bluuebunny/crossref_metadata_2025 huggingface dataset:
Decrements in the Thrombin Activatable Fibrinolysis Inhibitor (TAFI) Levels in Association with Orlistat Treatment in Obesity
Authors: Guven Gulay Sain , Kiliçaslan Alpaslan , Oz S. Gul , Haznedaroglu Ibrahim C. , Kirazli Serafettin , Aslan Dilek , Sözen Tümay
Published: June 2007

Obesity and its associated metabolic complications can impair the physiologic regulation of fibrinolysis, leading to a hyper coagulable state. We aimed to assess circulating thrombin activatable fibrinolysis inhibitor (TAFI) levels in obese female patients and to test the effects of orlistat-induced weight loss on basal TAFI concentrations. Obese female outpatients age 18 and older, with a body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) of at least 30, were included into the study. Thirteen nonobese (median BMI, 22.60 kg/m2) age-matched females were taken as controls. Plasma TAFI levels were measured before orlistat administration and after 6 months of orlistat treatment in the obese group and only one measurement was done in the control group. Twenty-seven obese patients were recruited into the study. The median TAFI level of the control group was 124.00; this value was significantly lower than the basal TAFI level of the obese group (p < 0.001). TAFI levels after orlistat therapy were statistically significantly lower than basal TAFI levels (p < 0.001) in the obese group. Hemostatic abnormalities including TAFI alterations represent a link between obesity and vascular thrombosis. Effective interventions should be considered in improving the obesity-associated prothrombotic risk profile.
Assessment of Total Thrombus Load in Symptomatic Patients With Venous Thromboembolism
Authors: Parakh R. , Kapadia S. , Agarwal S. , Grover T. , Bukhari S. , Yadav A. , Sen I. , Pankaj P.
Published: June 2007

Pulmonary embolism (PE) and Deep vein thrombosis (DVT) are separate but related aspects of the same dynamic process termed as venous thrombembolism (VTE). The existing Asian literature has shown a wide variation in the prevalence of VTE, with very limited data from the Indian subcontinent. Between January 2001 and July 2004, 1552 patients with clinically suspected lower limb DVT underwent a combined ascending radionuclide venogram and lung perfusion scan for assessment of the total thrombus burden. Of 744 patients with radionuclide venography proven DVT, 294 (40%) had a high probability lung scan. Nearly half of these patients were asymptomatic for pulmonary embolism. The high prevalence of PE in patients with DVT suggests the need for evaluation of thrombus load in the venous as well as pulmonary circulation. A combination radionuclide ascending venography with lung perfusion scan is a useful and reliable single test for this purpose.
Determination of von Willebrand Factor Activity: Evaluation of the HaemosIL™ Assay in Comparison With Established Procedures
Authors: Sucker Christoph , Senft Beate , Scharf Rüdiger E. , Zotz Rainer B.
Published: June 2007

Determination of von Willebrand factor activity is required for diagnosis and classification of von Willebrand disease. In addition, von Willebrand factor activity can be of prognostic relevance in several clinical entities including thromboembolic and cardiovascular disorders in which elevated activity correlates with a poor prognosis. The HaemosIL™ assay (Instrumentation Laboratory GmbH, Munich, Germany) provides a new fully automated procedure for determination of von Willebrand factor activity. This assay measures binding of the von Willebrand factor to GP Ibα of the platelet glycoprotein complex Ib-V-IX. In our study, we analyzed 300 samples including those of patients with hereditary von Willebrand disease. The results obtained with the HaemosIL™ assay were compared to von Willebrand factor activities determined by established procedures. Activities determined with HaemosIL™ correlated with those activities determined as ristocetin cofactor (r = 0.88, p < 0.0001), collagen-binding (r = 0.93, p < 0.0001), and GP Ib-binding (r = 0.91, p < 0.0001). The comparability of results obtained by HaemosIL™ and the GP Ib-binding ELISA were excellent ([HaemosIL™] = 0.96 ∞ activity [GP Ib-binding ELISA] + 10.7), whereas activities determined by ristocetin cofactor or collagen-binding revealed more variance. Like the other assays, the HaemosIL™ failed to indicate a loss of high-molecular-weight von Willebrand factor multimers. The HaemosIL™ assay can replace the GP Ib-binding ELISA for the determination of von Willebrand factor activity. Advantages of this assay include accuracy of results, full automation, and, thus, broad availability. Since the assay does not predict the absence of high-molecular-weight multimers, multimeric analysis remains the procedure of choice for the differentiation of functional defects.
Circulated Activated Platelets and Increased Platelet Reactivity in Patients With Behçet’s Disease
Authors: Akar Servet , Özcan Mehmet Ali , Ateş Halil , Gürler Oğuz , Alacacioglu Inci , Özsan G. Hayri , Akkoç Nurullah , Özkan Sebnem , Demirkan Fatih , Onen Fatos
Published: June 2007

