bluuebunny/crossref_metadata_2025 huggingface dataset:
A new sectional combination in Nageia Gaertn. (Podocarpaceae)
Authors: MILL R. R.
Published: July 2008

The genus Nageia has received varying taxonomic treatments. The most recent are those by de Laubenfels (1969, under the name Decussocarpus de Laub.; 1987, as Nageia Gaertn.), by Fu (1992) and by Melikyan & Bobrov (2000). De Laubenfels treated the genus in a broad sense, embracing three sections that are now generally recognized respectively as the separate genera Afrocarpus (J. Buchholz & N. E. Gray) Gaussen ex C. N. Page, Nageia sensu stricto, and Retrophyllum C. N. Page (as by Page, 1989, 1990). In de Laubenfels's earlier paper, these three sections were respectively called Decussocarpus de Laub. sect. Afrocarpus (J. Buchholz & N. E. Gray) de Laub., D. sect. Dammaroideae (Benn.) de Laub. [as ‘Dammaroides’], and D. sect. Decussocarpus. The name Decussocarpus had been substituted for Nageia Gaertn. as the type of that generic name is based upon mixed elements belonging to Myrtaceae and Podocarpaceae and, in 1969, an Article of the International Code then in force (Art. 70) banned the use of names based on such ‘discordant elements’. This Article was deleted by the Leningrad Congress and the name Nageia once again became legitimate and available for use. This necessitated de Laubenfels's brief paper of 1987, where the three sections of Decussocarpus which he had earlier recognized were respectively renamed Nageia sect. Afrocarpus (J. Buchholz & N. E. Gray) de Laub., N. sect. Nageia and N. sect. Polypodiopsis (C. E. Bertrand) de Laub.
Introduction
Authors: Vincent Mary
Published: July 2008

‘Certain things go inevitably with war and are war. The main thing is fighting, winning, killing and being killed, being masculine and aggressive and abnormally vigorous, violent and physical.’

The experience of total war dominated the history of Europe in the first half of the twentieth century. Not only did the First World War inaugurate a new era in warfare, but its memory, commemoration and image was also incorporated in a profound sense into the culture of the interwar period. Combatants' memories and cinematic images contributed to keeping the war ever-present, as much in the pacifist desires of those who abhorred it as in the militarist ambitions of those intoxicated by it. The spirit of the trenches was to be reborn in the new fascist man of the 1920s and 1930s. As the opening quotation suggests, soldiering was the quintessential masculine experience. Military service – repackaged as national service during peacetime – was a school for forging men from callow boys, a cultural supposition which spanned the political divides of left and right, democracies and dictatorships. The experience of war restated and exaggerated conventional expectations of men and women. Indeed, for some theorists, war in the twentieth century was men's equivalent to women's experience of child-bearing. The front was an heroic, male arena, explicitly contrasted to the home front where women, children and those ‘unmanned’ by age or injury provided support and succour for the soldiers.
Feminism as if All People Mattered: Working to Remove the Causes of War, 1919–1929
Authors: Vellacott Jo
Published: July 2008

This paper first looks briefly at the connections – personal, political, practical and philosophical – between pre-First World War British and European women's suffrage and feminist pacifism as it emerged after 1914. Two feminist approaches to postwar peacemaking are compared, and the underlying assumptions of the Paris Peace Conference of the Allied and Associated Powers are compared with those of the women gathered at Zurich in May 1919. The aspirations and achievement of the Women's International League for Peace and Freedom between 1919 and 1930 are analysed less in terms of what the organisation did for women than in terms of the women's own intent, and what they hoped to do for the world. The article considers how they confronted the political disabilities they faced as women, and on occasion turned them to their advantage, and shall show how they saw their pacifism as integral to their feminism, although it frequently took them out of gender stereotypes, particularly in their insistence on moving into that most male preserve, international relations.
‘You Can't Even Call them Women’: Poles and ‘Others’ in Soviet Exile during the Second World War
Authors: Jolluck Katherine R.
Published: July 2008

Hundreds of thousands of Poles were forcibly transported to the interior of the USSR after the Red Army invaded eastern Poland in 1939. These individuals, male and female, ended up in Soviet prisons, labour camps or special deportation settlements. This article examines how women interpreted and coped with this traumatic experience of exile, arguing that this entailed the articulation of a traditional, homogenous identity for Polish females. One component of this self-definition was differentiation from ‘others’, isolated on the basis of nationality. On the whole, the exiled Polish women did not feel solidarity with women of other nationalities, regardless of the fact that they too were victims of the Stalinist regime. Polish women continually linked the configuration of gender roles which they regarded as proper, civilised and even natural, to their own national group. In this way, they affirmed that they did not belong in this new world and maintained a connection to home, to what they understood to be Polish, European and civilised.
From Heroines to Hyenas: Women Partisans during the Greek Civil War
Authors: Anagnostopoulou Margaret Poulos
Published: July 2008

