bluuebunny/crossref_metadata_2025 huggingface dataset:
Design Modification for Reducing Silent Chain Annoying Noise
Authors: Pan M. , Shieh T.
Published: December 2002

In the design of driving systems, silent chains have extensively replaced roller chains thanks to annoying noise problems. For some types of cab-motorcycles, especially sheet-frame cabs, however, the annoying noise generated by silent chains is still not acceptable. In this study, silent chain noise of cab motorcycles is investigated first by order analysis and time-frequency (TF) analysis of measured noise, and second by the analysis of noise-origination, transmission and amplification via frame. The noise mechanism can therefore be precisely uncovered. Some experiments have been conducted to discover three primary issues of a noise problem, i.e., noise source, transmission path, and response. Additionally, a mode shape (1,3) at 1650 Hz can be constructed based on the running mode principle to interpret a dominant structure-borne noise.
An Accurate Full Car Ride Model Using Model Reducing Techniques
Authors: Kim Chul , Ro Paul I.
Published: December 2002

In this study, an approach to obtain an accurate yet simple model for full-vehicle ride analysis is proposed. The approach involves linearization of a full car MBD (multibody dynamics) model to obtain a large-order vehicle model. The states of the model are divided into two groups depending on their effects on the ride quality and handling performance. Singular perturbation method is then applied to reduce the model size. Comparing the responses of the proposed model and the original MBD model shows an accurate matching between the two systems. A set of identified parameters that makes the well-known seven degree-of-freedom model very close to the full car MBD model is obtained. Finally, the benefits of the approach are illustrated through design of an active suspension system. The identified model exhibits improved performance over the nominal models in the sense that the accurate model leads to the appropriate selection of control gains. This study also provides an analytical method to investigate the effects of model complexity on model accuracy for vehicle suspension systems.
Kinematic Synthesis of a Six-Member Mechanism for Automotive Steering
Authors: Pramanik S.
Published: December 2002

A six-member mechanism has been synthesized to achieve five precision points of an automotive steering mechanism. The inner wheel can be rotated up to 61 degrees with fair accuracy. This result has been compared with those achieved by the Ackermann steering mechanism (ASM) and the Fahey-Eight-Member-Mechanism (FEMM). Results show that the divergent end behavior of ASM has been overcome by the present mechanism. The FEMM gives high accuracy but the ASM is less accurate. The suggested mechanism gives fairly accurate result that falls between the above two mechanisms.
Design of Developable Surfaces Using Optimal Control
Authors: Park F. C. , Yu Junghyun , Chun Changmook , Ravani Bahram
Published: December 2002

This paper formulates the developable surface design problem in an optimal control setting. Given a regular curve bt on the unit sphere corresponding to a one-parameter family of rulings, and two base curve endpoints a0,a1∈R3, we consider the problem of constructing a base curve at such that at0=a0,at1=a1, and the resulting surface fs,t=at+sbt is developable. We formulate the base curve design problem as an optimal control problem, and derive solutions for objective functions that reflect various practical aspects of developable surface design, e.g., minimizing the arc length of the base curve, keeping the line of regression distant from the base curve, and approximating a given arbitrary ruled surface by a developable surface. By drawing upon the large body of available results for the optimal control of linear systems with quadratic criteria, our approach provides a flexible method for designing developable surfaces that are optimized for various criteria.
Numerical Determination of Cutting Parameters for the Control of Klingelnberg Spiral Bevel Gear Geometry
Authors: Lelkes Ma´rk , Ma´rialigeti Ja´nos , Play Daniel
Published: December 2002

A numerical method for the contact analysis of uniform tooth height epicyclical spiral bevel gears stemming from the Klingelnberg’s Cyclo-Palloid System is proposed. The analysis is based on simultaneous generations of gear surfaces and contact simulation. A theoretical contact identification program has been developed. Conjugated tooth contact is examined. Longitudinal settings of contact patterns or contact across the surfaces from tooth root to tooth top were obtained as a function of machine-settings. The influences of each cutting parameter were isolated and were discussed.
Mobilizing for pedestrian safety: an experiment in community action
Authors: Bergman A B , Gray B , Moffat J M , Simpson E S , Rivara F P
Published: December 2002

In contrast to the steady reduction in mortality and morbidity from collisions involving motor vehicle occupants, relatively little progress has been made in controlling motor vehicle/pedestrian collisions. Engineering modifications are the most effective means of reducing such collisions, but mainly because of their cost, and public apathy about pedestrian safety, are too rarely employed.

A modest experiment in community action was undertaken by attempting to induce the authorities of 10 small cities to apply for state funds to create a single model pedestrian refuge in their respective communities. Our hope was that this model would later lead to more widespread improvements. The key elements of the campaign were organizing local pedestrian safety task forces, compiling local pedestrian injury statistics, and publicizing the stories of pedestrian injury victims.

At the conclusion of the planning process, all 10 target communities submitted grant applications and all 10 received full grant funding. Five projects were completed as planned, two are under construction, and the plans for three were abandoned.

Pedestrian safety is not an issue that captures public attention. To make progress, goals must be modest, and a dedicated constituency must be developed. “Victim advocacy” is a vital part of this process. Progress in injury control requires concerted community action.
Motor vehicle and fall related deaths among older Americans 1990–98: sex, race, and ethnic disparities
Authors: Stevens J A , Dellinger A M
Published: December 2002

Objectives:To examine differences in motor vehicle and fall related death rates among older adults by sex, race, and ethnicity.