Behçet’s disease (BD) is a multisystem disorder. Venous as well as arterial thrombosis is a common complication of BD but exact pathogenetic mechanism of the thrombotic tendency is not well known. This study aimed to evaluate circulating activated platelets and platelet reactivity in Behçet’s patients. Twenty-two Behçet’s patients (4 female, 18 male; mean age 38.6 ± 10.9 years) and 20 control subjects (8 female, 12 male; mean age 38.8 ± 9.4 years) were included. Those patients who had hypertension, hyperlipidemia, peripheral or coronary artery disease, hepatic or renal function abnormality, and who were using aspirin and other platelet-active drugs were excluded. Platelet activity and reactivity to adenosine diphosphate (ADP) were measured by whole blood flow cytometry. We assessed markers of platelet degranulation (P-selectin; CD62P) and the activated glycoprotein IIb/IIIa receptor (PAC1 binding to fibrinogen binding site) before and after stimulation with ADP. Platelet P-selectin expression was not significantly different between patients and control subjects both at baseline (p=0.420) and after stimulation (p=0.56). Baseline (p=0.001) and ADP-stimulated (p=0.003) PAC1 binding was significantly higher in Behçet’s patients than in the control group. Clinical activity has no effect on P-selectin expression and PAC1 binding. There is evidence of platelet activity and hyperreactivity in patients with BD and this may contribute to a prothrombotic state. In addition to aspirin, other antiplatelet drugs may be useful in the prevention and treatment of thrombosis in Behçet’s patients.
The Fibrinogen Antigenic Turbidimetric Assay (FIATA): The X2x Test—The Corrected Chi-Square Comparison Against the Control-mean
Authors: Stief Thomas W.
Published: June 2007

Vancomycin precipitates fibrinogen. The turbidity induced by this vancomycin-fibrinogen interaction is used to establish a simple standardized antigenic assay for plasmatic fibrinogen, the FIATA. 1 mM vancomycin or 2 mM chloramine-T inactivates 50% of fibrinogen in human plasma. In contrast to chloramine-T, vancomycin does not react in NaJ-based photometric assay for chloramines, vancomycin does not inactivate the singlet oxygen-sensible antithrombin III, and the vancomycin action against fibrinogen is not changed in spite of the presence of the 1O2 quenchers methionine or ascorbic acid. The FIATA is performed as follows: to 25 μL plasma 50 μL PBS are added and the absorbance (A) at 405 nm is read. Then 50 μL FIATA-reagent, consisting of 4.4 mM vancomycin in PBS, are added. After 2 minutes (RT) δA is determined and standardized against a plasma pool of 100% of norm (2.8 g/L) fibrinogen. The FIATA is nearly linear up to a fibrinogen concentration of about 150% of norm (4.2 g/L), resulting in a δA of about 600 mA. The lower detection limit is 4% of norm (0.1 g/L). The intra-assay and interassay CV values are < 4%. The normal range of FIATA is 100% ± 20% ([ILLEGIBLE] ± 1 SD). In = 321 or 344 unselected patient plasmas the FIATA ([ILLEGIBLE] = 130%; SD = 52% or 43%) correlated with the functional fibrinogen assays a) modified Clauss-Method ([ILLEGIBLE] = 4.1 g/L; SD = 1.7 g/L) with r = 0.755 and b) FIFTA ([ILLEGIBLE] = 124%; SD = 40%) with r = 0.813. The vancomycin/fibrinogen interaction (binding of about 16 molecules of vancomycin/molecule of fibrinogen) can be used to purify fibrinogen out of plasma. Vancomycin also clouds dysfunctional fibrinogen (fibrinogen in presence of EDTA or chloramine-T) or soluble fibrin. Vancomycin-reacted fibrinogen stimulates tissue-type plasminogen activator (t-PA) up to about 20-fold. The experimental data are analyzed by a new significance test: the twofold Yates-corrected chi-square comparison against the mean value of the control-collective, called the [ILLEGIBLE] Test. The P < .05 barrier calculated with the [ILLEGIBLE] significance - Test is equivalent to that calculated with the Fisher’s Exact Test. The FIATA might be considered an interesting screening test for inactive fibrinogen forms or soluble fibrin, as eg in disseminated intravascular coagulation. Fibrinogen precipitation by vancomycin within the blood vessel might explain why vancomycin has to be infused slowly (< 10 mg/min) to prevent nephrotoxicity. The FIATA is of such a simplicity that the determination of fibrinogen antigen in plasma can be performed anywhere—even outside a hospital—within seconds. Thus, the presented FIATA might contribute to extrahospital testing of patients for assessing their risk for myocardial or cerebral ischemia/infarction.
A Prospective Comparative Study of Three Sets of Criteria for Disseminated Intravascular Coagulation: ISTH Criteria vs Japanese Criteria
Authors: Hayakawa Mineji , Gando Satoshi , Hoshino Hirokatsu
Published: June 2007