The participation of women in armed combat was arguably the most striking feature of the Greek Civil War (1946–9). The advent of civil conflict marked a shift in the gendered division of military labour, as the female ‘novelty’ soldier of the earlier Resistance period (1941–4) gave way to the fully integrated female combatant. This article seeks to examine the circumstances which lead to such high levels of female representation within the ranks of the partisan army (the Greek Democratic Army), but also to explore the symbolic functions of this volatile imagery in the context of intense struggles to define Greek national culture and identity.
Packing Circuits into KN
Authors: BALISTER PAUL
Published: July 2008

We shall pack circuits of arbitrary lengths into the complete graph KN. More precisely, if N is odd and [sum ]ti=1mi = (N2), mi [ges ] 3, then the edges of KN can be written as an edge-disjoint union of circuits of lengths m1,…,mt. Since the degrees of the vertices in any such packing must be even, this result cannot hold for even N. For N even, we prove that if [sum ]ti=1mi [les ] (N2) − N−2 then we can write some subgraph of KN as an edge-disjoint union of circuits of lengths m1,…,mt. In particular, KN minus a 1-factor can be written as a union of such circuits when [sum ]ti=1mi = (N2) − N−2. We shall also show that these results are best possible.
G-Intersecting Families
Authors: BOHMAN TOM , FRIEZE ALAN , RUSZINKÓ MIKLÓS , THOMA LUBOš
Published: July 2008

Let G be a graph on vertex set [n], and for X ⊆ [n] let N(X) be the union of X and its neighbourhood in G. A family of sets [Fscr ] ⊆ 2[n] is G-intersecting if N(X) ∩ Y ≠ [empty ] for all X, Y ∈ [Fscr ]. In this paper we study the cardinality and structure of the largest k-uniform G-intersecting families on a fixed graph G.
Characterization Results Based on a Functional Derivative Approach
Authors: LILLO R. E. , MARTIN M.
Published: July 2008

We introduce a notion of the derivative with respect to a function, not necessarily related
to a probability distribution, which generalizes the concept of derivative as proposed by
Lebesgue [14]. The differential calculus required to solve linear differential equations using
this notion of the derivative is included in the paper. The definition given here may also be
considered as the inverse operator of a modified notion of the Riemann–Stieltjes integral.
Both this unified approach and the results of differential calculus allow us to characterize
distributions in terms of three different types of conditional expectations. In applying these
results, a test of goodness of fit is also indicated. Finally, two characterizations of a general
Poisson process are included. Specifically, a useful result for the homogeneous Poisson
process is generalized.
On Minimally 3-Connected Binary Matroids
Authors: REID TALMAGE JAMES , WU HAIDONG
Published: July 2008

We generalize a minimal 3-connectivity result of Halin from graphs to binary matroids. As
applications of this theorem to minimally 3-connected matroids, we obtain new results and
short inductive proofs of results of Oxley and Wu. We also give new short inductive proofs
of results of Dirac and Halin on minimally k-connected graphs for k ∈ {2,3}.
Stress, ageing and quality of life
Authors: SIEGRIST JOHANNES
Published: July 2008

This paper highlights the role of chronic psychosocial stress in accelerated ageing and age-associated degenerative diseases, referring to the free radical theory of ageing. Chronic work stress in midlife provides an illustrative case to explore these associations, with an emphasis on cardiovascular disease and its subclinical precursors. It is argued that lack of control at work and the experience of an imbalance between efforts spent and rewards received at work trigger continued stress reactions with adverse long term effects on health. These conditions impair the working person's successful self-regulation in a core social role in adult life – the work role. Self-efficacy and self-esteem, two important psychological components of well-being and health, are compromised if personal control and social reward are lacking. Selected empirical results derived from epidemiological and experimental investigations are reported to illustrate this argument. In particular, otherwise healthy middle-aged employees suffering from stress at work are twice as likely to report a new cardiovascular disease in a five year period compared with their less stressed colleagues. In another study, an increase in average ambulatory systolic blood pressure and heart rate is observed in a group of workers characterized by an imbalance between effort and reward at work. The implications of this research for improved quality of life and healthy ageing in early old age concern the provision of adequate social roles, which offer opportunities for experiencing continued personal control and social reward. At the socio-political level, new forms of social productivity in economic and non-monetarized sectors need to be developed.
Facing another modernity: individualization and post-traditional ligatures
Authors: JAIN ANIL K. , KEUPP HEINER , HÖFER RENATE , KRAUS WOLFGANG
Published: July 2008

Social change is taking place today with enormous acceleration. The globalization of politics, economy, and culture, changes in information technology and the revolution in genetic engineering are the major transforming powers. They create a complex of change and have an effect on the individual as well as the community. Known structures are coming apart and this evokes feelings of fear. However, spaces of opportunity will be opened, too. They can be used if (what we call) post-traditional ligatures constitute a new basis of social embedding. Examples of such bondings, which are more flexible and (to a large extent) self-created, are mentioned at the end of this article.
Jack Tizard Memorial Lecture: Educational Reform and the Mental Health of Vulnerable Children and Young People
Authors: Galloway David
Published: July 2008

