bluuebunny/crossref_metadata_2025 huggingface dataset:
Delivering services and influencing policy: Health care professionals join forces to improve maternal, newborn, and child health
Authors:   The Health Care Professional Association Writing Group
Published: April 2009

This article reviews the major activities of health care professional organizations (HCPAs), and emphasizes the role they can play in advocating for women and children and influencing maternal, newborn, and child health (MNCH) programs and policies. The ICM/FIGO joint effort to prevent postpartum hemorrhage and the 40‐year partnership between the American Academy of Pediatrics (AAP) and the Indian Health Service (IHS) are highlighted as examples of how and why HCPAs should assume a leadership role in advocacy work. The action‐oriented multicountry HCPA workshops organized by the Partnership for Maternal, Newborn, and Child Health (PMNCH) and the international HCPAs are also described. These capacity building workshops are aimed at strengthening the ability of HCPAs to organize, coordinate activities, and become more involved in program and policy development.
Differential effects of defoliation by mopane caterpillars and pruning by African elephants on the regrowth of Colophospermum mopane foliage
Authors: Hrabar Halszka , Hattas Dawood , du Toit Johan T.
Published: April 2009

Plant responses to herbivory vary depending on herbivory type, yet the comparative effects of defoliation (e.g. by insects) and pruning (e.g. by large mammals) on a single tree species are poorly documented. We investigated this in the Northern Province of South Africa by comparing the regrowth of Colophospermum mopane trees previously defoliated by caterpillars or pruned by elephants, the two main browsers of C. mopane foliage. Shoots were up to 160% and 125% longer after natural (elephant) and simulated pruning and leaves ~25% longer in regrowth after natural pruning (n = 13–15 trees per treatment). Shoot density and chemical defences in leaves (tannin:protein ratio and total polyphenolic concentration) were, however, no different from control trees. Simulated defoliation resulted in statistically insignificant changes to regrowth in terms of leaf and shoot size (both slightly decreased) and shoot density (slightly increased). Natural (caterpillar) defoliation, however, resulted in regrowth with significantly decreased shoot and leaf size (about 50% and 20% of control lengths, respectively), as well as decreased leaf chemical defence. Shoot and leaf length were longer on trees flushing for the first time after pruning and late-season defoliation had a greater negative impact than mid-season defoliation. Despite the differences in regrowth characteristics after pruning and defoliation, mopane plants showed no apparent trade-off in investment between tolerance and resistance after either herbivory type, as neither regrowth nor chemical defence occurred at the expense of the other.
Habitat use, activity patterns and use of mineral licks by five species of ungulate in south-eastern Peru
Authors: Tobler Mathias W. , Carrillo-Percastegui Samia E. , Powell George
Published: April 2009

We studied the habitat use, activity patterns and use of mineral licks by five species of Amazonian ungulate using data from four 60-d camera trap surveys at two different sites in the lowland rain forest of Madre de Dios, Peru. Camera traps were set out in two regular grids with 40 and 43 camera stations covering an area of 50 and 65 km2, as well as at five mineral licks. Using occupancy analysis we tested the hypothesis that species are spatially separated. The results showed that the grey brocket deer (Mazama gouazoubira) occurred almost exclusively in terra firme forests, and that the white-lipped peccary (Tayassu pecari) used floodplain forest more frequently during some surveys. All other species showed no habitat preference and we did not find any spatial avoidance of species. The white-lipped peccary, the collared peccary (Pecari tajacu) as well as the grey brocket deer were strictly diurnal while the lowland tapir (Tapirus terrestris) was nocturnal. The red brocket deer (Mazama americana) was active day and night. The tapir was the species with the highest number of visits to mineral licks (average 52.8 visits per 100 d) followed by the white-lipped peccary (average 16.1 visits per 100 d) and the red brocket deer (average 17.1 visits per 100 d). The collared peccary was only recorded on three occasions and the grey brocket deer was never seen at a lick. Our results suggest that resource partitioning takes place mainly at the diet level and less at a spatial level; however, differences in small-scale habitat use are still possible.
Leaf tissue water relations and hydraulic properties of sclerophyllous vegetation on white sands of the upper Rio Negro in the Amazon region
Authors: Sobrado M. A.
Published: April 2009

The objective of this study was to explore the leaf tissue water relations in terminal branches, as well as the relations between xylem structure and function of five sclerophyllous species coexisting on white sands within the Amazon region. In these species, which possess costly leaves and thrive in an extremely nutrient-poor habitat, the preservation of leaf survival would be of comparable importance to the preservation of xylem vessels. Three trees per species were tagged in the field for all measurements. Minimum leaf water potential (Ψ) was −1.53 ± 0.61 and −0.94 ± 0.10 MPa during rainless and rainy days, respectively. The Ψ for turgor loss averaged −1.92 ± 0.05 MPa. Therefore, minimum Ψ was maintained within a safety range above the critical value for turgor loss. Xylem (Kx) and leaf (Kl) specific conductivity averaged 1.4 ± 0.22 and 0.00033 ± 0.000045 kg m−1 s−1 MPa−1, respectively. Water supply was favoured in species with higher vessel density, and all species depended on relatively less abundant larger vessels for water transport. This would be advantageous because leaves were unable to develop very negative water potentials in order to maintain transpiration. High transpiration rates may be restricted to a few hours daily so as to prevent cavitation of widest vessels.
Dietary predictors of serum total carotene in low-income women living in São Paulo, south-east Brazil
Authors: Tomita Luciana Y , Almeida Lana C , Roteli-Martins Cecília , D’Almeida Vania , Cardoso Marly A ,   for the BRINCA Study Team
Published: April 2009

Objective

Dietary intake and nutritional status of antioxidant vitamins have been reported to protect against some cancers. The objective of the present study was to assess the correlations between serum levels of carotenoids (including β-, α- and γ-carotene), lycopene, retinol, α- and γ-tocopherols, and dietary intakes estimated by an FFQ, among low-income women in the Brazilian Investigation into Nutrition and Cervical Cancer Prevention (BRINCA) study.

