bluuebunny/crossref_metadata_2025 huggingface dataset:
Left Ventricular Systolic Dysfunction Induced by Ventricular Ectopy
Authors: Huizar Jose F. , Kaszala Karoly , Potfay Jonathan , Minisi Anthony J. , Lesnefsky Edward J. , Abbate Antonio , Mezzaroma Eleonora , Chen Qun , Kukreja Rakesh C. , Hoke Nicholas N. , Thacker Leroy R. , Ellenbogen Kenneth A. , Wood Mark A.
Published: May 2011

Background—

Premature ventricular contractions (PVCs) commonly coexist with cardiomyopathy. Recently, PVCs have been identified as a possible cause of cardiomyopathy. We developed a PVC-induced cardiomyopathy animal model using a novel premature pacing algorithm to assess timeframe and reversibility of this cardiomyopathy and examine the associated histopathologic abnormalities.

Methods and Results—

Thirteen mongrel dogs were implanted with a specially programmed pacemaker capable of simulating ventricular extrasystoles. Animals were randomly assigned to either 12 weeks of bigeminal PVCs (n=7) or no PVCs (control, n=6). Continuous 24-hour Holter monitoring corroborated ventricular bigeminy in the PVC group (PVC, 49.8% versus control, <0.01%;
P
<0.0001). After 12 weeks, only the PVC group had cardiomyopathy, with a significant reduction in left ventricular ejection fraction (PVC, 39.7±5.4% versus control, 60.7±3.8%;
P
<0.0001) and an increase in left ventricular end-systolic dimension (PVC, 33.3±3.5 mm versus control, 23.7±3.6 mm;
P
<0.001). Ventricular effective refractory period showed a trend to prolong in the PVC group. PVC-induced cardiomyopathy was resolved within 2 to 4 weeks after discontinuation of PVCs. No inflammation, fibrosis, or changes in apoptosis and mitochondrial oxidative phosphorylation were observed with PVC-induced cardiomyopathy.

Conclusions—

This novel PVC animal model demonstrates that frequent PVCs alone can induce a reversible form of cardiomyopathy in otherwise structurally normal hearts. PVC-induced cardiomyopathy lacks gross histopathologic and mitochondrial abnormalities seen in other canine models of cardiomyopathy.
Molecular Analysis of Patterning of Conduction Tissues in the Developing Human Heart
Authors: Sizarov Aleksander , Devalla Harsha D. , Anderson Robert H. , Passier Robert , Christoffels Vincent M. , Moorman Antoon F.M.
Published: May 2011

Background—

Recent studies in experimental animals have revealed some molecular mechanisms underlying the differentiation of the myocardium making up the conduction system. To date, lack of gene expression data for the developing human conduction system has precluded valid extrapolations from experimental studies to the human situation.

Methods and Results—

We performed immunohistochemical analyses of the expression of key transcription factors, such as ISL1, TBX3, TBX18, and NKX2–5, ion channel HCN4, and connexins in the human embryonic heart. We supplemented our molecular analyses with 3-dimensional reconstructions of myocardial TBX3 expression. TBX3 is expressed in the developing conduction system and in the right venous valve, atrioventricular ring bundles, and retro-aortic nodal region. TBX3-positive myocardium, with exception of the top of the ventricular septum, is devoid of fast-conducting connexin40 and connexin43 and hence identifies slowly conducting pathways. In the early embryonic heart, we found wide expression of the pacemaker channel HCN4 at the venous pole, including the atrial chambers. HCN4 expression becomes confined during later developmental stages to the components of the conduction system. Patterns of expression of transcription factors, known from experimental studies to regulate the development of the sinus node and atrioventricular conduction system, are similar in the human and mouse developing hearts.

Conclusions—

Our findings point to the comparability of mechanisms governing the development of the cardiac conduction patterning in human and mouse, which provide a molecular basis for understanding the functioning of the human developing heart before formation of a discrete conduction system.
Modulation of Novel Cardiorenal and Inflammatory Biomarkers by Intravenous Nitroglycerin and Nesiritide in Acute Decompensated Heart Failure
Authors: Chow Sheryl L. , O'Barr Stephen A. , Peng Jessica , Chew Eric , Pak Firooz , Quist Ryan , Patel Paryus , Patterson J. Herbert , Heywood J. Thomas
Published: May 2011

Background—

Modulation of novel cardiorenal and inflammatory markers may provide insight into the disease process and outcomes of patients with acute decompensated heart failure.

Methods and Results—

In this open-labeled, prospective, randomized study, 89 patients received either nesiritide (NES) or nitroglycerin (NTG) infusion by standard protocol. The serum or plasma concentrations of cystatin-C and inflammatory markers (high-sensitivity C-reactive protein, tumor necrosis factor-α, transforming growth factor-β1, and interleukin-6) were measured in 66 patients with acute decompensated heart failure at baseline and during drug infusion. Mean baseline values for demographics were not significantly different between NTG and NES groups; however, baseline inflammatory markers were elevated on admission. In NES compared with NTG groups, lower cystatin-C (1449 versus 2739 ng/mL,
P
<0.05) and IL-6 (25 versus 50 pg/mL,
P
<0.05) were observed. There were no significant differences in concentrations of high-sensitivity C-reactive protein, tumor necrosis factor-α, and transforming growth factor-β1 between groups over time.