Although research has demonstrated the differential influence of schools on children's psychosocial adjustment, the influence of radical legislative changes since 1979 is less clear. Evidence of a sharp rise in exclusions and in referral for special educational needs is contrasted with evidence that behaviour in most schools is good, and with data showing a steep reduction in the number of pupils leaving school with no qualifications. It is argued that these reforms have improved overall standards and may thereby have contributed positively to the mental health of many vulnerable children. However, the way they have been implemented has undermined teachers in some schools and, as a result, pupils there experience education as an additional source of stress rather than of stability and support.
The heterogeneity of epithelial ovarian cancers: reconciling old and new paradigms
Authors: Naora Honami
Published: July 2008

Epithelial ovarian cancer comprises several subtypes of tumours that exhibit diverse histopathological features. The intriguing assumption by many epithelial ovarian cancers of specialised features of nonovarian tissue lineages has promoted considerable debate as to whether these tumours arise from the deceptively simple surface epithelium of the ovary. This review focuses on recent molecular and pathological studies of epithelial ovarian cancers that support and challenge their surface-epithelial derivation, and discusses the findings in the context of current views of the ‘cell-of-origin’ of solid tumours.
The geriatric depression scale in palliative care
Authors: Crawford Gregory B. , Robinson Julie A.
Published: July 2008

Objective:

This research examined the psychometric properties of previously published short forms of the Geriatric Depression Scale (GDS) in patients receiving palliative care. It also uses the full form of the GDS to examine the prevalence of nonsomatic symptoms of depression in palliative patients.

Method:

Participants were 84 patients with advanced cancer attending palliative care outpatient clinics. Scores for short forms of the GDS were derived from administering the original 30-item scale. Patients also completed the single item numerical analogue scale for depression from the Edmonton Symptom Assessment System and parallel numerical analogue scales for will-to-live and hope. A subset of the sample completed the measures twice. Short forms were judged on the extent to which they captured information gained from the full scale and their internal consistency, test–retest reliability, convergent and concurrent validity, and their distribution of scores.

Results:

Overall, five short forms showed good psychometric properties at both visits. Two of these forms were very brief. Some nonsomatic symptoms assessed on the full GDS were reported with high frequency. However, few individuals reported a large number of symptoms. At both visits, patients identified as likely to have severe depression gave different responses from other patients on most items on the GDS-30.

Significance of results:

Several short forms of the GDS may be appropriate for use in palliative care. Patients identified as likely to have severe depression showed many of the same symptoms that characterise depression in other geriatric populations.
Psychiatric disorders and background characteristics of cancer patients' family members referred to psychiatric consultation service at National Cancer Center Hospitals in Japan
Authors: Asai Mariko , Akechi Tatsuo , Nakano Tomohito , Shimizu Ken , Umezawa Shino , Akizuki Nobuya , Uchitomi Yosuke
Published: July 2008

Objective:

Psychological distress of cancer patients' family members is treated by psychiatric consultation service for outpatients at National Cancer Center Hospitals in Japan. The purpose of this study was to identify psychiatric disorders and explore background characteristics of cancer patients' family members referred to psychiatric consultation service, so that we could better understand current utilization of this psychiatric consultation service for cancer patients' family members.

Methods:

A retrospective descriptive study using clinical practice data obtained for 5 years (from January 2000 to December 2004) was conducted at two National Cancer Center Hospitals. We reviewed the psychiatric consultation database, computerized patient database of the National Cancer Center Hospitals, and medical charts of cancer patients' family members who were referred to psychiatry and their cancer patients.

Results:

Out of a total of 4992 psychiatric consultations, 118 (2%) were for cancer patients' family members. The most common psychiatric disorders among cancer patients' family members were adjustment disorders (n = 69, 58%), followed by major depression (n = 30, 25%). Female (n = 101, 86%), spouse (n = 87, 74%), married (n = 92, 78%), and housewife (n = 63, 53%) were the most common background characteristics of the family members. Sixty-four percent of cancer patients (n = 75) were hospitalized at the time of their family members' referral and 34% of cancer patients (n = 40) had already received psychiatric consultation service and 55% of cancer patients (n = 65) had delivered bad news prior to their family members' referral.

Significance of the research:

We found that very few family members were provided with psychiatric consultation service at two National Cancer Center Hospitals. Adjustment disorders are suggested to be the most common psychiatric disorders among cancer patients' family members.
Recent advances in modeling swash zone dynamics: Influence of surf‐swash interaction on nearshore hydrodynamics and morphodynamics
Authors: Brocchini M. , Baldock T. E.
Published: July 2008

The role of the swash zone in influencing the whole nearshore dynamics is reviewed with a focus on the interaction between surf and swash zone processes. Local and global hydromorphodynamic phenomena are discussed in detail, and a description of the overall swash zone operation is given. The effects of swash zone boundary conditions are highlighted, together with the importance of surf zone boundary conditions. Major emphasis is placed on illustrating the interactions of various hydrodynamic modes which, in turn, control the swash and surf zone morphology. Finally, methods to account for swash zone processes in coastal models with different temporal and spatial resolutions are proposed.
Abnormal evening vertical plasma drift and effects on ESF and EIA over Brazil‐South Atlantic sector during the 30 October 2003 superstorm
Authors: Abdu M. A. , de Paula E. R. , Batista I. S. , Reinisch B. W. , Matsuoka M. T. , Camargo P. O. , Veliz O. , Denardini C. M. , Sobral J. H. A. , Kherani E. A. , de Siqueira P. M.
Published: July 2008