Design

Cross-sectional study of data for 918 women aged 21–65 years participating in the BRINCA study in São Paulo city. Multiple linear regression models were used with serum nutrient levels as the dependent variable and dietary intake levels as the independent variable, adjusted for confounding factors.

Results

In energy-adjusted analyses, the intakes of dark green and deep yellow vegetables and fruits (partial R2 = 4·8 %), total fruits and juices (partial R2 = 1·8 %), vegetables and fruits (partial R2 = 1·8 %), carrots (partial R2 = 1·4 %) and citrus fruits and juices only (partial R2 = 0·8 %) were positively correlated only with serum total carotene levels, after adjusting for serum total cholesterol concentration, age, hospital attended, smoking status, BMI and presence of cervical lesions. Multiple-adjusted serum levels of carotenoids were positively correlated with intake quartiles of dark green and deep yellow vegetables and fruits and total fruits and juices independent of smoking status.

Conclusions

The intake of specific fruits and vegetables was an independent predictor of serum total carotene levels in low-income women living in São Paulo.
Eddy diffusivities estimated from observations in the Labrador Sea
Authors: Funk A. , Brandt P. , Fischer T.
Published: April 2009

Eddy diffusivities in the Labrador Sea (LS) are estimated from deep eddy resolving float trajectories, moored current meter records, and satellite altimetry. A mean residence time of 248 days in the central LS is observed with several floats staying for more than 2 years. By applying a simple random walk diffusion model, the observed distribution of float residence times in the central LS could be explained by a mean eddy diffusivity of about 300 m2 s−1. Estimates from float trajectories themselves and from moored current meter records yield significantly higher eddy diffusivities in the central LS of 950–1100 m2 s−1. This discrepancy can be explained by an inhomogeneity of the eddy diffusivity at middepth with high/low values in the central LS/region between central LS and deep Labrador Current, which could be conjectured from the mean altimetric eddy kinetic energy (EKE) distribution. The different diffusivities explain both (1) a fast lateral homogenization of water masses in the central LS and (2) a weak exchange between central LS and boundary current. The mean Lagrangian length scale of 11.5 ± 0.7 km as estimated from deep float trajectories is only slightly larger than the mean Rossby radius of deformation (8.8 km). Largest eddy diffusivities within the central LS are associated with strong eddy drifts, rather than with large swirl velocities and associated large EKE.
Incremental prognostic value of combining left ventricular lead position and systolic dyssynchrony in predicting long-term survival after cardiac resynchronization therapy
Authors: Zhang Qing , Yip Gabriel W.-K. , Chan Yat-Sun , Fung Jeffrey W.-H. , Chan Winnie , Lam Yat-Yin , Yu Cheuk-Man
Published: April 2009

The efficacy of CRT (cardiac resynchronization therapy) can be affected by a number of factors; however, the prognostic significance of the LV (left ventricular) lead position has not been explored. The aim of the present study was to examine whether a PL (posterolateral) lead position has an additional value to systolic dyssynchrony in predicting a better survival after CRT. Patients (n=134) who received CRT were followed-up for 39±24 months. The LV lead position was determined by cine fluoroscopy, and baseline dyssynchrony was assessed by TDI (tissue Doppler imaging). The relationship between the LV lead position/dyssynchrony and mortality was compared using Kaplan–Meier curves, followed by Cox regression analysis. The all-cause and cardiovascular mortalities were 38 and 31% respectively. The presence of dyssynchrony and a PL lead position predicted a lower all-cause mortality (29 compared with 47%; log-rank χ2=5.38, P=0.02) and cardiovascular mortality (21 compared with 41%; log-rank χ2=6.75, P=0.009) than when absent. The all-cause mortality was as high as 62% when patients had neither dyssynchrony nor a PL lead position, but was reduced to 29% when both criteria were present, and was between 45 and 46% when only one criterion was present (χ2=6.79, P=0.01). The corresponding values for cardiovascular mortality were 62% when patients had neither dyssynchrony nor a PL lead position, 36–38% when patients had either dyssynchrony or a PL lead position, and 21% when patients had both criteria present (χ2=9.54, P=0.004). Combining dyssynchrony and a PL lead position independently predicted a lower all-cause morality {HR (hazard ratio), 0.496 [95% CI (confidence interval), 0.278–0.888]; P=0.018} and cardiovascular mortality [HR, 0.442 (95% CI, 0.232–0.844); P=0.013]. In conclusion, the placement of the LV lead at a PL position provides additional value to baseline dyssynchrony in predicting a lower all-cause and cardiovascular mortality during long-term follow-up after CRT.
Noise-enhanced target discrimination under the influence of fixational eye movements and external noise
Authors: Starzynski Christian , Engbert Ralf
Published: April 2009

