic Approach
Authors: Morshedi‐Meibodi Ali , Menuet Robert , McFadden P. Michael , Ventura Hector O. , Mehra Mandeep R.
Published: February 2007

In this case review, the authors propose a fluent diagnostic algorithm for the consideration and therapeutic approach to either constrictive pericarditis or restrictive cardiomyopathy. Additionally, while focusing on the differential diagnosis of these clinically vexing entities, the authors outline the therapeutic expectations from surgical pericardiectomy in constrictive pericarditis.
Nesiritide for the Treatment of Diastolic Dysfunction
Authors: Diaz Tulio , Alderman James
Published: February 2007

Despite advances in the treatment of left ventricular diastolic dysfunction, therapy is still primarily empiric and readmission rates remain high, with up to half of patients discharged with the diagnosis of congestive heart failure being rehospitalized within 6 months due to recurrent decompensation. Even with this high economic burden, no effective, long‐term therapies have been developed. The authors present a patient with recurrent hospitalizations for decompensated congestive heart failure due to left ventricular diastolic dysfunction becoming refractory to parenteral diuretic therapy. The patient exhibited a dramatic response to a 96‐hour intravenous infusion of nesiritide and experienced prolonged clinical benefit, remaining in New York Heart Association functional class I for more than 6 months after the infusion.
Advanced Glycation End Product Cross‐Linking: Pathophysiologic Role and Therapeutic Target in Cardiovascular Disease
Authors: Zieman Susan J. , Kass David A.
Published: February 2007

Advanced glycation end products (AGEs) form by a nonenzymatic reaction between reducing sugars and biological proteins. These stable compounds accumulate slowly throughout the life span and contribute to structural and physiologic changes in the cardiovascular system such as increased vascular and myocardial stiffness, endothelial dysfunction, altered vascular injury responses, and atherosclerotic plaque formation. Mechanisms underlying these alterations include AGE cross‐linking of collagen and AGE interactions with circulating proteins and AGE receptors. The clinical manifestations of AGE accrual—isolated systolic hypertension, endothelial and diastolic dysfunction, and atherosclerosis—underscore their role in increased cardiovascular risk associated with aging as well as diabetes and hypertension, conditions that enhance AGE formation. New pharmacologic agents that prevent AGE, break cross‐links, or block AGE receptors reduce vascular and myocardial stiffness, inhibit atherosclerotic plaque formation, and improve endothelial function. These agents promise to reduce the risk of isolated systolic hypertension, diastolic dysfunction, and diabetes, and thus, heart failure.
Improvement In Blood Pressure Control With Impedance Cardiography‐Guided Pharmacologic Decision Making
Authors: Sharman Donald L. , Gomes Cathy P. , Rutherford Jillian P.
Published: February 2007

Previous reports have demonstrated improvement in blood pressure (BP) control utilizing noninvasive hemodynamic measurements with impedance cardiography (ICG). The purpose of this article is to report the effect of utilizing ICG‐guided decision making to treat uncontrolled hypertension in a community generalist setting. Patient medical records were retrospectively reviewed for subjects on two antihypertensive agents with systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg. All subjects were treated utilizing a previously published ICG‐guided treatment algorithm. Twenty‐one subjects met the BP and medication criteria. BP at entry was 157.2±13.9/78.7±9.9 mm Hg. Subjects were treated for 215±85 days (5.0±2.0 visits). After ICG‐guided treatment, 12/21 (57.1%) achieved sustained BP control (p<0.001). BP was lowered to 141.6±22.0 (p<0.001)/77.1±10.7 (p>0.05) mm Hg. Antihypertensive agents increased from 2.0±0.0 to 2.5±0.7 (p<0.05). In this series of subjects with uncontrolled BP taking two antihypertensive agents, ICG‐guided pharmacologic decision making resulted in significant reduction in BP and improvement in BP control.
Serum Brain Natriuretic Peptide Level in a Patient With Chronic Obstructive Pulmonary Disease and Chronic Heart Failure
Authors: Ghitelman Jaime , Krumerman Drew , Latif Farhana , Le Jemtel Thierry H.
Published: February 2007

