bluuebunny/crossref_metadata_2025 huggingface dataset:
The Korean Wave: An Asian Reaction to Western-Dominated Globalization
Authors: Hogarth Hyun-key Kim
Published: January 2013

Abstract

In this article I analyze “the Korean Wave (hallyu),” the term coined by Chinese media towards the end of the last millennium to describe the meteoric rise in the popularity of Korean pop culture in Asian countries. It has attracted the attention of not only the general public, but also academic and other researchers because of the far-reaching ramifications in terms of the Korean national economy and the cultural unity and exchange among the Asian peoples.

The world of popular entertainment has seen a high degree of globalization with Hollywood as its utopia. However, Hollywood has proved to be a dystopia to the peoples of Asia, in that it is dominated by non-Asians, and underpinned by the contemporary Western ethos, i.e. individualism, commercialism and sensationalism. Scenes containing unadulterated sex and violence, which offend the sensitivities of the Asian general public, are almost an integral part of many a commercially successful film. Opportunities for big roles are almost non-existent to ethnic Asian actors. Romantic heroes and heroines are very rarely played by Asian actors, who usually appear as weird villains or, very rarely, wizards with supernatural powers.

In contemporary Korean cinemas, TV dramas and pop music, globalization is also evident. The stars follow the world trend in performance, presentation and fashion, and emulate their Western compatriots. English is often used as lyrics in songs. However, the big difference is that the performers have distinct Asian physical features, and the dramas reflect the traditional Asian values and ethos, which helps to make the Asian fans feel at home. The “Asian-ness” is no longer something weird or marginal, but takes center stage. Therefore there is a sense in which the Korean Wave is a reaction of the Asian people to the West-dominated globalization in popular culture. But what distinguishes the Korean Wave from other similar phenomena, such as Bollywood and Nollywood, is the juxtaposition of globalized and traditional Korean cultures.
“Occupying” Our Social Imagination: The Necessity of Utopian Discourses in an Anti-Utopian Age
Authors: Webb Graeme
Published: January 2013

Abstract

We are in the depths of multiple catastrophes that Western society is seemingly unwilling and unable to address: growing inequalities between the rich and the poor, a willful blindness to climate change, and a political system mired in uncompromising and ever increasing extremism. However, there are no reality transcending dialogues, no new social imaginaries to drive change—our own dystopic reality has no utopian response. The greatest importance that the Occupy movements may play in spurring social change and revolution is their success at bringing radical discourses into mainstream society. Occupy not only occupied fixed public locations, but also occupied our social imagination.
Governmentality and the Analytics of Development
Authors: Ove Peter
Published: January 2013

Abstract

In this article, I discuss the extension of Foucault’s work on governmentality into the fields of global studies in general and development studies in particular. Drawing on insights from postdevelopment theory and critical race theory, I present an adaptation of governmentality—labeled developmentality—that is intended to bridge the gap between those studies dealing with the regulatory aspects of development in the global South and those dealing with construction of ethical identities in the North.
Two Hoards of Coins and Jewellery Items from the Time of the Roman-Bosporan War of AD 45–49 from the Site of Artezian
Authors: Abramzon Mikhail G. , Treister Mikhail Yu. , Vinokurov Nikolaï I.
Published: January 2013

Abstract

This article is the publication of two hoards found in 2009 during excavations of the fortified settlement of Artezian in the Eastern Crimea, which met its end at the very beginning of the Roman-Bosporan war of AD 45–49. The assemblages contain 244 bronze Bosporan coins from the end of the 1st century BC to the first half of the 1st century AD (Caesarea, Agrippia, Aspurgus, Gepaepyris, Mithridates VIII), 10 silver denarii of the Roman emperors Augustus and Tiberius, and also various items of gold, silver and bronze jewellery and glass vessels. The discovery of these hoards not only provides further archaeological confirmation of the historical events of the mid-1st century BC, but also makes it possible to establish, with more precision, the chronology of certain categories of jewellery items and glass vessels, which in a number of cases had only been represented by rare specimens of Bosporan, Eastern-Mediterranean and Roman workmanship of a high level. Deserving of special attention is the find, in the context of hoards, of a well-preserved gladius of the Mainz type. For the first time it has proved possible reliably to record the initial phase of the Bosporan-Roman War of AD 45–49 at an archaeological site, situated within the territory of the European Bosporus. The unique nature of the materials from Artezian lies in their diversity and the narrow chronological range of their hoarding, linked to important events of not only Bosporan but also Mediterranean history, which had a considerable influence on the military-political situation in the Pontic region.
Notes on Dichomeris Hübner, 1818 from Southern Africa and Kenya, with description of seven new species (Lepidoptera, Gelechiidae, Dichomeridinae)
Authors: LI HOUHUN , ZHEN HUI , MEY WOLFRAM
Published: January 2013

