bluuebunny/crossref_metadata_2025 huggingface dataset:
High Prevalence of Chlamydia and Pap‐smear Abnormalities in Pregnant Adolescents Warrants Routine Screening
Authors: Quinlivan Julie A. , Petersen Rodney W. , Gurrin Lyle C.
Published: February 2008

Summary: A prospective cohort of pregnant adolescent patients who planned to deliver at 1 of 3 Perth metropolitan hospitals was studied; 1 subgroup of this cohort was offered universal screening for cervical chlamydial infection and Pap‐smear abnormalities (screened), and the remainder of the cohort were offered screening at the discretion of the attending medical staff (control). High prevalences of both chlamydial infection (27%) and Pap‐smear abnormalities (38%) were detected in the screened cohort. The majority of Pap‐smear abnormalities were inflammatory atypia, but high‐grade Bethesda lesions were also diagnosed. In the control group, the prevalence of positive swabs and abnormal Pap‐smear reports in those tested was also high (22% and 35% respectively), but significantly fewer patients were tested (18% and 33% respectively in the control group, compared to 92% and 94% in the screened group; both p < 0.001). Screening and treatment of chlamydia was associated with a significant decrease in the incidence of newborn febrile morbidity (10% versus 25%; p = 0.02). In view of the high prevalence of positive results, it is cost‐effective to offer universal screening in this setting. Failure to introduce a specific screening policy can result in a significant number of patients being denied the advantages of diagnosis and treatment.
Assessing the Teratogenic Potential of Angiotensin‐Converting Enzyme Inhibitors in Pregnancy
Authors: Burrows R.F. , Burrows E.A.
Published: February 2008

Summary: To assess the teratogenic potential of angiotensin‐converting enzyme (ACE) inhibitors, we report on 20 prospective pregnancies and 85 identified from articles in the literature. The anomaly rate was 20.6% in small series <10 entrants (95% CI 8.7–37.9%) and 1.4% in larger series ≥10 entrants (95% CI 0.03–7.3%) p = 0.0016. The most consistent anomaly seen, skull hypoplasia, along with renal dysfunction appear to be more related to prolonged or late pregnancy exposure than to first trimester exposure. There is little supportive evidence that ACE inhibitors (captopril or enalapril) are teratogenic. There seems to be no absolute reason to discontinue these 2 medications prior to pregnancy, nor to create anxiety when a patient is identified with the combination of early pregnancy and treatment with these medications. There appears to be reason to discontinue the medication in pregnancy but the adverse event rate cannot be assessed because of inadequate prospective information.
Transvaginal Saerospinous Colpopexy for Posthysterectomy Vault Prolapse
Authors: Hewson A.D.
Published: February 2008

Summary: This study assesses the results of transvaginal sacrospinous colpopexy in the treatment of posthysterectomy vault prolapse; 114 of 135 women were available for follow‐up between 8 months and 5 years after surgery. There was an initial overall satisfaction rate of approximately 90% and this was maintained at 80% even beyond 4 years. Those initially complaining of a lump or a swelling were relieved of the symptom in almost 90% of cases. Those with a drag or ache were cured in approximately 80% of cases. There was greatly improved bowel function in approximately 60% of patients and in approximately 60% there was cure of stress incontinence with additional buttressing sutures. Frequency and/or urgency was relieved in over 50% of the group and there was more comfortable intercourse in approximately 35% of those in whom this was a problem initially. As in previous series, subsequent prolapse is more likely to be in the anterior vaginal wall and there was an approximately 5% risk of this occurring over this period of follow‐up. The variation in technique in this series in which nonabsorbable Ethibond sutures were used to secure the vaginal vault to the sacrospinous ligament, appears to provide better long‐term vault support than previous reports in the literature, without altering morbidity. Continuing follow‐up will be required to confirm that this will prove to be so in the longer term. This series therefore confirms that the operation produces long‐term support of the vaginal vault with preservation of a functional vagina, and has a satisfactory success rate in the relief of bladder and bowel symptoms associated with vault prolapse. However, it also demonstrates that in this mostly aged group of patients there will be a significant minority with limited relief of symptoms. It is important therefore that appropriate preoperative counselling is carried out so that patients have realistic expectations regarding the medium and long‐term results of this procedure.
Total Parenteral Nutrition (TPN) and Steroid Usage in the Management of Hyperemesis Gravidarum
Authors: Subramaniam Raman , Son Eric Boon Swee , Dhillon Harbans Kaur , Abidin Hakimi Zainal
Published: February 2008

EDITORIAL COMMENT: We accepted this case report for publication to remind readers that the usual nausea and vomiting of early pregnancy can become persistent and severe. In a series of 92,838 consecutive antenatal patients at the Mercy Hospital for Women, 1.1% had vomiting of sufficient severity to warrant admission to hospital. Most admissions were of 2–6 days' duration and more than 70% required only 1 admission. However, the condition was refractory in about 10% of these women who required repeated admissions to hospital. As in the case reported here the condition can be recurrent in subsequent pregnancies. In the series quoted above, 75% of the women were admitted in the first 14 weeks of pregnancy, and the positive association with multiple pregnancy (21 cases), hydatidiform mole (7 cases) and urinary tract infection (31 cases) was less than expected. Nonetheless these conditions should always be excluded. When the editor was a medical officer at The Royal Women's Hospital, Melbourne, 1957–1960, he saw 2 cases of hyperemesis gravidarum where the vomiting of black fluid was suggestive of acute dilatation of the stomach. Both women were moribund. The first woman had a hydatidiform mole and hysterotomy was performed successfully. The second woman, who had required prolonged hospitalization in her only other pregnancy, was treated successfully by hypnosis by our Indian resident medical officer. The vomiting ceased, but the hypnosis was reinforced daily and the woman remained in hospital for several weeks. In the series quoted, there was a history of past psychiatric disease in 6.3% and many of the remaining women had an underlying problem of anxiety, depression or psychosocial disturbance. Since these women have dehydration and even starvation when admitted to hospital they should receive vitamins as well as intravenous fluids, calories and antinausea preparations as in the case presented here.
Women's Knowledge and Attitudes About Emergency Contraception: A Survey in a Melbourne Women's Health Clinic
Authors: McDonald Geraldine , Dip WornHealth Grad , Amir Lisa
Published: February 2008