Equatorial F region vertical plasma drifts, spread F and anomaly responses, in the south American longitude sector during the superstorm of 30 October 2003, are analyzed using data from an array of instruments consisting of Digisondes, a VHF radar, GPS TEC and scintillation receivers in Brazil, and a Digisonde and a magnetometer in Jicamarca, Peru. Prompt penetrating eastward electric field of abnormally large intensity drove the F layer plasma up at a velocity ∼1200 ms−1 during post dusk hours in the eastern sector over Brazil. The equatorial anomaly was intensified and expanded poleward while the development of spread F/plasma bubble irregularities and GPS signal scintillations were weaker than their quiet time intensity. Significantly weaker F region response over Jicamarca presented a striking difference in the intensity of prompt penetration electric field between Peru and eastern longitudes of Brazil. The enhanced post dusk sector vertical drift over Brazil is attributed to electro‐dynamics effects arising energetic particle precipitation in the South Atlantic Magnetic Anomaly (SAMA). These extraordinary results and their longitudinal differences are presented and discussed in this paper.
Estimation of single station interfrequency receiver bias using GPS‐TEC
Authors: Arikan F. , Nayir H. , Sezen U. , Arikan O.
Published: July 2008

Dual‐frequency Global Positioning System (GPS) receivers present a plausible and cost‐effective way of computing Total Electron Content (TEC). For accurate estimates of TEC, frequency‐dependent satellite and receiver instrumental biases should be removed from GPS measurements properly. Although instrumental satellite bias values are widely available through the internet from various International GPS Service (IGS) analysis centers, receiver biases (also known as differential code biases or interfrequency biases) are provided only for a very few GPS stations and a select number of days. This makes it very difficult to compute TEC for a single station. In this study, an online, single station receiver bias estimation algorithm, IONOLAB‐BIAS, is developed and implemented to obtain daily and monthly averages of receiver bias. The algorithm is successfully applied to both quiet and disturbed days of the ionosphere for stations positioned in high‐latitude, midlatitude, and equatorial regions. The receiver bias estimates are compared with two of the basic methods in the literature that can be applied off‐line, and also with the receiver bias values provided from the IGS centers for a select number of stations. It is observed that IONOLAB‐BIAS is in excellent accordance with the sparse estimates from the IGS centers for all ionospheric states and regions. IONOLAB‐BIAS has a high potential to be an alternative receiver bias computation algorithm with its ease of implementation and accurate estimates for any single station GPS‐TEC.
Physics‐based continuous simulation of long‐term near‐surface hydrologic response for the Coos Bay experimental catchment
Authors: Ebel Brian A. , Loague Keith , Montgomery David R. , Dietrich William E.
Published: July 2008

The study reported here employed the physics‐based Integrated Hydrology Model (InHM) to conduct continuous hydrologic‐response simulation from 1990 through 1996 for the Coos Bay experimental catchment. The uniqueness of the boundary‐value problem used to simulate three sprinkling experiments was assessed, via model performance evaluation against observed piezometric and discharge data, for 33 events extracted from the continuous record. The InHM simulations could not adequately reproduce the distributed observed pore water pressures, suggesting that detailed characterization of the locations and connectivities of bedrock fractures is critical for future efforts designed to simulate distributed hydrologic response at the field scale for locations where bedrock fracture flow is important. The simulations presented here suggest the potential for interaction between the deeper water table and near‐surface hydrologic response. The results reported herein suggest that while uniqueness can be reasonably achieved with respect to the integrated response (i.e., discharge), the integrated response uniqueness is no guarantee that the distributed response (i.e., pressure head) is either unique or well simulated.
Density‐driven Southern Hemisphere subpolar gyres in coupled climate models
Authors: Wang Z. , Meredith M. P.
Published: July 2008

We investigate the representation of Southern Hemisphere subpolar gyres in 20 IPCC AR4 climate models. The models reproduce three southern subpolar gyres: the Weddell Gyre, Ross Gyre, and Australian‐Antarctic Gyre, in agreement with observations. Some models simulate the presence of a subpolar “supergyre”, with strong connectivity between the three gyres. The gyre strengths and structures show a great range across the models. It is found that the link between the gyre strengths and wind stress curls is weak, indicating that the Sverdrup balance does not hold for the modelled southern subpolar gyres; instead, the simulated gyre strengths are mainly determined by upper layer meridional density gradients, which are themselves determined predominantly by the salinity gradients. These findings suggest that a correct simulation of salinity is crucial in the simulation of southern subpolar ocean circulation.
Tomographic evidence for hydrated oceanic crust of the Pacific slab beneath northeastern Japan: Implications for water transportation in subduction zones
Authors: Tsuji Yusuke , Nakajima Junichi , Hasegawa Akira
Published: July 2008

