bluuebunny/crossref_metadata_2025 huggingface dataset:
Cbfa-1 (Runx-2) and Osteocalcin Expression by Human Osteoblasts in Heparin Osteoporosis in Vitro
Authors: Handschin Alexander E. , Egermann Marcus , Trentz Otmar , Wanner Guido A. , Kock Hans-Jürgen , Zünd Gregor , Trentz Omana Anna
Published: June 2007

Heparin may cause adverse effects on bone formation following long-term application. The exact pathomechanism is unclear, but in vitro data suggest an impaired osteoblast function. The transcription axis of Cbfa-1 ( Runx-2) and osteocalcin is crucial in maintaining an equilibrium of bone formation and resorption in vivo. We used a human osteoblast cell culture model to further investigate the effect of heparin (low-molecular-weight heparin, dalteparin) on the expression of these two regulators of osteoblast differentiation. At high doses, dalteparin caused a significant inhibition of both osteocalcin and Cbfa-1 expression in vitro. Our data support the hypothesis of a direct inhibition of osteoblast function underlying heparin osteoporosis.
Spectrum of Bleeding in Acquired Factor V Inhibitor: A Summary of 33 Cases
Authors: Wiwanitkit Viroj
Published: June 2007

Coagulation factor V (FV) is an essential component of the prothrombinase complex, which activates the zymogen prothrombin to thrombin. Acquired FV inhibitor is rare and clinical symptoms are quite variable. The aim of this study was to summarize the spectrum of the bleeding presentation of acquired FV deficiency and characterize the underlying causes of the clinical symptoms. This study was designed as a descriptive retrospective and 30 case reports were included for further analysis. At least 33 cases of acquired FV inhibitor were investigated. Most patients have a presentation of bleeding and most of those are from hematuria and bleeding at surgical sites. Seven cases of asymptomatic acquired FV inhibitor were also detected. A total of 39.4% (19 of 33) of those cases with acquired FV inhibitor have an unknown cause. For those with known etiologies, chemical and drug-induced causes are the most common (30.8%).
Elevation of Activated Platelet-Dependent Chemokines in Patients With Anti-CD20 Monoclonal Antibody (Rituximab)−Treated Non-Hodgkin's Lymphoma
Authors: Nomura Shosaku , Ishii Kazuyoshi , Kamitsuji Yuka , Uoshima Nobuhiko , Ishikawa Emiko , Kitayama Hitoshi , Hayashi Kunio
Published: June 2007

.ocn.ne.jp. This study measured and compared levels of some chemokines in patients with rituximab-treated non-Hodgkin lymphoma because they may participate in the mechanism of efficacy of rituximab in non-Hodgkin lymphoma patients. Monocytic chemotactant protein-1, RANTES (regulated on activation, normally T-cell expressed and secreted), eotaxin, interleukin-8, neutrophil-activating protein-78, stromal cell-derived factor-1, and growth-regulating oncogene-α in patients with rituximab-treated non-Hodgkin lymphoma were measured by enzyme-linked immunosorbent assay. Levels of RANTES were higher in non-Hodgkin lymphoma patients than in controls. Levels of monocytic chemotactant protein-1, RANTES, and neutrophil-activating protein-78 were significantly elevated before and after chemotherapy with rituximab treatment. However, the level of stromal cell-derived factor-1 did not exhibit a significant change. Before to after chemotherapy without rituximab treatment, all chemokine levels did not exhibit significant changes. These findings suggest that activated platelet-dependent chemokines such as RANTES and neutrophil-activating protein-78 may modulate the efficacy of rituximab in antibody-dependent cellular cytotoxity.
Prevention of Influenza Episodes With Colostrum Compared With Vaccination in Healthy and High-Risk Cardiovascular Subjects
Authors: Cesarone Maria Rosaria , Belcaro Gianni , Di Renzo Andrea , Dugall Mark , Cacchio Marisa , Ruffini Irma , Pellegrini Luciano , Del Boccio Gilberto , Fano Filiberto , Ledda Andrea , Bottari Angelica , Ricci Andrea , Stuard Stefano , Vinciguerra Giulia
Published: June 2007

The efficacy of a 2-month treatment with oral colostrum in the prevention of flu episodes compared with antiinfluenza vaccination was evaluated. Groups included healthy subjects without prophylaxis and those receiving both vaccination and colostrum. After 3 months of follow-up, the number of days with flu was 3 times higher in the non-colostrum subjects. The colostrum group had 13 episodes versus 14 in the colostrum + vaccination group, 41 in the group without prophylaxis, and 57 in nontreated subjects. Part 2 of the study had a similar protocol with 65 very high-risk cardiovascular subjects, all of whom had prophylaxis. The incidence of complications and hospital admission was higher in the group that received only a vaccination compared with the colostrum groups. Colostrum, both in healthy subjects and high-risk cardiovascular patients, is at least 3 times more effective than vaccination to prevent flu and is very cost-effective.
The Relationship Between Circulating Fibrinogen and Lipoprotein (a) Levels in Patients With Primary Dyslipidemia
Authors: Ganotakis Emmanuel S. , Gazi Irene F. , Papadakis John A. , Jagroop I. Anita , Nair Devaki R. , Mikhailidis Dimitri P.
Published: June 2007