Methods:Annual mortality tapes for 1990–98 provided demographic data including race and ethnicity, date, and cause of death. Trend analyses were conducted using Poisson regression.

Results:From 1990–98, overall motor vehicle related death rates remained stable while death rates from unintentional falls increased. Motor vehicle and fall related death rates were higher among men. Motor vehicle related death rates were higher among people of color while fall related death rates were higher among whites. Among whites, fall death rates increased significantly during the study period, with an annual relative increase of 3.6% for men and 3.2% for women.

Conclusions:The risk of death from motor vehicle and fall related injuries among older adults differed by sex, race and ethnicity, results obscured by simple age and sex specific death rates. This study found important patterns and disparities in these death rates by race and ethnicity useful for identifying high risk groups and guiding prevention strategies.
Assessing community child passenger safety efforts in three Northwest Tribes
Authors: Smith M L , Berger L R
Published: December 2002

Objective:To identify strengths and weaknesses in community based child passenger safety programs by developing a scoring instrument and conducting observations of child restraint use in three Native American communities.

Setting:The three communities are autonomous Tribal reservations in the Pacific Northwest. Their per capita incomes and rates of unemployment are comparable.

Methods:In each community, 100 children under 5 years old were observed for car seat use. A six item community assessment tool (100 points maximum) awarded points for such items as the type (primary or secondary) and enforcement of child restraint laws; availability of car seats from distribution programs; extent of educational programs; and access to data on vehicle injuries.

Results:For children from birth to 4 years, the car seat use rate ranged from 12%–21%. Rates for infants (71%–80%) far exceeded rates for 1–4 year old children (5%–14%). Community scores ranged from 0 to 31.5 points. There was no correlation between scores and observed car seat use. One reason was the total lack of enforcement of restraint laws.

Conclusions:A community assessment tool can highlight weaknesses in child passenger efforts. Linking such a tool with an objective measure of impact can be applied to other injury problems, such as fire safety or domestic violence. The very process of creating and implementing a community assessment can enhance agency collaboration and publicize evidence based “best practices” for injury prevention. Further study is needed to address methodologic issues and to examine crash and medical data in relation to community child passenger safety scores.
Childhood injury prevention practices by parents in Mexico
Authors: Mock C , Arreola Rissa C , Trevino Perez R , Almazan Saavedra V , Enrique Zozaya J , Gonzalez Solis R , Simpson K , Hernandez Torre M
Published: December 2002

Objective:Scientifically based injury prevention efforts have not been widely implemented in Latin America. This study was undertaken to evaluate the baseline knowledge and practices of childhood safety on the part of parents in Monterrey, Mexico and in so doing provide information on which to base subsequent injury prevention efforts.

Methods:Interviews were carried out with parents from three socioeconomic strata (upper, middle, lower). Questionnaires were based on Spanish language materials developed by The Injury Prevention Program (TIPP) of the American Academy of Pediatrics.

Results:Data were obtained from parents of 1123 children. Overall safety scores (percent safe responses) increased with increasing socioeconomic status. The differences among the socioeconomic groups were most pronounced for transportation and less pronounced for household and recreational safety. The differences were most notable for activities that required a safety related device such as a car seat, seat belt, helmet, or smoke detector. Appropriate use of such devices declined from 47% (upper socioeconomic group) to 25% (middle) to 15% (lower).

Conclusions:Considerable differences in the knowledge and especially the practice of childhood safety exist among parents in different socioeconomic levels in Mexico. Future injury prevention efforts need to address these and especially the availability, cost, and utilization of specific highly effective safety devices.
Association of rates of household handgun ownership, lifetime major depression, and serious suicidal thoughts with rates of suicide across US census regions
Authors: Hemenway D , Miller M
Published: December 2002

Objective:Cross sectional studies in the United States often find a significant positive association between levels of household firearm ownership and suicide rates. This study investigates whether the association can be explained by differences in levels of mental health.

Methods:The relationship between household handgun ownership and overall suicide rates across United States regions after accounting for two mental health variables—lifetime prevalence of major depression and serious suicidal thoughts—were examined. Analyses also add another control variable (urbanization, education, unemployment, or alcohol consumption). Data on mental health variables come from the National Comorbidity Study, conducted in the early 1990s. Data on household handgun ownership come from the General Social Surveys.

Results:Across the nine regions for the early 1990s (n = 9), household handgun ownership rates are positively correlated with the suicide rate (r= 0.59) and are not correlated with either the lifetime prevalence of major depression or suicidal thoughts. After controlling for major depression and suicidal thoughts (and any of the four additional control variables), handgun ownership rates remain significantly associated with the overall suicide rate.

Conclusions:In United States regions with higher levels of household handgun ownership, there are higher suicide rates. This relationship cannot be explained by differences in the prevalence of two mental health indicators—lifetime rates of either major depression or suicidal thoughts.
New Zealand bicycle helmet law—do the costs outweigh the benefits?
Authors: Taylor M , Scuffham P
Published: December 2002

Objectives:This paper examines the cost effectiveness of the compulsory bicycle helmet wearing law (HWL) introduced in New Zealand on 1 January 1994. The societal perspective of costs is used for the purchase of helmets and the value of injuries averted. This is augmented with healthcare costs averted from reduced head injuries.