Summary: The aim of the study was to determine the level of awareness of emergency contraception in women seeking pregnancy counselling and to investigate their attitudes towards emergency contraception. All women presenting for pregnancy counselling at a Melbourne women's health clinic in October 1997 were invited to complete a questionnaire detailing their contraceptive practices. One hundred and sixty‐six questionnaires were distributed and 153 were completed (92% response rate). The majority of this sample population had heard of some form of emergency contraception and knew where to access it. However only 26% knew that emergency contraception should be taken within 72 hours of unprotected intercourse. Although 80% of the sample had heard of emergency contraception (or the morning after pill) only 9% used it in an attempt to prevent this pregnancy. The majority of the women surveyed support the increased availability of emergency contraception by rescheduling it to a non‐prescription item and re‐packaging as a single treatment.
Knowledge and attitudes about vaginal birth after Caesarean section in Australian hospitals
Authors: Appleton Bill , Target Christopher , Rasmussen Michael , Readman Emma , Sale Fiona , Permezel Michael , Group The VBAC Study
Published: February 2008

Summary: A survey of staff attitudes and knowledge about vaginal birth after Caesarean section (VBAC) was undertaken in Australian hospitals. There was a high response rate (67%), and over 900 responses were analysed. Generally, there was a high level of awareness about outcomes and the relative importance of many issues in considering VBAC. Registrars, consultants and midwives differed significantly in some aspects of their knowledge and attitudes to VBAC. There was also a wide range of opinion within each group. Approximately half (53%) of respondents believed patients should be actively encouraged to consider VBAC, whereas 47% felt it should be simply presented as an option.
The impact of nausea and vomiting on women: a burden of early pregnancy
Authors: Smith Caroline , Crowther Caroline , Beilby Justin , Dandeaux Jenny
Published: February 2008

Summary: Nausea and vomiting are troublesome symptoms occurring in the first trimester of pregnancy. The aim of this study was to describe the impact these symptoms have on women in early pregnancy by interviewing, using a structured questionnaire, 593 pregnant women presenting with nausea and vomiting in the first trimester of pregnancy. The women were asked to complete the Rhodes index of nausea and vomiting and the MOS 36 Short Form Health Survey (SF‐36).

Symptoms of nausea and vomiting started early in pregnancy. Nausea was the most troublesome symptom experienced by women, both in its duration and intensity. Low scores for the SF‐36 were found for all items, particularly physical functioning, energy and social functioning. The women described substantial effects on working, household duties and parenting activities.

Findings from this study suggest nausea and vomiting in early pregnancy has a profound impact on women's general sense of well‐being and day to day life activities.
A wish‐list for improving Australian women's reproductive health in the new millennium
Authors: Short R V.
Published: February 2008

Australian women are missing out in terms of their reproductive health, when compared to women in other developed countries. Now seems an appropriate moment in time to spell out the nature of their disadvantages, and suggest ways in which they could be overcome.
Incisionless cystourethropexy‐the Intac device‐an initial experience
Authors: MacGibbon Anne , Brieger Geoffrey , Korda Andrew
Published: February 2008

Our aim was to evaluate a new minimally invasive device for the treatment of genuine stress incontinence in women by both objective and subjective measures of outcome. Fifteen women with Type I or Type II urinary stress incontinence were treated with a new per vaginal bone anchor device designed to fix periurethral tissues to the pubic bone. No patients had significant operative morbidity. After 6–13 months a follow‐up questionnaire and repeat urodynamic testing was performed for all the women. Subjectively 73% of patients had improvement in symptoms and on urodynamic testing 53% of patients were cured.
Antenatal exercise and birthweight
Authors: Bell Robin , Palma Sonia
Published: February 2008

Does strenuous antenatal exercise reduce birth‐weight? Does reducing maternal exercise increase birthweight? What to advise about exercise during pregnancy?

We recruited 117 women who intended to exercise 5 or more times weekly during pregnancy to a study of whether reducing the amount of maternal exercise during pregnancy is associated with an increase in birthweight. Only 61/117 (52%) of women agreed to be randomised to either continue or to reduce (to 3 or fewer sessions of exercise weekly) their intended pregnancy exercise program. Most women who refused randomisation did not want to risk being asked to reduce their exercise during pregnancy.