The correlation between 2 predictors of vascular events, plasma fibrinogen and serum lipoprotein (a), was evaluated in patients referred to a specialist clinic because of primary hyperlipidemia. A significant correlation existed between fibrinogen and lipoprotein (a) in nonsmokers but not in smokers. Plasma fibrinogen concentration correlated positively and significantly with serum lipoprotein (a) levels in men nonsmokers without cardiovascular disease and in women nonsmokers with cardiovascular disease. Nonsmoker women without cardiovascular disease had significantly higher plasma fibrinogen (3.63 g/L versus 3.07 g/L, P < .0001) than the corresponding men. Nonsmoker women with and without cardiovascular disease had significantly higher lipoprotein (a) levels than the corresponding groups of men (0.36 versus 0.18 g/L; P = .0015 and 0.40 versus 0.26 g/L; P = .008), respectively. The relationship between fibrinogen and lipoprotein (a) levels alters markedly depending on the population selected. This relationship is influenced by gender, the presence of cardiovascular disease and smoking status.
An Evaluation of Venous Thromboembolic Risk in Acutely Ill Medical Patients Immobilized at Home: The AT-HOME Study
Authors: Haas Sylvia K. , Hach-Wunderle Viola , Mader Frank H. , Ruster Katherine , Paar Wilhelm D.
Published: June 2007

Many risk factors for venous thromboembolism (VTE) in hospitalized medical patients are also present in medical outpatients. VTE prevention represents an important challenge for physicians treating patients at home. The AT-HOME study was a prospective cross-sectional observational study designed to assess awareness of the risk of VTE in immobilized acutely ill medical outpatients among German physicians, many of whom were participating in a national Continuing Medical Education (CME) program designed to raise awareness of VTE. The study involved 1210 medical patients who were acutely confined to bed at home. Physicians performed a subjective assessment of VTE risk, which was rated on a 10-point scale (1 = very low risk; 10 = very high risk). The risk of VTE was also assessed retrospectively by using a scorecard developed for use in hospitalized medical patients. Of the 1210 patients, 198 (16%) had risk scores of 0-4, 319 (26%) had scores of 5 or 6, and 693 (57%) had scores ≥7. Overall, 966 patients (80%) received thromboprophylaxis. The proportion of patients receiving thromboprophylaxis was 0% to 47% in risk score groups 0-4, 76% to 85% in groups 5 and 6, and 90% to 100% in risk score groups 7-10. In the retrospective assessment of VTE risk, 74% of patients were at high risk, 15% were at intermediate risk, and 11% were at low risk. The proportions of patients receiving thromboprophylaxis in these groups were 87%, 61%, and 55%, respectively. The involvement of physicians in educational activities focusing on VTE awareness appeared to create awareness of the risks of VTE in acutely ill medical outpatients.
Propagation of S-H Waves in Laminated Composites: A Gradient Elasticity Approach
Authors: Altan Burhanettin S , Miskioglu Ibrahim , Vilmann Carl R
Published: June 2007

The propagation of shear waves in a stratified, infinite medium consisting of alternating layers of two homogeneous, isotropic materials is studied within the framework of gradient elasticity. The special form of gradient elasticity employed in this study is introduced. The classical solution is analyzed in detail, and compared with the solution obtained using this form of the special form of gradient elasticity. The advantages of the proposed constitutive equation for modeling the mechanical behavior of composites is briefly discussed.
Vibration of Elastically Coupled Cantilever Beams using Greens's Functions
Authors: Mohamad Abdel-Salaam , Al-Jawi Abdulghaffar A N
Published: June 2007

The dynamic characteristics of cantilever beams, elastically coupled into linear and cyclic chains are considered theoretically, using Green's functions. This leads to finite difference equations, which can be solved easily for the tuned structure, or to tri-diagonal and cyclic tri-diagonal matrices for the linear and cyclic chains respectively, when mistuning is present, which can be inverted by standard routines. Free wave propagation and forced vibrations are both studied. Propagation constants for the tuned problem are presented and discussed. Mode localization factors are determined using Monte Carlo simulation when mistuning is introduced. The finite element code (ABAQUS) is also applied in the determination of natural frequencies and the study of free mode localization.
On the Weakly Damped Vibrations of a String Attached to a Spring Mass Dashpot System
Authors: Van Horssen W.T.
Published: June 2007

In this paper, we consider an initial-boundary value problem for a homogeneous string (or wave) equation. One end of the string is assumed to be fixed and the other end of the string is attached to a spring-mass-dashpot system, where the damping generated by the dashpot is assumed to be small. This problem can be regarded as a simple model describing oscillations of flexible structures such as overhead power transmission lines. A semigroup approach will be used to show the well-posedness of the problem as well as the asymptotic validity of formal approximations of the solution on long timescales. A multiple timescales perturbation method will be used to construct asymptotic approximations of the solution. Although the problem is linear the construction of these approximations is far from being elementary because of the complicated, non-classical boundary condition.
Two-Dimensional Control for Ship-Mounted Cranes: A Feasibility Study
Authors: Abdel-Rahman Eihab , Nayfeh Ali H
Published: June 2007