Conclusions—

The differential modulation effects of cystatin-C and interleukin-6 but not other inflammatory markers, in response to NES compared with NTG therapy, may provide important implications for vasodilator therapy. Further studies are warranted to confirm these findings.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00842023.
Landmark Analysis at the 25-Year Landmark Point
Authors: Dafni Urania
Published: May 2011

This statistical primer presents the landmark analysis method, exploring its appropriate use and interpretation while recognizing its limitations. This observational method is used for comparing time-to-event outcome between groups determined during study follow-up. The goal of the landmark method is to estimate in an unbiased way the time-to-event probabilities in each group conditional on the group membership of patients at a specific time point, the landmark time. The need that led to its development, the impact of the method, and its pros and cons, along with available alternative approaches, are presented. Simulations explore its performance, using realistic parameters from a recent cardiovascular study. As long as the limitations of the method are recognized and the interpretation of its results clearly reflect their “conditional” nature, landmark analysis, 25 years from its introduction, can still be of value.
Incidence, Risk Factors, and Clinical Sequelae of Angiographic Peri-Stent Contrast Staining After Sirolimus-Eluting Stent Implantation
Authors: Imai Masao , Kadota Kazushige , Goto Tsuyoshi , Fujii Satoki , Yamamoto Hiroyuki , Fuku Yasushi , Hosogi Shingo , Hirono Akitoshi , Tanaka Hiroyuki , Tada Takeshi , Morimoto Takeshi , Shiomi Hiroki , Kozuma Ken , Inoue Katsumi , Suzuki Nobuaki , Kimura Takeshi , Mitsudo Kazuaki
Published: May 2011

Background—

We have noted abnormal angiographic findings—at the sites of drug-eluting stent implantation, suggesting contrast staining outside the stent struts—that do not fulfill the classic definition of coronary artery aneurysm. We propose a new term, peri-stent contrast staining (PSS), for these abnormal angiographic findings and assess their incidence, risk factors, and clinical sequelae.

Methods and Results—

Peri-stent contrast staining was defined as contrast staining outside the stent contour extending to ≥20% of the stent diameter. The study population consisted of 3081 lesions (1998 patients) that were treated exclusively with sirolimus-eluting stents and were evaluated by follow-up angiography within 12 months after sirolimus-eluting stent implantation in a single center. Late acquired PSS was observed in 58 lesions (1.9%) in 49 patients (2.5%). Independent risk factors of PSS included chronic total occlusion, whereas negative risk factors for PSS were left circumflex coronary artery lesion and in-stent restenosis lesion. Stent fracture was more frequently observed in lesions with PSS than in lesions without PSS (43.1% versus 5.4%,
P
<0.0001). Excluding 269 lesions with target-lesion revascularization within 12 months, the study population for long-term follow-up consisted of 51 lesions (42 patients) with PSS and 2761 lesions (1751 patients) without PSS. Cumulative incidence of target-lesion revascularization and definite very late stent thrombosis at 3 years in the PSS group was higher than that in the non-PSS group (15.0% versus 6.5%, and 8.2% versus 0.2%, respectively).

Conclusions—

Peri-stent contrast staining found within 12 months after sirolimus-eluting stent implantation appeared to be associated with subsequent target-lesion revascularization and very late stent thrombosis.
Casein Kinase-2α1 Induces Hypertrophic Response by Phosphorylation of Histone Deacetylase 2 S394 and its Activation in the Heart
Authors: Eom Gwang Hyeon , Cho Young Kuk , Ko Jeong-Hyeon , Shin Sera , Choe Nakwon , Kim Yoojung , Joung Hosouk , Kim Hyung-Seok , Nam Kwang-Il , Kee Hae Jin , Kook Hyun
Published: May 2011

Background—

Cardiac hypertrophy is characterized by transcriptional reprogramming of fetal gene expression, and histone deacetylases (HDACs) are tightly linked to the regulation of those genes. We previously demonstrated that activation of HDAC2, 1 of the class I HDACs, mediates hypertrophy. Here, we show that casein kinase-2α1 (CK2α1)–dependent phosphorylation of HDAC2 S394 is required for the development of cardiac hypertrophy.

Methods and Results—

Hypertrophic stimuli phosphorylated HDAC2 S394, which was necessary for its enzymatic activation, and therefore the development of hypertrophic phenotypes in rat neonatal cardiomyocytes or in isoproterenol-administered mice hearts. Transgenic mice overexpressing HDAC2 wild type exhibited cardiac hypertrophy, whereas those expressing phosphorylation-resistant HDAC2 S394A did not. Compared with that in age-matched normal human hearts, phosphorylation of HDAC2 S394 was dramatically increased in patients with hypertrophic cardiomyopathy. Hypertrophy-induced phosphorylation of HDAC2 S394 and its enzymatic activity were completely blocked either by CK2 blockers or by
CK2
α
1 short interfering RNA
. Hypertrophic stimuli led CK2α1 to be activated, and its chemical inhibitors blocked hypertrophy in both phenylephrine-treated cardiomyocytes and isoproterenol-administered mice. CK2α1-transgenic mice developed hypertrophy, which was attenuated by administration of trichostatin A, an HDAC inhibitor. Overexpression of CK2α1 caused hypertrophy in cardiomyocytes, whereas chemical inhibitors of both CK2 and HDAC as well as HDAC2 S394A blunted it. Hypertrophy in CK2α1-transgenic mice was exaggerated by crossing these mice with wild-type-HDAC2-overexpressing mice. By contrast, however, it was blocked when CK2α1-transgenic mice were crossed with HDAC2 S394A-transgenic mice.