We estimate detailed seismic‐velocity structure around the Pacific slab beneath northeastern Japan by double‐difference tomography. A remarkable low‐velocity zone with a thickness of ∼10 km, which corresponds to much hydrated oceanic crust, is imaged coherently along the arc at the uppermost part of the slab. The zone gradually disappears at depths of 70–90 km, suggesting the occurrence of intensive dehydration reactions there. The concentration of intraslab earthquakes at these depths supports dehydration‐embrittlement hypothesis as a mechanism for generating intraslab earthquakes. A low‐velocity zone imaged immediately above the slab at depths >70 km probably reflects a hydrous layer that absorbs water expelled from the slab and carries it to deeper depths along the slab. Our observations suggest that an along‐arc variation in arc volcanism might be related to that in the development of the hydrous layer above the slab.
The impact of varying autonomic states on the dynamic beat‐to‐beat QT–RR and QT–TQ interval relationships
Authors: Fossa A A
Published: July 2008

The beat‐to‐beat dynamicity of the QT–RR interval relationship is difficult to assess with the use of traditional correction factors (QTc) and changes in QTc do not accurately reflect or quantify arrhythmogenic risk. Further, the interpretation of arrhythmogenic risk is influenced by autonomic state. To visualize the QT–RR interval dynamics under varying conditions of autonomic state from impaired repolarization, we have developed a system to sequentially plot the beat‐to‐beat confluence of ECG data or ‘clouds’ obtained from conscious dogs and humans. To represent the non‐uniformity of the clouds, a bootstrap sampling method that computes the mathematical centre of the uncorrected beat‐to‐beat QT value (QTbtb) and defines the upper and lower 95% confidence bounds is used. The same method can also be used to examine heterogeneity, hysteresis (both acceleration and deceleration) and restitution (beat‐to‐beat QT–TQ interval relationship). Impaired repolarization with the combination of E‐4031 and L‐768,673 (inhibitor of IKs current) increased heterogeneity of restitution at rest 55–91%; increased hysteresis during heart rate acceleration after isoproterenol challenge by approximately 40–60%; and dramatically diminished the minimum TQ boundary by 72% to only 28 ms. Impaired repolarization alters restitution during normal sinus rhythm and increases hysteresis/heterogeneity during heart rate acceleration following sympathetic stimulation. These findings are supported by similar clinical observations in LQT1 and LQT2 syndromes. Therefore, the assessment of the dynamic QT–RR and QT–TQ interval relationships through quantification of heterogeneity, hysteresis and restitution may allow a more accurate non‐invasive evaluation of the conditions leading to cardiac arrhythmia.

British Journal of Pharmacology (2008) 154, 1508–1515; doi:fn1; published online 21 April 2008
PDE4 inhibitors: current status
Authors: Spina D
Published: July 2008

Phosphodiesterase4 inhibitors are currently under development for the treatment of respiratory diseases including asthma and chronic obstructive pulmonary disease. The rationale for the development of this drug class stems from our understanding of the role of PDE4 in suppressing the function of a range of inflammatory and resident cells thought to contribute toward the pathogenesis of these diseases. Similarly, numerous preclinicalin vivostudies have shown that PDE4 inhibitors suppress characteristic features of these diseases, namely, cell recruitment, activation of inflammatory cells and physiological changes in lung function in response to a range of insults to the airways. These potentially beneficial actions of PDE4 inhibitors have been successfully translated in phase II and III clinical trials with roflumilast and cilomilast. However, dose limiting side effects of nausea, diarrhoea and headache have tempered the enthusiasm of this drug class for the treatment of these respiratory diseases. A number of strategies are currently being pursued in attempts to improve clinical efficacy and reduce side effects, including delivery via the inhaled route, and/or development of non‐emetic PDE4 inhibitors and mixed PDE inhibitors.

British Journal of Pharmacology(2008)155, 308–315; doi:fn1; published online 28 July 2008
Teaching a Young Child With Autism to Request Assistance Conditionally: A Preliminary Study
Authors: Reichle Joe , Dropik Patricia L. , Alden-Anderson Elizabeth , Haley Tom
Published: July 2008

Purpose

Investigators taught a 5-year-old boy with autistic disorder and severe language delay to conditionally use requests for assistance.

Method

A within-participant multiple-probe design across 3 functional tasks was implemented in order to evaluate the child’s acquisition and conditional use of requests for assistance during intervention with each task.

Results

Results indicated initial acquisition of requests for assistance followed by a brief period of overgeneralization. As independence in completing a task increased, requests for assistance correspondingly decreased. The participant’s conditional use of requests for assistance and independent task completion were sustained across time.