Within the randomised trial, there was no statistically significant difference between the mean birthweight of babies born to women who continued and those who reduced their intended exercise program. The high rate of refusal of randomisation limits the power of the study to find a difference in birthweight, limits the generalisability of the results and shows that many women intending to exercise at this level during pregnancy have an uncompromising attitude to exercise.
Plasma HIV‐1 RNA viral load and serum vitamin A and E levels in HIV‐1 infected pregnant women
Authors: Phuapradit Winit , Panburana Panyu , Jaovlsidha Adithep , Puchaiwatananon Orawan , Chantratita Wasun , Bhodhiphala Pisamai , Pairoj Wantanit
Published: February 2008

The aim of this study was to assess the correlation between plasma HIV‐1 RNA viral load and serum vitamin A and E concentrations and vitamin E/cholesterol ratio in HIV‐1 infected pregnant women not receiving antiretroviral therapy. There were no significant correlations between plasma HIV‐1 RNA viral load and serum vitamin A and E concentrations and vitamin E/cholesterol ratio. However, the presence of underlying vitamin A deficiency in these pregnant women was common.
An unusual case of choriocarcinoma following live term pregnancy
Authors: Sood Madhoolika , Sangwaan Krishna , Sherwaal Vinita , Marwah Sanjay , Sen Rajeev
Published: February 2008

Post‐term choriocarcinoma is an infrequent event with poor prognosis. The diagnosis is usually delayed due to failure to recognise the mode of presentation of this disease. Being a rare occurrence. limited data is available regarding its clinical features. The choriocarcinoma in our patient presented as an isolated huge pedunculated growth over the uterine serosa without intrauterine involvement and distant metastasis.
Team midwife care: maternal and infant outcomes
Authors: Waldenström Ulla , McLachlan Helen , Forster Delia , Brennecke Shaun , Brown Stephanie
Published: February 2008

Summary: The aim of this study was to add additional information on intervention rates and maternal and infant outcomes of team midwife care to previous reports which have suggested this model of care can be associated with a reduction in medical interventions during labour and birth with no statistically significant influence on maternal and infant outcomes.

The study was designed as a randomised controlled trial, with 495 women randomised to team midwife care being compared to 505 women randomsed to standard care.

The study revealed no statistical differences between team midwife care and standard care in medical interventions, maternal health and infant health. These findings suggest that team midwifery as it is practised in this study is a safe alternative for women.
Comparison of transvaginal ultrasound, saline infusion sonography and hysteroscopy to investigate postmenopausal bleeding and unscheduled bleeding on HRT
Authors: Cameron Sharon T , Walker Jane , Chambers Sarah , Critchley Hilary
Published: February 2008

Summary: A study was conducted to compare transvaginal ultrasound (TVS), saline infusion sonography (SIS) and outpatient hysteroscopy for examining the uterine cavity in women with postmenopausal bleeding and unscheduled bleeding on hormone replacement therapy (HRT). Fourty Subjects agreed to undergo TVS, SIS and hysteroscopy in addition to endometrial sampling. The abnormalities detected by each imaging method were recorded together with the discomfort (visual analogue scale). Thirty women completed all three imaging procedures. In 18 cases TVS suggested an abnormal cavity. SIS and hysteroscopy were of similar efficacy in clarifying the nature of this, and confirmed an abnormality in 12 cases (40%). TVS was significantly less painful than the other procedures (p < 0.001). SIS and hysteroscopy were associated with pain scores similar to endometrial sampling. These findings justify the need for a large randomised trial of TVS, SIS, hysteroscopy and endometrial sampling, in order to develop the most appropriate strategy for investigating postmenopausal bleeding and unscheduled bleeding on HRT.
Abnormal uterine artery Doppler in small‐for‐gestational‐age pregnancies is associated with later hypertension
Authors: McCowan Lesley ME , North Robyn A , Harding Jane E
Published: February 2008

In a cohort of normotensive small‐for‐gestational‐age (SGA) pregnancies, we aimed to determine the prevalence of later preeclampsia and gestational hypertension. We hypothesised that (i) uterine artery Doppler abnormalities would increase in severity from those with normotension to gestational hypertension to preeclampsia and (ii) the severity of uterine artery Doppler abnormalities would be related to the severity of fetal disease.

Serial uterine and umbilical artery Doppler studies were performed on 224 normotensive women with SGA pregnancies, from detection of SGA until delivery. Outcomes were compared between groups that remained normotensive (n = 174) and those that developed gestational hypertension and preeclampsia.

Of the women studied, 50 (22%) subsequently developed hypertension [(3% (n = 8) preeclampsia, 19% (n = 42) gestational hypertension)) at a median (interquartile range) of 19 (12 32) days after recog nition of SGA. Mean uterine artery resistance indices (RI) increased from women who remained normotensive (n = 174) to those who later developed gestational hypertension or preeclampsia [0.51 <SD 0.09), 0.55 (0.09), 0.62 (0.13), p < 0.001). as did the proportion of abnormal uterine RI (33%. 39%, 88%. p = 0.007) and umbilical RI (28%. 40%. 75% p = 0 007). Mean uterine RI correlated negatively with z score birthweight (R2= 0.069. p < 0.001) and positively with umbilical RI (R‐ = 0.16. p < 0.001).
The current status of polycystic ovary syndrome
Authors: Kovacs Gabor , Wood Carl
Published: February 2008

The importance of polycystic ovary syndrome (PCOS) has recently received much publicity. Whereas previously it was thought simply to be a disorder which was characterised by irregular ovulation, there is now evidence to show that it is a systemic metabolic disease determined genetically and inherited. As well as treating the presenting problem which, for gynaecologists is usually one of irregular menstruation and anovulation, or sometimes signs of hyperandrogenism, we believe that women should also be screened for their lipid status and insulin resistance.