Conclusions—

We have demonstrated a novel mechanism in the development of cardiac hypertrophy by which CK2 activates HDAC2 via phosphorylating HDAC2 S394.
Renin-Angiotensin-Aldosterone Genotype Influences Ventricular Remodeling in Infants With Single Ventricle
Authors: Mital Seema , Chung Wendy K. , Colan Steven D. , Sleeper Lynn A. , Manlhiot Cedric , Arrington Cammon B. , Cnota James F. , Graham Eric M. , Mitchell Michael E. , Goldmuntz Elizabeth , Li Jennifer S. , Levine Jami C. , Lee Teresa M. , Margossian Renee , Hsu Daphne T.
Published: May 2011

Background—

We investigated the effect of polymorphisms in the renin-angiotensin-aldosterone system (RAAS) genes on ventricular remodeling, growth, renal function, and response to enalapril in infants with single ventricle.

Methods and Results—

Single ventricle infants enrolled in a randomized trial of enalapril were genotyped for polymorphisms in 5 genes: angiotensinogen, angiotensin-converting enzyme, angiotensin II type 1 receptor, aldosterone synthase, and chymase. Alleles associated with renin-angiotensin-aldosterone system upregulation were classified as risk alleles. Ventricular mass, volume, somatic growth, renal function using estimated glomerular filtration rate, and response to enalapril were compared between patients with ≥2 homozygous risk genotypes (high risk), and those with <2 homozygous risk genotypes (low risk) at 2 time points: before the superior cavopulmonary connection (pre-SCPC) and at age 14 months. Of 230 trial subjects, 154 were genotyped: Thirty-eight were high risk, and 116 were low risk. Ventricular mass and volume were elevated in both groups pre-SCPC. Ventricular mass and volume decreased and estimated glomerular filtration rate increased after SCPC in the low-risk (
P
<0.05), but not the high-risk group. These responses were independent of enalapril treatment. Weight and height z-scores were lower at baseline, and height remained lower in the high-risk group at 14 months, especially in those receiving enalapril (
P
<0.05).

Conclusions—

Renin-angiotensin-aldosterone system–upregulation genotypes were associated with failure of reverse remodeling after SCPC surgery, less improvement in renal function, and impaired somatic growth, the latter especially in patients receiving enalapril. Renin-angiotensin-aldosterone system genotype may identify a high-risk subgroup of single ventricle patients who fail to fully benefit from volume-unloading surgery. Follow-up is warranted to assess long-term impact.

Clinical Trial Registration—

http://www.clinicaltrials.gov
. Unique identifier: NCT00113087.
Risk of Bleeding With 2 Doses of Dabigatran Compared With Warfarin in Older and Younger Patients With Atrial Fibrillation
Authors: Eikelboom John W. , Wallentin Lars , Connolly Stuart J. , Ezekowitz Mike , Healey Jeff S. , Oldgren Jonas , Yang Sean , Alings Marco , Kaatz Scott , Hohnloser Stefan H. , Diener Hans-Christoph , Franzosi Maria Grazia , Huber Kurt , Reilly Paul , Varrone Jeanne , Yusuf Salim
Published: May 2011

Background—

Dabigatran 150 and 110 mg twice a day and warfarin are effective for stroke prevention in atrial fibrillation. The purpose of this study was to compare their risks of bleeding in the Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY) trial.

Methods and Results—

The RE-LY trial randomized 18 113 patients to receive dabigatran 110 or 150 mg twice a day or warfarin dose adjusted to an international normalized ratio of 2.0 to 3.0 for a median follow-up of 2.0 years. Compared with warfarin, dabigatran 110 mg twice a day was associated with a lower risk of major bleeding (2.87% versus 3.57%;
P
=0.002), whereas dabigatran 150 mg twice a day was associated with a similar risk of major bleeding (3.31% versus 3.57%;
P
=0.32). There was a significant treatment-by-age interaction, such that dabigatran 110 mg twice a day compared with warfarin was associated with a lower risk of major bleeding in patients aged <75 years (1.89% versus 3.04%;
P
<0.001) and a similar risk in those aged ≥75 years (4.43% versus 4.37%;
P
=0.89;
P
for interaction <0.001), whereas dabigatran 150 mg twice a day compared with warfarin was associated with a lower risk of major bleeding in those aged <75 years (2.12% versus 3.04%;
P
<0.001) and a trend toward higher risk of major bleeding in those aged ≥75 years (5.10% versus 4.37%;
P
=0.07;
P
for interaction <0.001). The interaction with age was evident for extracranial bleeding, but not for intracranial bleeding, with the risk of the latter being consistently reduced with dabigatran compared with warfarin irrespective of age.

Conclusions—

In patients with atrial fibrillation at risk for stroke, both doses of dabigatran compared with warfarin have lower risks of both intracranial and extracranial bleeding in patients aged <75 years. In those aged ≥75 years, intracranial bleeding risk is lower but extracranial bleeding risk is similar or higher with both doses of dabigatran compared with warfarin.