Conclusion

This study highlights the need to assess conditional use of newly taught communicative behavior.
Anesthesia for Pacemaker Insertion
Authors: Veve Isidra , Melo Luisa Fernanda
Published: July 2008

In recent years, the nature of pacemaker implantation in the United States has changed dramatically, as ad vances continue in the technology of pacemakers and the techniques for insertion. Changes have also allowed for the expansion of indications for pacing to include cases in which it can serve as a therapeutic modality to alter hemodynamic states. Where once surgeons were primarily responsible for the procedure, the task now falls under the services of cardiologists. Insertions are commonly performed on an outpatient basis in the cardiac catherization suite. Local anesthesia is sufficient and, therefore, limits the need for anesthesiologists during pacemaker insertion. However, complicated, high-risk patients are now presented for pacemaker insertion. Furthermore, the 1998 American College of Cardiology/American Heart Association (ACC/AHA) guidelines include hypertrophic obstructive cardiomy opathy, dilated cardiomyopathy, and pacing after car diac transplantation as 3 new indications of particular interest. It is these conditions that enlist the expertise of anesthesiologists for monitoring, administering of anal gesics and sedatives, and resuscitation because of complications. This article provides a comprehensive description of common implantation procedures and the anesthesia used for pacemaker insertion. The focus is on the new 1998 ACC/AHA indications as well as general complications that invariably arise even during routine insertion. It is these areas that are of particular interest to anesthesiology as technology, technique, and indications for pacemaker insertion continue to evolve.
Anesthetic Implications for Patients With Permanent Pacemakers
Authors: Collard Charles D. , Body Simon C.
Published: July 2008

Anesthesiologists will increasingly be required to treat patients with permanent pacemakers in the periopera tive period. Careful preoperative anesthetic evaluation is mandatory and includes attention to both the initial pathology that led to pacemaker insertion as well as to coexisting disease and treatment. Specific information regarding the patient's pacemaker should be sought, including the type and model, battery state, ability to stimulate the heart, and the expected response to placement of a magnet over the device. Additional preoperative considerations are discussed. Important intraoperative considerations for patients with perma nent pacemakers are also reviewed, including issues of rate-adaptive pacing, electrical interference with pace maker function, and loss of pacing capability. Additional intraoperative anesthetic issues, including the choice of anesthetic technique and the use of invasive monitoring for patients with permanent pacemakers are addressed. Specific considerations for lithotripsy, radiotherapy, and magnetic resonance imaging are also discussed. Finally, postoperative considerations are reviewed. Although pacemaker complications are unusual during anesthe sia, it is essential that anesthesiologists be able to anticipate, recognize, and treat pacemaker dysfunction in the perioperative period.
Cardiac Embryology: Understanding Congenital Heart Disease for the Noncardiac Anesthesiologist
Authors: Kussman Barry D. , Holzman Robert S.
Published: July 2008

Understanding cardiac embryology gives the pediatric anes thesiologist a better appreciation of the anatomy and disor dered physiology of a particular defect, and ultimately is the basis of rational management decisions during the course of anesthesia and perioperative care. In addition, such an un derstanding is helpful in predicting or identifying associated malformations or syndromes that are of critical importance for the cardiac and noncardiac anesthesiologist.
Essentials of Nitric Oxide for the Pediatric (Cardiac) Anesthesiologist
Authors: Bushman Gerald
Published: July 2008

Short- and long-term survival rates for the operative treat ment of congenital heart disease (CHD) have improved significantly in the past 2 decades. The increasing sophisti cation of the pediatric cardiologist's diagnostic armamen tarium has led to more pervasive use of fetal screening with echocardiography. Early diagnosis and pre-emptive care of the neonate with complex CHD have allowed interventional strategies in the catheterization suite or the operating room to be optimized in both the timing and the quality of pallia tive or corrective procedures. Medications such as prosta glandin E and ventilator strategies using hypoxic and hyper carbic inspired gases exemplify therapies benefitting the contemporary neonate with CHD, often allowing stabiliza tion of the patient before surgery. Surgical care of neonates, infants, and children with CHD has also improved. Insights into maturational differences in myocardial and autonomic function have led to more appropriate myocardial protection strategies and pharmacologic support of the circulation. Recognition of those anomalies in which total correction in the neonate is desirable has stimulated improvements in the technical and cognitive skills of pediatric cardiovascular sur geons and pediatric cardiac anesthesiologists to meet these challenges. The goal of this article is to provide the pediatric anesthesiologist with an overview of inhaled nitric oxide and its relevance to clinical practice.
The Use of Regional Anesthesia in Combination With General Anesthesia for Cardiac Surgery in Children
Authors: Hammer Gregory B. , Wellis Vinit , Boltz M. Gail , Uezono Shoichi , Rodefeld Mark D. , Pike Nancy A. , Black Michael D.
Published: July 2008

The use of regional anesthesia in combination with general anesthesia for children undergoing cardiac surgery is the subject of a growing number of publications and presenta tions. Benefits of regional anesthesia in patients having car diac surgery include attenuation of the neuroendocrine response to surgical stress, improved postoperative pulmo nary function, enhanced cardiovascular stability, and im proved postoperative analgesia. To the extent that regional anesthesia facilitates early tracheal extubation in cardiac surgical patients, complications and costs associated with postoperative mechanical ventilation may be reduced. These benefits must, however, be weighed against the ad verse effects that may accompany the use of regional anes thesia, including hypotension, postoperative respiratory de pression, and epidural hematoma formation. In this article, the benefits and risks of regional anesthesia in infants and children undergoing open heart surgery are reviewed. In addition, specific spinal and epidural techniques currently in use are described, including management of side effects. Copyright © 2001 by W.B. Saunders Company.
The Preoperative Evaluation of the Patient With Cardiac Risk Factors for Noncardiac Surgery: Which Patients Need Further Cardiac Risk Stratification Tests?
Authors: Mathes Donald D.
Published: July 2008

