bluuebunny/crossref_metadata_2025 huggingface dataset:
Jordanian women: Perceptions and practices of first‐time pregnancy
Authors: Safadi Reema
Published: October 2005

A woman's child‐bearing encounter is an experience that reflects the cultural beliefs and practices of the society. The purpose of this study was to describe the perceptions and practices of urban, low socioeconomic, Jordanian women (aged 18–30 years) in relation to their pregnancy career. An opportunistic sample consisting of 67 Muslim first‐time pregnant women who followed up antenatal care at two maternity‐care centres in East Amman was selected. A qualitative approach, including ethnographic semistructured interview, participant observation data from the households and clinics and oblique interviewing in random conversations initiated by the primigravidae, was conducted over 18 months. Women gave elaborative accounts of their pregnancy and childbirth expectations in narrative, phenomenological forms. Qualitative data analysis was performed concurrently with data collection, revealing the essential themes of immediacy of pregnancy; familial support and changing networks, especially for the after‐birth period; fear of pain and medical interventions, all emphasizing the traditional and religious perceptions and practices in a familial context.
Bringing the professional challenges for nursing in Jordan to light
Authors: Oweis Arwa I
Published: October 2005

The definition of a profession consists of contributing characteristics. Nursing must achieve these characteristics in order to confirm its professional status. These characteristics include: a standard of education; professional organizations; commitment; autonomy; continuing education; body of knowledge and competencies; social value; and a code of ethics. Nursing in Jordan faces a unique set of challenges to meet these criteria. The purpose of this discussion is to bring the professional challenges of nursing in Jordan to light, to motivate collaborative efforts to remediate them and to discuss the value of evidence‐based practice in this process. The key to confirming Jordanian nurses’ professional status is for nurses to seek every opportunity to prove themselves, earn respect, take control over their work, support their colleagues and to make informed decisions. In addition, a more active and effective role for the nursing organizations is necessary to change the public's view of nursing. Efforts to reform regulation also should be intensified.
“Poetry? Of course we do it. It's in the National Curriculum.” Primary children's perceptions of poetry
Authors: Kelly Alison
Published: October 2005

What can listening to children's ideas about poetry teach us? This article considers ways in which exploring primary‐aged students' perceptions of poetry can inform teachers' work with children. Using strategies from earlier studies in secondary schools, a small‐scale project with Year 6 students revealed their complex and sometimes contradictory ideas. These ideas reflect some of the current debates around the nature of poetry and ways of teaching it. The children's ideas are analysed with critical attention paid to the impact of the view of literacy in England's National Literacy Strategy on the teaching and learning of poetry.
Beginning readers' use of talking books: styles of working
Authors: Wood Clare , Littleton Karen , Chera Pav
Published: October 2005

This paper examines young children's working styles when they are engaged with a peer on a computer‐based reading task. Two types of pairing were investigated: (i) ‘Equal’ pairs, where the children were of equal reading attainment and (ii) ‘Unequal pairs’, where there was a disparity between the children's reading attainment. The results suggest that the children's reading attainment and/or their gender may be more significant factors in determining the nature of children's collaborative activity than pair type. The implications of these results for practitioners who wish to use talking books as a classroom resource are discussed.
THE ROLE OF HOUSE PRICES IN THE MONETARY TRANSMISSION MECHANISM ACROSS EUROPEAN COUNTRIES
Authors: Giuliodori Massimo
Published: October 2005

This paper provides a discussion of the ‘housing market’ channels of the monetary transmission mechanism and offers some evidence of institutional differences in the European housing and mortgage markets. Using a number of Vector Autoregressive models, estimated individually for nine European countries over the pre‐EMU period, we find that house prices are significantly affected by interest rate shocks. The relative role of these interest‐rate‐induced fluctuations in house prices for private consumption is then investigated. We show that house prices may enhance the effects of interest rate shocks on consumer spending in those economies where housing and mortgage markets are relatively more developed and competitive.
Authority Concepts Among Children and Adolescents in the Island of Macao
Authors: Laupa Marta , Tse Pamela
Published: October 2005