This paper deals with 12 species of the genus Dichomeris Hübner, 1818 from Southern Africa and Kenya. Seven species are described as new: D. arquata sp. nov., D. brevicornuta sp. nov., D. dentata sp. nov., D. ligulacea sp. nov., D. paulidigitata sp. nov., D. tenextrema sp. nov. and D. ventriprojecta sp. nov.; and other five known species are listed. Images of adults and illustrations of genitalia are provided.
Re-description of two species of the cardinalfish genus Archamia (Teleostei: Apogonidae) from the Red Sea and Western Indian Ocean
Authors: GON OFER , GOUWS GAVIN , MWALE MONICA , MWALUMA JAMES
Published: January 2013

The cardinalfishes Archamia bilineata and A. pallida were originally described from a small number of specimens collected in the Gulf of Aqaba, Red Sea and Oman, respectively. Both species are re-described using specimens collected recently in Yemen and Kenya, including the first known adult of A. pallida. These new collections increased the geographical range of both species considerably. Differences between the two populations now known for each of the species are discussed.
Turbulence Dynamics at the Shoal–Channel Interface in a Partially Stratified Estuary
Authors: Collignon Audric G. , Stacey Mark T.
Published: January 2013

Turbulence observations at the shoal–channel interface in South San Francisco Bay are described and analyzed in this work. Profiles of turbulent kinetic energy (TKE) shear production and dissipation rate are estimated from ADCP beam velocities over a nine-day period during winter 2009 when the estuary was partially stratified. The TKE shear production profiles are consistent with a tidally driven bottom boundary layer, except late in the ebb when shear production intensifies and the region of maximum production is located in the upper half of the water column. A simple scaling for the depth-averaged TKE shear production based on bed friction performs well except during this late ebb period when it fails to predict the peak in shear production, which suggests that a mechanism other than bottom drag drives turbulence dynamics during this period. The profiles of TKE dissipation rates also display a late ebb peak. A lateral circulation develops at the shoal–channel interface during this late ebb period, and its effects on turbulence dynamics are investigated. An analytical framework is developed to identify and quantify these effects. Four mechanisms through which the lateral circulation can impact stability are identified, and two are found to be important during the late ebb period in South San Francisco Bay: the straining of the lateral density and velocity gradients in the lateral circulation. These results suggest that the lateral circulation acts to reduce the gradient Richardson number and is driving the late ebb peak in turbulence production and dissipation.
Punctuated Generosity
Authors: Tilcsik András , Marquis Christopher
Published: January 2013

This article focuses on geographic communities as fields in which human-made and natural events occasionally disrupt the lives of organizations. We develop an institutional perspective to unpack how and why major events within communities affect organizations in the context of corporate philanthropy. To test this framework, we examine how different types of mega-events (the Olympics, the Super Bowl, political conventions) and natural disasters (such as floods and hurricanes) affected the philanthropic spending of locally headquartered Fortune 1000 firms between 1980 and 2006. Results show that philanthropic spending fluctuated dramatically as mega-events generally led to a punctuated increase in otherwise relatively stable patterns of giving by local corporations. The impact of natural disasters depended on the severity of damage: while major disasters had a negative effect, smaller-scale disasters had a positive impact. Firms’ philanthropic history and communities’ intercorporate network cohesion moderated some of these effects. This study extends the institutional and community literatures by illuminating the geographic distribution of punctuating events as a central mechanism for community influences on organizations, shedding new light on the temporal dynamics of both endogenous and exogenous punctuating events and providing a more nuanced understanding of corporate-community relations.
Do former substance users with psychosis differ in their symptoms or function from non-substance users? A systematic meta-analysis
Authors: Gupta Pal , Mullin Katherine , Nielssen Olav , Harris Anthony , Large Matthew
Published: January 2013

Objective:

To compare the symptoms and function of patients with psychosis who have ceased using substances to those who have psychosis but do not have a history of substance use.

Method:

The databases EMBASE, MEDLINE and PsycINFO were searched for peer-reviewed publications in English reporting the characteristics of patients with psychotic illness who had stopped using substances and those who had never used substances. The searches yielded 20 articles that met the inclusion criteria. Four key outcome variables – positive symptoms, negative symptoms, depression and global function – and four other outcome measures reported in five or more studies were examined using meta-analysis.

Results:

Former substance-using patients were significantly younger than non-substance-using patients and were more likely to be male, but did not differ in age at onset of psychosis or in their level of education. There were no significant differences between former substance users and non-substance users in ratings of positive symptoms, negative symptoms, depression or global function. Among first-episode patients there was a trend towards former substance users having less severe depressive symptoms than non-substance users. In contrast, among non-first-episode patients, former substance users had significantly more depressive symptoms than non-substance users. In studies rated as being of higher quality, former substance users had significantly less severe positive symptoms than non-substance users.