Active motor processes are present in many sensory systems to enhance perception. In the human visual system, miniature eye movements are produced involuntarily and unconsciously when we fixate a stationary target. These fixational eye movements represent self-generated noise which serves important perceptual functions. Here we investigate fixational eye movements under the influence of external noise. In a two-choice discrimination task, the target stimulus performed a random walk with varying noise intensity. We observe noise-enhanced discrimination of the target stimulus characterized by a U-shaped curve of manual response times as a function of the diffusion constant of the stimulus. Based on the experiments, we develop a stochastic information-accumulator model for stimulus discrimination in a noisy environment. Our results provide a new explanation for the constructive role of fixational eye movements in visual perception.
Dispersion of heavy particles in stably stratified turbulence
Authors: van Aartrijk M. , Clercx H. J. H.
Published: April 2009

The dispersion of heavy inertial particles in statistically stationary stably stratified turbulence is studied by means of direct numerical simulations. The following issues have been addressed: What distinguishes dispersion in such stratified flows from dispersion processes in statistically stationary homogeneous isotropic turbulence? How is the dispersion process affected by the Stokes number of the inertial particles (0.1≲St=τp/τK≲10, with τp the particle response time and τK the Kolmogorov time)? What is the interplay between buoyancy and the Stokes number? And what is the effect, if any, of particle settling, nonlinear drag, and lift forces (particularly relevant for stratified turbulence with its vertical shear layers) on particle dispersion? The long-time dispersion in isotropic turbulence is found to be maximum around St=1, in agreement with the observation of preferential concentration for St≈1. In stably stratified turbulence such a maximum in the dispersion is only found for the horizontal direction. The horizontal and vertical dispersions in stably stratified turbulence show different behaviors due to the anisotropy of the flow, and in particular, vertical dispersion is strongly affected by the inertia of the particles. With increasing St the classical plateau found for vertical fluid particle dispersion becomes less pronounced and it even vanishes for Stokes numbers of O(10) and higher. Furthermore, the long-time vertical dispersion increases with increasing St. The effects of gravity, nonlinear drag, and lift forces have been considered in more detail. It turned out that the settling enhancement of inertial particles, as observed in isotropic turbulence, is suppressed by stratification and by nonlinear drag effects. Moreover, nonlinear drag only affects the dispersion in the vertical direction in stably stratified turbulence. Finally, it is found that lift forces can safely be neglected for dispersion studies under the current parameter settings.
Evolutionary significance of phenotypic accommodation in novel environments: an empirical test of the Baldwin effect
Authors: Badyaev Alexander V
Published: April 2009

When faced with changing environments, organisms rapidly mount physiological and behavioural responses, accommodating new environmental inputs in their functioning. The ubiquity of this process contrasts with our ignorance of its evolutionary significance: whereas within-generation accommodation of novel external inputs has clear fitness consequences, current evolutionary theory cannot easily link functional importance and inheritance of novel accommodations. One hundred and twelve years ago, J. M. Baldwin, H. F. Osborn and C. L. Morgan proposed a process (later termed the Baldwin effect) by which non-heritable developmental accommodation of novel inputs, which makes an organism fit in its current environment, can become internalized in a lineage and affect the course of evolution. The defining features of this process are initial overproduction of random (with respect to fitness) developmental variation, followed by within-generation accommodation of a subset of this variation by developmental or functional systems (‘organic selection’), ensuring the organism's fit and survival. Subsequent natural selection sorts among resultant developmental variants, which, if recurrent and consistently favoured, can be inherited when existing genetic variance includes developmental components of individual modifications or when the ability to accommodate novel inputs is itself heritable. Here, I show that this process is consistent with the origin of novel adaptations during colonization of North America by the house finch. The induction of developmental variation by novel environments of this species's expanding range was followed by homeostatic channelling, phenotypic accommodation and directional cross-generational transfer of a subset of induced developmental outcomes favoured by natural selection. These results emphasize three principal points. First, contemporary novel adaptations result mostly from reorganization of existing structures that shape newly expressed variation, giving natural selection an appearance of a creative force. Second, evolutionary innovations and maintenance of adaptations are different processes. Third, both the Baldwin and parental effects are probably a transient state in an evolutionary cycle connecting initial phenotypic retention of adaptive changes and their eventual genetic determination and, thus, the origin of adaptation and evolutionary change.
Mental health of current and former recipients of foster care: a review of recent studies in the USA
Authors: Pecora Peter J. , White Catherine Roller , Jackson Lovie J. , Wiggins Tamera
Published: April 2009

This paper presents data about the emotional, behavioural and substance abuse disorders of youth in foster care and former recipients of foster care (‘alumni’) in the USA. The prevalence rates of these groups are compared to those of the youth and young adults in the US general population. The implications of these data for policy and program design are discussed.
Effect of atorvastatin on microRNA 221 / 222 expression in endothelial progenitor cells obtained from patients with coronary artery disease
Authors: Minami Y. , Satoh M. , Maesawa C. , Takahashi Y. , Tabuchi T. , Itoh T. , Nakamura M.
Published: April 2009

Background  Endothelial progenitor cells (EPCs) play an important role in the maintenance of vascular integrity. Lipid lowering therapy (LLT) with statins may contribute to biologically relevant activities including the proliferation of endothelial cells. The physiological role of microRNA (miR)‐221/222, a newly discovered class of small RNA, is closely linked to the proliferation of endothelial cells. We therefore investigated whether LLT with statins might affect miR‐221/222 expression in EPCs obtained from patients with coronary artery disease (CAD).