Advice on behaviour modification such as increased exercise and dietary adjustment should be recommended in addition to the treatment for ovulation induction. In the future, the use of insulin sensitising agents may become important in the treatment of PCOS.
Neonatal pneumococcal sepsis in association with fatal maternal pneumococcal sepsis
Authors: Hughes Brian R , Mercer Joanne L , Gosbell Iain B
Published: February 2008

A live male infant was born at 37 weeks' gestation after a normal pregnancy to a 34‐year‐old mother. The baby developed bacteraemia with Streptococcus pneumoniae and recovered completely following treatment with antibiotics. The mother simultaneously developed bacteraemia with the same organism and died from septic shock. Blood culture isolates from mother and child were both serogroup 23E and were shown to be identical by DNA fingerprinting. The literature reports rare cases of vaginal carriage and/or endometritis with this organism resulting in neonatal sepsis. Transmission to the neonate may have been ascending or haematogenous. A postmortem examination was refused.
Varicella and the pregnant woman: Prevention and management
Authors: DALEY Andrew J. , THORPE Susan , GARLAND Suzanne M.
Published: February 2008

Infection with varicella zoster virus (VZV) is often considered a childhood ‘right of passage’; however, primary infection occurring in women of child‐bearing age can have significant adverse consequences both for the mother and for her fetus. During the first trimester, primary VZV infection may result in stillbirth or a baby born with the stigmata of the congenital varicella syndrome, while infection in the peripartum period can result in neonatal varicella, which carries a significant mortality rate despite appropriate antiviral therapy. Varicella in pregnant women can progress to pneumonitis and other severe sequelae that may also compromise the viability of the fetus. Exposure to VZV most commonly occurs in the community or from children in the household, but occasionally, exposure may occur in the hospital environment. Determining a woman's serostatus prior to pregnancy is advised, as effective vaccines are now available and should be administered to non‐pregnant seronegative women of child‐bearing age. Clinical practice guidelines for management of a pregnant woman exposed to VZV are presented.
Capacity to monitor severe maternal morbidity in Australia
Authors: POLLOCK Wendy , SULLIVAN Elizabeth , NELSON Sioban , KING James
Published: February 2008

Maternal mortality has traditionally been the key element in the monitoring of maternal health and adequacy of obstetric services in Australia and around the world. In developed countries, the ability of maternal mortality to serve this purpose is reduced because of the rarity of maternal mortality, reflected in very low maternal mortality ratios. Internationally, there has been increasing interest in severe maternal morbidity as an indicator to monitor maternal health and maternity services. The aim of this paper is to critically examine the capacity to measure and monitor maternal morbidity in Australia. There is a paucity of reliable maternal morbidity data in Australia; Australia is lagging behind peer countries that are endeavouring to monitor severe maternal morbidity. Dedicated efforts and adequate resources are needed in order to monitor severe maternal morbidity in Australia.
Differential effects of hyaluronan and its fragments on fibroblasts: Relation to wound healing
Authors: David‐Raoudi Maha , Tranchepain Frédéric , Deschrevel Brigitte , Vincent Jean‐Claude , Bogdanowicz Patrick , Boumediene Karim , Pujol Jean‐Pierre
Published: February 2008

Hyaluronan (HA) is involved in wound healing and its biological properties depend on its molecular size. The effects of native HA and HA‐12 and HA‐880 saccharide fragments on human fibroblast proliferation and expression of matrix‐related genes were studied. The three HA forms promoted cell adhesion and proliferation. Matrix metalloproteinase‐1 and ‐3 mRNA were increased by all HA forms, whereas only HA‐12 stimulated the expression of the tissue inhibitor of metalloproteinase 1. HA‐12 enhanced type I collagen and transforming growth factor‐β (TGF‐β) 1 expression. Interestingly, HA‐12 and native HA stimulated type III collagen and TGF‐β3. HA and its fragments activated Akt and extracellular‐regulated kinases 1/2 and p38. Inhibition of these signaling pathways suggested their implication in most of the effects. Only native HA activated nuclear factor‐κB and activating protein 1. Use of CD44 siRNA suggests that this HA receptor is partly implicated in the effects, although it does not rule out the involvement of other receptors. Depending on its size, HA may exert differential regulation on the wound‐healing process. Furthermore, the HA up‐regulation of type III collagen and TGF‐β3 expression suggests that it may promote a fetal‐like cell environment that favors scarless healing.
Garnet–clinopyroxene intermediate granulites in the St. Leonhard massif of the Bohemian Massif: ultrahigh‐temperature metamorphism at high pressure or not?
Authors: RACEK M. , ŠTÍPSKÁ P. , POWELL R.
Published: February 2008