We test the feasibility of employing an exclusively planar control effort to suppress unsafe ship-mounted crane pendulations induced by sea motions. The new crane configuration, designed to apply the control effort, is modeled and the proposed control effort, employing Coulomb friction and viscous damping, is applied. The three-dimensional nonlinear dynamics of the crane is then investigated. The new crane configuration, dubbed Maryland rigging, transforms a crane from a single spherical pendulum to a double pendulum system. The upper pendulum, a pulley riding on a cable suspended from the boom, is constrained to move over an ellipsoid. The major axis of the ellipsoid is the boom and the foci are the two points at which the riding cable attaches to it. The lower pendulum, the payload suspended by a cable from the pulley, continues to act as a spherical pendulum. Due to the geometry of the ellipsoid, the natural frequencies of the crane in the plane of the boom (in-plane) are almost equal to the out-of-plane natural frequencies. The model is used to examine the response of a Maryland rigged crane to direct, in-plane, harmonic forcing. The frequency of the excitation is set almost equal to the crane's lowest natural frequency. It is found that under this excitation and due to the one-to-one internal resonance between the lowest in-plane and out-of-plane natural frequencies, significant out-of-plane motions are induced by applying a purely in-plane forcing. Thus, an in-plane control mechanism is not adequate for safe operation of the crane. To guarantee safe operation of a ship-mounted crane, both in-plane and out-of-plane control efforts must be applied.
H(Infinity) Robust Vibration Control of a Thin Plate Covered with a Controllable Constrained Damping Layer
Authors: Xie Shi Lin , Zhang Xi Nong , Zhang Jing Hui , Yu Lie
Published: June 2007

In this paper, we investigate the robust vibration control of a thin plate covered with a controllable constrained damping layer. The mixed sensitivity method in H\#8734; control theory is employed to synthesize the robust controller, which can reject the model uncertainties resulting from the modeling of the electromechanical dynamic characteristic of the structure and model reductions. The disturbance/output characteristic of the structure is considered in robust control design. The numerical simulations and experimental results indicate that H\#8734; control can suppress effectively low-frequency modal vibrations of a thin plate covered with a controllable constrained damping layer without spillovers of the truncated modes. Thereby, it provides more robust stability than displacement proportional feedback control.
Design of Non-Fragile H∞ Controller for Active Vehicle Suspensions
Authors: Du Haiping , Lam James , Sze Kam Yim
Published: June 2007

In this paper we present an approach to design the non-fragile H ∞ controller for active vehicle suspensions. A quarter-car model with active suspension system is considered in this paper. By suitably formulating the sprung mass acceleration, suspension deflection and tire deflection as the optimization object and considering a priori norm-bounded controller gain variations, the non-fragile state-feedback H ∞ controller can be obtained by solving a linear matrix inequality. The designed controller not only can achieve the optimal performance for active suspensions but also preserves the closed-loop stability in spite of the controller gain variations.
Effects of Primary Care Case Management (PCCM) on Medicaid Children in Alabama and Georgia: Provider Availability and Race/Ethnicity
Authors: Adams E. Kathleen , Bronstein Janet M. , Florence Curtis S.
Published: June 2007

This study analyzes the 4-year phase-in of Medicaid Primary Care Case Management (PCCM) in Georgia and Alabama. The effect of PCCM implementation on children's primary and preventive care, independent of changes in Medicaid participating providers, was measured by race. Accounting for provider supply, PCCMwas associated with lower use of primary care for all children except white non-Hispanics in urban Georgia. In urban Alabama, PCCM reduced preventive care for white and black non-Hispanic children. This held only for blacks in urban Georgia, while PCCM was associated with increased preventive care among all children in rural Georgia. The negative effect of PCCM was further compounded by negative effects of reduced provider availability. Reductions in office-based Medicaid providers affected Alabama children more often, while reductions in hospital-based physicians had a negative effect for Georgia children. Implementation of PCCM without fee increases may have had unexpected negative effects that differentially affected minority children.
Incentive Implementation in Physician Practices: A Qualitative Study of Practice Executive Perspectives on Pay for Performance
Authors: Bokhour Barbara G. , Burgess James F. , Hook Julie M. , White Bert , Berlowitz Dan , Guldin Matthew R. , Meterko Mark , Young Gary J.
Published: June 2007

Pay-for-performance (P4P) programs offer health care providers financial incentives to achieve predefined quality targets. Practice executives sit at a key nexus point for determining how P4P programs are implemented in physician practices. Using a qualitative interview design, this article examines the role practice executives play in the implementation of P4P programs and how their perspectives and decisions can influence the success of these programs. The authors identified five key findings related to practice executives’ views on P4P: quality incentives are better than utilization incentives, quality incentives are bonus rewards, quality incentives are agents for change, providers do not feel they have control over attaining quality targets, and the ways in which quality is measured are problematic. The authors discuss five different ways in which practice executives distribute rewards to physicians. These findings may help payers more effectively design and implement financial rewards for quality.
Ethical Research in Reflexive Relationships
Authors: Etherington Kim
Published: June 2007