Materials and methods  This study included 44 patients with stable CAD and 22 subjects without CAD (non‐CAD). Patients with CAD were randomized to 12 months of LLT with atorvastatin (10 mg day−1) or pravastatin (10 mg day−1). EPCs were obtained from peripheral blood at baseline and after 12 months of statin therapy. Levels of miR‐221/222 in EPCs were measured by real‐time RT‐PCR.

Results  Levels of miR‐221/222 were significantly higher in the CAD group than in the non‐CAD group (P < 0·01). Levels of miR‐221/222 were weakly negatively correlated with EPC number in the CAD group. After 12 months of therapy, changes in lipid profiles were greater in the atorvastatin group than in the pravastatin group. LLT with atorvastatin markedly increased EPC numbers and decreased miR‐221/222 levels (all P < 0·05), whereas LLT with pravastatin did not change EPC numbers or miR‐221/222 levels.

Conclusions  This study demonstrates that LLT with atorvastatin increases EPC numbers and decreases miR‐221/222 levels in patients with CAD, possibly contributing to the beneficial effects of LLT with atorvastatin in this disorder.
CLAMOUR FOR GLAMOUR? CITY COMPETITION FOR HOSTING THE SWEDISH TRYOUTS TO THE EUROVISION SONG CONTEST
Authors: ANDERSSON IDA , NIEDOMYSL THOMAS
Published: April 2009

For some time it has been argued that cities all over the world have become more entrepreneurial and increasingly competitive. Most research has focused on spectacular events in well‐known metropolises, but far less is known about how smaller cities engage in competitive activities. This paper focuses on how, why and what Swedish cities hope to achieve by engaging themselves in hosting the tryouts to the Eurovision Song Contest (ESC), which provides an opportunity for a critical case study of place marketing and city competition in Sweden. The empirical material is based on interviews with stakeholders in the tryouts. Our findings show that the local authorities do not compete in the same way as suggested by the literature, but instead collaborate to a great deal. While there are various motives behind arranging a tryouts tryout, it is noted that whereas the ESC presents an opportunity for a host city to ‘place itself on the map’, hosting a tryout is often mainly seen as an opportunity to show the organisers of the event the city's potential for hosting other events in the future. Our findings suggest that the main outcome of hosting a tryout, an outcome that the local authorities seem content with, is having arranged a glamorous party for the local inhabitants. The paper concludes by discussing why competition was found to be less outspoken than the literature suggests.
Update of a Retrospective Cohort Study of Changes in Hip Joint Phenotype of Dogs Evaluated by the OFA in the United States, 1989–2003
Authors: KANEENE JOHN B. , MOSTOSKY ULREH V. , MILLER ROSEANN
Published: April 2009

Objective—To determine whether there has been improvement in canine hip joint phenotype classifications of dogs whelped from 1989 to 2003 by the Orthopedic Foundation for Animals (OFA), by examining results of radiographic evaluations and identifying any trends in percentages of dogs classified as having desirable hip joint phenotypes.

Study Design—Retrospective cohort study.

Sample Population—OFA radiographic classifications (n=431,483) on dogs whelped between 1989 and 2003.

Methods—Numbers and percentages of dogs classified by hip joint phenotypes were determined for 2‐year cohorts. Differences between breeds and sexes were assessed using the Fisher's exact test, and odds ratios with 95% confidence intervals were calculated to express associations. The Cochran–Armitage test for trend was calculated to identify significant trends over time.

Results—There were statistically significant (P<.05) increases in the proportion of all breeds of dogs evaluated as excellent and good from 1993 to 2003, controlling for gender and age at evaluation. Labrador Retrievers, Bernese Mountain Dogs, and Rottweilers had the highest proportions of excellent and good scores, and the highest rates of improvement in excellent and good scores were seen in Bernese Mountain Dogs and Rottweilers.

Conclusions—Results support the contention that there have been improvements in hip joint phenotype classifications in dogs in the United States since the previous study (1989–1992), through increases in the proportion of dogs receiving excellent and good classifications.

Clinical Relevance—Hip joint phenotype classifications can be used by dog breeders to develop breeding programs to improve the hip joints of future generations of dogs.
Laparoscopic Mesh Incisional Hernioplasty in Five Horses
Authors: CARON JOHN P. , MEHLER STEVEN J.
Published: April 2009

Objective—To report a technique for incisional hernioplasty in horses using laparoscopic placement of a prosthetic mesh.

Study Design—Case series.

Animals—Horses (n=5) with ventral median abdominal incisional hernia.

Methods—A telescope and 2 instrument portals were established bilaterally, lateral to and distant from the hernia margins. After exposure of the internal rectus sheath by removal of retroperitoneal fat with endoscopic scissors and monopolar cautery, a prosthetic mesh was introduced into the abdomen and secured intraperitoneally using transfascial sutures with or without supplemental endoscopic hernia fixation devices.

Results—Successful placement of the prostheses was achieved without major intra‐ or postoperative complications. Repairs were intact in all horses (follow‐up range: 6–23 months) without evidence of adhesion formation. Cosmetic results compared favorably with those typically achieved using conventional, open hernioplasty techniques.