Clinical Trial Registration—

http://www.clinicaltrials.gov
. Unique identifier: NCT00262600.
Evaluating Communication Between Pediatric Primary Care Physicians and Hospitalists
Authors: Ruth Jennifer L. , Geskey Joseph M. , Shaffer Michele L. , Bramley Harry P. , Paul Ian M.
Published: May 2011

To determine the preferences for and satisfaction with communication between pediatric primary care physicians (PCPs) and hospitalists, 2 surveys (PCP and hospitalist versions with matching questions) were developed. Overall, PCPs were less satisfied than hospitalists with communication ( P < .01). The 2 provider types had differing opinions on responsibility for care after hospital discharge, with hospitalists more likely than PCPs to assign responsibility to the PCP for pending labs (65% vs 49%; P < .01), adverse events (85% vs 67%; P < .01), or status changes (85% vs 69%; P < .01). Whereas satisfaction with and preferences for patient-related communication differed between hospitalists and PCPs, the incongruent views on the responsibility for care after patient discharge have major implications for safety particularly if poor communication occurs at discharge. Successful transitions from the hospital to primary care require communication between hospitalists and PCPs to be consistent, timely, and informative with responsibility for care discussed at discharge.
Political Risk, Reputation, and the Resource Curse
Authors: Jensen Nathan M. , Johnston Noel P.
Published: May 2011

There is a growing literature on how natural resources affect both economic performance and political regimes. In this article the authors add to this literature by focusing on how natural resource wealth affects the incentives of governments to uphold contracts with foreign investors across all sectors. They argue that although all states suffer reputation costs from reneging on contracts, governments in natural-resource-dependent economies are less sensitive to these costs, leading to a greater probability of expropriation and contract disputes. Specifically, leaders weigh the benefits of reneging on contracts with investors against the reputation costs of openly violating agreements with firms. The authors’ theoretical model predicts a positive association between resource wealth and expropriation. Using a data set from the political risk insurance industry, the authors show that resource dependent economies have much higher levels of political risk.
Reduction, Stasis, and Expansion of Budgets in Advanced Democracies
Authors: Breunig Christian
Published: May 2011

This article investigates changes within national budget by examining actors’ behavioral predilections and the institutional constraints under which they operate. The article presents three theoretical propositions about the influence of attention and institutions on all magnitudes of programmatic budget changes ranging from large cuts to massive expansions. Using quantile regression, the author is able to uncover which distinct processes bear on cuts, stasis, and expansion across spending categories within a budget. An examination of budgetary data from Denmark, Germany, the United Kingdom, and the United States from 1964 to 1999 leads to the conclusion that attention shifts lead to contractions and expansions of budgetary items, whereas preference-based explanations have marginal support. In addition, institutional costs involved in budgetary politics amplify budgetary shifts. The author closes the article by discussing the implications of the findings for partisan theories of government and institutional theories.
Perceptual Pressures on Lenition
Authors: Kaplan Abby
Published: May 2011

The phonological processes known as ‘lenition’ have traditionally been explained as articulatory effort reduction. However, such a motivation for lenition has never been directly demonstrated; in addition, there are reasons to doubt the articulatory explanation.This paper focuses on a particular type of lenition (intervocalic spirantization of voiced stops) and presents two experiments that investigate what role, if any, perceptual considerations might play in lenition. Experiment 1 shows that spirantization of intervocalic voiced stops is a less perceptually salient change than devoicing of intervocalic voiced stops (an unattested process). Using the line of reasoning of Steriade’s P-map hypothesis, perceptual facts offer an alternative to the articulatory account: lenition of intervocalic voiced stops yields spirants rather than voiceless stops because the latter change is perceptually highly salient. The results of Experiment 2 show that the perceptual facts differ by place of articulation, such that the difference between stops and spirants is greater for labials than for dorsals. These results do not match the attested typology; if anything, languages are more likely to spirantize labials than they are to spirantize dorsals. Thus, perceptual facts have the potential to explain some, but not all, of the typology of lenition.
Voice Modulations in German Ironic Speech
Authors: Scharrer Lisa , Christmann Ursula
Published: May 2011

Previous research has shown that in different languages ironic speech is acoustically modulated compared to literal speech, and these modulations are assumed to aid the listener in the comprehension process by acting as cues that mark utterances as ironic. The present study was conducted to identify paraverbal features of German ‘ironic criticism’ that may possibly act as irony cues by comparing acoustic measures of ironic and literal speech. For this purpose, samples of scripted ironic and literal target utterances produced by 14 female speakers were recorded and acoustically analyzed. Results showed that in contrast to literal remarks, ironic criticism was characterized by a decreased mean fundamental frequency (F0), raised energy levels and increased vowel duration, whereas F0-contours differed only marginally between both speech types. Furthermore, we found ironic speech to be characterized by vowel hyperarticulation, an acoustic feature which has so far not been considered as a possible irony cue. Contrary to our expectations, voice modulations in ironic speech were applied independently from the availability of additional, visual irony cues. The results are discussed in light of previous findings on acoustic features of irony yielded for other languages.
When Change Matters: An Analysis of Survey Interaction in Dependent Interviewing on the British Household Panel Study
Authors: Uhrig SC Noah , Sala Emanuela
Published: May 2011