Garnet–clinopyroxene intermediate granulites occur as thin layers within garnet–kyanite–K–feldspar felsic granulites of the St. Leonhard granulite body in the Bohemian Massif. They consist of several domains. One domain consists of coarser‐grained coexisting ternary feldspar, clinopyroxene, garnet, quartz and accessory rutile and zircon. The garnet has 16–20% grossular, and the clinopyroxene has 9% jadeite and contains orthopyroxene exsolution lamellae. Reintegrated ternary feldspar and the Zr‐in‐rutile thermometer give temperatures higher than 950 °C. Mineral equilibria modelling suggests crystallization at 14 kbar. The occurrence and preservation of this mineral assemblage is consistent with crystallization from hot dry melt. Between these domains is a finer‐grained deformed matrix made up of diopsidic clinopyroxene, orthopyroxene, plagioclase and K‐feldspar, apparently produced by reworking of the coarser‐grained domains. Embedded in this matrix, and pre‐dating the reworking deformation, are garnet porphyroblasts that contain clinopyroxene, feldspar, quartz, rutile and zircon inclusions. In contrast with the garnet in the coarser‐grained domains, the garnet generally has >30% grossular, the included clinopyroxene has 7–27% jadeite and the Zr content of rutile indicates much lower temperatures. Some of these high‐grossular garnet show zoning in Fe/(Fe + Mg), decreasing from 0.7 in the core to 0.6 and then increasing to 0.7 at the rim. These garnet are enigmatic, but with reference to appropriate pseudosections are consistent with localized new mineral growth from 650 to 850 °C and 10 to 17 kbar, or with equilibration at 20 kbar and 770 °C, modified by two‐stage diffusional re‐equilibration of rims, at 10–15 and 8 kbar. The strong pervasive deformation has obscured relationships that might have aided the interpretation of the origin of these porphyroblasts. The evolution of these rocks is consistent with formation by igneous crystallization and subsequent metamorphism to high‐T and high‐P, rather than an origin by ultrahigh‐T metamorphism. Regarding the petrographic complexity, combination of the high grossular garnet with the ternary feldspar to infer ultrahigh‐T metamorphism at high pressure is not justified.
Microphytobenthic species composition, pigment concentration, and primary production in sublittoral sediments of the Trondheimsfjord (Norway)1
Authors: Cibic Tamara , Blasutto Oriana , Hancke Kasper , Johnsen Geir
Published: February 2008

In spring 2005, monthly sampling was carried out at a sublittoral site near Tautra Island. Microphytobenthic identification, abundance (ABU), and biomass (BIOM), were performed by microscopic analyses. Bacillariophyceae accounted for 67% of the total ABU, and phytoflagellates constituted 30%. The diatom floristic list consisted of 38 genera and 94 species. Intact light‐harvesting pigments chl a, chl c, and fucoxanthin and their derivatives were identified and quantified by HPLC. Photoprotective carotenoids were also observed (only as diadinoxanthin; no diatoxanthin was detected). Average fucoxanthin content was 4.57 ± 0.45 μg fucoxanthin · g sediment dry mass−1, while the mean chl a concentration was 2.48 ± 0.15 μg · g−1 dry mass. Both the high fucoxanthin:chl a ratio (considering nondegraded forms) and low amounts of photoprotective carotenoids indicated that the benthic microalgal community was adapted to low light. Microphytobenthic primary production was estimated in situ (MPPs, from 0.15 to 1.28 mg C · m−2 · h−1) and in the laboratory (MPPp, from 6.79 to 34.70 mg C · m−2 · h−1 under light saturation) as 14C assimilation; in April it was additionally estimated from O2‐microelectrode studies (MPPO2) along with the community respiration. MPPO2 and the community respiration equaled 22.9 ± 7.0 and 7.4 ± 1.8 mg C · m−2 · h−1, respectively. A doubling of BIOM from April to June in parallel with a decreasing photosynthetic activity per unit chl a led us to suggest that the microphytobenthic community was sustained by heterotrophic metabolism during this period.
Seasonal growth, erosion rates, and nitrogen and photosynthetic ecophysiology of Undaria pinnatifida (Heterokontophyta) in southern New Zealand1
Authors: Dean Paul R. , Hurd Catriona L.
Published: February 2008

The goal of this study was to examine growth, erosion rates, and the photosynthetic and nitrogen ecophysiology of the invasive seaweed Undaria pinnatifida (Harv.) Suringar. Sporophytes of U. pinnatifida that appeared in Otago Harbour, southeastern New Zealand, in late autumn (May) 1996 were tagged, and their growth rates followed until the onset of senescence in early summer (November 1996). Blade growth rates were maximal between May and August when they ranged from 0.77 ± 0.05 to 0.93 ± 0.05 cm · d−1 and declined from September onward. In laboratory experiments, U. pinnatifida took up nitrate and ammonium simultaneously at rates ranging from 21.3 ± 2.1 to 179.3 ± 65.1 μmol · g−1 dry weight (dwt) · h−1. When monthly patterns of growth rate, seawater inorganic nitrogen, nitrogen uptake kinetics, soluble tissue nitrate, % tissue carbon (C) and nitrogen (N), and C:N ratio were considered together, there was no evidence that N limited the growth of U. pinnatifida. Furthermore, the photosynthetic parameters Pmax, α, Ek, Ec, and Rd derived from P versus E curves indicated that the growth of U. pinnatifida was not light limited, and that the population could potentially grow deeper than its observed location at 4 m depth. Nitrogen and light ecophysiological parameters of U. pinnatifida more closely resemble those of small, ephemeral seaweeds, such as Ulva, than other members of the Laminariales. We suggest that a “plastic” physiology may allow U. pinnatifida sporophytes to match their physiology to a range of environments, which is one reason for its success as an invasive seaweed.
Development of a Tool for Eliciting Patient Priority from Among Competing Cardiovascular Disease, Medication‐Symptoms, and Fall Injury Outcomes
Authors: Tinetti Mary E. , McAvay Gail J. , Fried Terri R. , Foody JoAnne M. , Bianco Luann , Ginter Sandra , Fraenkel Liana
Published: February 2008

OBJECTIVES: To develop a choice task for eliciting priorities in the face of competing cardiovascular disease (CVD) outcomes, medication‐related symptoms, and fall injuries.

DESIGN: Conjoint analysis.

SETTING: Senior housing site.

PARTICIPANTS: Convenience sample of 15 senior housing residents for the pretest, 13 residents for the pilot test.