Clinical and laboratory criteria and a scoring system for disseminated intravascular coagulation (DIC) were recently published by the International Society on Thrombosis and Haemostasis (ISTH). In Japan, the DIC Diagnostic Standards published in 1988 have been widely used for more than 10 years. In a general intensive care unit, we prospectively compared the diagnostic properties of the overt DIC, nonovert DIC, and Japanese DIC criteria sets, and investigated the influences of each set on patient morbidity and mortality. Seventy-four patients with platelet counts below 150 × 109/L were included in this study. Blood samples were collected daily from day 0 to day 4 after inclusion in the study. The Japanese DIC included the overt DIC and both of these were included in the nonovert DIC. The Japanese DIC criteria diagnosed DIC earlier than the nonovert DIC criteria did ( P = .020). The DIC patients diagnosed by the Japanese criteria and those diagnosed by the overt DIC criteria showed a higher incidence of multiple organ failure than those without DIC ( P = .013 and P = .022, respectively). The Japanese and the nonovert DIC criteria tended to predict patient prognoses effectively. In conclusion, the Japanese and the nonovert DIC criteria are of value in predicting outcome. However, the nonovert DIC criteria take more time to diagnose DIC than the Japanese criteria do. A more precise clinical study is needed to determined appropriate specific criteria and cutoff points in the nonovert DIC criteria set.
Platelet Glycoprotein Ia 807c/T and 873g/A Polymorphisms in Patients With Venous Thromboembolism
Authors: Okumus Gulfer , Kiyan Esen , Arseven Orhan , Tabak Levent , Bayrak Evrim Komurcu , Unaltuna Nihan Erginel , Issever Halim
Published: June 2007

Two silent polymorphisms (807C/T and 873G/A) within glycoprotein Ia (GPIa) gene have been implicated in increased risk of developing thrombosis and myocardial infarction in affected individuals. The aim of this study was to investigate the GPIa gene polymorphism in patients with venous thromboembolism (VTE). A multiplexed allele specific-polymerase chain reaction (AS-PCR)–based method was used to determine the GPIa 807T/873A allele frequency in 77 patients with VTE and 106 healthy controls. The allelic frequency for 807T/873A was 33% in the patient group and 38% in the control group. The allelic frequency for 807C/873G was 66% in the patient group and 62% in the control group. The genotypic frequencies were 8% for 807TT/873AA, 42% for 807CC/GG, and 50% for 807CT/GA in the patient group. In the control group, the frequencies were 12% for 807TT/873AA, 35% for 807CC/873GG, and 52% for 807CT/873GA. As a result, the glycoprotein Ia 807C/T and 873G/A dimorphisms were not shown as risk factors for VTE.
Identifying Carriers of Type 2N von Willebrand Disease
Authors: Casonato A. , Pontara E. , Sartorello F. , Cattini M.G. , Perutelli P. , Bertomoro A. , Gallinaro L. , Pagnan A.
Published: June 2007

The defective FVIII carrier function of von Willebrand factor (VWF) identifies type 2N von Willebrand disease (VWD), a variant with a pattern resembling hemophilia A. Type 2N characterization is based on the evaluation of the capacity of VWF to bind exogenous FVIII (VWF:FVIIIB). Here we report on a retrospective evaluation of hemostatic laboratory parameters most useful in detecting type 2N carriers. The diagnostic capacity of aPTT, FVIII, VWF:Ag, FVIII/VWF:Ag ratio, VWF:FVIIIB and VWF:FVIIIB/VWF:Ag ratio was evaluated in 21 type 2N VWD carriers. Twenty subjects were heterozygous for the R854Q mutation, one was heterozygous for the R760C missense mutation, which interferes with cleavage of the VWF propeptide. We found that prolongation of aPTT and decrease in FVIII and FVIII/VWF:Ag ratio were not frequent findings in type 2N carriers. The same was true for VWF:FVIIIB which was not always abnormal. On the contrary, VWF:FVIIIB/VWF:Ag ratio was always defective and its values were not related with FVIII and FVIII/VWF:Ag ratio or influenced by plasma VWF concentration. Given these results, we attribute the greatest significance to VWF:FVIIIB/VWF:Ag ratio in the diagnosis of type 2N defects, and only search for type 2N mutations, to validate the diagnosis, if the ratio proves abnormal.
Adaptive Control of Structural Acoustics using Intelligent Structures with Embedded Piezoelectric Patches
Authors: Ma Kougen , Melcher J
Published: June 2007

In this paper we focus on the adaptive control of structural acoustics using intelligent structures with embedded piezoelectric (PZT) patches and low cost digital signal processor systems. After a discussion on the adaptive feedforward control scheme, a hybrid adaptive control scheme is proposed, which takes advantage of both feedback control and adaptive feedforward control. The two schemes are realized on a low-cost, small volume, convenient and universal digital signal processing (DSP) board. A carbon fiber reinforced polymer plate with two embedded PZT patches is developed and used in two experiments. The first experiment is adaptive interior noise control using the intelligent plate, in which the adaptive feedforward control scheme is employed. Obvious noise reduction is obtained for constant frequency, swept frequency and varying amplitude harmonic disturbances. The second experiment is adaptive control of sound-induced vibration of the plate, where two embedded PZT patches are used as an actuator and a sensor, respectively, and the hybrid adaptive controller is applied. The full vibration reduction for various harmonic excitations is obtained, verifying the advantage of the hybrid adaptive control. It is demonstrated that active control of structural acoustics can be efficiently achieved by employing intelligent structures, advanced adaptive control schemes and the low-cost DSP board.
The Semi-Empirical and Empirical Models for Predicting Sound Absorption Coefficients for a Novel Porous Laminated Composite Material
Authors: Yang Tsung-Lung , Chen Rongshun
Published: June 2007