The authors examine how questionnaire structure affects survey interaction in the context of dependent interviewing (DI). DI is widely used in panel surveys to reduce observed spurious change in respondent circumstances. Although a growing literature generally finds beneficial measurement properties, little is known about how DI functions in interviews. The authors systematically observed survey interaction using behavior coding and analyzed an application of DI to obtain respondent employment characteristics. The authors found respondents indicated change in circumstances through a number of verbal machinations, including mismatch answers and explanations. Assessing whether these behaviors influenced subsequent question administration, the authors found qualitative evidence that the information disclosed when negating a DI question leads to subsequent interviewing errors. Quantitative analyses supported this evidence, suggesting that standardized interviewing deteriorates as respondents struggle to identify change in their circumstances. This analysis suggests that the reliability of detail about changed circumstances may not be improved using DI.
Homophily and Contagion Are Generically Confounded in Observational Social Network Studies
Authors: Shalizi Cosma Rohilla , Thomas Andrew C.
Published: May 2011

The authors consider processes on social networks that can potentially involve three factors: homophily, or the formation of social ties due to matching individual traits; social contagion, also known as social influence; and the causal effect of an individual’s covariates on his or her behavior or other measurable responses. The authors show that generically, all of these are confounded with each other. Distinguishing them from one another requires strong assumptions on the parametrization of the social process or on the adequacy of the covariates used (or both). In particular the authors demonstrate, with simple examples, that asymmetries in regression coefficients cannot identify causal effects and that very simple models of imitation (a form of social contagion) can produce substantial correlations between an individual’s enduring traits and his or her choices, even when there is no intrinsic affinity between them. The authors also suggest some possible constructive responses to these results.
A Phasic Analysis of Strategy Sequences and Their Mediating Effects on Interaction Goals and Negotiation Outcomes
Authors: Liu Meina
Published: May 2011

This study provides a sequential analysis of the bargaining interaction to shed light on how negotiators’ interaction goals influence their and their counterparts’ behavioral responses and outcomes. Sixty-seven negotiation dyads simulated an employment negotiation. Results showed that integrative reciprocal sequences mediated the influence of competitive goals on joint profit, whereas both distributive and integrative transformational sequences mediated the influence of negotiators’ goals on their counterparts’ individual gains. Such mediating effects, however, vary by phase, with reciprocal sequences in the second half of negotiation more predictive of joint profit but transformational sequences in the first half more predictive of individual gains. In addition, employers’ interaction goals and transformational sequences had a greater influence on employees’ individual gains than vice versa.
Globalization and Citizens’ Support for Global Capitalism
Authors: Machida Satoshi
Published: May 2011

World-systems theory emphasizes the unequal structure of the world economy. Relying on world-systems theory as an analytical framework, this study examines how globalization differently affects citizens’ perceptions of global capitalism in the core, semi-periphery, and periphery. Statistical analyses relying on the Pew Global Attitudes Project, 2002, generate findings that are consistent with world-systems theory. While globalization positively affects citizens’ evaluations of global capitalism in the core, globalization undermines citizens’ support for global capitalism in the periphery. By dissecting the relationship between globalization and citizens’ perceptions of global capitalism, this study contributes to our understanding of globalization.
Human Development and the Transformation of the Academy
Authors: Richards Howard
Published: May 2011

The idea of human is glossed in terms of agency and in terms of humans as the animals whose ecological niche is culture. The concept of “humanization by enlargement” is used to promote bringing modernity’s other (non-modern cultures) into the curriculum. The objective is not only to celebrate what humans have been, are, and can be, but also to solve the intractable problems of modernity by mobilizing non-modern cultural resources. It is claimed that many indigenous peoples know things many modern peoples do not know about how to achieve social cohesion and how to live in a sustainable relationship to the natural environment. “Modernity” is glossed in terms of typical characteristics of successor states of the Roman Empire (Britain, France, etc.) which formed the European World-system that later expanded to become the Modern World-system. The ancient word “metaphysics” is put to use to promote mutual respect among cultures who read the world through different categories.
Assessing Reliability, Validity, and Clinical Utility of the BEST-Index in Measuring Living Skills Among Forensic Inpatients
Authors: Ross Thomas , Reed Val , Fontao María Isabel , Pfäfflin Friedemann
Published: May 2011

The assessment of behavioral change as a result of inpatient treatment in forensic psychiatry is an important precondition for violence risk prediction in forensic psychiatry. In relation to a multitude of diagnostically based risk assessment instruments, there is a shortage of appropriate instruments with which to carry out valid and reliable therapeutic assessments that are behaviorally based and therefore appropriate for use within varied psychiatric contexts. There is also a need for instruments which will offer assessors the opportunity to examine possible relationships between criteria of social risk and criteria of more general aspects of social functioning. Tapping the issues pointed out above, the authors present an overview of a normatively based social profiling instrument (the BEST-Index), and discuss evidence for its validity, reliability, and aspects of clinical utility.
Having It Both Ways? Balancing Knights and Knaves When Motivating European Commission Officials
Authors: Grøn Caroline Howard
Published: May 2011