Conclusion—Incisional hernia repair in horses can be successfully achieved with a laparoscopic intraperitoneal mesh onlay technique.

Clinical Relevance—Laparoscopic mesh hernioplasty has promise as a safe and effective method for repair of incisional hernias in horses.
Multiple Concealed Accessory Pathways Associate with Antegrade Triple AV Nodal Pathways and Catheter Ablation
Authors: ZHOU JIN‐TAI , LIU WEI‐YU , WAN ZHENG , ZHAO JING , WANG ZHI‐YI , ZHANG YU‐SHU
Published: April 2009

This article describes a 54‐year‐old man with incessant supraven‐tricular tachycardia refractory to antiarrhythmic drugs. Multiple concealed accessory pathways associated with antegrade triple AV nodal pathways were documented by a series of successful catheter ablations and detailed electrophysiological studies. After the left‐wall accessory pathways were abolished with two courses of multiple low energy shocks, another two accessory pathways, one near the os of coronary sinus and the other near the site of the His bundle, were documented by programmed premature ventricular stimulation. This was followed by a third course of shocks to the os of coronary sinus for ablating posteroseptal AP and a fourth course of shock to proximal His bundle for control of SVT with a septal accessory pathway as a retrograde limb and AV nodal pathways as an antegrade limb. Without medications, the patient has remained asymptomatic even during moderate physical activity over a follow‐up period of 36 months. His ECG showed sinus rhythm with persistence of right bundle branch block.
Incidence and Pattern of Ventricular Late Potentials in the First Ten Days Following Acute Myocardial Infarction
Authors: GOEDEL‐MEINEN LISELOTTE , HOFMANN MONIKA , SCHMIDT GEORG , MAIER‐RUDOLPH WILLIBALD , BARTHEL PETRA , BAEDEKER WOLFGANG , BLÜMOMER HANS
Published: April 2009

In contrast to studies of late potentials (LP) during the chronic stage of myocardial infarction (MI), little has been published about signal averaged LP during the acute phase of MI. We therefore investigated the occurrence of LP during the first 10 days following acute MI in daily measurements of the signal averaged ECG. Thirty‐three patients with acute MI defined by clinical, history, diagnostic electrocardiographic changes, and enzymatic evaluation were prospectively included in the study. Thirty‐three percent suffered from anterior MI, 43% from inferior MI, and 24% had MI in both regions. Using the method of Simson, an LP was defined as a mean voltage of < 25 ±V in the last 40 msec of the filtered QRS complex. The incidence of LP ranged between 24% on the first day and 39% on day 6. There was no significant difference comparing the incidence of LP between consecutive days. Looking at the individual patient, only 3 patients exhibited a constant LP, 15 patients remained without LP, and 15 patients showed a variable incidence over the course of 10 days. There was no correlation between the incidence of LP and the localization of MI or the maximum level of the CK‐MB isoenzyme.
Effects of Cimetidine on Sinus Node Function and Atrioventricular Conduction in Man
Authors: CIEMNIEWSKI ZBIGNIEW , TRUSZ‐GLUZA MARIA , HUBNER DAMIAN , GIEC LESZEK
Published: April 2009

Electrophysiological effects of H2‐receptor blockade 200 mg cimetidine IV on sinus node (SN) function and atrioventricular (AV) conduction were evaluated. Tests were performed in 21 people in basal state (group I), and in 14 people (group II) after autonomic blockade (AB) (propranolol 0.2 mg/kg, and atropine 0.04 mg/kg). We analyzed sinus cycle length (SCL), sinus node recovery time (SNRT), corrected sinus node recovery time (CSNRT), and secondary pause (SP) as the longest sinus pause after incremental overdrive pacing, sinoatrial conduction time (Strauss method) (SACT), Wenckebach point (WP), and blood pressure (BP). In group I, cimetidine prolonged SCL (717 ± 98 vs 860 ± 138 msec P < 0.001), SNRT (1161 ± 153 vs 1263 ± 163 msec P < 0.002), SP (943 ± 183 vs 1072 ± 187 msec P < 0.001), SACT (121 ± 20 msec vs 149 ± 21 msec P < 0.002), and lowered rate at which AV nodal Wenckebach point were observed (169 ± 24 vs 160 ± 26 beats/min P < 0.02). The drug did not produce significant change of the CSNRT (439 ± 121 vs 402 ± 107 msec. In group II, after AB cimetidine prolonged SCL (643 ± 79 vs 656 ± 86 msec P < 0.05), SP (686 ± 114 vs 717 ± 109 msec P < 0.05) and lowered WP (170 ± 19 vs 166 ± 19 beats/min P < 0.02) significantly. The effects of cimetidine, after AB on SNRT (894 ± 180 vs 920 ± 164 msec, CSNRT (243 ± 99 vs 255 ± 85 msec), SACT (85 ± 20 msec vs 90 ± 22 msec) were not significant. We conclude that H2‐receptor blockade decreases SN automatically, prolongs SACT and AV conduction in man. The study suggests that histamine takes part in regulation of electrophysiological properties of the human heart in vivo.
Sudden Death in Pacemaker Patients
Authors: NÜRNBERG MICHAEL , PöTTLER ANDREAS , FROHNER KLAUS , KOFLER KLAUS , PODCZECK ANDREA , STELLWAG CHRISTIAN , STEINBACH KONRAD
Published: April 2009