This article aims to show how reflexivity helps create transparency and dialogue that is required for forming and sustaining ethical research relationships, especially when prior relationships with participants already exist. The article draws on literature relating to ethics and reflexivity and uses two stories, illustrated by conversations with research participants, to demonstrate how ethical issues emerge through conversation when planning research and how participants can use those conversations to inform later ethical decision-making practices. The article also presents literature, theories, and poetic representation that go some way toward explaining and describing the vulnerabilities experienced by researchers when using reflexivity. Reflexivity, although enabling the conduct of ethical relational research, also requires researchers to come from behind the protective barriers of objectivity and invite others to join with us in our learning about being a researcher as well as remaining human in our research relationships.
Tracking the Reflexivity of the (Dis)Engaged Citizen
Authors: Markham Tim , Couldry Nick
Published: June 2007

The relationship between governments and citizens in many contemporary democracies is haunted by uncertainty, and sociologists face the task of listening effectively to citizens' own reflections on this uncertain relationship. This article reflects on the qualitative methodology of a recently completed U.K. project that used a combination of diary and multiple interviews/focus groups to track over a fieldwork period of up to a year citizens' reflections on their relationship to a public world and the contribution to this of their media consumption. In particular, the article considers how the project's multiple methods enabled multiple angles on the inevitable artificiality and performative dimension of the diary process, resulting in rich data on people's complex reflections on the uncertain position of the contemporary citizen.
Methods and Applications of the Audibility Index in Hearing Aid Selection and Fitting
Authors: Amlani Amyn M. , Punch Jerry L. , Ching Teresa Y. C.
Published: June 2007

During the first half of the 20th century, communications engineers at Bell Telephone Laboratories developed the articulation model for predicting speech intelligibility transmitted through different telecommunication devices under varying electroacoustic conditions. The profession of audiology adopted this model and its quantitative aspects, known as the Articulation Index and Speech Intelligibility Index, and applied these indices to the prediction of unaided and aided speech intelligibility in hearing-impaired listeners. Over time, the calculation methods of these indices-referred to collectively in this paper as the Audibility Index-have been continually refined and simplified for clinical use. This article provides (1) an overview of the basic principles and the calculation methods of the Audibility Index, the Speech Transmission Index and related indices, as well as the Speech Recognition Sensitivity Model, (2) a review of the literature on using the Audibility Index to predict speech intelligibility of hearing-impaired listeners, (3) a review of the literature on the applicability of the Audibility Index to the selection and fitting of hearing aids, and (4) a discussion of future scientific needs and clinical applications of the Audibility Index.
Amplification With Digital Noise Reduction and the Perception of Annoying and Aversive Sounds
Authors: Palmer Catherine V. , Bentler Ruth , Mueller H. Gustav
Published: June 2007

Hearing aid users report difficulties using their hearing aids in noisy environments. Problems include understanding speech, loudness discomfort, and annoyance with background noise. Digital noise reduction algorithms have been promoted as a method to solve speech understanding and comfort in noise problems. Research has failed to find improved speech understanding in noise. Little is known about how digital noise reduction affects noise annoyance and aversiveness. The goals of this investigation were to determine how a specific digital noise reduction system affects hearing aid users’ perception of noise annoyance and aversiveness and to compare their perceptions to those of normal-hearing listeners. Ratings of noise annoyance and of aversiveness were obtained from 49 participants with moderate sensorineural hearing loss before fitting and after 3 weeks of hearing aid use. Findings were compared to measures obtained from normal-hearing listeners. Perceived annoyance and aversiveness increased with amplification. Annoyance and aversiveness with the hearing aid approximated normal perception. The results of this investigation suggest the need for counseling patients about realistic expectations related to annoyance and aversiveness of sounds at the time of hearing aid fitting.
The Neural Representation of Consonant-Vowel Transitions in Adults Who Wear Hearing Aids
Authors: Tremblay Kelly L. , Kalstein Laura , Billings Cuttis J. , Souza Pamela E.
Published: June 2007

Hearing aids help compensate for disorders of the ear by amplifying sound; however, their effectiveness also depends on the central auditory system's ability to represent and integrate spectral and temporal information delivered by the hearing aid. The authors report that the neural detection of time-varying acoustic cues contained in speech can be recorded in adult hearing aid users using the acoustic change complex (ACC). Seven adults (50–76 years) with mild to severe sensorineural hearing participated in the study. When presented with 2 identifiable consonant-vowel (CV) syllables (“shee” and “see”), the neural detection of CV transitions (as indicated by the presence of a P1-N1-P2 response) was different for each speech sound. More specifically, the latency of the evoked neural response coincided in time with the onset of the vowel, similar to the latency patterns the authors previously reported in normal-hearing listeners.
Endovascular Stent-Graft Repair of Penetrating Descending Thoracic Aortic Ulcer
Authors: Aidinian Gilbert , Massimiano Paul S. , Speir Alan M. , Mukherjee Dipankar
Published: June 2007