Is New Public Management (NPM) a threat to motivation in public organizations? Large parts of the public administration literature seem concerned that it might be the case. Through an in-depth case study of the implementation of a NPM-inspired appraisal system in the European Commission, an organization which has traditionally branded itself on strong intrinsic and altruistic motivation among employees, this claim is investigated. The case study concludes that, while the organization formally balances the two different approaches to motivation of employees, implementing performance management while underlining the importance the European project as well, in practice it is not possible to have it both ways. The performance appraisal system is undermined from below and transformed by employees and middle management into a system that is similar to the system in place before it was introduced.
Assessing the Temporary Use of At-will Employment for Reorganization and Workforce Reduction in Mississippi State Government
Authors: Goodman Doug , French P. Edward
Published: May 2011

Over the past two decades, at-will employment initiatives and a wave of other reforms have taken place, aimed at enhancing the efficiency of the public sector and the control that government has over it. Administrators in the State of Mississippi have continued to propose at-will employment for state workers, at least on a temporary basis, to facilitate reorganization. This study assesses state human resource directors’ attitudes toward the incremental use of at-will employment and the terminations that have resulted from its use. The authors find that while an incremental move toward the at-will environment may produce more optimism in the perception of human resource directors regarding motivation, performance, efficiency, and value, uncertainty still remains as to whether or not the declassification of civil service employees to at-will status truly enhances public sector employee responsiveness, productivity, and management.
Clinical Neurofeedback: Case Studies, Proposed Mechanism, and Implications for Pediatric Neurology Practice
Authors: Legarda Stella B. , McMahon Doreen , Othmer Siegfried , Othmer Sue
Published: May 2011

Trends in alternative medicine use by American health care consumers are rising substantially. Extensive literature exists reporting on the effectiveness of neurofeedback in the treatment of autism, closed head injury, insomnia, migraine, depression, attention deficit hyperactivity disorder, epilepsy, and posttraumatic stress disorder. We speculated that neurofeedback might serve as a therapeutic modality for patients with medically refractory neurological disorders and have begun referring patients to train with clinical neurofeedback practitioners. The modality is not always covered by insurance. Confident their child’s medical and neurological needs would continue to be met, the parents of 3 children with epilepsy spectrum disorder decided to have their child train in the modality. The children’s individual progress following neurofeedback are each presented here. A proposed mechanism and practice implications are discussed.
Gluten‐Free Diet in Nonceliac Disease
Authors: El‐Chammas Khalil , Danner Elaine
Published: May 2011

A gluten‐free diet (GFD) is commonly recognized as the treatment for celiac disease. It also has been investigated as a treatment option for other medical conditions, including dermatitis herpetiformis, irritable bowel syndrome, neurologic disorders, rheumatoid arthritis, diabetes mellitus, and HIV‐associated enteropathy. The strength of the evidence for the use of a GFD in these nonceliac diseases varies, and future research may better define the benefits of a GFD for those conditions with weak existing evidence.
Book Review: A Comprehensive Guide to Obtaining Nutrition Order Writing Privileges
Authors: DeChicco Robert
Published: May 2011

Silver H Skipper A Moreland K. A Comprehensive Guide to Obtaining Nutrition Order Writing Privileges. Lake Dallas, TX: Helm Publishing; 2009. Restruture page‐count as size[@units=“page”] 146 pp; $24.00. ISBN 978‐0‐9787829‐2‐4.
Hypocaloric Considerations in Patients With Potentially Hypometabolic Disease States
Authors: Magnuson Barbara , Peppard Amy , Auer Flomenhoft Deborah
Published: May 2011

The provision of nutrition has traditionally been driven by the desire to provide adequate calories. However, over the past decade it has become evident that provision of excess calories can be detrimental to patients’ outcomes in both critical care and long‐term care settings. This review examines patient populations for whom hypocaloric nutrition can be both appropriate and beneficial. In specific situations, critically ill patients, such as those with obesity, stroke, and spinal cord injury, may have decreased energy requirements. In patients with spinal cord injury, the level of injury significantly correlates with the extent of reduced caloric energy expenditure. Ventilator‐dependent patients with amyotrophic lateral sclerosis (ALS) have decreased energy needs; energy expenditure for ALS patients is lower than the predictive equation value. Aging patients will have decreased energy needs relative to a reduction in lean body mass. Patients with cerebral palsy (CP) have significantly lower caloric requirements than anticipated using predictive equations. Patients with CP pose a particular challenge in nutrition assessment. Several studies demonstrate that patients with CP have significantly lower caloric requirements than anticipated using predictive equations; thus, patients with CP benefit from indirect calorimetry. Provision of nutrition for obese patients is briefly addressed, as this is an increasingly important consideration for nutrition support in both the critical care and long‐term care settings. When indirect calorimetry is not available, clinicians should remember that most patients will have low resting energy expenditure regardless of functional status and require frequent evaluation during institution of nutrition recommendations to guard against overfeeding and obesity.
Low‐Carbohydrate Diet Review
Authors: Hite Adele H. , Berkowitz Valerie Goldstein , Berkowitz Keith
Published: May 2011