We examined the reasoning of children and adolescents in the island of Macao regarding the bases of legitimate authority across social contexts. We asked 101 children in 3rd, 5th, and 7th grades to evaluate the authority of persons issuing commands to children in two events. In one, persons with varying combinations of authority attributes issue a command that resolves a turn‐taking dispute between children in school. In another, persons with varying social positions issue a command to children to stop playing ball across three contexts: school, home, and a public park. Results show that, although young Macanese reason in many ways similar to American children, social position may be a less important legitimizing authority attribute for them than for American children.
What Do Grandmothers Think about Self‐esteem? American and Taiwanese Folk Theories Revisited
Authors: Cho Grace E. , Sandel Todd L. , Miller Peggy J. , Wang Su‐hua
Published: October 2005

The study investigates European American and Taiwanese grandmothers’ folk theories of childrearing and self‐esteem, building on an earlier comparison of mothers from the same families. Adopting methods that privilege local meanings, we bring grandmothers’ voices into the conversation about childrearing, thereby contributing to a deeper understanding of intergenerational nuances in folk theories. In each cultural case, 16 grandmothers of 3‐year‐olds participated in in‐depth interviews that were customized according to local communicative norms. Although self‐esteem emerged as a central organizing concept in the folk theories of European American mothers, grandmothers spoke in two voices, either echoing their daughters or invoking a counter‐discourse of wariness towards self‐esteem. By contrast, Taiwanese mothers and grandmothers resembled one another—but differed from their American counterparts—in treating self‐esteem as peripheral in childrearing. Results contribute to the growing consensus that self‐esteem is a culture‐specific childrearing goal and suggest that the European American tendency to valorize self‐esteem varies by generation.
Multilevel Modelling of the Number of Property Crimes: Household and Area Effects
Authors: Tseloni Andromachi
Published: October 2005

This study examines household and area effects on the incidence of total property crimes and burglaries and thefts. It uses data from the 2000 British Crime Survey and the 1991 UK census small area statistics. Results are obtained from estimated random-effects multilevel models, with an assumed negative binomial distribution of the dependent variable. Both household and area characteristics, as well as selected interactions, explain a significant portion of the variation in property crimes. There are also a large number of significant between-area random variances and covariances of household characteristics. The estimated fixed and random effects may assist in advancing victimization theory. The methods have potential for developing a better understanding of factors that give rise to crime and so assist in framing crime prevention policy.
A Bayesian Hierarchical Model for Categorical Longitudinal Data from a Social Survey of Immigrants
Authors: Pettitt A. N. , Tran T. T. , Haynes M. A. , Hay J. L.
Published: October 2005

The paper investigates a Bayesian hierarchical model for the analysis of categorical longitudinal data from a large social survey of immigrants to Australia. Data for each subject are observed on three separate occasions, or waves, of the survey. One of the features of the data set is that observations for some variables are missing for at least one wave. A model for the employment status of immigrants is developed by introducing, at the first stage of a hierarchical model, a multinomial model for the response and then subsequent terms are introduced to explain wave and subject effects. To estimate the model, we use the Gibbs sampler, which allows missing data for both the response and the explanatory variables to be imputed at each iteration of the algorithm, given some appropriate prior distributions. After accounting for significant covariate effects in the model, results show that the relative probability of remaining unemployed diminished with time following arrival in Australia.
Significance and Impotence: Towards a Balanced View of the Null and the Alternative Hypotheses in Marker Selection for Plant Breeding
Authors: Moerkerke B. , Goetghebeur E. , De Riek J. , Roldán-Ruiz I.
Published: October 2005