Conclusion:

The absence of significant differences between the two groups suggests that a history of substance use is not a poor prognostic indicator for patients who are able to stop using substances.
Metabolite profiles in the anterior cingulate cortex of depressed patients differentiate those taking N-acetyl-cysteine versus placebo
Authors: Das Pritha , Tanious Michelle , Fritz Kristina , Dodd Seetal , Dean Olivia M , Berk Michael , Malhi Gin S
Published: January 2013

Background:

Increased oxidative stress is thought to contribute to the pathophysiology of major depressive disorder (MDD), which is in part due to diminished levels of glutathione, the primary anti-oxidant of the brain. Oral administration of N-acetyl-cysteine (NAC) replenishes glutathione and has therefore been shown to reduce depressive symptoms. Proton magnetic spectroscopy (1H-MRS) that allows quantification of brain metabolites pertinent to both MDD and oxidative biology may provide some novel insights into the neurobiological effects of NAC, and in particular metabolite concentrations within the anterior cingulate cortex (ACC) are likely to be important given the key role of this region in the regulation of affect.

Objective:

The aim of this study was to determine whether the metabolite profile of the ACC in MDD patients predicts treatment with adjunctive NAC versus placebo.

Methods:

This study was nested within a multicentre, randomized, double-blind, placebo-controlled study of MDD participants treated with adjunctive NAC. Participants ( n = 76) from one site completed the spectroscopy component at the end of treatment (12 weeks). Spectra from a single-voxel in the ACC were acquired and absolute concentrations of glutamate (Glu), glutamate-glutamine (Glx), N-acetyl-aspartate (NAA) and myo-inositol (mI) were obtained. Binary logistic regression analysis was performed to determine whether metabolite profiles could predict NAC versus placebo group membership.

Results:

When predicting group outcome (NAC or placebo), Glx, NAA and mI were a significant model, and had 75% accuracy, while controlling for depression severity and sex. However, the Glu, NAA and mI profile was only predictive at a trend level, with 68.3% accuracy. For both models, the log of the odds of a participant being in the NAC group was positively related to NAA, Glx and Glu levels and negatively related to mI levels.

Conclusion:

The finding of higher Glx and NAA levels being predictive of the NAC group provides preliminary support for the putative anti-oxidative role of NAC in MDD.
Further evidence for slow binocular rivalry rate as a trait marker for bipolar disorder
Authors: Vierck Esther , Porter Richard J , Luty Sue E , Moor Stephanie , Crowe Marie T , Carter Janet D , Inder Maree L , Joyce Peter R
Published: January 2013

Objective:

Binocular rivalry refers to a situation where contradictory information is presented simultaneously to the same location of each eye. This leads to the alternation of images every few seconds. The rate of alternation between images has been shown to be slower in euthymic participants with bipolar disorder than in healthy controls. The alternation rate is not uniformly slowed in bipolar disorder patients and may be influenced by clinical variables. The present study examined whether bipolar disorder patients have slower alternation rates, examined the influence of depression and explored the role of clinical variables and cognitive functions on alternation rate.

Method:

Ninety-six patients with bipolar disorder and 24 control participants took part in the study. Current mood status and binocular rivalry performance were analysed with nonparametric tests. A slow and a normal alternation group were created by median split. We subsequently explored the distribution of several clinical variables across these groups. Further, we investigated associations between alternation rate and various cognitive functions, such as visual processing, memory, attention and general motor speed.

Results:

The median alternation rate was significantly slower for participants with bipolar disorder type I (0.39 Hz) and for participants with bipolar spectrum disorder (0.43 Hz) than for control participants (0.47 Hz). Depression had no effect on alternation rate. There were no differences between participants with bipolar disorder type I and type II and in regard to medication regime and predominance of one rivalry image. There were also no differences in regard to the clinical variables and no significant associations between alternation rate and the cognitive functions explored.

Conclusion:

We replicated a slowing in alternation rate in some bipolar disorder participants. The alternation rate was not affected by depressed mood or any of the other factors explored, which supports views of binocular rivalry rates as a trait marker in bipolar disorder.
Capillary effect in the impregnation of jute fiber mat reinforced polypropylene composites
Authors: Sun Zhanying , Zhao Xiongyan , Ma Jinsong
Published: January 2013

The main objective of this article was to study the capillary effects during the impregnation of polypropylene resin in the jute fiber mats. The static equilibrium contact angles between polypropylene matrix and fibers were measured and the dynamic impregnation of matrix in the fiber mats was researched in detail. The results show that the static contact angles are clam-shell shape. The capillary effects present little values in the dynamic impregnation. The preparation for low void composites should be performed below the critical resin flow velocity of 0.13 µm/s for polypropylene resin and 0.21 µm/s for polypropylene/maleated polypropylene blend resin, respectively.
Treatment Facility Neighborhood Environment and Outpatient Treatment Completion
Authors: Cho Young Ik , Johnson Timothy P. , Fendrich Michael , Pickup Lillian
Published: January 2013