Made of polymer, metal, and polymer fibers of low melting point, a porous laminated composite material (PLCM) exhibits very highly sound absorption coefficient over the frequency of 500-2000 Hz with a relatively thin structure. In this paper we present two models to predict sound absorption characteristics for a PLCM. Firstly, we derive a semi-empirical model in which the flow resistivity of the PLCM is a function of the fibrous surface area under the assumption that most energy loss is due to the viscous loss consumed in the fibrous surface of a PLCM. Secondly, we propose an empirical model to predict the characteristic impedance and the propagation constant, which then is employed to determine the sound absorption coefficient for a new PLCM. Numerical predictions have been performed and experiments have been conducted to validate the two proposed models.
Identification and Control of a Benchmark Flexible Structure using Piezoelectric Actuators and Sensors
Authors: Lin Chun-Liang , Lee Gean-Pao , Liu Van-Tsai
Published: June 2007

In this paper we propose a neural network approach for the identification and control of a benchmark flexible structure: a thin simply-supported plate with bonded piezoelectric film actuators and sensors. A specific linear differential inclusion is developed for a class of multilayer feedforward networks. With this technique, it is shown that the plant model identified by the neural network can be represented as a linear time-invariant system so that traditional or advanced linear control theory can be directly applied to design the stabilizing flexible structure controller.
Structural Damping and Vibration Control via Smart Sensors and Actuators
Authors: Garg Devendra P. , Anderson Gary L
Published: June 2007

In this paper we emphasize several advances recently made in the area of structural damping aimed towards reducing, and preferably eliminating, mechanical vibrations. First, a few commonly encountered undesirable effects of vibrations on structures are discussed. This is followed by an identification of research needs, and a discussion of typical research projects sponsored by the Structures and Dynamics Program of the United States Army Research Office towards meeting these needs. We include research projects in areas such as modeling of damping mechanisms, analysis and design of vibration absorbers, surface damping treatment of beams and similar other structures, and the use of magnetorheological and electrorheological fluids for vibration attenuation. Finally, we make recommendations for directions that are beneficial for future research in this area.
CAPES/PROCAD Intelligent Forecast System Applied to the Identification of Parameters in Flexible Structures
Authors: De Melo Hiran , Freire Raimundo C. S. , Da Silva José F. , Cavalcanti José H. F. , Barros Alessio T.
Published: June 2007

The Intelligent Forecast System (IFS) consists of three units: the main unit is a multilayer neural network; the second unit is based on fuzzy logic, which is used to prepare the data; and the third unit is based on a genetic algorithm and is used to determine the best set of data to be analyzed. The data were set up by using a strategy that classifies the terms of the series into parts with the same quantity of elements. Each part is called a window. The IFS was trained by using a group of windows, which is called a set of training windows. Next, the IFS was applied to solve several problems related to the evaluation of structural integrity. The IFS was applied as an identification strategy and forecast of parameters in a flexible structure. Additionally, by using the IFS we have developed a new strategy to analyze the temporary series obtained from vibrations of flexible structures with the distribution of variable mass. The results obtained in this research, using the IFS applied as an identification strategy and forecast of parameters in a flexible structure, show the effectiveness of the IFS.
The Cost-Effectiveness of Noninstitutional Long-Term Care Services: Review and Synthesis of the Most Recent Evidence
Authors: Grabowski David C.
Published: June 2007

There has been significant expansion and change in the financing, coverage, and delivery of home-and community-based services during the past decade. This article reviews the cost-effectiveness of Medicaid waiver programs, consumer-directed care, capitated models that blend acute and long-term care services, and case management and subsidized community services for individuals with dementia. Generally, these new care models were found to be associated with increased costs, but greater client and caregiver welfare. Depending on the specific features of the program, capitated care models and consumerdirected care were identified as potential mechanisms toward providing services more efficiently. Importantly, however, most recent evaluations have relied on potentially confounded research designs, which leaves open the question of whether the findings relate to the programs or biased selection across the treatment and comparison groups.
Quality Improvement Implementation and Hospital Performance on Patient Safety Indicators
Authors: Weiner Bryan J. , Alexander Jeffrey A. , Baker Laurence C. , Shortell Stephen M. , Becker Mark
Published: June 2007

This study examines the association between scope of Quality Improvement (QI) implementation in hospitals and hospital performance on patient safety indicators. Secondary data sources included a 1997 survey of hospital QI practices, Medicare Inpatient Database, American Hospital Association's Annual Survey of Hospitals, the Bureau of Health Professions'Area Resource File, and two proprietary data sets. Using a sample of 1,784 community hospitals, the study employed two-stage instrumental variables estimation in which predicted values of four QI scope variables and control variables were used to estimate four patient safety indicators. Involvement by multiple hospital units in the QI effort is associated with worse values on all four patient safety indicators. Percentages of hospital staff and of senior managers participating in QI teams exhibited no statistically significant association with any patient safety indicator. Percentage of physicians participating in QI teams is associated with better values on two patient safety indicators.
The Use of Contract Licensed Nursing Staff in U.S. Nursing Homes
Authors: Bourbonniere Meg , Feng Zhanlian , Intrator Orna , Angelelli Joseph , Mor Vincent , Zinn Jacqueline S.
Published: June 2007