The isolation of DNA markers that are linked to interesting genes helps plant breeders to select parent plants that transmit useful traits to future generations. Such ‘marker-assisted breeding and selection’ heavily leans on statistical testing of associations between markers and a well-chosen trait. Statistical association analysis is guided by classical p-values or the false discovery rate and thus relies predominantly on the null hypothesis. The main concern of plant breeders, however, is to avoid missing an important alternative. To judge evidence from this perspective, we complement the traditional p-value with a one-sided ‘alternative p-value’ which summarizes evidence against a target alternative in the direction of the null hypothesis. This p-value measures ‘impotence’ as opposed to significance: how likely is it to observe an outcome as extreme as or more extreme than the one that was observed when data stem from the alternative? We show how a graphical inspection of both p-values can guide marker selection when the null and the alternative hypotheses have a comparable importance. We derive formal decision tools with balanced properties yielding different rejection regions for different markers. We apply our approach to study rye-grass plants.
Temporary Layoffs and Unemployment Insurance: Is Experience Rating Desirable?
Authors: Fath Julia , Fuest Clemens
Published: October 2005

This paper explores how the introduction of an experience-rated system of unemployment insurance affects employment and welfare in a model where implicit contracts between firms and workers give rise to wage rigidities and unemployment. In the literature, it has been argued that experience-rated systems of unemployment insurance may reduce long-term employment as firms anticipate the higher costs of layoffs implied by experience rating. Our analysis shows that the introduction of experience rating may increase or decrease long-term employment but it unambiguously raises welfare.
Inflation and Relative Price Variability in a Low Inflation Country: Empirical Evidence for Germany
Authors: Nautz Dieter , Scharff Juliane
Published: October 2005

The recent literature on the welfare cost of inflation emphasizes inflation’s effect on the variability of relative prices. Expected and unexpected inflation have both been proposed to increase relative price variability (RPV) and, thereby, to distort the information content of nominal prices. This paper presents new evidence on the impact of inflation on RPV in Germany. Our results indicate that the influence of expected inflation disappears if a credible monetary policy stabilizes inflationary expectations on a low level. Yet the significant impact of unexpected inflation suggests that even low inflation rates can lead to welfare losses by raising RPV above its efficient level.
Empowerment and State Education: Rights of Choice and Participation
Authors: Harris Neville
Published: October 2005

Two separate discourses surround the involvement of parents in their children's education in schools. One is concerned with what is often referred to as ‘parent power,’ based on the conferment on parents of rights to a degree of choice and participation in respect of their children's education, a feature of legislative changes to the governance of state education that started with the Education Act 1980 and which, in part, rests on consumerist and liberal rights based notions. The other focuses on the home‐school partnership ideal in which parents and schools have obligations to support each other in realising children's potential. Labour and Conservative 2005 general election campaigns included proposals to ‘empower’ parents. But social rights such as those in education, which are important to notions of citizenship, tend to be weak. This article concludes that over the past 25 years little power has been ceded to parents, individually or collectively, and that, in the case of rights of choice at least, any further empowerment seems unrealistic. Moreover, the principal mechanism of parental involvement, particularly since 1997, has been the enforcement of parental responsibility, a form of ‘technology of citizenship’. The extent to which children hold participation and choice rights is also considered.
Thysanoptera dermatitis
Authors: Leigheb G , Tiberio R , Filosa G , Bugatti L , Ciattaglia G
Published: October 2005

Thysanoptera dermatitis is caused by the bite of small (1–2 mm) insects (generally thrips). Thrips usually feed on the juices of vegetables but if they reach human skin they can suck the epidermal lymph after biting. The cutaneous lesions formed are small pink and itchy papules localized mainly on the trunk and the arms. Diagnosis is only possible by demonstrating that the insect is present inside one of the lesions of the skin. Thysanoptera dermatitis is often misdiagnosed as mosquito bites. Although self‐resolving in a few days, Thysanoptera dermatitis should be known not only for the cultural and scientific training of the dermatologist but also to add more detailed diagnostic information to the generic diagnosis of ‘entomodermatosis’ and to confirm the benign evolution of the bites.
Subcutaneous Rosai–Dorfman disease: is surgical excision justified?
Authors: Cheng SP , Jeng KS , Liu CL
Published: October 2005