The current study focuses on three dimensions of treatment neighborhood environments that may influence treatment retention: neighborhood disadvantage, stability, and concentrated immigration. We examined treatment outcomes for a total of 9,319 individuals who were admitted for initial treatment in 56 outpatient clinics in Cook County, Illinois. Census-tract-level data were used to measure facility neighborhood environment. We found that neighborhood disadvantage was unrelated to individual treatment completion. Immigrant concentration was found to increase the likelihood of substance abuse treatment completion, although it was attenuated after controlling for patient problem severity and referral sources. Neighborhood stability was found to be positively related to treatment completion. These results suggest that knowledge of neighborhood context should be an important consideration when making placement decisions of new treatment facilities. Knowledge of neighborhood impact on treatment attrition should also be considered essential information to be used for client placement, treatment program design, and discharge protocols.
The Experience of Community College Faculty Involved in a Learning Community Program
Authors: Jackson Dimitra Lynette , Stebleton Michael J. , Laanan Frankie Santos
Published: January 2013

A study was undertaken to determine how teaching in learning communities (i.e., courses that are linked or intentionally integrated in terms of learning objectives and shared assignments) affects the perspectives and work of community college faculty members. Interviews with 14 faculty members who taught in learning communities at a Midwestern community college indicated that the benefits of participation included greater empathy for and awareness of students, the development of authentic relationships with students, enhanced engagement in the larger campus community, and active collaboration and professional development with faculty colleagues across disciplines. Study limitations and implications are discussed.
Babies Need Healthy Moms
Authors: Frazzitta Marie A. , Anderson Michele , Egan Elizabeth
Published: January 2013

Purpose

Healthy Babies Need Healthy Moms (HBNHM) is an innovative education program that combines the recommended 2-hour postpartum oral glucose tolerance test (OGTT) with diabetes prevention education for women who had gestational diabetes mellitus. During the class, the 2-hour OGTT is performed, and in the time between venipunctures, the women participate in group education focused on evidence-based diabetes prevention strategies that promote healthy family nutrition and lifestyle behavior, importance of preconception care for subsequent pregnancies, and the need for follow-up care for women who screen positive for abnormal glucose levels. The purpose of this article is to describe this model to encourage replication in other diabetes programs.

Conclusion

The HBNHM program is a low-budget education program that provides postpartum OGTT screening for women who had gestational diabetes mellitus during their pregnancies while simultaneously offering education designed to improve future outcomes. For those women whose screening is positive for overt diabetes or prediabetes, the educational strategies are directed at encouraging follow-up care. For those patients who have normal screening results, the program is designed to help the patient prevent the future development of type 2 diabetes. Preconception counseling is included in an effort to improve outcomes in future pregnancies and provide patients with the tools needed to help enhance the health of their families.
Shifting Communities in Early Jain Prabandha Literature: Sectarian Attitudes and Emergent Identities
Authors: Chojnacki Christine
Published: January 2013

Taking up the still debated question whether Muslims and particularly Hindus were or were not aware of forming a common religious community before the nineteenth century, David N. Lorenzen stated in the introduction to his essay Who Invented Hinduism? published in 2009 that the term Hinduism designed religious identity as early as the fifteenth century in Hindu texts and even one century earlier in inscriptions. However, most scholars did not take into account the Jain texts, probably because it was more or less unconsciously admitted that Jains are in fact Hindus. Nevertheless, the testimony of Jain Prabandhas, a new genre which includes biographies, eulogies and chronicles, reveals to be of peculiar interest. Indeed, on one hand, the Prabandhas attest that the Jains saw themselves as different to the Hindu sects and that they competed for instance with devotees of Śiva in order to obtain the favour of a sovereign or to control a sacred place. On the other hand, the Jain authors do not go so far as to assimilate Muslims and Hindus into a single composite ‘other’. Rather they identify a double ‘other’ represented by the non-Jains in the Indian world and by the Muslim newcomers. The terms in use are analyzed through various examples. Besides, as opposed to this double ‘other’, the Jains seem to have developed a sense of a larger community. As a matter of fact, if they go on using terms which apply to members of one and the same sectarian group, they also overcome sectarian divisions. Furthermore, by borrowing from Persian sources the term hinduka, they reveal that the advent of a foreign elite entailed the emergence of new identities.
The Throne of Worship: An ‘Archaeological Tell’ of Religious Rivalries
Authors: Goodall Dominic
Published: January 2013