The extent to which nursing homes rely on the use of contracted licensed staff, factors associated with this staffing practice, and the resultant effect on the quality of resident care has received little public attention. Merging the On-line Survey Certification and Reporting System database with the Area Resource File from 1992 through 2002, the authors regressed organizational and market-level variables on the use of 5 percent or more contract full-time equivalent registered nurses and licensed practical nurses. Since 1997, the proportion of facilities using 5 percent or more contract licensed staff more than tripled. Use of contract nurses was associated with more deficiency citations, characteristics of poorer facilities, and tight labor markets. Nursing homes increasingly rely on contract nurses. The failure of nursing homes to attract and retain a competent, stable workforce creates a vicious cycle of staffing practices, which may lead to decline in quality of care.
Cost-Effectiveness of Hospital Pay-for-Performance Incentives
Authors: Nahra Tammie A. , Reiter Kristin L. , Hirth Richard A. , Shermer Janet E. , Wheeler John R. C.
Published: June 2007

One increasingly popular mechanism for stimulating quality improvements is pay-for-performance, or incentive, programs. This article examines the cost-effectiveness of a hospital incentive system for heart-related care, using a principal-agent model, where the insurer is the principal and hospitals are the agents. Four-year incentive system costs for the payer were $22,059,383, composed primarily of payments to the participating hospitals, with approximately 5 percent in administrative costs. Effectiveness is measured in stages, beginning with improvements in the processes of heart care. Care process improvements are converted into quality-adjusted life years (QALYs) gained, with reference to literatures on clinical effectiveness and survival. An estimated 24,418 patients received improved care, resulting in a range of QALYs from 733 to 1,701, depending on assumptions about clinical effectiveness. Cost per QALY was found to be between $12,967 and $30,081, a level well under consensus measures of the value of a QALY.
What’s the Return? Assessing the Effect of “Pay-for-Performance” Initiatives on the Quality of Care Delivery
Authors: Grossbart Stephen R.
Published: June 2007

This article evaluates the impact of the Centers for Medicare & Medicaid Services/Premier pay-for-performance demonstration project on performance improvement in three clinical areas in a multihospital health care system. The study compares a group of hospitals participating in this project against a control group of similar hospitals that did not participate. Although the incentives are extremely small, the findings show that participation in the pay-for-performance initiative had a significant impact on the rate and magnitude of performance improvement. The project led to marked improvement in the quality of clinical process delivery and accelerated the adoption of evidence-based practices.
Persephone's Triumph
Authors: Brown Ruth Nicole
Published: June 2007

This article is a poetic retelling of insight gained as a Black woman surviving graduate school. The purpose of this autoethnographic narrative is to document a few pivotal graduate school experiences that illustrate all that it means to become disciplined in and by higher education. Although the violence committed in such a privileged space may seem trivial, the hurt is real and needs to be given voice. Written to warn and to inspire those not yet overcoming, the metaphor of Persephone and Demeter (as adapted by Rita Dove) is invoked in this essay to demonstrate how it is more than possible to reign in the midst of pain.
Silenced, Silence, Silent
Authors: Carpenter Lorelei , Austin Helena
Published: June 2007

This project explores the experiences of women who mother children with ADHD.1 The authors use the metaphor of the text and the margin. The text is the “motherhood myth” that describes a particular sort of “good” mothering. The margin is the space beyond that text. This marginal space is inhabited by some or all of the mothers they spoke with, some or all of the time, as they fail to be recognized by the text. They explore the many sorts of silence, whether imposed or “strategic choice,” that disable these women by segregating and isolating them. They also use the metaphor of trouble. They explore the troubling work these mothers do as they negotiate motherhood on the borders of that myth. The troubling work is itself troubled—as neither strategic silence nor strategic unsilence is without its risk, and both at times reinscribe the very mythology that denies these women.
Working Between Languages and Cultures
Authors: Hole Rachelle
Published: June 2007

In this article, the author examines how issues of representation, voice, and authority were intensified in a study conducted by a hearing researcher (the author) with culturally Deaf women who communicated in American Sign Language (ASL). First, a brief context of the original study is provided. Second, the collaborative narrative methods used are described. Third, some of the methodological implications of conducting collaborative narrative research across languages (English and ASL) and across cultures (hearing and Deaf) are explored. Finally, the author concludes with a short discussion of methodological implications arising from an exploration of how she chose to manage representational issues that occurred in her research across languages and across cultures.
Effects of Age on Auditory and Cognitive Processing: Implications for Hearing Aid Fitting and Audiologic Rehabilitation
Authors: Pichora-Fuller M. Kathleen , Singh Gurjit
Published: June 2007

Recent advances in research and clinical practice concerning aging and auditory communication have been driven by questions about age-related differences in peripheral hearing, central auditory processing, and cognitive processing. A “site-of-lesion” view based on anatomic levels inspired research to test competing hypotheses about the contributions of changes at these three levels of the nervous system. A “processing” view based on psychologic functions inspired research to test alternative hypotheses about how lower-level sensory processes and higher-level cognitive processes interact. In the present paper, we suggest that these two views can begin to be unified following the example set by the cognitive neuroscience of aging. The early pioneers of audiology anticipated such a unified view, but today, advances in science and technology make it both possible and necessary. Specifically, we argue that a synthesis of new knowledge concerning the functional neuroscience of auditory cognition is necessary to inform the design and fitting of digital signal processing in “intelligent” hearing devices, as well as to inform best practices for resituating hearing aid fitting in a broader context of audiologic rehabilitation. Long-standing approaches to rehabilitative audiology should be revitalized to emphasize the important role that training and therapy play in promoting compensatory brain reorganization as older adults acclimatize to new technologies. The purpose of the present paper is to provide an integrated framework for understanding how auditory and cognitive processing interact when older adults listen, comprehend, and communicate in realistic situations, to review relevant models and findings, and to suggest how new knowledge about age-related changes in audition and cognition may influence future developments in hearing aid fitting and audiologic rehabilitation.
A Historical Perspective on Digital Hearing Aids: How Digital Technology Has Changed Modern Hearing Aids
Authors: Levitt Harry
Published: June 2007