Rosai–Dorfman disease in soft tissue without nodal disease has been recognized as a distinct clinicopathologic entity. It may represent a diagnostic challenge and the natural history and optimal treatment has not been well clarified. We investigated a patient in whom Rosai–Dorfman disease was confined to the subcutis of the abdominal wall and recurred after incomplete excision. Complete resolution was achieved by wide surgical excision with negative margins. Pathologic examination confirmed the diagnosis of extranodal Rosai–Dorfman disease. The patient is disease‐free after 1 year of follow‐up. Despite the possibility that spontaneous remission may occur, our results suggest that when anatomically feasible, complete excision can be a treatment option for persistence or recurrence of exclusively extranodal disease. Larger case series and longer follow‐up are needed to assess the long‐term efficacy in these patients.
Naevus lipomatosus cutaneous superficialis on the nose
Authors: Sáez Rodríguez M , Rodríguez‐Martin M , Carnerero A , Sidro M , Rodríguez F , Cabrera R , Guimerá F , García M , Sánchez R , Noda A
Published: October 2005

Naevus lipomatosus cutaneous superficialis (NLCS) is an uncommon hamartomatous lesion with an exceptional presentation on the face. We report the case of an elderly patient who presented with a classic type of NLCS on the right nasal orifice. This patient was taking inhaled steroids for his allergic rhinitis during 35 years.
Neuroimaging tools to rate cognitive impairment
Authors: KANEKO Tomoki , MOMOSE Mitsuhiro , KADOYA Masumi
Published: October 2005

Various neuroimaging techniques have been employed to detect the subtle brain changes related to mild cognitive impairment (MCI) and Alzheimer's disease (AD). Current areas of interest in neuroimaging include the detection of predictive indicators, prognostic values and the effects of treatment, as well as the features of disease. In this article, the findings of structural studies, functional imagings and white matter lesions in MCI are reviewed. Several cases of MCI are presented, and the usefulness of neuroimaging in the prediction of the treatment course and prognosis of MCI is evaluated.
Risperidone therapy for post‐operative delirium in elderly patients
Authors: OKUMURA Kazuo
Published: October 2005

In elderly patients, post‐operative delirium can complicate the treatment of any underlying condition that requires surgical intervention. Two elderly patients who underwent surgical procedures for neoplasia developed symptoms of nocturnal delirium soon after recovery from general anesthesia. Risperidone therapy was initiated in both patients (0.5 mg/day in Case 1 and 0.2 mg/day in Case 2) and their mental states rapidly stabilized, enabling treatment of the underlying condition and resulting in good post‐operative progress. Both patients were discharged from hospital without symptoms. To the best of the author's knowledge, this is the first report of the successful use of risperidone in the treatment of post‐operative delirium.
Perception of Mobile Phone and Base Station Risks
Authors: Siegrist Michael , Earle Timothy C. , Gutscher Heinz , Keller Carmen
Published: October 2005