The throne of worship, which is typically a colourful grotesque of theriomorphic theologemes that is to be visualized similarly in both internal and external worship, is a common feature of most surviving tantric literature. We may often read of ritual and doctrine being locked in so close an embrace that the one may not be interpreted without the other2 and it is certainly true that their relationship can very often be demonstrated. Indeed, one article known to me demonstrates it with respect to the throne of worship: Sanderson3 has pointed out that the enthronement of the three deities—Parā, Parāparā and Aparā—on the tips of a trident that rises above the enthroned corpse of Sadāśiva is intended to express that the Trika has transcended, among other systems, the Śaiva Siddhānta. It is noteworthy, however, that we should ﬁnd not only that the enthronement of the principal deity should be an almost universal feature of tantric cults but also that many elements of the throne are the same or more than coincidentally similar in different systems. The most widespread common feature of thrones is that of a lotus resting upon a pīṭha that has at least four legs in the intermediate directions, these legs being formed by lions as incarnations of entities that have the names of the four positive qualities of the buddhi, namely, dharma, jñāna, vairāgya and aiśvarya. Furthermore, we ﬁnd both Śaiva and Pāñcarātra accounts in which the mantras of these entities involve the four so-called ‘neuter’ vowels. Thus, the rituals of these cults may be shown to express or reinforce doctrinal truths, but we cannot in such cases always assume that their original ‘sense’ is shining through: expression of doctrine must often rather be the result of successful secondary reinterpretation. Plainly, an examination of thrones furnishes evidence of the kind that led to Sanderson’s observation that ‘[t]he ritual systems taught in the Śaiva and Pāñcarātrika Saṃhitās resemble each other so closely in morphology and syntax that they have the appearance of two dialects of a single “Tantric” language.’4 In this article I will attempt an exploration of some textual accounts of thrones and I hope to provide a ‘footnote’ to Sanderson’s observation, which although is itself part of a footnote, deserves a more prominent place and, of course, examination in not a few further ‘footnotes’.
Cross, Sword and Conflicts: A Study of the Political Meanings of the Struggle between the Padroado Real and the Propaganda Fide
Authors: Malekandathil Pius
Published: January 2013

Geographical explorations and the subsequent intensification of external commerce made many political actors of the sixteenth and seventeenth centuries AD drag in religion and its various institutions as pliable devices for strengthening their claims of monopoly and control over the political and commercial life of the newly discovered regions. In the midst of these developments, the pre-colonial struggles for appropriating surplus from the European possessions in Asia were at times in the form of struggles between different religious institutions and administrative machineries within the same belief system professed by the various European powers. These conflicts often arose when some of the religious institutions, which were devised at different points of time in history to transmit various types of spiritual experiences to the believers, were appropriated by power-mongers for realizing their political and economic agenda. One of the religious institutions that were often utilized for political purposes during the early modern period was the church administrative system of patronage or the Patronato that the Spaniards introduced in America and the Padroado Real that the Portuguese set up in Asia. As per the right of patronage that the Pope conceded in AD 1455, the Portuguese Crown became the sole authority that could send missionaries to the lands controlled by the Lusitanians, which eventually created a certain type of monopoly for them in matters of Christianity in areas under their influence and kept missionaries of other nationalities out of Asian and Brazilian soil. When the religious issues in Asia began to get increasingly embroiled in the politics of the times, thanks to the dominance of Lusitanian interests in the Padroado system, Pope Gregory XV devised the Propaganda Fide in AD 1622 as an alternative church administrative system for Asia, which in fact was meant to provide opportunities basically for non-Portuguese people, both Indians and Europeans, for missionary work in Asia. However, this led to a chain of conflicts between the ecclesiastical administrative institutions of the Padroado Real and those of the Propaganda Fide, in Asia in general and India in particular, where the core issues of contestation began to revolve around matters of politics and the exercise of power. The central purpose of this article is to examine the nuanced nature of the conflicts that arose between the church administrative systems of the Padroado and the Propaganda at different points in time and also to see how the religious conflicts were appropriated and politicized by the various European colonial powers to further their politico-economic agenda in India.
Beyond the Archives: Doing Oral History in Contemporary India
Authors: Mahajan Sucheta
Published: January 2013

This article on extending the archive beyond its traditional avatar is intended for the researcher and enthusiast in contemporary history, those doing oral history and students and teachers offering courses in historical method.1 The process that I wish to highlight is the movement of historical study and research beyond the confines of the written archives, away from the official records, to the village chaupals and fields of the peasants, to the offices of trade unions, to factory canteens, to simple homes, where people gather, meet and live their lives. I discuss one such trend, namely, oral history, which has energized the field of history. In the second part of the article, I take a close look at two oral history initiatives to explore issues of methodology and ethics, as well as the transformative aspects of the exercise. The first is the project (of which I was a member) sponsored by the Indian Council of Social Science Research on the history of the freedom movement, conducted by professors and researchers at the Jawaharlal Nehru University (JNU); and the second, testimonies of the survivors/victims of the Partition recorded by researchers.
Exploring the role of an emotional support and counselling service for people with visual impairments
Authors: Hodge Suzanne , Barr Wally , Bowen Louise , Leeven Martina , Knox Paul
Published: January 2013

There is growing evidence of the need for services to address the emotional support needs of people with visual impairments. This article presents findings from a mixed methods evaluation of an emotional support and counselling (ESaC) service delivered within an integrated low vision service, focusing primarily on the qualitative findings. Data collected using a standardised measure of psychological well-being (Clinical Outcomes in Routine Evaluation–Outcome Measure; CORE-OM) show an improvement in the psychological well-being of clients of the service between baseline and follow-up assessment. Qualitative findings from interviews with service users and service providers help to illustrate and explain the experiences underlying the quantitative findings. The ESaC services are shown to be helpful to service users in two particular ways: helping them to normalise their experiences by talking to an impartial listener and helping them to accept and adapt to the physical, emotional and social changes in their lives resulting from their visual impairment.
Red blood cell trauma during cardiopulmonary bypass: narrow pore filterability versus free haemoglobin
Authors: Svenmarker Staffan , Jansson Erica , Stenlund Hans , Engström Karl Gunnar
Published: January 2013