Methods:Three age groups were examined: cyclists aged 5–12 years, 13–18 years, and ≥19 years. The number of head and non-head injuries averted were obtained from epidemiological studies. Estimates of the numbers of cyclists and the costs of helmets are used to derive the total spending on new bicycle helmets. Healthcare costs were obtained from national hospitalisation database, and the value of injuries averted was obtained directly from a willingness-to-pay survey undertaken by the Land Transport Safety Authority. Cost effectiveness ratios, benefit:cost ratios, and the value of net benefits were estimated.

Results:The net benefit (benefit:cost ratios) of the HWL for the 5–12, 13–18, and ≥19 year age groups was $0.3m (2.6), −$0.2m (0.8), and −$1.5m (0.7) (in NZ $, 2000 prices; NZ $1.00 = US $0.47 = UK £0.31 approx). These results were most sensitive to the cost and life of helmets, helmet wearing rates before the HWL, and the effectiveness of helmets in preventing head injuries.

Conclusions:The HWL was cost saving in the youngest age group but large costs from the law were imposed on adult (≥19 years) cyclists.
Potential public health importance of the oven ready chip: Table 1
Authors: Rowland D , Roberts I
Published: December 2002

Background:Chip pan fires are responsible for 25% of fire related injury in the UK, despite government strategies to encourage safer frying. To establish the feasibility of promoting oven ready chips (fries), the residents in a materially deprived ward of London were surveyed.

Sample frame:1073 of 2145 households participating in a randomised controlled trial.

Results:Approximately half of those surveyed deep fry, mostly chips, fish, and meat. Ownership of ovens and microwaves was high (99% and 80% respectively). Reasons for deep frying included taste (50%), speed (32%), and tradition (25%).

Conclusions:Improving the quality of oven baked alternatives may encourage consumers to change to safer and healthier cooking methods, with potentially important repercussions for public health.
Traps for the unwary in estimating person based injury incidence using hospital discharge data
Authors: Langley J , Stephenson S , Cryer C , Borman B
Published: December 2002

Background:Injuries resulting in admission to hospital provide an important basis for determining priorities, emerging issues, and trends in injury. There are, however, a number of important issues to be considered in estimating person based injury incidence using such data. Failure to consider these could result in significant overestimates of incidence and incorrect conclusions about trends.

Aim:To demonstrate the degree to which estimates of the incidence of person based injury requiring hospital inpatient treatment vary depending on how one operationally defines an injury, and whether or not day patients, readmissions, and injury due to medical procedures are included.

Method:The source of data for this study was New Zealand’s National Minimum Dataset. The primary analyses were of a dataset of all 1989–98 discharges from public hospital who had an external cause of injury and poisoning code assigned to them.

Results:The results show that estimates of the incidence of person based injury vary significantly depending on how one operationally defines an injury, and whether day patients, readmissions, and injury due to medical procedures are included. Moreover the effects vary significantly by pathology and over time.

Conclusions:(1) Those using New Zealand hospital discharge data for determining the incidence of injury should: (a) select cases which meet the following criteria: principal diagnosis injury only cases, patients with day stay of one day or more, and first admissions only, (b) note in their reporting that the measure is an estimate and could be as high as a 3% overestimate. (2) Other countries with similar data should investigate the merit of adopting a similar approach. (3) That the International Collaborative Effort on Injury Statistics review all diagnoses withinInternational Classification of Diseases9th and 10th revisions with a view to reaching consensus on an operational definition of an injury.
SIGNALING PATHWAYS AND PHYSIOLOGICAL FUNCTIONS OF DROSOPHILA MELANOGASTER FMRFAMIDE-RELATED PEPTIDES
Authors: Nichols Ruthann
Published: December 2002

▪ Abstract  FMRFamide-related peptides (FaRPs) contain a C-terminal RFamide but unique N-terminal extensions. They are expressed throughout the animal kingdom and affect numerous biological activities. Like other animal species, Drosophila melanogaster contains multiple genes that encode different FaRPs. The ease of genetic manipulations, the availability of genomic sequence data, the existence of established bioassays, and its short lifespan make D. melanogaster a versatile experimental organism in which to investigate peptide processing, functions, and signal transduction pathways. Here, the structures, precursor organizations, distributions, and activities of FaRPs encoded by D. melanogaster FMRFamide (dFMRFamide), myosuppressin (Dms), and sulfakinin (Dsk) genes are reviewed, and predictions are made on their signaling pathways and biological functions.
Communication with Substrate-Borne Signals in Small Plant-Dwelling Insects
Authors: Čokl Andrej , Virant-Doberlet Meta
Published: December 2002

Vibratory signals of plant-dwelling insects, such as land bugs of the families Cydnidae and Pentatomidae, are produced mainly by stridulation and/or vibration of some body part. Signals emitted by the vibratory mechanisms have low-frequency characteristics with a relatively narrow frequency peak dominant around 100 Hz and differently expressed frequency modulation and higher harmonics. Such spectral characteristics are well tuned to the transmission properties of plants, and the low attenuation enables long-range communication on the same plant under standing wave conditions. Frequencies of stridulatory signals extend up to 10 kHz. In some groups, vibratory and stridulatory mechanisms may be used simultaneously to produce broadband signals. The subgenual organ, joint chordotonal organs, campaniform sensilla and mechanoreceptors, such as the Johnston's organ in antennae, are used to detect these vibratory signals. Species-specific songs facilitate mate location and recognition, and less species-specific signals provide information about enemies or rival mates.
COMPARATIVESOCIALBIOLOGY OFBASALTAXA OFANTS ANDTERMITES
Authors: Thorne Barbara L. , Traniello James F. A.
Published: December 2002