This article provides the author's perspective on the development of digital hearing aids and how digital signal processing approaches have led to changes in hearing aid design. Major landmarks in the evolution of digital technology are identified, and their impact on the development of digital hearing aids is discussed. Differences between analog and digital approaches to signal processing in hearing aids are identified.
Evidence for the Use of Hearing Assistive Technology by Adults: The Role of the FM System
Authors: Chisolm Theresa Hnath , Noe Colleen M. , McArdle Rachel , Abrams Harvey
Published: June 2007

Hearing assistive technologies include listening, alerting, and/or signaling devices that use auditory, visual, and/or tactile modalities to augment communication and/or facilitate awareness of environmental sounds. The importance of hearing assistive technologies in the management of adults with hearing loss was recently acknowledged in an evidence-based clinical practice guideline developed by the American Academy of Audiology. Most currently available evidence for hearing assistive technology use by adults focuses on frequency-modulated (FM) technology. Previous research is reviewed that demonstrates the efficacy of FM devices for adults in terms of laboratory measures of speech understanding in noise. Also reviewed are the outcomes from field trials of FM use by community-dwelling adults, which, to date, have been disappointing. Few to no individuals, in previous studies, elected to use FM devices at the end of the trial periods. Data are presented from a 1-group pretest-posttest study examining the role of extensive counseling, coaching, and instruction on FM use by adults. In addition, the potential influence of the cost of devices to the individual was eliminated by conducting the study with veterans who were eligible to receive FM systems through the Veterans Affairs National Hearing Aid Program. Positive outcomes were obtained at the end of a 6-week trial period and were found to remain 1 year after study completion. Implications for increasing the evidence base for the use of FM devices by adults are discussed.
The National Private Duty Association: Making Strides in the Home Care Industry
Authors: Smith Cheryl A.
Published: June 2007

This article reviews the leading private-duty industry association, National Private Duty Association (NPDA), and discusses the contributions the organization has made to the private-duty industry as a whole. An overview of the history of the organization, the mission, values, and advocacy efforts is also discussed. With membership in NPDA growing rapidly, the future vision and goals for the organization and the industry are also covered.
A Closer Look at Franchised Home Care
Authors: Hogan Paul , Purcey Tim , Hager Allen
Published: June 2007

This article takes an in-depth look at the world of franchised home care and examines the benefits and downsides to owning and operating a franchised home care business. The article also compiles information from the franchised home care organizations in the United States and offers some interesting information about their business models and what contributes to the fact that franchised home care is a booming industry.
State Regulation of Personal Home Care 2005 Progress: Biggest Victory Came in Illinois and Indiana; Proposals in California Expected to Pass
Authors: Hager Allen
Published: June 2007

Private-duty care companies were winners in legislation passed that is favorable to agencies that employ their caregivers, provide employment-related coverages, and perform criminal background and other checks on direct care providers. The biggest victory was in Illinois, although Indiana was the first state to pass a law inspired by National Private Duty Association (NPDA) model legislation. California was expected to pass legislation that NPDA members would view favorably. And in Wisconsin, proposed legislation that followed the NPDA model was on the verge of being introduced with good prospects for passage at press time.
A cognitive tool to diagnose predominantly inattentive ADHD behavior
Authors: Aaron P. G. , Joshi R. M. , Phipps Jill
Published: June 2007

Poor performance on tests of reading comprehension could be the result of weak word-recognition skills, inconsistent attention (ADD), or a combination of the two. Identifying the source of the reading disability (RD) reliably has been difficult because inconsistent attention interferes with reading and weak word recognition skill makes attention wander.

The situation is further complicated by the fact that there are no objective diagnostic tests for ADD (Breggin, 1998; Diller, 1998). We proposed a new model of differential diagnosis of ADHD-I/RD and field-tested its utility in two studies. The new diagnostic procedure utilizes intra-individual differences seen in the performance of at-risk learners on tasks related to reading that vary in the degree of sustained attention required for successful performance. The hypothesis is that children whose attention is inconsistent would perform more poorly on tests such as listening comprehension, which require sustained attention, than on tests such as reading comprehension, which are more tolerant of inattention. Such differences will not be seen in the test scores of children who have only a reading disability because their performance on reading tests is determined more by the difficulty level of the tests than by the sensitivity of the tests to attention.