This article presents a case in which covered stent-graft cuffs were used to treat a penetrating ulcer of the descending thoracic aorta. An 80-year-old woman presented with penetrating ulcer in the descending thoracic aorta. Two endovascular stent graft cuffs were used for total exclusion of the penetrating ulcer, because the patient had a high operative risk. Her postoperative course was uneventful, and follow-up computed tomographic angiography showed complete coverage of the ulcer without evidence of leak. This case demonstrates that endoluminal stent-graft repair of penetrating descending thoracic aortic ulcers is a safe, less-invasive treatment, especially for elderly, high-risk patients.
Ethics in Home Care
Authors: Garcia Teresa
Published: June 2007

With the growth of in-home care provision, ethical questions have arisen. This articles looks at some of these questions for the purpose of discussion and awareness. Ethical questions arise from several facets of in-home care, including the paid staff/caregivers, the provider organization, the clients, and the family of clients, as well as the industry as a whole. This author shares information for the intent of increasing awareness and information sharing to the industry.
Lessons Learned: A Case Study
Authors: O’Doherty Mary
Published: June 2007

This article examines the real-life problems and issues of what can happen with registry care-givers. The case study profiles what happened to one family who hired a caregiver from a registry to care for their elderly parents and details the financial and emotional toll it took on the patients and the family. To protect the confidentiality of those involved in these case studies, all names used in this manuscript are fictitious.
The attributions of children with Attention-Deficit/Hyperactivity Disorder for their problem behaviors
Authors: Kaidar I. , Wiener J. , Tannock R.
Published: June 2007

This study investigated the attributions children with ADHD make about their most problematic symptoms. Children were interviewed to determine the degree to which they felt their behavior was controllable, stable, global, and stigmatizing; and about the locus of the cause of their behavior. Participants were 16 children with ADHD (10 boyd, 6 girls), and 16 children without ADHD (9 boyd, 7 girls), ages 7 to 13.

The present study demonstrated that children with ADHD viewed their most problematic behaviors as less within their control and more global across situations than children without ADHD. Children with ADHD were more likely than children without ADHD to view their most problematic behavior as always having been present, but were no more likely to view their most problematic behavior as persisting into the future. No significant group differences emerged on the locus of causality dimension. With regards to stigmatization, girls without ADHD reported that their behaviors can bother their teachers, parents, and peers, whereas girls and boys with ADHD did not perceive their behavior as bothersome.
Assessment of short-term verbal memory impairments in adolescents and adults with ADHD
Authors: Quinlan Donald M. , Brown Thomas E.
Published: June 2007

The purpose of this study was to determine whether a brief measure of verbal memory can assess short-term verbal memory impairments relative to verbal abilities in adolescents and adults with Attention-Deficit/Hyperactivity Disorder (ADHD) and to ascertain whether significant differences between short-term verbal memory and verbal abilities are more common among persons with ADHD than in the general population.

One hundred seventy-six adolescents and adults diagnosed with ADHD (DSM-IV criteria) were assessed with a measure of short-term verbal memory. The short-term verbal memory score of each subject was compared with the verbal abilities on two measures. Percentages of ADHD subjects with “significant discrepancy” between verbal IQ and short-term verbal memory were compared with the standardization sample for the verbal memory measure.

A majority of adolescents and adults diagnosed with ADHD demonstrated significant discrepancy between performance on the short-term verbal memory measure and verbal IQ. The percentage of ADHD subjects with a significant discrepancy between these two measures greatly exceeded the percentage of persons in the general population showing such a discrepancy.

This brief measure of short-term verbal memory may be a useful measure to include in a comprehensive assessment for ADHD symptoms in adolescents and adults. Replication in other groups of ADHD patients is needed to test the generalizability of the findings.
Assessing inhibitory control: A revised approach to the stop signal task
Authors: Carter J. D. , Farrow M. , Silberstein R. B. , Stough C. , Tucker A. , Pipingas A.
Published: June 2007

The stop signal task (stop task) is designed to assess inhibitory control and is a frequently used research tool in clinical disorders such as ADHD and schizophrenia. Previous methods of setting stop signal delay and of assessing inhibitory control are problematic. The current study reports two modifications that improve the task as a measure of inhibitory control.

The first modification was to set stop signal delays proportional to go mean reaction time (go MRT) to better account for inter-subject variability in go MRT. Twenty-eight normal children were tested, and all standard, stop task dependent measures were obtained when delays were set by this method.

The second modification was to calculate a novel dependent measure called the area of inhibition (AOI) which provides a more complete measure of inhibitory control than the slope of the relative finishing time z-scores (ZRFT-slope). Implications for the assessment of inhibitory control in clinical populations are discussed.
Presenting problems and assigned diagnoses among young Latino children with disruptive behavior
Authors: Arcia Emily , Fernández María C.
Published: June 2007

It is unclear whether the behaviors that alert families to the need for services are those that classify children for the diagnoses they receive. This study describes the behaviors that Latina mothers from Cuba, Puerto Rico, and the Dominican Republic report to have induced them to seek services for their young children. Both qualitative and quantitative analyses were used. Results indicated that mothers most frequently cited behaviors that fell in the categories of Hyperactivity, Aggression/Temper Tantrums, and School Complaints as reasons for help seeking. Whereas aggression and self-injurious acts were most alarming to mothers, School Complaints appeared to be a strong motivator for help seeking.