What does a clinician need to know about low‐carbohydrate (LC) diets? This review examines and compares the safety and the effectiveness of a LC approach as an alternative to a low‐fat (LF), high‐carbohydrate diet, the current standard for weight loss and/or chronic disease prevention. In short‐term and long‐term comparison studies, ad libitum and isocaloric therapeutic diets with varying degrees of carbohydrate restriction perform as well as or better than comparable LF diets with regard to weight loss, lipid levels, glucose and insulin response, blood pressure, and other important cardiovascular risk markers in both normal subjects and those with metabolic and other health‐related disorders. The metabolic, hormonal, and appetite signaling effects of carbohydrate reduction suggest an underlying scientific basis for considering it as an alternative approach to LF, high‐carbohydrate recommendations in addressing overweight/obesity and chronic disease in America. It is time to embrace LC diets as a viable option to aid in reversing diabetes mellitus, risk factors for heart disease, and the epidemic of obesity.
Development of a Tool to Measure Dietitians' Involvement in the Intensive Care Setting
Authors: Ferrie Suzie , Allman‐Farinelli Margaret
Published: May 2011

Background: Intensive care is a relatively new work area for dietitians in Australasia, and the role of the dietitian appears to differ widely between facilities. This may create difficulties with multicenter research collaboration and workforce planning. The aim of this study was to develop a validated survey tool to assess dietitians’ involvement in their intensive care teams. Methods: A full list of all 182 adult intensive care units in Australia and New Zealand was obtained from the Australian and New Zealand Intensive Care Society, and all of these units were contacted. A survey tool was developed, piloted, and validated using correlation tests of construct validity; factor analysis was used to develop a 5‐item short‐form survey tool. Results: At least 1 dietitian participated from each of the 182 hospitals that were contacted, and no dietitians declined to participate in the survey (100% response rate). The survey had strong validity and test–retest reliability in the population surveyed. Conclusions: The survey tools presented here can be used to assess dietitians’ involvement in their intensive care team. The short‐form tool developed in this study is conveniently brief and easy to administer, but it will need to be validated for use outside the Australian and New Zealand health systems prior to conduct of a large‐scale survey.
Nutrition for Brain Recovery After Ischemic Stroke
Authors: Aquilani Roberto , Sessarego Paolo , Iadarola Paolo , Barbieri Annalisa , Boschi Federica
Published: May 2011

In patients who undergo rehabilitation after ischemic stroke, nutrition strategies are adopted to provide tube‐fed individuals with adequate nutrition and/or to avoid the body wasting responsible for poor functional outcome and prolonged stay in the hospital. Investigations have documented that nutrition interventions can enhance the recovery of neurocognitive function in individuals with ischemic stroke. Experimental studies have shown that protein synthesis is suppressed in the ischemic penumbra. In clinical studies on rehabilitation patients designed to study the effects of counteracting or limiting this reduction of protein synthesis by providing protein supplementation, patients receiving such supplementation had enhanced recovery of neurocognitive function. Cellular damage in cerebral ischemia is also partly caused by oxidative damage secondary to free radical formation and lipid peroxidation. Increased oxidative stress negatively affects a patient's life and functional prognosis. Some studies have documented that nutrition supplementation with B‐group vitamins may mitigate oxidative damage after acute ischemic stroke. Experimental investigations have also shown that cerebral ischemia changes synaptic zinc release and that acute ischemia increases zinc release, aggravating neuronal injury. In clinical practice, patients with ischemic stroke were found to have a lower than recommended dietary intake of zinc. Patients in whom daily zinc intake was normalized had better recovery of neurological deficits than subjects given a placebo. The aim of this review is to highlight those brain metabolic alterations susceptible to nutrition correction in clinical practice. The mechanisms underlying the relationship between cerebral ischemia and nutrition metabolic conditions are discussed.
Nutrition in the Stroke Patient
Authors: Corrigan Mandy L. , Escuro Arlene A. , Celestin Jackie , Kirby Donald F.
Published: May 2011

Malnutrition is common both before and after stroke, with dysphagia adding to nutrition risk. Many patients require specialized nutrition support in the acute phase and beyond when swallowing function does not improve or return to allow for nutrition autonomy. When neurologic deficits improve, assessment of the swallowing function, introduction of dysphagia diets, and specialized swallowing techniques are used to transition away from enteral feeding tubes to oral diets. This article reviews the evaluation and treatment of dysphagia, use of specialized nutrition support, strategies for weaning enteral tube feedings, and the impact of nutrition on quality of life in the stroke patient population.
Dietary Adherence to Long‐Term Controlled Feeding in a Calorie‐Restriction Study in Overweight Men and Women
Authors: Moreira Emilia Addison Machado , Most Marlene , Howard Jennifer , Ravussin Eric
Published: May 2011