Ten patients admitted for coronary artery bypass grafting were investigated with respect to the influence of cardiopulmonary bypass (CPB) on red blood cell (RBC) trauma. Blood samples were collected prior to, at the start of, and at 30 and 60 min of CPB. RBC deformability was assessed by filtering re-suspended RBCs through a polycarbonate membrane using a computer-controlled filtrometer. Multiple regression analysis was employed to evaluate RBC flow-curve characteristics denoted by the initial filtration rate (IFR) and clogging slope (CS). Release of free haemoglobin was determined concomitantly. IFR was estimated at 90.39 μl/s and CS at -5.32 μl/s2 prior to CPB. During 60 min of CPB, neither IFR nor CS deviated significantly ( p > 0.05) from these reference values. However, release of free haemoglobin increased significantly ( p < 0.018) from the start of CPB to the 60-min determination. In conclusion, 60 min of CPB seems not to alter significantly RBC deformability in a 5 μm pore filtration model, despite a significant release of haemoglobin.
Practical techniques Vacuum-assisted venous return in pediatric cardiopulmonary bypass
Authors: Berryessa Richard , Wiencek Robert , Jacobson John , Hollingshead Dan , Farmer Ken , Cahill George
Published: January 2013

Vacuum-assisted venous return (VAVR) has been reported to offer benefits for adults undergoing cardiopulmonary bypass (CPB), such as improved venous return, lowering priming volume (by eliminating the need to prime the venous line), and the use of smaller venous cannulae. All these benefits would be of particular value in pediatric perfusion because of the unique challenges of these smaller patients and the relatively large components of the CPB circuit. We have been using VAVR in children since the early summer of 1998 after we became comfortable with the technique and convinced of its efficacy in adults.

Ours is a medium-sized pediatric caseload of slightly more than 100 CPB cases per year. With that caseload, it is most effective for us to minimize the inventory of different sizes of disposables used. We have opted for an oxygenator/reservoir that has a maximum flow of 4 liters with a priming volume of about 1 liter. We have been unhappy with the large prime volume in infants and earlier, in 1997-1998, were using a smaller prime oxygenator/reservoir until it was recalled. Faced again with a larger priming volume in the infants, we decided to try vacuum to decrease hemodilution and to evaluate other possible benefits. Through the use of VAVR, we have been able to decrease our priming volume, use smaller venous cannulae, and have more consistent return while experiencing no adverse effects of VAVR in our pediatric cardiac surgery patients.
The role of nitric oxide synthase/nitric oxide in vascular smooth muscle control
Authors: Sanders D Bradford , Kelley Tara , Larson Douglas
Published: January 2013

Vascular compliance is dependent on endogenous and exogenous sources of nitric oxide (NO). In a discussion of therapeutics and NO derived via nitric oxide synthase (NOS) enzymes, it is necessary to examine the pathways of each drug to provide the clinical perfusionist with a greater understanding of the role of NOS/NO in vascular function. Endothelial-derived NO is a contributor in the vasoregulation of vascular smooth muscle. Therapeutics seek to mimic the vasodilatory effects of the endogenous NO. The therapeutics included in this review are nitroglycerin, nitroprusside, amyl nitrite, and inhalation of NO. L-Arginine supplementation provides additional substrate for the endogenous pathway that can augment NO production. NO is a small bioactive molecule involved in various biochemical pathways. Dysregulation of NO production can impair normal physiologic control of vascular compliance. Therefore, the purpose of this review is to provide the perfusionist with an understanding of the biochemical and pharmacological aspects of NOS/NO associated with vascular function.
Extracorporeal support in an adult with severe carbon monoxide poisoning and shock following smoke inhalation: a case report
Authors: McCunn Maureen , Reynolds H Neal , Cottingham Christine A , Scalea Thomas M , Habashi Nader M
Published: January 2013

The objective of this study was to discuss the case of a patient with severe smoke inhalation-related respiratory failure treated with extracorporeal support. The study was set in a 12-bed multi-trauma intensive care unit at a level one trauma center and hyperbaric medicine center. The patient under investigation had carbon monoxide poisoning, and developed acute respiratory distress syndrome and cardiovascular collapse following smoke inhalation. Rapid initiation of extracorporeal support, extreme inverse-ratio ventilation and intermittent prone positioning therapy were carried out. Admission and serial carboxyhemoglobin levels, blood gases, and computerized tomography of the chest were obtained. The patient developed severe hypoxia and progressed to cardiovascular collapse resistant to resuscitation and vasoactive infusions. Veno-venous extracorporeal support was initiated. Cardiovascular parameters of blood pressure, cardiac output, and oxygen delivery were maximized; oxygenation and ventilation were supported via the extracorporeal circuit. Airway pressure release ventilation and intermittent prone positioning therapy were instituted. Following 7 days of extracorporeal support, the patient was decannulated and subsequently discharged to a transitional care facility, neurologically intact. Smoke inhalation and carbon monoxide poisoning may lead to life-threatening hypoxemia associated with resultant cardiovascular instability. When oxygenation and ventilation cannot be achieved via maximal ventilatory management, extracorporeal support may prevent death if initiated rapidly.
Assessing quality in cardiac surgery: why this is necessary in the twenty-first century
Authors: Swain Julie A , Hartz Renee S
Published: January 2013