Children whose mothers cited school behavior as a reason for help seeking had significantly poorer global functioning and presented significantly higher care giving demands than peers. In addition, their mothers reported significantly more disciplinary laxity than the mothers of peers without School Complaints. Maternal narratives of children’s behaviors moderately concurred with assigned diagnoses. Mothers overlooked inattentive behaviors in children with ADHD and reported much more aggression and oppositionality than might be expected from the number of diagnoses of ODD that were assigned.
Parenting of children with Attention-Defecit/Hyperactivity Disorder (ADHD): The role of parental ADHD symptomatology
Authors: Harvey E. , Danforth J. S. , McKee T. Eberhardt , Ulaszek W. R. , Friedman J. L.
Published: June 2007

Objective: The present study examined the relation between parental ADHD symptomatology and parent-child behavior among 46 mothers and 26 fathers of ADHD children.

Results: Fathers’ self-reports of inattention and impulsivity were strongly associated with self-reports of lax parenting both before and after parent training, and with self-reports of overreactivity after parent training. Fathers’ impulsivity was also associated with more arguing during audiotaped observations of parent-child interactions prior to parent training. Mothers’ self-reports of inattention were modestly associated with self-reports of laxness before and after parent training. Prior to parent training, there were nonlinear relations between mothers’ inattention and observations of mother-child behavior, with mothers who reported moderate levels of inattention engaging in the most negative parent-child interactions. After parent training, these relations were linear, with the mothers who reported the most inattention engaging in the most negative parent-child interactions. These results were weakened but were generally still significant when parental depression and alcohol use were controlled.
Persistence of Attention-Deficit/Hyperactivity Disorder into adulthood: What have we learned from the prospective follow-up studies?
Authors: Mannuzza Salvatore , Klein Rachel G. , Moulton John L.
Published: June 2007

Objectives: Longitudinal studies of children with Attention-Deficit/Hyperactivity Disorder (ADHD) into adolescence have all reported high rates of ADHD. However, findings from studies into adulthood are inconsistent. This article reviews factors that may account for disparate rates found in adult follow-ups, and recommends optimal methodologies for prospective studies of children with ADHD in particular and childhood mental disorders in general.

Method: Follow-up studies of children with ADHD into adulthood are critically reviewed to identify factors that influence adult ADHD prevalence estimates.

Results: Four factors are identified: (1) ascertainment procedure, (2) attrition rate, (3) reporting source, and (4) disorder criteria.

Conclusions: Estimates of the proportion of children with ADHD who will experience symptoms of the childhood syndrome in adulthood are likely to vary considerably, as a function of multiple factors. Several recommendations are made for designing future follow-up investigations.
Maternal and child attributions in ADHD versus non-ADHD populations
Authors: Collett Brent R. , Gimpel Gretchen A.
Published: June 2007

Objective: This study explores child and maternal attributions in ADHD and non-ADHD populations. Participants included children with ADHD ( N = 26) and without ADHD ( N = 24) and their mothers.

Method: Children completed the Children’s Attributional Style Questionnaire-Revised (CASQ-R; Kaslow & Nolen-Hoeksema, 1991) and mothers completed the Written Analogue Questionnaire (WAQ; Johnston & Freeman, 1997).

Results: Consistent with hypotheses, differences were observed between the ADHD and non-ADHD groups on both child and maternal attributions measures. Post hoc analyses in the ADHD sample indicate that maternal, but not child, attributions differ as a function of medication status. Finally, correlations between child and maternal attributions were not found to be statistically significant.

Conclusion: The findings suggest that the attributional styles of children with ADHD may place them at risk for poor self-esteem and/or depression in later life. The attributions provided by these children’s mothers appear to differ slightly as a function of medication status, a finding that may lend insight into factors that influence parental choice of intervention and/or changes over the course of treatment.
Attention-Deficit/Hyperactivity Disorder in adult patients with Posttraumatic stress disorder (PTSD): Is ADHD a vulnerability factor?
Authors: Adler L. A. , Kunz M. , Chua H. C. , Rotrosen J. , Resnick S. G.
Published: June 2007

Objective: There is limited evidence suggesting a link between posttraumatic stress disorder (PTSD) and Attention-Deficit/Hyperactivity Disorder (ADHD). This study examined the association between PTSD and ADHD using retrospective and current clinical evaluations.

Method: Twenty-five male veterans with PTSD and 22 male veterans with panic disorder were evaluated for ADHD. The data was analyzed using chi-square and student’s t-tests.

Results: Thirty-six percent of participants with PTSD and 9% of participants with panic disorder met criteria for childhood ADHD. Twenty-eight percent of participants with PTSD and 5% of participants with panic disorder met criteria for current ADHD.