Cardiac risk stratification tests should be pursued only in the subgroup of patients who have a moderate to high incidence of significant coronary artery disease and only in those who will gain long-term benefit from coronary revascularization if they are found to have significant coronary artery disease. Furthermore, car diac risk stratification tests should be pursued only if the perioperative mortality and morbidity from com bined coronary revascularization followed by noncar diac surgery is not significantly higher than proceeding straight to noncardiac surgery alone. Indentification of the subgroup of patients who will need cardiac strati fication tests should be based on integration of the patient's cardiac risk factors and functional capacity with the risk and stress of the particular surgery.
Treatment of Perioperative Myocardial Ischemia
Authors: Zvara David A.
Published: July 2008

Prevention and treatment of myocardial ischemia re mains a central focus of perioperative care. Myocardial ischemia is best understood in terms of myocardial oxygen supply and demand ratios. Conventional ther apy includes nitrates, β-blockers, and calcium channel blockers. In all 3 drug classes, ischemia is reduced by either improving supply, decreasing demand, or both. More recent investigation evaluates these medications either as prophylactic therapy or as a component of long-term risk reduction for cardiac morbid events. Newer therapies, including anticoagulation, pain ther apy, normothermia, central neuroaxial techniques, and other therapies, are reviewed.
Hemostatic Abnormalities in Cardiopulmonary Bypass: Pathophysiologic and Transfusion Considerations
Authors: Kottke-Marchant Kandice , Sapatnekar Suneeti
Published: July 2008

Cardiac surgical procedures typically use cardiopulmo nary bypass (CPB), a technique that diverts blood from the heart and lungs, where it is oxygenated and pumped back into the circulation. CPB is associated with significant pathophysiologic changes leading to an increased bleeding risk. Bleeding during CPB occurs for multiple reasons; the primary reason is the expo sure of blood to the material components of the CPB system, with intense systemic coagulation and platelet, fibrinolytic, and endothelial activation. To counteract the coagulation activation, extremely high levels of heparin anticoagulation are required to prevent sys temic thrombosis. Thrombin generation through tissue factor pathway activation is now thought to be the predominant mechanism of coagulation activation in CPB. The stimulus for tissue factor exposure to blood is thought to be a systemic activation of tissue factor on monocytes and endothelial cells caused by comple ment activation by the CPB materials and circulating inflammatory mediators. Despite improvements in the CPB system, surgical techniques, and blood conserva tion methods, the demand for blood in such procedures remains sustantial. Optimal blood use can be achieved by combining blood conservation measures with the transfusion of blood components according to strict guidelines. Blood is a limited resource and must be used wisely and cautiously. The risks and costs associ ated with transfusion are compelling reasons to mini mize unnecessary exposure to blood. However, the bene fits of transfusion are well established, and the risks are reasonably low. New developments in the surfaces of the CPB system, use of established and new protease inhibitors, and new blood conservation measures offer promise in decreasing the bleeding risk associated with CPB.
Optimal Management of Bleeding Complications After Cardiac Surgery
Authors: Skubas Nikolaos J. , Despotis George J.
Published: July 2008

Patients undergoing cardiac surgery with cardiopulmo nary bypass (CPB) are at increased risk for excessive perioperative blood loss requiring transfusion of blood products. Point-of-care evaluation of platelets, coagu lation factors, and fibrinogen can enable physicians to assess bleeding abnormalities rapidly. They also can facilitate the optimal administration of pharmacologic and transfusion-based therapy and allow physicians to identify patients with surgical bleeding. The ability to reduce the unnecessary use of blood products in this setting has important implications for emerging issues in blood inventory and blood costs. The ability to de crease operative time along with re-exploration rates has important consequences for health care costs in an increasingly managed health care environment. Copyright© 2001 by W.B. Saunders Company.
Inflammatory Mediators and S-100β Protein Concentrations in Neonates and Infants With Congenital Heart Disease
Authors: Appachi Elumalai , Mossad Emad B.
Published: July 2008

Patients undergoing cardiac surgery experience an ab normal whole-body inflammatory response after the initiation of cardiopulmonary bypass (CPB). The inflam matory response to CPB may cause postoperative or gan dysfunction and morbidity, especially in the pedi atric population. The systemic inflammatory response may be initiated during CPB by blood contact with the foreign surface of the pump circuit, ischemia-reperfu sion injury, and endotoxemia. Although significant mortality is rare, most patients undergoing CPB expe rience some degree of organ dysfunction as a result of the inflammatory response.
Cerebral Protection During Surgery of the Aortic Arch
Authors: Soong William A. L. , Uysal Suzan , Reich David L.
Published: July 2008