Of 264 pacemaker patients who died within 27.6 ± 21 months following pacemaker implantation, 36 (13.6%) died suddenly. There was no difference between them and the remaining patients in terms of age, sex, indications for pacing, type of pacemaker used, and interval between pacemaker implantation and death. On autopsy, all but one patient were found to show severe three‐vessel disease without evidence of acute myocardial infarction. The cause of death would thus be compatible with malignant ventricular tachycardia.
Infection of an Automatic Implantable Cardioverter Defibrillator Pocket with Campylobacter Jejuni
Authors: WILSON JOHN H. , RATH RANJIT , MILLER HUXLEY
Published: April 2009

Infection of an Automatic Implantable Cardioverter Defibrillator Pocket with Campylobacter Jejuni. A patient with a defibrillator pocket infected with Campylobacter jejuni is presented. The patient was treated with antibiotics without removal of the device. He made a complete recovery. He has remained free of infection for 1 year. This case indicates that patients with defibrillator pocket infections with Campylobacter and perhaps other low pathogenicity infections may be treated without removal of the device.
Use of Amiodarone in the Management of the Wolff‐Parkinson‐White Syndrome
Authors: KAPPENBERGER LUKAS J.
Published: April 2009

The ayitiarrhythmic properties of amiodarone in WPW‐syndrome depend on several simultaneously active mechanisms. Its electrophysiologic properties lead to reduction of excitabUity, lengthening of refractory periods and slowing of conduction. With these effects, it reduces premature ectopic beats and thus initiating events for tachycardias. The ventricular response during atrial fibrillation will be reduced in most but unfor‐tunately not all patients and tachycardia cycle length will be prolonged. Therefore amiodarone seems to be the drug of choice in WPW‐syndrome if there was not a high incidence of side‐effects and an extremely long tissue half‐life. The prescription has therefore to be made with caution since if once applied, its effects are not immediately renersible. Hoioever, in some cases it offers an alternative for surgery of IVPW.
Amiodarone in Pediatric Patients
Authors: DICK MACDONALD , SCOTT WILLIAM A.
Published: April 2009

The reported world clinical experience of amiodarone in children is revieived; the known age‐dependent electro physiological and pharmacokinetic characteristics of amiodarone are examined; and guidelines for the use of amiodarone in children are suggested.
Mexiletine: Its Role in the Management of Chronic Ventricular Arrhythmias
Authors: SAMI MAGDI HANNA
Published: April 2009

Mexiletine is a class IB anti arrhythmic agent structurally similar to lidocaine but with the advantage of a high bioavailability and relatively long half‐life, making it useful for long‐term oral therapy of ventricular arrhythmias. Mexiletine can be used orally or intravenously. Orally, it has a high bioavailability, reaching peak plasma concentration between 2 and 4 hours after administration. The steady‐state therapeutic plasma concentration ranges from 0.5 to 2.5 fig/ml. These levels are obtained by doses of 200–300 mg every 6–8 hours. It is mostly metabolized by the liver and its metabolism and excretion are not significantly affected by renal failure. Mexiletine has very few deleterious drug interactions; more importantly, it does not affect digoxin blood levels. Its efficacy in controlling ventricular arrhythmias has been widely studied. The reported success rate varies from 84% to 52%. In our study of patients with symptomatic and refractory ventricular arrhythmias, the success rate with mexiletine was 55% initially and 33% at one year. Mexiletine appears to be most useful in combination with other anti arrhythmic agents such as propranolol, quinidine, procainamide, or amiodarone. Mexiletine has very few cardiac side effects. It was found not to have significant negative inotropic effects even in patients with congestive heart failure. Its major side effects, however, include gastric intolerance. Other less common side effects include central nervous system manifestations. Like all other antiarrhythmics, it can potentially aggravate ventricular arrhythmias in about 10% of patients but in most cases the proarrhythmic effect is not Clin cally significant.
The Complementary Role of Electrogram, Event Marker, and Measured Data Telemetry in the Assessment of Pacing System Function
Authors: LEVINE PAUL A.
Published: April 2009

Increasing numbers of pulse generators have one or more features that assist in the diagnostic evaluation of the pacing system. Interrogation of programmed parameters, measured lead and battery data, telemetry of event markers, endocardial electrograms, diagnostic data concerning the frequency of pacing and the presence or absence of spontaneous arrhythmias all facilitate the ease with which the pacing system is evaluated and the patient managed. The utility of these features is illustrated from five separate cases demonstrating the value of the individual features and how they may complement one another in extremely complicated pacing system problems.
Mechanism of Action of Antiarrhythmic Agents: Focus on Propafenone
Authors: SINGH BRAMAH N.
Published: April 2009

Propafenone is a new antiarrhythmic compound that has an unusual spectrum of pharmacological actions. Its dominant action in cardiac muscle is to block the fast sodium channel with slow onset and offset kinetics. Thus it has a marked depressant effect on conduction with a modest effect in prolonging the effective refractory period in fibers that are fast‐channel dependent. In addition, it has beta‐blocking and calcium‐channel blocking actions that are likely to affect its overall spectrum of activity. Propafenone should be effective in suppressing both ventricular as well as supraventricular arrhythmias.
Comparison Between Flecainide and Atenolol in the Suppression of Complex Ventricular Ectopic Activity After Myocardial Infarction: Results of a Double‐Blind, Randomized Trial
Authors: CRIPPS TIM , MANNERING DAVID , BENNETT DAVID
Published: April 2009