The cost and high-profile nature of coronary surgery means that this is an area of close public scrutiny. As much pioneering work in data collection and risk analyses has been carried out by cardiac surgeons, substantial information exists and the correct interpretation of that data is identified as an important issue. This paper considers the background and history of risk-adjustment in cardiac surgery, the uses of quality data, examines the observed/expected mortality ratio and looks at issues such as cost and reactions to outliers. The conclusion of the study is that the continuation of accurate data collection by the whole operative team and a strong commitment to constantly improving quality is crucial to its meaningful application.
Haemodilution improves organ function during normothermic cardiopulmonary bypass: investigations in isolated perfused pig kidneys
Authors: Dittrich S , Schuth A , Aurich H , vonLoeper J , Grosse-Siestrup C , Lange P E
Published: January 2013

We investigated the effects of haemodilution on kidney function during normothermic cardiopulmonary bypass (CPB) by performing in vitro haemoperfusion of pig kidneys for 90 min after cold preservation. We compared two groups ( n = 14 each) with respect to rheologic and haemodynamic parameters and glomerular and tubular function. Group 1 was perfused at a haematocrit of 0.33 ± 0.01, group 2 at 0.21 ± 0.01. Blood flow was adjusted according to blood pressure. Blood viscosity and vascular resistance were reduced in group 2. Comparison of group 1 versus group 2 revealed a metabolic rate of oxygen 3.4 ± 1.7 versus 4.3 ± 1.8 ml/min/100 g, sodium transport 1.2 ± 1.2 versus 1.8 ± 1.2 mmol/min/100 g, and creatinine clearance 9.9 ± 9.1 versus 15.6 ± 11.9 ml/min/100 g, p < 0.05. We conclude that haemodilution leads to an overproportional decrease in blood viscosity and improves the properties of flow and kidney function. In the ongoing discussion about the optimal extent of haemodilution in CPB, the importance of viscosity and blood flow should be further emphasized.
Perfusion method for thoracoabdominal aneurysm repair using the open distal technique
Authors: DeBois William J , Girardi Leonard N , Lawrence Stephen , McVey James , Cahill Andrew , Elmer Barbara , Zanichelli Marie
Published: January 2013

Challenges related to perfusion support of thoracoabdominal aneurysm repair include maintenance of distal aortic perfusion, rapidity of fluid resuscitation, and avoidance of both hypothermia and excessive hemodilution. Using available technology, we have devised a circuit and protocol that addresses these issues. To accomplish such support a bypass circuit consisting of 3/8 inch tubing connected to a centrifugal pump and low-prime heat exchanger was constructed. The circuit was primed via 1/4 inch spiked connectors attached to a 3-liter bag of normal saline. After initial de-airing, the solution was recirculated through this bag. Patients were anticoagulated with 1 mg/kg of heparin prior to initiation of support. Left atrial-descending aorta bypass was used primarily. A cell salvage device was used for autotransfusion. All blood products were delivered via a rapid infusion device. During partial exsanguination, shed blood was not processed, but directed to the rapid infusor for immediate retransfusion. Any packed cells given were washed prior to transfusion. Citrate dextrose solution was used as an anticoagulant for the cell scavenger. This configuration was used successfully in 50 procedures during an 18-month period. Use of this low-prime, custom circuit reduced both hemodilution and cost. A connection off the cell salvage pump offers fast retransfusion of shed blood during partial exsanguination. Minimal heparinization and citrate anticoagulation appears to reduce coagulopathy.
Oxygen consumption, carbon dioxide production and lactic acid during normothermic cardiopulmonary bypass
Authors: Engoren Milo , Evans Michael
Published: January 2013

The objective of this study was to measure oxygen consumption, carbondioxide production and lactic acid levels during normothermic cardiopulmonary bypass. A prospective study was undertaken in a tertiary care community hospital, involving 20 adults undergoing cardiopulmonary bypass with prolonged (>65 min) crossclamping of the aorta. O2 consumption, CO2 production, hemoglobin and lactic acid levels were measured 5, 35 and 65 min after crossclamping of the aorta. O2 consumption was 79.7 ± 14.5, 78.8 ± 15.4 and 81.5 ± 14.1 ml/min/m2 at 5, 35 and 65 min after crossclamping the aorta. CO2 production was 61.8 ± 42.9, 60.6 ± 26.3 and 62.2 ± 35.9 ml/min/m2 at the same times. Lactic acid levels were 1.6 ± 0.5 mM/dl at all three times and did not correlate with O2 consumption or CO2 production.