A 52‐year‐old woman with chronic obstructive pulmonary disease (COPD) and chronic heart failure presented in respiratory distress. Physical examination could not differentiate COPD exacerbation from chronic heart failure decompensation. As her serum B‐type natriuretic peptide level was 1030 pg/mL, she was initially treated for chronic heart failure decompensation. Serum B‐type natriuretic peptide level fell to 308 pg/mL, but respiratory distress persisted. She was then treated with intravenous solumedrol for COPD exacerbation. Respiratory distress rapidly resolved. Serum B‐type natriuretic peptide level is useful to detect heart failure in the presence of COPD but does not substitute for clinical judgment to initiate proper management.
Quality of Life in Bridge‐to‐Transplant Patients With Chronic Heart Failure After Implantation of an Axial Flow Ventricular Assist Device
Authors: Miller Kathy , Myers Timothy J. , Robertson Kimberly , Shah Nyma , Delgado Reynolds M. , Gregoric Igor D.
Published: February 2007

Research suggests that ventricular assist devices improve quality of life for congestive heart failure patients awaiting heart transplantation. Axial flow ventricular assist devices like the Jarvik 2000 (Jarvik Heart, Inc., New York, NY) represent the newest type of ventricular assist device technology, but their effects on quality of life are not well understood. Therefore, the authors administered the Minnesota Living with Heart Failure Questionnaire to patients who had the Jarvik 2000 implanted as a bridge to heart transplantation. Patients completed the Minnesota Living with Heart Failure Questionnaire immediately before device implantation, 1 month after implantation, immediately before heart transplantation, and 1 month after transplantation. One month after implantation of the device, the nine patients who completed the study showed significant improvements in physical (p<0.008), emotional (p<0.02), and overall (p<0.008) quality of life. These improvements were maintained until the device was explanted. The authors conclude that implantation of the Jarvik 2000 ventricular assist device can substantially improve quality of life for patients awaiting heart transplantation.
B‐Type Natriuretic Peptide: Practical Diagnostic Use for Evaluating Ventricular Dysfunction
Authors: Lubarsky Lev , Mandell Kenneth , Coplan Neil L.
Published: February 2007

Assessment of brain natriuretic peptide levels may provide important information that can be used in the evaluation of patients with dyspnea and follow‐up of heart failure. Brain natriuretic peptide levels have been shown to be useful for evaluating patients in the emergency department and for evaluating patients complaining of dyspnea in the outpatient setting. Brain natriuretic peptide assessment also provides an adjunct to diagnosis of both systolic and diastolic dysfunction, has prognostic value for heart failure and in acute coronary syndromes, and may be a useful measure to guide therapy. Further work needs to be done to establish the best type of assay to use, to determine the optimal cutoff point for what is considered abnormal, and to determine how conditions other than ventricular dysfunction affect brain natriuretic peptide levels.
Mechanisms and Treatment of Anemia in Chronic Heart Failure
Authors: Katz Stuart D.
Published: February 2007

Anemia is highly prevalent in patients with chronic heart failure (HF) and is associated with poor clinical outcomes. Multiple mechanisms contribute to anemia in chronic HF, and subnormal compensatory rise in endogenous erythropoietin levels in response to anemia is one contributory factor. Randomized trials with recombinant human erythropoietin therapy in anemic patients with chronic kidney disease and concomitant heart disease have demonstrated a reduction in left ventricular hypertrophy but variable effects on clinical outcome. Preliminary clinical trials in anemic patients with chronic HF demonstrate that erythropoietin therapy is well tolerated and associated with short‐term clinical improvement. The optimum target hemoglobin, erythropoietic agent, and dosing regimen, and the role of iron supplementation in patients with chronic HF, are not known. Additional studies are needed to determine the safety and efficacy of long‐term erythropoietic therapy in chronic HF patients.