▪ Abstract  Lacking a comprehensive fossil record, solitary representatives of the taxa, and/or a definitive phylogeny of closely related insects, comparison of the life history and social biology of basal, living groups is one of the few available options for developing inferences regarding the early eusocial evolution of ants and termites. Comparisons of a select group of basal formicid and isopteran taxa suggest that the reproductive organization of colonies and their patterns of division of labor were particularly influenced, in both groups, by nesting and feeding ecology. Opportunities for serial inheritance of the nest structure and colony population by kin may have been significant in the evolution of multiple reproductive forms and options. Disease has been a significant factor in the evolution of social organization in ants and termites, but the adaptive mechanisms of infection control differ. Evaluations of the convergent and divergent social biology of the two taxa can generate novel domains of research and testable hypotheses.
Key Interactions Between Neurons and Glial Cells During Neural Development in Insects
Authors: Oland Lynne A. , Tolbert Leslie P.
Published: December 2002

Nervous system function is entirely dependent on the intricate and precise pattern of connections made by individual neurons. Much of the insightful research into mechanisms underlying the development of this pattern of connections has been done in insect nervous systems. Studies of developmental mechanisms have revealed critical interactions between neurons and glia, the non-neuronal cells of the nervous system. Glial cells provide trophic support for neurons, act as struts for migrating neurons and growing axons, form boundaries that restrict neuritic growth, and have reciprocal interactions with neurons that govern specification of cell fate and axonal pathfinding. The molecular mechanisms underlying these interactions are beginning to be understood. Because many of the cellular and molecular mechanisms underlying neural development appear to be common across disparate insect species, and even between insects and vertebrates, studies in developing insect nervous systems are elucidating mechanisms likely to be of broad significance.
ANALYSIS ANDFUNCTION OFTRANSCRIPTIONALREGULATORYELEMENTS: Insights fromDrosophila
Authors: Arnosti David N.
Published: December 2002

▪ Abstract  Analysis of gene expression is assuming an increasingly important role in elucidating the molecular basis of insect biology. Transcriptional regulation of gene expression is directed by a variety of cis-acting DNA elements that control spatial and temporal patterns of expression. This review summarizes current knowledge about properties of transcriptional regulatory elements, based largely on research in Drosophila melanogaster, and outlines ways that new technologies are providing tools to facilitate the study of transcriptional regulatory elements in other insects.
Effect of Atorvastatin on High-Density Lipoprotein Apolipoprotein A-I Production and Clearance in the New Zealand White Rabbit
Authors: Rashid Shirya , Uffelman Kristine D. , Barrett P. Hugh R. , Lewis Gary F.
Published: December 2002

Background—

HMG-CoA reductase inhibitors reduce the incidence of cardiovascular disease predominantly by their LDL-lowering effect. Recently, there has been great interest in the pleiotropic effects of statins, which appear to differ among the various agents in this class. Unlike other statins, atorvastatin exhibits a decline in its HDL-raising effect at higher doses in humans. Whether atorvastatin-mediated alterations in HDL turnover in vivo contribute to this effect has not previously been investigated. We therefore studied the effect of atorvastatin on HDL apolipoprotein (apo) A-I production and clearance in normolipidemic male New Zealand White rabbits.

Methods and Results—

Kinetic studies of HDL-apoA-I radiolabeled with
131
I were performed in chow-fed rabbits after 3 weeks of atorvastatin treatment of 5 mg · kg
−1
· d
−1
(n=7) versus placebo-treated rabbits (n=7). Our results showed a significantly (
P
<0.001) more rapid clearance (≈2-fold) of HDL apoA-I in atorvastatin-treated animals compared with the control group (0.121±0.012 versus 0.061±0.004 pools/h, respectively), accompanied by a lesser 48% increase in the apoA-I production rate (3.84±0.38 versus 2.59±0.41 mg · kg
−1
· h
−1
,
P
=0.06). Accordingly, plasma apoA-I levels in atorvastatin-treated animals declined significantly (
P
<0.05, n=8 animals) after 3 weeks of treatment (173.5±1.8 mg/dL) from baseline values.

Conclusions—

These data suggest that the effect on apoA-I levels observed with atorvastatin at higher drug doses in humans may be caused at least in part by enhanced HDL apoA-I catabolism, which is not entirely offset by a concomitant increase in apoA-I production. Whether this finding results from an effect of atorvastatin on HDL particle composition or on receptors involved in circulating HDL holoparticle clearance will require further study.
Expression and Regulation of ST2, an Interleukin-1 Receptor Family Member, in Cardiomyocytes and Myocardial Infarction
Authors: Weinberg Ellen O. , Shimpo Masahisa , De Keulenaer Gilles W. , MacGillivray Catherine , Tominaga Shin-ichi , Solomon Scott D. , Rouleau Jean-Lucien , Lee Richard T.
Published: December 2002

Background—

We identified an interleukin-1 receptor family member, ST2, as a gene markedly induced by mechanical strain in cardiac myocytes and hypothesized that ST2 participates in the acute myocardial response to stress and injury.