Background: The success of clinical dietary interventions depends on the motivation and willingness of study participants to adhere to the prescribed or provided diet. The aim of this study was to assess participants’ adherence to their provided diet over the 6‐month duration of the Comprehensive Assessment of Long‐term Effects of Reducing Intake of Energy (CALERIE). Methods: Investigators assessed the dietary adherence of 46 men and women who completed the first phase of the CALERIE trial. Volunteers were randomized to 1 of 4 dietary intervention groups: control, calorie restriction, calorie restriction with exercise, and low‐calorie diet. Participants were provided with foods during 2 weeks of baseline and during the first 12 weeks and the last 2 weeks of the intervention as outpatients, and they completed a daily self‐report form to assess diet adherence. The data are expressed as mean ± standard deviation or standard error of the mean. Pearson's correlation coefficient was determined to examine the relationship between assigned energy levels and total energy intake. Results: Deviations reported were for eating nonstudy foods as well as not eating study foods. There were few deviations, and when converted to mean calories per day these did not affect total energy (weeks −3 to 2 = 10.25 ± 4.82, weeks 1‐4 = 9.93 ± 12.52, weeks 5‐11 = 8.38 ± 7.42, weeks 22‐23 = 0.53 ± 3.97 kcal/d). The associations between assigned energy level and actual intake were high for all groups (P = .001), weeks −3 to −2 (r = 0.999), weeks 1‐4 (r = 0.998), weeks 5‐11 (r = 0.999), and weeks 22‐23 (r = 0.998). Conclusions: The data provide evidence that dietary adherence is good when all foods are provided and when participants are highly motivated.
Evaluation of a Lifestyle Modification Program for Treatment of Overweight and Nonmorbid Obesity in Primary Healthcare and Its Influence on Health‐Related Quality of Life
Authors: Arrebola E. , Gómez‐Candela C. , Fernández‐Fernández C. , Loria V. , Muñoz‐Pérez E. , Bermejo L. M.
Published: May 2011

Background: The impact of overweight and nonmorbid obesity on health‐related quality of life (HRQL) has not been widely researched. The aim of this study was to evaluate the effects of a lifestyle modification program (LMP) focused on diet, exercise, and psychological support on HRQL in overweight and nonmorbidly obese patients treated in a primary healthcare setting. Methods: Sixty patients with grade II overweight and nonmorbid grade I‐II obesity were included in this open pilot clinical trial; subjects’ ages ranged from 18 to 50 years. They were provided with an LMP combining nutrition education, physical activity, and psychological support. Subjects attended group sessions every 2 weeks. The main outcome measures at baseline and 6 months were body composition parameters (body mass index, body fat percentage, and waist circumference) and HRQL using the 1.4 Spanish version of the SF‐36 questionnaire. The questionnaire yields an 8‐scale profile of physical functioning (PF), role—physical (RP), bodily pain (BP), vitality (VT), social functioning (SF), role—emotional (RE), mental health (MH), and general health (GH) factors. Results: The LMP achieved improvements in SF‐36 subscales at the end of the intervention: PF (80.37 ± 18.90 vs 89.40 ± 13.95, P < .001), RP (20.37 ± 9.10 vs 23.14 ± 6.67, P < .05), VT (58.71 ± 21.98 vs 70.91 ± 26.56, P < .01), SF (79.62 ± 27.76 vs 86.57 ± 25.45, P < .03), and GH (61.03 ± 19.13 vs 69.42 ± 18.80, P < .001). Conclusion: An LMP focused on balanced and moderate energy‐restricted diets, increased physical activity, and psychological support may improve the anthropometric parameters and the quality of life in moderately obese patients treated in a primary healthcare center.
Tubing Misconnections
Authors: Simmons Debora , Symes Lene , Guenter Peggi , Graves Krisanne
Published: May 2011

Background: Accidental connection of an enteral system to an intravenous (IV) system frequently results in the death of the patient. Misconnections are commonly attributed to the presence of universal connectors found in the majority of patient care tubing systems. Universal connectors allow for tubing misconnections between physiologically incompatible systems. Methods: The purpose of this review of case studies of tubing misconnections and of current expert recommendations for safe tubing connections was to answer the following questions: In tubing connections that have the potential for misconnections between enteral and IV tubing, what are the threats to safety? What are patient outcomes following misconnections between enteral and IV tubing? What are the current recommendations for preventing misconnections between enteral and IV tubing? Following an extensive literature search and guided by 2 models of threats and errors, the authors analyzed case studies and expert opinions to identify technical, organizational, and human errors; patient‐related threats; patient outcomes; and recommendations. Results: A total of 116 case studies were found in 34 publications. Each involved misconnections of tubes carrying feedings, intended for enteral routes, to IV lines. Overwhelmingly, the recommendations were for redesign to eliminate universal connectors and prevent misconnections. Other recommendations were made, but the analysis indicates they would not prevent all misconnections. Conclusions: This review of the published case studies and current expert recommendations supports a redesign of connectors to ensure incompatibility between enteral and IV systems. Despite the cumulative evidence, little progress has been made to safeguard patients from tubing misconnections.
Current Concepts in the Simultaneous Transplantation of Kidney and Pancreas
Authors: Scalea Joseph R. , Cooper Matthew
Published: May 2011

Diabetes mellitus (DM) represents an enormous health care concern for the United States and other countries. According to the American Diabetes Association in 2007, there were more than 23 million Americans living with diabetes. This is a 13.5% increase from 2005, likely representing increases in Type II DM (DMII). Diabetes mellitus results when the beta cells of the pancreas are unable to produce sufficient insulin to prevent hyperglycemia. Simultaneous pancreas and kidney transplantation, or SPK, may be indicated for patients that have experienced renal failure as a complication of DM (either type I or type II). Until recently, technical failure represented a significant impediment to the success of pancreas transplantation. At the turn of the century, however, both renal and pancreatic graft survival dramatically improved. Immunologic and nonimmunologic causes of graft failure continue to challenge inpatient and outpatient management. With vigilance in the ICU postoperatively and in the clinic, SPK can provide significant benefit both in patient survival and quality of life.