Perceptions of risks associated with mobile phones, base stations, and other sources of electromagnetic fields (EMF) were examined. Data from a telephone survey conducted in the German‐ and French‐speaking parts of Switzerland are presented (N= 1,015). Participants assessed both risks and benefits associated with nine different sources of EMF. Trust in the authorities regulating these hazards was assessed as well. In addition, participants answered a set of questions related to attitudes toward EMF and toward mobile phone base stations. According to respondents' assessments, high‐voltage transmission lines are the most risky source of EMF. Mobile phones and mobile phone base stations received lower risk ratings. Results showed that trust in authorities was positively associated with perceived benefits and negatively associated with perceived risks. People who use their mobile phones frequently perceived lower risks and higher benefits than people who use their mobile phones infrequently. People who believed they lived close to a base station did not significantly differ in their level of risks associated with mobile phone base stations from people who did not believe they lived close to a base station. Regarding risk regulation, a majority of participants were in favor of fixing limiting values based on the worst‐case scenario. Correlations suggest that belief in paranormal phenomena is related to level of perceived risks associated with EMF. Furthermore, people who believed that most chemical substances cause cancer also worried more about EMF than people who did not believe that chemical substances are that harmful. Practical implications of the results are discussed.
Hospital Volume versus Outcome: An Unusual Example of Bivariate Association
Authors: Betensky Rebecca A. , Christian Caprice K. , Gustafson Michael L. , Daley Jennifer , Zinner Michael J.
Published: October 2005

Summary The Leapfrog Group, a consortium of more than 100 large employers, purchasing coalitions, and states that collectively provide health insurance to more than 33 million people, convened in 2000 with the goal of using market forces to improve the quality of healthcare. The resulting Leapfrog initiative suggested selective referral of complex procedures to high‐volume hospitals and set volume thresholds for five procedures. This was based on the hypothesis that low‐volume hospitals have higher mortality, which can be viewed in simplified statistical terms as the hypothesis that the binomial p is a decreasing function of n. The analysis of the correlation between hospitals' standardized mortality ratios (SMR, i.e., the ratio of observed to expected deaths) and hospitals' procedural volumes is revealing about the volume/mortality hypothesis. This presents an unusual pedagogic example in which the detection of correlation in the presence of nonlinear dependence is of primary interest, and thus the Pearson correlation is ideally suited. The frequently preferred nonparametric measures of bivariate association are inappropriate as they are unable to discriminate between correlation and dependence.
Family‐Specific Approaches to the Analysis of Case–Control Family Data
Authors: Neuhaus J. M. , Scott A. J. , Wild C. J.
Published: October 2005

SummaryCase–control studies augmented by the values of responses and covariates from family members allow investigators to study the association between the response and genetics and environment by relating differences in the response directly to within‐family differences in covariates. However, existing approaches for case–control family data parameterize covariate effects in terms of the marginal probability of response, the same effects that one estimates from standard case–control studies. This article focuses on the estimation of family‐specific covariate effects and develops efficient methods to fit family‐specific models such as binary mixed‐effects models. We also extend the approach to cover any setting where one has a fully specified model for the vector of responses in a family. We illustrate our approach using data from a case–control family study of brain cancer and consider the use of weighted and conditional likelihood methods as alternatives.
Robust Semiparametric Microarray Normalization and Significance Analysis
Authors: Ma Shuangge , Kosorok Michael R. , Huang Jian , Xie Hehuang , Manzella Liliana , Bento Soares Marcelo
Published: October 2005

Summary Microarray technology allows the monitoring of expression levels of thousands of genes simultaneously. A semiparametric location and scale model is proposed to model gene expression levels for normalization and significance analysis purposes. Robust estimation based on weighted least absolute deviation regression and significance analysis based on the weighted bootstrap are investigated. The proposed approach naturally combines normalization and significance analysis, and incorporates the variations due to normalization into the significance analysis properly. A small simulation study is used to compare finite sample performance of the proposed approach with alternatives. We also demonstrate the proposed method with a real dataset.
Empirical Likelihood Inference for the Area under the ROC Curve
Authors: Qin Gengsheng , Zhou Xiao‐Hua
Published: October 2005