In conclusion, although oxygen consumption was low, there was no evidence of abnormal lactate or anaerobic metabolism to suggest tissue ischemia.
Simple modified ultrafiltration
Authors: Myers Gerard J , Leadon Richard B , Mitchell Lance B , Ross David B
Published: January 2013

After reviewing all available methods of modified ultrafiltration (MUF), an attempt was made to develop a more simplified approach to this beneficial method of post-bypass fluid removal by withdrawing blood from the right atrium and reinfusing into the aortic cannula (venoarterial). The simplicity of operation, ease of setup and analysis of hemoglobin, hematocrit, total proteins and colloid osmotic pressure, and fluid removed were examined in 12 consecutive neonatal and pediatric patients undergoing cardiac surgery. Results indicate that this simplified modified ultrafiltration (SMUF) is comparable to all other methods of MUF by achieving dramatic improvements in all parameters measured. In addition, SMUF provides the perfusionist with the ability to run conventional ultrafiltration throughout the bypass procedure, using this one circuit design.

As well as finding the learning curve for SMUF to be very short, this method was found to be superior in its simplicity of operation, ease of setup, reduced risk of complications and acceptance by the surgeon and anesthetist.
Assembly of the Heparin Removal Device for patients with suspected adverse reaction to protamine sulphate
Authors: Jegger D , Tevaearai H T , Horisberger J , Mueller X M , Seigneuil I , Pierrel N , Boone Y , von Segesser L K
Published: January 2013

Protamine sulphate is routinely used after cardiopulmonary bypass (CPB) to restore the patient’s baseline coagulatory state. However, adverse reactions are encountered, and alternative means to neutralize heparin are, therefore, necessary. The Heparin Removal Device (HRD) constitutes an extracorporeal circuit that allows ex vivo deheparinization by mean of a polycationic ligand that binds heparin molecules.

This paper presents the setup of the HRD circuit. It is illustrated by the report of a 68-year-old man with a known severe crustacean allergy. The patient (78 kg, 170 cm) was admitted for elective coronary artery bypass graft surgery. It was decided that the HRD would be used as a precaution in order to avoid the risks of using protamine sulphate. The CPB time and aortic crossclamp time were 70 and 40 min, respectively. At the end of CPB, the device was inserted and processing started. Activated coagulation time values were monitored over a 130 min period and diminished from 480 to 300 s after 45 min, 220 s after 90 min, and settled at 150 s. Haemostasis was acceptable and processing stopped. The operation was terminated and the patient transferred to the intensive care unit. Clinical evolution was excellent, with minimal postoperative bleeding.

The HRD presents an alternative to protamine sulphate when this drug is contraindicated for a certain patient population who might have a suspected, known or emergency adverse reaction.
Spallation performance of extracorporeal membrane oxygenation tubing
Authors: Peek Giles J , Thompson Andrew , Killer Hilliary M , Firmin Richard K
Published: January 2013

During the prolonged roller pump use of extracorporeal membrane oxygenation (ECMO), tubing wear generates spallation. The spallation performance of Tygon® S-65-HL was measured and compared with a potential new ECMO tubing, LVA (Portex 800-500-575). Spallation was measured by on-line laser diode particle counting (HIAC) during simulated ECMO. The effects of differing levels of occlusion and pump speed were examined, as was the effect of spallation over time. The spallation produced by Tygon S-65-HL was less than that seen with LVA during 24 h of simulated ECMO ( p < 0.001), and after 72 h had fallen almost to zero. Spallation with Tygon tubing increases with increasing pump speed and decreases over time. There appears to be only a weak correlation with occlusion, which is surprising. The spallation performance of Tygon S-65-HL was variable and under some conditions exceeded that of LVA. Overall, however, Tygon S-65-HL produced less spallation than LVA. Therefore, LVA cannot be recommended for clinical ECMO use.
Impact of closed versus open venous reservoirs on patient outcomes in isolated coronary artery bypass graft surgery
Authors: Mahoney Chris Brown , Donnelly James E
Published: January 2013

Data were collected retrospectively on 1681 consecutive isolated coronary artery bypass graft patients at Millard Fillmore Hospital (Buffalo, New York, USA) undergoing coronary artery bypass. No patients were excluded. There were 616 patients in the open circuit group and 1065 in the closed circuit group. Patients in the closed circuit group exhibited a trend towards a higher incidence of most pre-existing comorbidities, with acute myocardial infarction, pre-existing cerebrovascular disease and the incidence of extensively calcified aortas all being significantly higher. Significantly different postbypass outcomes favored the closed circuit group, with levels of sepsis of 1% for open and 0% for closed and respiratory failure of 4% for open and 1% for closed. The length of stay approached significance with a p-value of 0.057 (open 9.85 days and closed 7.53). Use of an open circuit was a significant, independent predictor for increased use of units of packed red blood cells and total units of blood products. This study provides evidence that closed venous reservoirs can favorably impact surgical outcomes and reduce resulting healthcare costs.