Conclusions : There appears to be a significant association of PTSD with ADHD. ADHD or common predisposing factors may increase the vulnerability for developing PTSD.
Longer eye contact improves ADHD children’s compliance with parents’ commands
Authors: Kapalka G. M.
Published: June 2007

This study evaluated the effectiveness of eye contact in reducing ADHD children’s problems with compliance. Seventy-six parents of ADHD boys between ages 5 and 10 were randomized into two treatment groups and a control group. Repeated-measures ANOVA revealed that, as hypothesized, eye contact was effective in reducing ADHD children’s problems with non-compliance to their parents’ commands. In addition, those parents who subsequently used a stare technique for 20 to 30 seconds following the command reported even greater reduction in problems with compliance. It is possible that the additional time following the command allows the child to process the situation and decide whether compliance or non-compliance is the better option. It is apparent that parent - training programs should consider the inclusion of this technique in their treatment paradigms.
Temperature Management During Cardiopulmonary Bypass: Effect of Rewarming Rate on Cognitive Dysfunction
Authors: Borger Michael A. , Rao Vivek
Published: June 2007

Hypothermia is a very strong neuroprotective agent during cerebral ischemia. However, several randomized clinical trials have failed to demonstrate a protective effect of hypothermic cardiopulmonary bypass on postoperative cognitive deficits. The lack of neuroprotection may be due to rapid rewarming, which in turn may result in cerebral hyperthermia. The purpose of this study was to detennine if rapid rewarming at the end of cardiopulmonary bypass is associated with an increased risk of postoperative neuropsychologic impairment.

Methods: A battery of neuropsychologic tests were administered preand postoperatively to patients undergoing elective coronary bypass surgery. Patients were allowed to drift to 34°C then rewarmed to 37.5°C at the end of cardiopulmonary bypass. Patients were divided into 2 groups according to the median time to rewarm (21 minutes): a rapid group (n = 70) and a slow group (n = 76).

Results: The 2 groups of patients were similar for all pre-, intra-, and postoperative variables, with the exception of rewarming times (15 ± 4 minutes [mean ± SD]) in the rapid group versus 30 ± 9 minutes in the slow group, p < 0.001). The rapid group had a significantly higher prevalence of neuropsychologic impairment 1 week postoperatively than the slow group (82% versus 57%, p < 0.05), as well as worse mean scores on all neuropsychologic tests. There was a nonsignificant trend toward increased neuropsychologic impairment 3 months postoperatively in the rapid group, as well as worse mean scores on 8 of the 10 tests.

Conclusions: Rapid rewarming at the end of cardiopulmonary bypass may increase the risk of postoperative cognitive impairment. Until further studies are performed, rapid rewarming should be avoided in order to minimize the risk of cerebral hyperthermia.
Pathophysiology of Thoracic Trauma
Authors: Kramer Jan L.
Published: June 2007

The major pathophysiologic mechanisms of thoracic trauma will be discussed. In the chest, anatomy and physiology are inextricably linked. The normal functions of the thoracic organs depend on normal anatomic compartmentation. When these compartments are either openedto atmospheric pressure or filled with fluids, normal physiologicmechanisms are interrupted. An injury to one thoracic organ alters the function of the other. Anesthesiologists must understand these interactions to provide proper care for the patient with cardiotho-racic trauma.
Diagnosing Perioperative Myocardial Infarction in Cardioth oracic and Vascular Surgery
Authors: Nass Caitlin , Fleisher Lee A.
Published: June 2007

Patients undergoing cardiac and high-risk noncardiac surgery have a high incidence of perioperative myocardial infarction. The early diagnosis of perioperative myocardial injury in these patients is complicated. In the perioperative period, there is a high incidence of nonspecific electrocardiographic changes and cardiac biomarker release. It is becoming increasingly imortant to differentiate myocardial necrosis from nonspecific changes because of the need for early intervention and the poential long term implications of a perioperative myocardial event. Although sensitive and specific assays to assess myoardial damage have been developed, specific thresholds to establish the occurrence a significant perioperative event have not been firmly defined. This review will attempt to outline the current evidence supporting the use of clinical symptoms, electrocardiographic changes, and cardiac biomarkers in the diagnosis of perioperative myocardial infarction and the longerm implication of these findings.
Does Off-Pump Coronary Surgery Reduce Morbidity and Mortality? A Review of the Recent Literature
Authors: Sabik Joseph F.
Published: June 2007

By reviewing the recent literature, determine if off-pump myocardial revascularization reduces operative morbidity and mortality. Five recent reports comparing on-pump to off-pump coronary artery bypass surgery are summarized. Three of the studies are relatively large, retrospective clinical studies, and two are smaller, prospective randomized studies. In the three retrospective reports, different statistical techniques were used to reduce the effect selection bias has on outcome. In four of the five studies, off-pump myocardial revascularization reduced operative risk. In one of the prospective randomized studies, off-pump revascularization resulted in equivalent outcomes to on-pump surgery. In the reports demonstrating a beneficial effect of off-pump surgery, there were different degrees of benefit. Two of the studies reported a significant benefit of off-pump surgery, with decreased operative mortality and morbidity, and in two of the studies a more modest benefit was identified, with decreased morbidity and equivalent mortality. Off-pump coronary artery bypass surgery decreases the operative risk of coronary artery bypass surgery. However, to what degree is debatable.
Anesthesia for Noncardiac Surgery in Children with Congenital Heart Disease
Authors: Yumul Roya , Emdadi Alireza , Moradi Nassim
Published: June 2007