The most significant challenge in surgical repair of the aortic arch (transverse thoracic aorta) is to protect the brain from ischemic injury. During the portion of the procedure when the brachiocephalic vessels are at tached to a graft, there is an obligatory interruption in the normal path of circulation to the brain. Various strategies are used to overcome the potential for brain injury during discontinuity between the aorta and the cerebral circulation. These include deep hypothermic circulatory arrest, retrograde cerebral perfusion, and selective anterograde cerebral perfusion. Pharmaco logic adjuncts to these procedures are also used to further enhance brain protection. This review ad dresses the relative merits of these techniques as means of cerebral protection.
Off-Pump Coronary Artery Bypass Surgery: Revival of an Old Technique
Authors: Capdeville Michelle , Lee Jai H.
Published: July 2008

The ability to perform surgical procedures on the heart was one of the greatest accomplishments of the 20th century. What was once considered an impossible task has become a routine in daily clinical activity. The in troduction of extracorporeal circulation and myocardial protection strategies opened the doors to what was considered by most an insurmountable barrier— unhin dered access to the coronary circulation and intracar diac structures. In the United States, approximately 85% of coronary artery bypass graft procedures are performed with the use of cardiopulmonary bypass (CPB). CPB was and remains the gold standard for this type of cardiac surgical intervention. Over the years, investigators have struggled to find ways of lessening or eliminating the adverse physiologic effects of CPB. These efforts have focused on pharmacologic interven tion, monitoring procedures, blood gas management, and temperature management. Another way of avoid ing these effects is inherently obvious — eliminate the main source of the problem.
The Role of Transesophageal Echocardiography in Perfusion Management
Authors: Licina Michael G. , Savage Robert M. , Hearn Charles , Kraenzler Erik J.
Published: July 2008

Intraoperative transesophageal echocardiography (TEE) has been a valuable tool in cardiac surgery. The TEE probe can easily be inserted after endotracheal intuba tion to provide continuous monitoring and diagnosis during surgery. The role of TEE in the operating room is always expanding. This article examines the role of TEE specifically for cardiopulmonary bypass and perfusion management.
Anesthetic and Perioperative Considerations in Patients Undergoing Placement of Totally Implantable Replacement Hearts
Authors: Thielmeier Kenneth A. , Pank John R. , Dowling Robed D. , Gray Laman A.
Published: July 2008

The recent successful implantation of the AbioCor im plantable replacement heart at the Rudd Heart-Lung Institute, Jewish Hospital, Louisville, KY, has renewed clinical interest in the use of the mechanical replace ment heart as therapy for intractable heart failure. Al though the number of orthotopic heart transplants has plateaued in the past decade, the number of patients requiring transplantation continues to increase. This supply/demand discrepancy continues to be the main catalyst for the research and development of other therapies for the failing heart. This review addresses perioperative considerations, monitoring modalities, and perioperative therapeutic interventions that may help guide the cardiac anesthesiologist through the challenges presented by implantation of total replace ment hearts in end-stage cardiac patients.
Physical and Pharmacological Neuroprotection in Cardiac Surgery
Authors: Mitchell Simon J. , Willcox Timothy , Paget Milsom F. , Gorman Des F.
Published: July 2008

Stroke and neurocognitive deficits may follow cardiac surgery and have been linked to perioperative cerebral embolism. Alteration of cardiopulmonary bypass (CPB) or surgical technique to reduce embolism is, therefore, a rational neuroprotective strategy. Pharmacological cerebral protection has been advocated as an ideal "back-stop" to such "physical" interventions. A series of relevant studies conducted at Green Lane Hospital, Auckland, New Zeatand is described. Doppler ultra sound was used to monitor cerebral embolism during left heart valve surgery. Subsequently, salvaged CPB circuits were used to investigate several unexpected sources of emboli. The efficacy of a novel left heart deairing technique was audited using the Doppler de vice. Finally, a randomized double-blind trial of lidocaine in cerebral protection during cardiac surgery was con ducted. Most cerebral emboli were recorded after aortic declamping. However, cerebral emboli counts increased during stable CPB when the hard shell venous reservoir (HSVR) was operated at lower blood volumes and when air was seen in the venous return line. In vitro 2 HSVRs were found to generate bubbles when operated at blood volumes in excess of the manufacturer's recom mended minimum. Air in the venous return line was found to readily transit the CPB circuit and vacuum- assisted venous drainage markedly exacerbated this phenomenon. The novel deairing technique was mark edly superiorto conventional methods. Lidocaine admin istered in a standard antiarrhythmic dose for 48 hours from induction of anesthesia reduced the incidence of neuropsychological deficits at 10 days and 10 weeks postoperatively.
Central Nervous System Complications in Cardiac Surgery: Retrograde Cerebral Perfusion, Pressure, Pulsatility, Temperature, and pH Management During Cardiopulmonary Bypass
Authors: Murkin John M.
Published: July 2008

Currently, clinical management strategies during cardio pulmonary bypass (CPB) are undergoing profound changes. Renewed interest in normothermic versus hypothermic perfusion during CPB has resulted in appar ently contradictory results regarding patient outcomes. Much effort has been devoted to defining physiological responses of the brain to various alterations during CPB (eg, pH strategy, normothermia versus hypothermia, pulsatile or nonpulsatile perfusion, use of arterial line filtration, circulatory arrest, retrograde cerebral perfu sion). In addition, prospective studies are examining the impact of diverse strategies on neuropsychological and neurological outcomes after CPB, to define optimal management techniques.