The efficacy of flecainide (100–150 mg bd) in comparison with atenolol (50–100 mg bd) in suppressing frequent (5/hour) ventricular ectopic activity and nonsustained ventricular tachycardia on ambulatory monitoring was assessed in 26 patients one month after myocardial infarction in a randomized, double‐blind trial. Blood drug levels were monitored and monthly follow‐up ambulatory monitoring and exercise testing were performed for three months, A successful response (70% suppression of ectopic activity or elimination of ventricular tachycardia) was seen in 100% of patients randomized to flecainide compared with 50% randomized to atenolol (p<.05). Three patients developed serious adverse reactions to treatment, one of whom was receiving flecainide and the other two atenolol. The patient on flecainide suffered an exacerbation of heart failure; one on atenolol experienced bronchospasm and the other a proarrhythmic effect. Flecainide is superior to atenolol in the suppression of ventricular ectopics and nonsustained ventricular tachycardia in patients with recent myocardial infarction, though should be used with care in patients with critically impaired left ventricular function.
Anterior Q‐Wave Infarction Complicating Attempted Catheter Electrode Ablation of Ventricular Tachycardia
Authors: MULLER DAVID W.M. , HARPER RICHARD W. , BROUGHTON ARCHER , FEDERMAN JACK , PITT AUBREY
Published: April 2009

This report describes an attempt to treat recurrent ventricular tachycardia by catheter electrode ablation. The procedure failed to control the arrhythmia and resulted in a Q‐wave anteroseptal myocardial infarction. The potential complications of catheter electrode ablation in the normal ventricle are emphasized.
Clinical Experience with Dual‐Chamber Rate Responsive Pacemakers
Authors: KAPPENBERGER LUKAS J. , VOGT PIERRE , SCHLÄPFER JÜRG J. , GOY JEAN‐JACQUES , FROMER MARTIN A.
Published: April 2009

The development of dual‐chamber rate responsive pacing is the logical consequence of technical and clinical developments and research in pacemaker technology. The first rate responsive dual‐chamber pacemaker was implanted in June 1986 and the successful performance of this device encouraged manufacturers to further develop this technology. The rhythmic corrections that could be achieved were a strong argument to make use of this new technology in patients suffering from combined sinus node and AV nodal disease. DDD rate responsive pacemakers, therefore, have been implanted in 16 patients with a mean follow‐up of 10.4 months. No technical complications were encountered, 2 patients died from causes not related to an arrhythmic problem. Of the 14 remaining patients, 12 are still in a dual‐chamber rate responsive mode, 2 are in DDD or DDI‐mode because of chronotropic competence of the sinus node. Therefore, we, conclude that dual‐chamber rate responsive pacing is a reliable mode for long‐term physiological pacing. Different features that can be included in a DDDR pacemaker may widen its use so that 85% of pacemaker indications might be covered with the DDDR pacemaker.
Programming of Rate Responsive Pacemakers
Authors: ISAEFF DALE M. , JUTZY ROY V. , FLORIO JOSEPH
Published: April 2009

Rate adaptive pacing adds a new dimension to pacemaker therapy. The possibility of near physiological pacing utilizing the piezoelectric sensor is now offered to a broad range of patients with varied clinical problems. Improved cardiac output during exercise increases exercise capabilities and patient satisfaction. Single‐chamber rate adaptive pacing has been demonstrated to improve cardiac performance. The expansion of this technology into a dual‐chamber pacing unit achieves the combined benefit of AV synchrony with synthesized chronotropic competence. The challenge in clinical practice is to construct an appropriate rate responsive regimen and then to confirm the adequacy and safety of the programmed parameters. Considerable experience with single‐ and dual‐chamber rate adaptive pacemakers led us to develop a protocol for initial pacemaker selection, subsequent programming of these units, and confirmation of optimal function. A practical method for evaluation of rate adaptive pacemaker patients is outlined with programming guidelines.
Pharmacological Conversion of Atrial Fibrillation of Ten‐Years Duration with Flecainide
Authors: COHEN TODD J. , LEE RANDALL J. , LIEM L. BING
Published: April 2009

A case of idiopathic atrial fibrillation of ten‐years duration refractory to quinidine therapy, but successfully converted to sinus rhythm following flecainide therapy is presented. With the availability of newer more potent antiarrhythmic drugs, such as flecainide, conversion of previously refractory atrial fibrillation may be possible.
A Novel Approach to Teaching Periocardiocentesis
Authors: Aloi Mara , Davenport Moira
Published: April 2009