Methods and Results—

ST2 mRNA was induced in cardiac myocytes by mechanical strain (4.7±0.9-fold) and interleukin-1β (2.0±0.2-fold). Promoter analysis revealed that the proximal and not the distal promoter of ST2 is responsible for transcriptional activation in cardiac myocytes by strain and interleukin-1β. In mice subjected to coronary artery ligation, serum ST2 was transiently increased compared with unoperated controls (20.8±4.4 versus 0.8±0.8 ng/mL,
P
<0.05). Soluble ST2 levels were increased in the serum of human patients (N=69) 1 day after myocardial infarction and correlated positively with creatine kinase (
r
=0.41,
P
<0.001) and negatively with ejection fraction (
P
=0.02).

Conclusions—

These data identify ST2 release in response to myocardial infarction and suggest a role for this innate immune receptor in myocardial injury.
Effects of Selective α
1
- and α
2
-Adrenergic Blockade on Coronary Flow Reserve After Coronary Stenting
Authors: Gregorini Luisa , Marco Jean , Farah Bruno , Bernies Monique , Palombo Carlo , Kozàkovà Michaela , Bossi Irene M. , Cassagneau Bernard , Fajadet Jean , Di Mario Carlo , Albiero Remo , Cugno Massimo , Grossi Adalberto , Heusch Gerd
Published: December 2002

Background—

Coronary flow reserve (CFR) is not normalized shortly after coronary stenting. We hypothesized that α-adrenergic coronary vasoconstriction acts to limit CFR.

Methods and Results—

We assessed flow velocity by Doppler wires and cross-sectional area by angiography in 46 patients undergoing coronary culprit lesion stenting (81±4% stenosis). Hyperemia was induced by adenosine (24 μg IC or 140 μg/kg per minute IV) before and after stenting. Finally, either the α
1
-antagonist urapidil (10 mg IC) or the α
2
-antagonist yohimbine (3 mg IC) was randomly combined with adenosine. In 8 subjects with angiographically normal coronary arteries, CFR was increased from 3.21±0.30 to 3.74±0.43 by yohimbine and to 4.58±0.65 by urapidil, respectively (
P
=0.0001). Patients were divided according to the cutoff of CFR ≥3.0 (n=18) or <2.5 (n=28). Revascularization per se did not change CFR. However, 15 minutes after stenting, CFR decreased to 2.05±0.55 from CFR 3.64±0.58, whereas in patients with CFR 2.39±0.51, it remained unchanged. Yohimbine improved CFR to 3.26±0.42 and to 3.41±0.58 in patients with >3.0 and <2.05±0.55 baseline CFR, respectively. Urapidil improved CFR to 3.52±0.30 and 3.98±1.07, respectively.

Conclusions—

Urapidil and yohimbine attenuated the CFR impairment occurring after revascularization by increasing both the epicardial vasodilator effect of adenosine and the blood flow velocity, thus suggesting that the adrenergic system plays an important role in limiting the capacity of the coronary circulation to dilate.
Demonstration of a Left Atrial Input to the Atrioventricular Node in Humans
Authors: Gonzalez Mario D. , Contreras Leonardo J. , Cardona Francisco , Klugewicz Christopher J. , Conti Jamie B. , Curtis Anne B. , Morey Timothy E. , Dennis Donn M.
Published: December 2002

Background—

During right atrial stimulation, the anterior and posterior approaches provide inputs to the atrioventricular (AV) node. The purpose of the present study was to determine how activation proceeding from the left atrium reaches the AV node.

Methods and Results—

We studied AV nodal conduction during right and left atrial (coronary sinus) stimulation in 46 patients (27 women and 19 men; mean age, 46±4 years) who had structurally normal hearts. At an identical cycle length (600 ms), left atrial stimulation resulted in shorter A-H intervals than right atrial stimulation (73±3 ms versus 99±3 ms;
P
<0.05). In addition, atrial electrograms recorded close to the His bundle changed from near to far field potentials when stimulation was shifted to the left atrium. The A-H interval prolonged as the site of pacing was progressively moved from the distal to the proximal coronary sinus. During constant pacing from the distal coronary sinus, atrial activation close to the His bundle could be advanced by late extrastimuli delivered at the anterior and posterior approaches (up to 11±2 ms and 9±1 ms, respectively), without altering His bundle activation time. In contrast, late extrastimuli delivered at the inferoparaseptal mitral annulus advanced both the A and H electrograms in 19 of 20 patients, which is consistent with a left-sided input to the AV node. Right and left atrial stimulation resulted in similar AV nodal function.

Conclusion—

The mitral annulus provides a left atrial input to the human AV node.
Predictive Value of Cardiac Troponin I and T for Subsequent Death in End-Stage Renal Disease
Authors: Apple Fred S. , Murakami MaryAnn M. , Pearce Lesly A. , Herzog Charles A.
Published: December 2002

Background—

This study determined the prevalence of increased cardiac troponin I (cTnI) and T (cTnT) in end-stage renal disease (ESRD) patients and whether an increased troponin was predictive of death.