MEASUREMENTS: The final task included 11 sets of choices. In each, one option optimized the risk of one or two of the three outcomes at the expense of the other(s); the second option did the reverse. Relative importance scores for CVD, fall injury, and medication‐symptom outcomes were calculated. Reliability was assessed for two administrations using intraclass correlations (ICCs). Wilcoxon rank sum tests were used to evaluate order effects.

RESULTS: The ICCs between choice task administrations were 0.70 for fall injuries, 0.73 for medication symptoms, and 0.56 for CVD outcomes. The ICCs with removal of two outliers were 0.84, 0.72, and 0.84, respectively. Whether CVD or fall injuries appeared first had no effect on scores.

CONCLUSION: Preliminary evidence of comprehensibility and reliability supports using the choice task to determine whether individuals' priorities differ in the face of competing outcomes.
Associations Between Lower Extremity Ischemia, Upper and Lower Extremity Strength, and Functional Impairment with Peripheral Arterial Disease
Authors: McDermott Mary M. , Tian Lu , Ferrucci Luigi , Liu Kiang , Guralnik Jack M. , Liao Yihua , Pearce William H. , Criqui Michael H.
Published: February 2008

OBJECTIVES: To identify associations between lower extremity ischemia and leg strength, leg power, and hand grip in persons with and without lower extremity peripheral arterial disease (PAD). To determine whether poorer strength may mediate poorer lower extremity performance in persons with lower arterial brachial index (ABI) levels.

DESIGN: Cross‐sectional.

SETTING: Academic medical centers.

PARTICIPANTS: Four hundred twenty‐four persons with PAD and 271 without PAD.

MEASUREMENTS: Isometric knee extension and plantarflexion strength and handgrip strength were measured using a computer‐linked strength chair. Knee extension power was measured using the Nottingham leg rig. ABI, 6‐minute walk, and usual and fastest 4‐m walking velocity were measured. Results were adjusted for potential confounders.

RESULTS: Lower ABI values were associated with lower plantarflexion strength (P trend=.04) and lower knee extension power (P trend <.001). There were no significant associations between ABI and handgrip or knee extension isometric strength. Significant associations between ABI and measures of lower extremity performance were attenuated after additional adjustment for measures of strength.

CONCLUSION: These results are consistent with the hypothesis that lower extremity ischemia impairs strength specifically in distal lower extremity muscles. Associations between lower extremity ischemia and impaired lower extremity strength may mediate associations between lower ABI values and greater functional impairment.
Influence Tactics in the Classroom and Their Relationship to Student Satisfaction*
Authors: Standifird Stephen S. , Pons Frank , Moshavi Dan
Published: February 2008

We argue that an instructor's use of influence tactics can be classified as soft, rational, and strong in nature and that the use of these tactics will have a differential impact on student satisfaction. We find support for the existence of the three categories of influence. We find that student satisfaction is positively influenced by the use of soft and rational tactics, but is uninfluenced by the use of strong tactics.
Left Atrial Posterior Wall Thickness in Patients with and without Atrial Fibrillation: Data from 298 Consecutive Autopsies
Authors: PLATONOV PYOTR G. , IVANOV VITALY , HO SIEW YEN , MITROFANOVA LUBOV
Published: February 2008

Introduction: Radiofrequency ablation of atrial fibrillation (AF) is associated with energy delivery on the posterior left atrial (LA) wall with small but significant risk of life‐threatening complications. Anatomy of LA walls has been described, but wall thickness in patients with AF has not been studied systematically. The aim of the present study was to describe LA posterior wall thickness in patients with and without history of AF.

Methods and Results: Heart mass and LA wall thickness was measured during 298 consecutive autopsies (142 male, age 61 ± 17 years). LA posterior wall was measured at three levels: between the superior pulmonary veins (SPV), in the center of the posterior LA wall (CPV), and between the inferior pulmonary veins (IPV). Information about AF history was obtained from medical records. Fifty‐nine subjects (20%) had documented AF. They were older than subjects without AF (74 ± 10 years vs 58 ± 17 years, P < 0.0001) and had greater heart mass (522 ± 114 g vs 389 ± 99 g, P < 0.0001). LA posterior wall thickness increased from the most superior to the most inferior measured level (2.3 ± 0.9 mm vs 2.5 ± 1.0 mm vs 2.9 ± 1.3 mm for SPV, CPV, and IPV, respectively; P < 0.001). Subjects with AF history had thinner LA posterior wall at CPV and IPV compared with those without AF.

Conclusions: LA posterior wall thickness is described on a large series of consecutive autopsies. LA posterior wall is found to be generally thinner in patients with history of AF. Study results have clinical implications for understanding complication risk and improvement of safety of AF ablation procedures.
Time‐Dependence of Appropriate Implantable Defibrillator Therapy in Patients with Ischemic Cardiomyopathy
Authors: ALSHEIKH‐ALI ALAWI A. , HOMER MICHAEL , MADDUKURI PRASAD V. , KALSMITH BENJAMIN , ESTES N. A. MARK , LINK MARK S.
Published: February 2008

Introduction: Little is known about the risk of appropriate implantable cardioverter‐defibrillator (ICD) therapy outside the context of controlled clinical trials where routine practice patients are followed for longer durations and questions of device replacement frequently arise. We assessed the incidence and time‐dependence of appropriate ICD therapy in a routine clinical practice primary prevention population with prior myocardial infarction (MI) and reduced left ventricular ejection fraction (LVEF).