The validity of this new model was evaluated by determining the relationship between differences seen in the scores of tests that differ in their attention requirement and the degree of inconsistency in sustained attention as measured by Conners’ CPT. The results of the two studies indicate this to be a viable approach. The results of the second study are presented in this report.
The marital and family functioning of adults with ADHD and their spouses
Authors: Eakin L. , Minde K. , Hechtman L. , Ochs E. , Krane E. , Bouffard R. , Greenfield B. , Looper K.
Published: June 2007

Little is known about the family relationships of adults with Attention-Deficit/Hyperactivity Disorder (ADHD). Thus, the marital adjustment and family functioning of 33 married adults with ADHD and their spouses was compared to 26 non-ADHD control participants and their spouses. Results revealed that married adults with ADHD reported poorer overall marital adjustment on the Dyadic Adjustment Scale (DAS; Spanier, 1989) and more family dysfunction on the Family Assessment Device (FAD; Eptein, Baldwin, & Bishop, 1983) than control adults. The spouses of adults with ADHD did not differ from control spouses in reports of overall marital adjustment and family dysfunction. A greater proportion of their marital adjustment scores, however, fell within the maladjusted range. The ADHD adults’ perceptions of the health of their marriages and families were more negative than their spouses’ perceptions. The way in which spouses of ADHD adults compensated for their partners’ difficulties were explored through clinical interviews. The findings in this study underscore the need for assessments and treatments to address marital and family functioning of adults with ADHD.
Emotional reactivity in children with Attention-Deficit/Hyperactivity Disorder
Authors: Jensen S. A. , Rosén L. A.
Published: June 2007

Objective: This study examined Barkley’s (1997b) theory regarding the emotional regulation of children with Attention-Deficit/Hyperactivity Disorder (ADHD).

Method: Mothers of children with and without ADHD between the ages of 6 and 15 were asked to rate their child’s emotional response on each of three measures.

Results: Children with ADHD were rated as significantly more emotionally reactive to both immediate and future events than were children without ADHD. Differences at both the immediate and future time periods were stronger in response to negative as opposed to positive emotional events. In response to the consequences of their behavior, however, children with ADHD were rated as less emotionally reactive than children without ADHD.

Discussion: Conclusions are made in reference to Barkley’s theory and implications are explored.
Neuroprotection During Carotid Endarterectomy
Authors: Granton Jeff T. , Gelb Adrian W.
Published: June 2007

The goal of neuroprotection during carotid endarterectomy is a reduction in the frequency and severity of perioperative stroke. This includes cerebral ischemic events secondary to hypoperfusion during cross clamping, emboli, or both. However, rational use of protective techniques requires that patients at risk first be identified. This process begins with a thorough preoperative assessment, including neurological status and angiographic findings. lntraoperative monitoring is the next step in the identification. This can include the awake patient, electroencephalogram, transcranial Doppler, stump pressure or combinations of these. Unfortunately, evidence is lacking to demonstrate that any of these modalities is superior to another or to no monitoring at all. Finally, when a patient is at risk, a protective technique needs to be chosen. The use of surgical shunt placement has received mixed acceptance from surgeons performing these procedures. Barbiturate coma and anticoagulation may offer benefit but come with inherent risks as well. Maintenance of a high mean arterial pressure with vasopressors and fluids may also help improve collateral flow.
Cardiac Trauma (Penetrating and Blunt) and Anesthetic Issues
Authors: Matthews Anthony J. , Baum Victor C.
Published: June 2007

Patients with blunt or penetrating trauma can require anesthesia and surgery for cardiac injury in the face of noncardiac trauma, or can require anesthesia and surgery for noncardiac injury in the face of cardiac trauma. The true incidence of blunt cardiac trauma is not known, and estimates vary widely with different diagnostic criteria. The diagnosis of traumatic cardiac injury, particularly bluntcardiac injury, may be difficult even with a wealth of available diagnostic tools. Both blunt and penetrating trauma can result is a variety of injuries to cardiac structures. Manifestations of acute traumatic cardiac injury can differ from the clinical manifestations ofsimilar defects in the chronic setting on physical examination, radiography, and in symptomatology. There may be sequelae of traumatic injury which persist, or which may not become apparent for some period of time. Inexpensive, easily-interpreted laboratory criteria for reliably diagnosing cardiac trauma remain. Preexisting cardiacdisease and acute myocardial injury can complicate appropriate resuscitation from massive noncardiac injury. In general, and if unassociated with major noncardiac injuries, patients with cardiac injury be managed with low perioperative mortality.
Blunt and Penetrating Trauma to the Thoracic Aorta
Authors: Williams Michael Jon
Published: June 2007

Blunt and penetrating trauma to the thoracic aorta carries a highmortality at the scene of injury. The patients who arrive salvageable to the hospital need rapid diagnosis and treatment of the thoracicvessel injury. Blunt aortic injury is usually due to motor vehicle accidents. Penetrating injuries due to stab wounds or gunshot injury are regionally specific. The cardiac and pulmonary systems are associated with injury to the tho racic aorta in the majority of cases. The use of radiologic stud ies and recently, transesophageal echocardiography, aid in defining the site of injury and if there is accompanying cardiac injury. Large bore intravenous ines, multiple arterial lines, a pulmonary artery catheter to manage fluid replacement, and a double lumen endobronchial tube are needed for anesthetic management. The majority of patients die from exsanguina tion. There isneed while repairing the thoracic aorta, to main tain perfusion to the spinal cord with various methods in order to avoid perioperativeparaplegia. The injuries, diagnostic tests for locating sites of trauma, and perioperative management ap proaches associated with surgical repair are reviewed.
Anesthetic Considerations for Thoracic Trauma
Authors: Pechet Taine T. V. , Bogar Linda , Grunwald Zvi
Published: June 2007