Methods and Results—

Serum was obtained from 733 ESRD patients and measured for cTnI and cTnT. Relative risks were estimated using Cox proportional hazards regressions univariately and adjusted for age, time on dialysis, and coronary artery disease. Kaplan-Meier curves compared time to event data between groups. Greater percentages of patients had an increased cTnT versus cTnI at each cutoff, as follows: 99th percentile, 82% versus 6%; 10% coefficient of variation, 53% versus 1.0%; and receiver operator characteristic, 20% versus 0.4%. Increased versus normal cTnT was predictive of increased mortality using all cutoffs and only above the 99th percentile for cTnI. Two-year cumulative mortality rates increased (
P
<0.001) with changes in cTnT from normal (<0.01 μg/L, 8.4%) to small (≥0.01 to <0.04 μg/L, 26%), moderate (≥0.04 to <0.1 μg/L, 39%), and large (≥0.1 μg/L, 47%) increases. Two-year mortalities were 30% for cTnI <0.1 μg/L and 52% if ≥0.1 μg/L. Univariate and adjusted relative risks of death associated with elevated (>99th percentile) cTnT were 5.0 (CI, 2.5 to 10;
P
<0.001) and 3.9 (CI, 1.9 to7.9;
P
<0.001) and cTnI were 2.0 (CI, 1.3 to 3.3;
P
=0.008) and 2.1 (CI, 1.3 to 3.3;
P
=0.007). Age, coronary artery disease, and time on dialysis were also independent predictors of mortality.

Conclusions—

Increases in cTnT and cTnI in ESRD patients show a 2- to 5-fold increase in mortality, with a greater number of patients having an increased cTnT.
Serum Albumin and Risk of Myocardial Infarction and All-Cause Mortality in the Framingham Offspring Study
Authors: Djoussé Luc , Rothman Kenneth J. , Cupples L. Adrienne , Levy Daniel , Ellison R. Curtis
Published: December 2002

Background—

Coronary disease remains the leading cause of death in the United States. The association between serum albumin and cardiovascular disease remains controversial. We used data collected prospectively from participants of the Framingham Offspring Study to assess whether a lower concentration of serum albumin was associated with an increased risk of myocardial infarction (MI) and all-cause mortality.

Methods and Results—

During 21.9 years of mean follow-up, 280 cases of MI occurred. From the highest to the lowest tertile of serum albumin, crude incidence rates of MI were 26.7, 46.7, and 67.8 cases per 10 000 person-years, respectively, for men and 5.9, 15.0, and 16.8 cases per 10 000 person-years, respectively, for women. In a Mantel-Haenszel method adjusting for age, total cholesterol, and hypertension, lower serum albumin was associated with an increased risk of MI in both sexes. From the highest to the lowest tertile of albumin, the adjusted hazard ratios (95% CI) of MI were 1.0 (reference), 1.25 (0.84 to 1.84), and 1.49 (1.01 to 2.21), respectively, for men and 1.0, 1.79 (0.88 to 3.65), and 2.12 (1.06 to 4.27), respectively, for women. The albumin-MI association was stronger among hypertensive subjects in both sexes. In addition, low albumin was associated with an increased rate of all-cause mortality in women.

Conclusions—

Lower serum albumin concentrations appear to be associated with an increased risk of coronary disease in both sexes and with all-cause mortality in women and could help along with traditional risk factors in identifying people at risk of MI.
Neutrophil Infiltration of Culprit Lesions in Acute Coronary Syndromes
Authors: Naruko Takahiko , Ueda Makiko , Haze Kazuo , van der Wal Allard C. , van der Loos Chris M. , Itoh Akira , Komatsu Ryushi , Ikura Yoshihiro , Ogami Masayuki , Shimada Yoshihisa , Ehara Shoichi , Yoshiyama Minoru , Takeuchi Kazuhide , Yoshikawa Junichi , Becker Anton E.
Published: December 2002

Background—

Neutrophils in unstable atherosclerotic lesions have not received much consideration, despite accumulating evidence suggesting a link between systemic inflammation and acute coronary syndromes.

Methods and Results—

Coronary artery segments were obtained at autopsy from 13 patients with acute myocardial infarction (AMI); 8 had a ruptured and 5 an eroded plaque. Patients (n=45) who had died of noncardiovascular diseases served as reference. Atherectomy specimens were obtained from 35 patients with stable angina pectoris (SAP) and from 32 patients with unstable angina pectoris (UAP). Antibodies against CD66b, elastase, myeloperoxidase, and CD11b identified neutrophils; CD10 identified neutral endopeptidase (NEP). CD66b-positive and NEP-positive neutrophils were counted and expressed as a number per square millimeter of tissue. All specimens with plaque rupture or erosion showed distinct neutrophil infiltration; the number did not differ between ruptured and eroded plaques. However, the number of NEP-positive neutrophils was significantly higher (
P
<0.0001) in ruptured plaques than in eroded plaques. UAP patients showed neutrophils in 14 of 32 culprit lesions; in SAP only 2 of 35 lesions contained neutrophils. The number of neutrophils and NEP-positive cells in patients with UAP was significantly higher (neutrophils,
P
<0.0005; NEP-positive cells,
P
<0.005) than in patients with SAP.

Conclusions—

The observations suggest that neutrophil infiltration is actively associated with acute coronary events. The high number of NEP-positive neutrophils in ruptured plaques, compared with eroded plaques, may reflect differences in the underlying pathophysiological mechanisms.
Plasma Urotensin in Human Systolic Heart Failure
Authors: Ng Leong L. , Loke Ian , O’Brien Russell J. , Squire Iain B. , Davies Joan E.
Published: December 2002

Background—

Human urotensin II (UTN) has potent vasoactive and cardiostimulatory effects, acting on the G protein–linked receptor GPR14. Myocardial UTN expression is upregulated in heart failure, and UTN stimulates myocardial expression of the natriuretic peptides. We investigated plasma UTN levels in heart failure (HF; left ventricular systolic dysfunction) in comparison with plasma N-terminal pro-brain natriuretic peptide (N-BNP) levels.