Methods and Results: Patients with prior MI and LVEF ≤35%, who received an ICD at our institution (1995–2005) for primary prevention, were identified. Incidence and time‐dependence of first appropriate ICD therapy for ventricular arrhythmia (VA) and rapid VA (cycle length ≤260 ms) were determined. Of 525 ICD recipients for primary prevention, 115 (22%) had appropriate ICD therapy. Incidence of first appropriate ICD therapy was highest in the first year postimplant (20%), decreased to 12% in year 2, and remained at 6–11% yearly thereafter. A similar trend was observed with rapid VA, a higher risk in the first year (6%), and a lower but persistent risk thereafter (3.8% in year 7).

Conclusion: In a routine clinical practice primary prevention population with prior MI and LVEF ≤35%, the incidence of first ICD therapy for VA, including potentially life‐threatening VA, is highest in the first year postimplant, and persists for up to seven years thereafter. Risk of first appropriate ICD therapy persists over time, and thus replacement of ICDs appears to be indicated for all patients.
Unusual Bileaflet Tricuspid Valve by Real Time Three‐Dimensional Echocardiography
Authors: Anwar Ashraf M. , Attia Wael M. , Nosir Youssef F. M. , El‐Amin Ali M.
Published: February 2008

The right atrioventricular valve is formed by three leaflets as described by the classic anatomic studies. Two‐dimensional transthoracic echocardiography (2DE) shows the tricuspid valve (TV) in its long axis. However, short‐axis views of the TV leaflets are not generally obtained and therefore distinction between leaflets by 2DE is difficult. Real time three‐dimensional echocardiography (RT3DE) overcomes this limitation of 2DE and facilitates obtaining short axis view (enface view) of the TV. In the current case study, en face view of the TV obtained by RT3DE was found to be formed of only two leaflets with two commissures. The surgical findings were consistent with that of RT3DE.
The Influence of Ambulatory Blood Pressure Profile on Global and Regional Functions of the Left and the Right Ventricles in Orderly Treated Hypertensive Patients
Authors: Sokmen Gulizar , Sokmen Abdullah , Aksu Ekrem , Koroglu Sedat , Suner Arif , Tuncer Cemal
Published: February 2008

Background: The association between nondipping profile and adverse cardiovascular outcome is still controversial. Tissue Doppler imaging (TDI), a new and useful addition to standard echocardiographic imaging techniques, permits a quantitative assessment of both global and regional function and timing of myocardial velocities. In this study, we aimed to assess whether a reduced nocturnal fall in blood pressure (BP) in orderly treated hypertensive patients with satisfactory BP control is related to more prominent structural and functional alterations of the ventricles. Method and Results: Sixty‐nine hypertensive patients with adequate BP control were divided into two groups with respect to ambulatory BP profiles as dippers and nondippers. In addition to conventional echocardiographic parameters, in septal and lateral segments of left ventricle and free wall of right ventricle, peak systolic velocity (Sm), early (Em), and late (Am) diastolic velocities, isovolumic contraction time (ICTm), isovolumic relaxation time (IRTm), and ejection times (ETm) were measured, and modified myocardial performance index (MPIm) was calculated. Left ventricular (LV) and atrial dimensions, ejection fraction, transmitral early to late diastolic flow ratio, LV mass index, and LV hypertrophy ratio did not differ between groups. Both regional and mean LV Sm, Em/Am, MPIm and right ventricular Sm and MPIm were similar in both groups. Conclusion: In treated hypertensive patients with satisfactory BP control, there was no significant difference in cardiac structural and functional abnormalities among dipper and nondipper subjects.
Right Ventricular Dimensions and Function in Isolated Left Bundle Branch Block: Is There Evidence of Biventricular Involvement?
Authors: Van Dijk Jeroen , Knaapen Paul , Bekkering Irma , Götte Marco J.W. , Kamp Otto
Published: February 2008

Background: Isolated left bundle branch block (LBBB) may be an expression of idiopathic cardiomyopathy affecting both ventricles. The present study was conducted to evaluate right ventricular (RV) dimensions and function in asymptomatic LBBB patients with mildly depressed left ventricular (LV) function. Methods: Fifteen patients with asymptomatic LBBB in whom coronary artery disease, hypertension, and valvular pathology was excluded were studied. Fifteen healthy volunteers and 15 idiopathic dilated cardiomyopathy LBBB patients served as controls. RV long axis and tricuspid annulus diameter were obtained, as were tricuspid annular plane systolic excursion (TAPSE) and peak systolic velocity (Sm) of the RV free wall annulus. Tricuspid regurgitation (TR) jets (peak TR jets) were used for RV pressure assessment. Results: RV dimensions were comparable between the asymptomatic LBBB patients and controls. RV functions of healthy volunteers and asymptomatic LBBB patients were similar (TAPSE: 24 ± 3 and 24 ± 4 mm, Sm: 13 ± 2 and 13 ± 3 cm/s, respectively), whereas functional parameters in idiopathic dilated cardiomyopathy patients were significantly reduced (TAPSE: 19 ± 5 mm, Sm: 9 ± 2 cm/s, both P < 0.01 by analysis of variance [ANOVA]). For the three groups combined, a significant inverse correlation between RV pressure (peak TR jets) and RV function (Sm) was observed (r =–0.52, P = 0.017). Conclusions: In patients with an asymptomatic LBBB, RV dimensions and function are within normal range. The present study suggests that screening of RV functional parameters in asymptomatic LBBB patients is not useful for identification of an early‐stage cardiomyopathy, and RV dysfunction is merely a consequence of increased RV loading conditions caused by left‐sided heart failure and does not indicate a generalized cardiomyopathy affecting both ventricles.
Simultaneous Confidence Intervals for Comparing Binomial Parameters
Authors: Agresti Alan , Bini Matilde , Bertaccini Bruno , Ryu Euijung
Published: February 2008