This review covers the classification of congenital heart diseases, and the preoperative assessment, monitoring, anesthetic considerations, and management in the pediatric population with congenital heart disease. It does not present “recipes” for individual cardiac defects. The pathophysiology is presented as it relates to principles of management, patient assessment, selection, and application of an anesthetic regimen to specific cardiac lesions and procedures. Familiarity with the child's pathophysiology, preoperative preparation, choice of monitors, induction, maintenance, emergence from anesthesia, and plans for the postoperative period should avoid major problems in anesthetic management.
Unfractionated and Low-Molecular-Weight Heparins, Basic Mechanism of Action and Pharmacology
Authors: Fareed Jawed , Ma Qing , Florian Michelle , Maddineni Jyothi , Iqbal Omer , Hoppensteadt Debra A. , Bick Rodger
Published: June 2007

Unfractionated heparin has enjoyed sole anticoagulant status for nearly 50 years. Despite a dramatic growth in the development and the introduction of many newer anticoagulant and antithrombotic drugs and polytherapeutic approaches during the past decade, unfractionated and low-molecular-weight heparins remain the drugs of choice for many indications, including surgical anticoagulation, interventional cardiology, and in several additional considerations. Unfractionated heparin has a major role in the areas of vascular medicine and surgery, and it is the only parenteral anticoagulant drug that can be empirically neutralized by such agents as protamine sulfate. The development of low and ultra low-molecularweight heparins, which are a class of depolymerized heparin derivatives with distinct pharmacologic profiles that are largely determined by their composition, represents a refinement for the use of heparin. These drugs produce their major effects by combining with antithrombin Ill and exerting antithrombin and anti-Xa inhibition. The low-molecular-weight heparins also increase non-antithrombin III-dependent effects, such as tissue factor pathway inhibitor release, modulation of adhesion molecules, and the release of profibrinolytic and antithrombotic mediators from the blood vessels. Each of the low-molecular-weight heparins has different cumulative effects, and each product exhibits a distinct profile. Initially developed for the prophylaxis of postsurgical deep vein thrombosis, these drugs are now also used for the treatment of both venous and arterial thrombotic disorders. To a large extent, the low-molecular-weight heparins have replaced unfractionated heparin in most of the subcutaneous indications. This has resulted in a dramatic evolution in anticoagulant management that allows patients with thrombotic disorders to be treated in an outpatient setting. Thus, the introduction of low-molecular-weight heparins represents a major advance in improving the use of heparin. Generic versions of these drugs are likely to be developed as their patents expire. Currently, there are no clear guidelines for the acceptance of the generic versions of branded products. To avoid safety and efficacy-related problems, a generic drug must meet both the chemical and biologic equivalence criterion. Synthetically and biosynthetically derived agents such, as pentasaccharide, will also be introduced for clinical use; however, these drugs will have a narrower therapeutic spectrum due to their monotherapeutic nature. Heparin and its derivatives will continue to have a crucial role in the management of thrombotic and cardiovascular disorders in years to come.
Management of Patients with Heparin-Induced Thrombocytopenia During Cardiac Surgery
Authors: Koster Andreas , Fischer Thomas
Published: June 2007

The role of heparin-induced thrombocytopenia and its possibly severe complications in patients undergoing cardiac surgery is increasingly appreciated. Increasing evidence indicates that in patients without the presence of antibodies, unfractionated heparins can be safely used during cardiopulmonary bypass, if their employment is restricted to this short period. This strategy is the first choice in patients with a current negative status of antibodies and in patients in whom surgery can be delayed until antibodies cannot be detected by laboratory tests. To date, however, no alternative anticoagulant to heparin during cardiopulmonary bypass has been approved. With the introduction of the class of direct thrombin inhibitors, effective anticoagulants have become available; however, they have no antidote and require specific monitoring. The availability of direct thrombin inhibitors is currently restricted. The administration of unfractionated heparin with anti-platelet agents such as prostaglandins or the short-acting platelet glycoprotein llb/Illa antagonist tirofiban is another option. Despite successful use of these strategies in fairly large numbers of patients, recent information suggests that in the case of tirofiban, renal failure may cause persistence of the agent with subsequent severe hemorrhage. If surgery is restricted to coronary artery bypass grafting, recent data show that off-pump strategies with use of the direct thrombin inhibitor bivalirudin appear to be a promising option. Therefore, if surgery cannot be postponed, the anticoagulation protocol and the surgical strategy must be adjusted to the condition of the patient and the experience of the center in order to reduce the risk of these “offlabel” strategies.
Future Directions in Cardiac and Vascular Anesthesia: Unanswered Questions Regarding Variables Controllable by Anesthetic Management
Authors: Reich David L.
Published: June 2007

The influence of anesthetic choices and techniques upon outcomes in cardiac surgery is difficult to ascertain because of the low incidence of morbid and fatal outcomes that are attributable to anesthetic management. This discussion summarizes several areas that have been addressed in clinical trials, including temperature management, intraoperative hemodynamics, and glucose control.