Methods and Results—

N-BNP and UTN were measured in plasma from 126 patients with HF and 220 age- and sex-matched controls. Both peptides were elevated in plasma of HF patients and were correlated (r
s
=0.35,
P
<0.001). In contrast to N-BNP, there was no relationship of plasma UTN with New York Heart Association (NYHA) class. Although plasma N-BNP showed a positive relationship with age and female sex, there was no such age-dependent change in plasma UTN, and control women had lower levels compared with control men. Receiver operating characteristic curves for the diagnosis of HF had areas of 0.90 and 0.86 for N-BNP and UTN, respectively (
P
<0.001 for both). Receiver operating characteristic curve area for diagnosis of NYHA class I HF with UTN was better than that with N-BNP.

Conclusions—

Plasma UTN is elevated in HF, which suggests a pathophysiological role for this peptide. Plasma UTN may be a useful alternative to N-BNP in the diagnosis of HF, inasmuch as its levels are elevated irrespective of age, sex, or NYHA class.
Comparison of Triage Assessments among Pediatric Registered Nurses and Pediatric Emergency Physicians
Authors: Bergeron Sylvie , Gouin Serge , Bailey Benoît , Patel Hema
Published: December 2002

Objectives: To compare triage level assignments, using simulated written case scenarios, in a pediatric emergency department (ED) among registered nurses (RNs) and pediatric emergency physicians (PEPs) and to compare the triage level assignments among RNs and PEPs with a consensus criterion standard. Methods: This was a cross‐sectional mailed questionnaire survey. The study was conducted at a pediatric tertiary care center with more than 65,000 annual patient visits. Participants were PEPs and RNs working in the ED. Dillman's Total Design Method, with three mailouts, was used for questionnaire construction and implementation. The survey included 55 case scenarios of patients presenting to the ED. Participants were instructed to assign triage level on each case, using the following four‐level triage scale: 1 = resuscitation / emergent, 2 = urgent, 3 = less‐urgent, and 4 = non‐urgent. A priori, all cases were assigned a triage level by consensus agreement of three PEPs, using established triage guidelines from the RNs' teaching manual. Kappa statistics (95% CI) and the mean percentage of correct responses (±1 SD) were calculated. Results: There was a 100% response rate (39 RNs, 24 PEPs). The kappa level of agreement (95% CI) was 0.453 (0.447 to 0.459) among the RNs and was 0.419 (0.409 to 0.429) among the PEPs. The mean percentage of correct responses (±1 SD) for the RNs was 64.2% (±8.0%) and for the PEPs was 53.5% (±8.1%, p < 0.01). There was no significant difference within groups by experience level (<10 vs. ≥10 years) or by the type of work schedule (day vs. evening vs. overnight) or full‐time vs. part‐time status. Conclusions: The level of agreement and accuracy of triage assignment was only moderate for both RNs and PEPs. Triage, a crucial step in emergency care, requires improved measurement.
The Effect of Seatbelt Use on Injury Patterns, Disposition, and Hospital Charges for Elders
Authors: Coley Andrew , Partridge Robert , Kaylor Cynthia , Shapiro Marc
Published: December 2002

Objective: To study the relationships between seatbelt use and injury patterns, hospital charges, morbidity, and mortality in elder motor vehicle crash victims. Methods: A retrospective review of individuals at least 65 years old presenting to an urban emergency department (ED) after a motor vehicle crash. Results: Over a two‐year period, 339 patients had documentation of seatbelt use or non‐use at the time of the crash. Of these, 241 (71%) patients had been wearing a seatbelt and 98 (29%) had not. Elders not using seatbelts were more likely to require hospitalization (29% unbelted vs. 17% belted) and had a higher mortality rate. Injury patterns were different in the two groups. Emergency department charges were significantly different between belted and unbelted elders ($351 vs. $451, p = 0.01) and head computed tomography (CT) utilization was higher in the unbelted group (25.6% vs 12.7%, p = 0.005). Conclusions: Improved seatbelt compliance in elders can reduce injuries, hospitalization rates, ED charges, and mortality resulting from motor vehicle crashes.
Variability in Institutional Review Board Assessment of Minimal‐risk Research
Authors: Hirshon Jon Mark , Krugman Scott D. , Witting Michael D. , Furuno Jon P. , Limcangco M. Rhona , Perisse Andre R. , Rasch Elizabeth K.
Published: December 2002