SummaryTo compare proportions with several independent binomial samples, we recommend a method of constructing simultaneous confidence intervals that uses the studentized range distribution with a score statistic. It applies to a variety of measures, including the difference of proportions, odds ratio, and relative risk. For the odds ratio, a simulation study suggests that the method has coverage probability closer to the nominal value than ad hoc approaches such as the Bonferroni implementation of Wald or “exact” small‐sample pairwise intervals. It performs well even for the problematic but practically common case in which the binomial parameters are relatively small. For the difference of proportions, the proposed method has performance comparable to a method proposed byPiegorsch(1991,Biometrics 47,45–52).
Analysis of Ordered Categorical Data: Two Score‐Independent Approaches
Authors: Zheng Gang
Published: February 2008

Summary A trend test is often employed to analyze ordered categorical data, in which a set of increasing scores is assigned a priori. There is a drawback in this approach, because how to choose a set of scores is not clear. There have been debates on which scores should be used (e.g., Graubard and Korn, 1987, Biometrics 43, 471–476; Ivanova and Berger, 2001, Biometrics 57, 567–570; Senn, 2007, Biometrics 63, 296–298). Conflicting conclusions are often obtained with different sets of scores. Two approaches, which have been applied to genetic case–control studies, are appealing for ordered categorical data, because they take into account the natural order in the data, are score independent, and not contingent on asymptotic theory. These two approaches are applied to a prospective study for detecting association between maternal drinking and congenital malformations.
Oral Abuse of Fentanyl Patches (Duragesic®): Seven Case Reports
Authors: Woodall Karen L. , Martin Teri L. , McLellan Barry A.
Published: February 2008

Abstract:  In order to increase the understanding regarding the oral abuse and potential toxicity of fentanyl patches seven cases were identified over a 3‐year period where fentanyl, either alone or in combination with other factors, contributed to death following the oral abuse of Duragesic® patches. The decedents comprised three females and four males with ages ranging from 20 to 51 years. Postmortem blood fentanyl concentrations were determined in all cases and ranged from 7 to 97 ng/mL. Two deaths were classified as a fentanyl overdose, three deaths were classified as a fentanyl and ethanol overdose, one death was considered a mixed drug intoxication and the remaining death was determined to be a combination of fentanyl and medical causes. These cases represent the largest reported series of deaths following the oral administration of transdermal fentanyl patches and provide detailed information on the potential for the abuse of transdermal Duragesic® patches via this route. The postmortem blood fentanyl concentrations detected for each of the decedents demonstrate the potentially fatal blood concentrations that can arise after this relatively rare route of administration.
Stature Estimation Based on Dimensions of the Bony Pelvis and Proximal Femur*
Authors: Giroux Carolyn L. , Wescott Daniel J.
Published: February 2008

Abstract:  Pelin et al. recently showed that sacral height measured on lateral magnetic resonance images can be used with moderate accuracy to reconstruct stature in males. In most forensic anthropological cases, however, sacral dimensions must be obtained from dry bones. In this study, the relationship between stature and sacral height, hip height, and femur head diameter measured on dry bone was evaluated for American Blacks and Whites of both sexes (n = 247). There are significant correlation between stature and these three dimensions, but the results suggest that none of the dimensions predict stature with the accuracy needed to be useful in forensic anthropological investigations.
Identification of Colorants in Pigmented Pen Inks by Laser Desorption Mass Spectrometry*
Authors: Papson Kaitlin , Stachura Sylwia , Boralsky Luke , Allison John
Published: February 2008

Abstract:  Pigments are rapidly replacing dyes as colorants in pen and printer inks, due to their superior colors and stability. Unfortunately, tools commonly used in questioned document examination for analyzing pen inks, such as TLC, cannot be used for the analysis of insoluble pigments on paper. Laser desorption mass spectrometry is demonstrated here as a tool for analyzing pigment‐based pen inks. A pulsed nitrogen laser can be focused onto a pen stroke from a pigmented ink pen on paper, and positive and negative ions representative of the pigment can be generated for subsequent mass spectrometric analysis. Targeted pens for this work were a set of Uni‐ball® 207™ pigmented ink pens containing blue, light blue, orange, green, violet, red, pink, and black inks. Copper phthalocyanine was identified as the pigment used to make both blue inks. A mixture of halogenated copper phthalocyanines were identified in the green ink. Unexpectedly, the pink ink was found to contain a red pigment, Pigment Red 12, treated with a mixture of water‐soluble dyes. Each sample yielded ions representative of the pigments present.
Sudden Death in Toddlers Caused By Influenza B Infection: A Report of Two Cases and a Review of the Literature*
Authors: Landi Kristen K. , Coleman Andrea T.
Published: February 2008

Sudden fatal cases of influenza B infection in a 4‐year‐old girl and a 2‐year‐old boy are presented. Both children complained of abdominal pain without respiratory, neurologic or cardiac symptoms; additionally the girl had vomiting within 2 days of death. Autopsy revealed histological changes in the respiratory system consistent with a viral infection. Influenza B infection was identified by immunohistochemistry in the girl and real‐time polymerase chain reaction in the boy. Additional testing including cultures, toxicology, and screening for metabolic disorders were negative. These cases illustrate the usefulness of viral testing, especially for influenza, in the medical legal autopsy of children even when the classic respiratory symptoms of flu are lacking.