Summary For a continuous‐scale diagnostic test, the most commonly used summary index of the receiver operating characteristic curve (ROC) is the area under the curve (AUC) that measures the accuracy of the diagnostic test. In this article, we propose an empirical likelihood (EL) approach for the inference on the AUC. First we define an EL ratio for the AUC and show that its limiting distribution is a scaled chi‐square distribution. We then obtain an EL‐based confidence interval for the AUC using the scaled chi‐square distribution. This EL inference for the AUC can be extended to stratified samples, and the resulting limiting distribution is a weighted sum of independent chi‐square distributions. Additionally we conduct simulation studies to compare the relative performance of the proposed EL‐based interval with the existing normal approximation‐based intervals and bootstrap intervals for the AUC.
Safe Scanning, but Frequent Artifacts Mimicking Bradycardia and Tachycardia During Magnetic Resonance Imaging (MRI) in Patients with an Implantable Loop Recorder (ILR)
Authors: Gimbel J. Rod , Zarghami Jamal , Machado Christian , Wilkoff Bruce L.
Published: October 2005

Background: Patients with implantable devices are generally not permitted to undergo magnetic resonance imaging (MRI) because of potentially deleterious interactions. Little has been reported regarding the safety and effects of MRI scanning of patients with implantable loop recorders (ILRs). We evaluated the safety of scanning patients with ILRs and the output of the ILR after undergoing MRI.

Methods: Ten patients underwent 11 MRI scanning events. All patients had Reveal Plus (Medtronic, Minneapolis, MN) ILRs. Seven cranial, two lumbar‐spine, one shoulder, and one knee MRI were performed. All of the MRIs were performed with the understanding that the patient had an ILR. In each patient, the ILR was cleared moments before the scan and the integrity of the signal and time date stamp were verified. The devices were reinterrogated immediately after MRI in 10 patients and two days post MR scanning in one patient. Each patient was questioned post MRI regarding any symptoms experienced during the scan.

Results: Both tachy and bradyarrhythmias appeared as artifacts as a result of ILR exposure to MRI. Post MRI, none of the ILRs showed diminished signal integrity, altered programmed parameters, diminished battery status, inability to communicate or be reprogrammed. No sensations of tugging or warmth at the implant site were noted.

Conclusion: MRI was performed in ILR patients without harm to the patient or permanent damage to the ILR. MRI scanning of the Reveal appears safe. Artifact mimicking an arrhythmia was common, however, and must be excluded in any ILR patient undergoing MRI to avoid mistakenly attributing a syncopal episode, or palpitations to the artifacts produced from MRI exposure.
Prediction of the Recurrence of Atrial Fibrillation After Successful Cardioversion with P Wave Signal‐Averaged ECG
Authors: Budeus Marco , Hennersdorf Marcus , Perings Christian , Wieneke Heinrich , Erbel Raimund , Sack Stefan
Published: October 2005

Background: The recurrence of atrial fibrillation (AF) was often observed after cardioversion.

Methods: In our study, a P wave triggered P wave signal‐averaged ECG (P‐SAECG) was performed on 118 consecutive patients 1 day after successful electrical cardioversion in order to evaluate the utility of this method to predict AF after cardioversion. We measured the filtered P wave duration (FPD) and the root mean square voltage of the last 20 ms of the P wave (RMS 20).

Results: During a 1‐year follow‐up, a recurrence was observed in 57 patients (48%). Patients with recurrence of AF had a larger left atrial size (41.9 ± 4.0 vs 39.3 ± 3.1 mm, P < 0.0003), a longer FPD (139.6 ± 16.0 vs 118.2 ± 14.1 ms, P < 0.0001), and a lower RMS 20 (2.57 ± 0.77 vs 3.90 ± 0.99 μV, P < 0.0001). A cutoff point (COP) of FPD ≥126 ms and RMS 20 ≤3.1 μV could predict AF with a specificity of 77%, a sensitivity of 72%, a positive value of 75%, a negative predictive value of 75%, and an accuracy of 75%. A stepwise logistic regression analysis of variables identified COP (odds ratio 9.97; 95% CI, 4.10–24.24, P < 0.0001) as an independent predictor for recurrence.