The thoracic cavity encompasses three vital organ systems: the lungs with the major airways, the heart with the major blood vessels, and the spinal cord. Therefore, traumatic injury to the thoracic cavity presents a unique clinical challenge to the anesthesiologist. Itstems from the gravity of the patients' situation, the need to rapidly diagnose and treat cardiopulmonary injuries, and to coordinatethese steps with a multidisciplinary trauma team. It is importanttobe well prepared and to review the fundamentals of securing an airway in many different traumatic scenarios. Good communication between team members is the key to a positive outcome. The anesthesiologist, therefore, may play a key role in airway management, diagnosis, respiratory management, and pain management throughout the perioperative continuum of the thoracic trauma patients' care.
Venilator Management and Criical Care Issues Following Cardiothoracic Trauma
Authors: Habashi Nader M. , O'Connor James , McCunn Maureen
Published: June 2007

Traumatic injury of the cardiac, pulmonary, or vascular systemsmay result in severe critical illness. Not only does the injury itself result in compromise of normal physiology, but initiation of the inflammatory cascade and mismanagement of the ventilator may lead to worsening status, the acute respiratory distress syndrome, and multiple organ dysfunction. Traumatic injury places the patient athigh risk of infection and nutritional compromise. We review basic concepts of mechanical ventilation and ventilator -associated or -induced lung injury. Barotrauma, volutrauma, atelectrauma and biotrauma, and methods for the clinician to prevent them, arediscussed. Airway pressure release ventilation, mandatory minute ventilation and adaptive support ventilation techniques are intro-duced, as is a discussion of the importance of spontaneous breathing during mechanical ventilation. Special attention is paid to a comprehensive approach to respiratory care. Unique modalities such as prone positioning, independent lung ventilation, and extracorporeal support are presented. The importance of adapting the mode or the minimal-injury concepts of mechanical ventilation to specific injuries is presented. Management approaches to these injuries, including ventilator therapy, pain control, surgical techniques, and critical care issues are described. An overview of the issues of infection inherent to trauma, and nutritional matters, including enteral versus parenteral therapy is presented. Immune-enhanced diets and antioxidantdrugs are integral components of the comprehensive approach to the trauma patient suffering critical illness, and pertinent literatureis summarized.
Role of Transesophageal Echocardiography in Blunt Chest Trauma
Authors: Karalis Dean G. , Tortella Bartholomew J. , Chandrasekaran Krishnaswamy
Published: June 2007

Patients who suffer blunt chest trauma are at risk for injury to the heart, and the thoracic aorta and its branch vessels. Unrecognized injury to the heart or aorta may lead to life threatening complications. Therefore, the physician caring for the trauma patient must be able to accurately and rapidly diagnose cardiac and thoracic aortic injury. Transesophageal echocardiography is an ideal tool to diagnose cardiac and aortic injury in the patient with blunt chest trauma because it provides high quality images of the heart and thoracic aorta and can safely and rapidly be performed in the emergency department, operating suite or intensive care unit. To utilize transesophageal echocardiography most effectively, the echocardiographer must be familiar with the indications, limitations, and piffalls of transesophageal echocardiography in patients with blunt chesttrauma. This review describes the role of transesophageal echocardiography in evaluating the patient with blunt chest trauma for cardiac, thoracic aortic, and mediastinal injury.
Initial Perioperative Care of the Cardiac Surgical Patient
Authors: Bainbridge Daniel , Cheng Davy
Published: June 2007

Recently, changes in the management of cardiac patients have allowed earlier discharge from the cardiac recovery area and reduced hospital length of stay. These changes have been drien by a need to reduce the cost of cardiac surgery and imrove efficiency. This change has been both financially sucessful and safe for patients. To allow for this success, a joint effort is required between the departments of cardiac surgery and anesthesiology involving the preoperative, intraoperative and postoperative treatment of these patients. Through recogition of suitable candidates, modifications in anesthetic techique, and appropriate postoperative management, the goal of extubation within 6 hours of admission to the cardiac recovery area can be achieved. Changes in intraoperative and early postoperative management of cardiac surgical patients are discussed. Specific recovery models are reviewed with disussion of the parallel and integrated models. Methods of preicting prolonged extubation times and intensive care unit length of stay are also discussed. Initial management of the cardiac patient in the cardiac recovery area is presented with a more in-depth review of specific complications: stroke, atril fibrillation, blood loss, left ventricular dysfunction, and pulonary dysfunction.
Best Practice for Cardiopulmonary Bypass in the High-Risk Elderly Patient
Authors: Willcox Timothy W. , van Uden Rachel
Published: June 2007

The management of cardiopulmonary bypass has evolved over the last 50 years resulting in a largely consistent approach to both adult and pediatric perfusion. Very little has been written or prospectively researched on the best practice for cardiopulmonary bypass in the high-risk elderly patient, despite the challenge this patient cohort presents compared to the general adult population and the rapidly increasing number of such patients undergoing cardiac surgery. We propose a framework for perfusion strategies for the high-risk elderly patient from our current understanding of cardiopulmonary bypass. It should stimulate discussion for a consensus on perfusion strategies for the elderly and encourage further research into perfusion variables as they relate to the outcome of patients of advanced age.