Objectives: To examine variability in responses from institutional review boards (IRBs) to submission of a proposed minimal‐risk survey. Methods: Identical research proposals to obtain information concerning beliefs about the needs of victims of intimate partner violence via surveys were submitted for IRB approval to three institutions in the Baltimore metropolitan area. One institution is an academic center, one is an inner‐city hospital affiliated with the academic center, and the third is a suburban community hospital. The study population consisted of emergency department health care providers and individuals in emergency department waiting areas. Results: Inconsistencies emerged among the three IRBs in the review process itself, the need for participant consent, and the need for revision of the consent form and study protocol. One institution approved the proposal in 15 business days after expedited review. The second institution approved the proposal in 12 business days and waived the requirement for informed consent. The third institution approved the research in 77 business days after three revisions. Questions raised included: methodology for selecting participants; appropriateness of surveying individuals in emergency department waiting areas; a request for background literature to assure that the research questions had not already been answered; and concerns about study methodology and sample size justification. Conclusions: In this sample, there is considerable variability in IRB processes even for minimal‐risk studies.
2001‐2002 SAEM Emergency Medicine Faculty Salary and Benefits Survey
Authors: Kristal Steven L. , Randall‐Kristal Karen A. , Thompson Bruce M.
Published: December 2002

Objective: The Society for Academic Emergency Medicine (SAEM) commissioned an emergency medicine (EM) faculty salary and benefits survey for all 2001 residency review committee (RRC)‐EM‐accredited programs using the SAEM fifth‐generation survey instrument. Responses were collected by SAEM and blinded from the investigators. Data represent compensation paid for the 2001‐02 academic year. Seventy‐six of 124 (61%) accredited programs responded, yielding usable data on 1,355 full‐time faculty representing all four Association of American Medical Colleges (AAMC) regions. Methods: Blinded program and individual faculty data were entered into a customized version of Filemaker Pro, a relational database program with a built‐in statistical package. Salary data were sorted by criteria such as program region, faculty title, American Board of Emergency Medicine (ABEM) certification, academic rank, years postresidency, program size, and whether data were reported to the AAMC. Demographic data were analyzed with regard to numerous criteria, including department staffing levels, emergency department (ED) volumes, ED length of stay, department income sources, salary incentive components, research funding, and specific type and value of fringe benefits offered. Data were compared with those from previous SAEM studies. Results: Mean salaries were reported as follows: all faculty, $180,913; first‐year faculty, $147,746; programs reporting data to the AAMC, $174,354; programs not reporting data to the AAMC, $191,397. Mean salaries as reported by AAMC region: northeast, $178,593; south, $176,314; midwest, $200,095; west, $166,779. Full‐time emergency medicine residency program faculty work an average of 1,129 clinical hours per year. Conclusions: Reported salaries for full‐time EM residency faculty have risen approximately 8.7% since the last survey. Up to approximately 1,200 clinical hours worked per year, salary varies inversely with clinical hours worked. Total per‐faculty patient contact time (overall workload) has grown approximately 13% since the last survey. Patient wait times have increased approximately 27% since the last survey. Significant regional differences in salaries have been present in all five SAEM surveys. Emergency medicine residency faculty continue to work at the upper extremes of patient encounters per physician, patient acuity levels, and department lengths of stay.
Shaw GM, Lammer EJ, Huiping Z, Wang Baker M, Neri E, Finnell RH. 2002. Maternal preconceptual vitamin use, genetic variation of infant reduced folate carrier (A80G), and risk of spina bifida. Am J Med Genet 108:1–6.
Authors: Shaw Gary M. , Lammer Edward J. , Zhu Huiping , Baker Mei Wang , Neri Eric , Finnell Richard H.
Published: December 2002

The original article to which this Erratum refers was published in American Journal of Medical Genetics (2002) 108(1) 1–6
Could cognitive vulnerability identify high‐risk subjects for schizophrenia?
Authors: Sarfati Yves , Hardy‐Baylé Marie‐Christine
Published: December 2002

This review puts into questions the possible role of cognitive vulnerability markers in prediction and prevention of schizophrenia. Until recently, none of the identified cognitive anomalies has been proved to be definitive. However, as new promising candidates are emerging (DS‐CPT, CPT‐IP, P suppression, Saccadic Eye Movements), the predictive value of these trait–type anomalies may be criticized regarding four issues, which are discussed: technical, metrological, theoritical, and clinical. As things stand, the existence of a cognitive vulnerability marker, which testify to a permanant pathological trait, does not constitute a suffisant factor to identify and treat subjects who are at risk for schizophenia. © 2002 Wiley‐Liss, Inc.
Caruncle abnormalities in the oculo‐auriculo‐vertebral spectrum
Authors: Nijhawan Navdeep , Morad Yair , Seigel‐Bartelt Jacqueline , Levin Alex V.
Published: December 2002

Goldenhar syndrome (GS) is a congenital disorder believed to be caused by the defective development of the first and second brachial arches and the first brachial clefts during the fourth through eighth weeks of embryologic development. It is characterized by epibulbar dermoids and/or lipodermoids, preauricular tags, pretragal fistulas, hemifacial microsomia, and vertebral anomalies. Other ocular and nonocular symptoms have also been described. To our knowledge there are only three previous reports of abnormal caruncles in GS. We have reviewed our experience with a consecutive series of seven GS patients with caruncular malformations. Caruncular abnormalities included dysplatic and/or bilobed caruncles (two cases), ectopic caruncles (three bilateral cases and one unilateral case), and ectopic plus dysplastic caruncles (one case). Our experience suggests that the incidence of caruncular malformations in GS anomalies is higher than previously reported. This may be clinically important in differentiating GS from other first‐ and second‐arch syndromes. Additionally, linking abnormalities in the first and second months of gestation that cause the typical stigmata of GS with malformation of the caruncles, which normally develop in the third month of gestation, could provide clues to the pathogenesis of GS. © 2002 Wiley‐Liss, Inc.