Pericardiocentesis can be a life‐saving intervention but it is associated with significant complications if not performed appropriately. Periocardiocentesis should ideally be done under ultrasound guidance. However, in many community emergency departments (EDs) ultrasound is not routinely available, leaving the ED physician the anatomic approach. Emergency medicine residents need to achieve competence in this procedure using both techniques, but there are limited opportunities for residents to perform this procedure on live patients. Many residency programs teach this procedure using cadaver models. We have devised a model, made with readily available, inexpensive materials, that allows residents to practice pericardiocentesis using both the subxiphoid and parasternal approach in a setting that we feel is more life‐like than with that using the dessicated tissue of routine cadaver models. Materials: Two racks of pork or beef ribs, wire, pericardiocentesis tray, Betadine, plastic baggies. The racks of ribs are wired together to make a thorax and are then covered with an opaque covering to simulate skin. One plastic bag is filled with Betadine and then placed within another plastic bag containing water, to simulate pericardial effusion. The bag‐within‐bag set‐up is then secured on the under surface of the thorax. Residents can then practice either the parasternal or subxiphoid approach with the intent of aspirating clear fluid. Aspiration of dark‐fluid represents cardiac penetration and is considered an unsuccessful procedure. Bags can be replaced as needed, but based on our experience, approximately 10 attempts were done before any significant leakage occurred. Total cost for the materials was less than $35.
An Inexpensive, Easily Constructed, Reusable Task Trainer for Simulating Ultrasound‐Guided Pericardiocentesis
Authors: Girzadas Daniel , Zerth Herb , Harwood Robert
Published: April 2009

Pericardiocentesis is a low frequency, high‐risk procedure integral to the practice of emergency medicine.1, 2 Ultrasound‐guided pericardiocentesis is the preferred technique for providing this critical care.3 Traditionally, emergency physicians learned pericardiocentesis real time, at the beside, on critically ill patients. Medical education is moving toward simulation for training and assessment of procedures such as pericardiocentesis, because it allows learners to practice time‐sensitive skills without risk to patient or learner.4 There are mannequin‐based simulators capable of supporting landmark‐guided pericardiocentesis, but they are expensive. No commercially available simulation models enable physicians to practice pericardiocentesis under ultrasound guidance. We have developed an ultrasound‐guided pericardiocentesis task trainer that allows the physician to insert a needle under ultrasound guidance, pierce the “pericardial sac” and aspirate “blood”. Our model can be simply constructed in a home kitchen and the overall preparation time is one hour. Our model costs $20.00 (US, 2008). Materials needed for the construction include 12 ounces of plain gelatin, one large balloon, one golf ball, food coloring, non‐stick cooking spray, one wooden cooking skewer, Betadine™, and a 3‐quart sized Tupperware container. Refrigeration and a heat source for cooking are also required. Once prepared, the model is usable for two weeks at room temperature and may be preserved an additional week if refrigerated. When the model shows signs of wear, it can be easily remade, by simply recycling the existing materials. 1. Ann Emerg Med. 2001, 37:745–770. 2. Acad Emerg Med. 2008, 15:1046–1057. 3. Crit Care Med. 2007, 35:S290–304. 4. Ann Emerg Med. 2008, 15:1117–1129.
Effect of an Integrated Public Health Curriculum in an Emergency Medicine Residency
Authors: Betz Marian , Tibbles Carrie , Joyce Nina , Fisher Jonathan
Published: April 2009

Background: Emergency departments (EDs) serve as a central point of interaction between the public and the medical system. Emergency physicians need education in public health in order to optimize their clinical care and their ability to evaluate potential public health interventions in the ED. Methods: As part of the Centers for Disease Control and Prevention (CDC) and the Association of American Medical College's (AAMC) national initiative for “Regional Medicine‐Public Health Education Centers‐Graduate Medical Education”, we designed and implemented a new public health curriculum for the emergency medicine residents. Over four sessions during regular didactic time, we used a modular approach to link a basic public health principle, such as environmental hazard assessment, to a relevant clinical topic, such as violent patients and ED safety. Each session emphasized resident involvement, including small group work and role‐plays. Journal clubs and quality assurance projects supplemented the curriculum. We sought resident feedback through focus groups and anonymous online pre‐ and post‐tests for each session. Assessment: Both before and after the curriculum, 76% of responders felt it was important for physicians to receive training in public health. The program appeared to have a positive effect on residents’ comfort level with various public health topics, and felt the residency program had taught them the skills necessary to implement public health principles in clinical practice (23.8%, versus 11.5% before; p<0.05). Conclusions: Integration of public health principles into existing clinical curricula in emergency medicine may increase resident interest and knowledge. Combining public health and emergency medicine topics in regular didactic conferences facilitates public health education for residents.
Basic Emergency Medicine Skills Workshop as the Introduction to the Medical School Clinical Skills Curriculum
Authors: Carter Wallace , Sperling Jeremy
Published: April 2009

Introduction: Most medical school curricula lack training in basic skills needed in a medical emergency. After the September 11th, 2001 terrorist attacks, junior level medical students at our institution volunteered their time in the emergency department[ or at Ground Zero. They quickly realized they had little or no practical training for an emergency situation. Objectives: To correct this curriculum deficit, a five hour basic emergency medicine skills / first responder course for students in their first few weeks of medical school was designed. Methods: The course consists of lectures followed by related skills stations. Lectures include an introduction to the first responder concept, basic airway, breathing, and circulation management, and a rapid, systematic approach to common emergencies. Skills stations teach basic airway management, bag valve mask ventilation, splinting and immobilizing, and moving patients in the field, stressing improvisation. Multiple skills are practiced in a final simulation station using actors with wound moulage and scripted scenarios. Results: This course, instituted at Weill Cornell Medical School in 2002, has become a mainstay of the first year curriculum. Student evaluations have been uniformly superlative. There is strong student sentiment that this is the most practical course of the first year. Conclusion: After six years of experience, we have shown it is possible to present a truncated first responder course as part of the first year curriculum. The course generates tremendous interest and awareness regarding emergency medicine. Future research will examine whether skills taught in this course are retained and can be correctly applied later in medical school.