Conclusions: We conclude that the probability of recurrence of AF after cardioversion could be predicted by P‐SAECG. This method seems to be appropriate to demonstrate a delayed atrial conduction that might be a possible risk factor of reinitiation of AF.
Short QT Syndrome
Authors: Bjerregaard Preben , Gussak Ihor
Published: October 2005

Short QT syndrome (SQTS) is an inheritable primary electrical disease of the heart, discovered in 1999. It is characterized by an abnormally short QT interval (<300 ms) and a propensity to atrial fibrillation and sudden cardiac death (SCD). Like in the case of long QT syndrome there is more than one genetic mutation that can lead to a short QT interval in the ECG and so far two have been identified. Shortening of the effective refractory period combined with increased dispersion of repolarization is the likely substrate for reentry and life threatening tachyarrhythmias. Only 22 people have been classified as having SQTS: 15 from the actual measurement of a short QT interval in their ECG and 7 by history, all having died from SCD. It is very likely that several cases, especially among children, have been overlooked, since the shortness of the QT interval only becomes apparent at heart rates <80 beats/min. The best form of treatment is still not known, but prevention of atrial fibrillation has been accomplished by propafenone, and an implantable cardioverter defibrillator is recommended for prevention of SCD.
Relationship of the Implantable Cardioverter Defibrillator and Chronic Resynchronization Therapy: The Perfect Marriage?
Authors: Cannom David S. , Mower Morton
Published: October 2005

Background: The two major modes of death in the patient with a reduced ejection fraction (EF) are death due to heart failure and death due to lethal arrhythmia, essentially the two sides of the same coin. Over the last 20 years, two therapies—cardiac resynchronization therapy (CRT) and the implantable cardioverter defibrillator (ICD)—have been developed and tested in clinical trials. They are now, in conjunction with appropriate medical therapy, the mainstays of therapy for these two commonly encountered clinical problems.

Method and Results: Both of these therapies were conceived and patented by two Baltimore cardiologists, Michel Mirowski and Morton Mower (Table I). The path to everyday acceptance of both therapies was remarkably similar. The concept and early success of both devices was accomplished but the proof of concept depended on a series of carefully designed randomized clinical trials that showed that both the CRT and ICD devices saved lives in the low EF population, especially when used together. These trials overcame substantial skepticism on behalf of elements of the cardiology and electrophysiology establishment.

Mirowski/Mower Legacy of Pivotal Therapies

ICD
CRT

Concept
1970
Mid 1970s

Patent
1971
1990

First implant
1981
1991

FDA/CMS approval
1984
2004

Pivotal trials
MADIT I & II
COMPANION

SCD‐HeFT
CARE‐HF

AVID

CIDS

ICD = implantable cardioverter defibrillator; MADIT = Multicenter Automatic Defibrillator Implantation Trial; COMPANION = Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure; SCD‐HeFT = Sudden Cardiac Death in Heart Failure Trial; AVID = Antiarrhythmics versus Implantable Defibrillator; CIDS = Canadian Implantable Defibrillator Study.

Conclusion: We are now at a crossroads in the further extension of either therapy. The majority of the indications for either device alone or in combination are established. In the next few years, assuming the continued commitment on the part of regulatory agencies to fully embrace evidence‐based medicine, we will see indications extended but only by the careful clinical trials that became the bedrock of their initial acceptance.
Cost‐Effectiveness of Implanted Defibrillators in Young People with Inherited Cardiac Arrhythmias
Authors: Goldenberg Ilan , Moss Arthur J. , Maron Barry J. , Dick Andrew W. , Zareba Wojciech
Published: October 2005

Background:The implanted cardioverter‐defibrillator (ICD) has been shown to improve survival in adult patients with high risk acquired cardiac disease, with a cost‐effectiveness ratio in the range of $30,000 to $185,000 per quality‐adjusted‐life‐year saved. However, data on the benefit and cost‐effectiveness of device therapy in high‐risk patients with inherited cardiac disorders are limited.

Methods:We developed two separate computer‐based analytical models to compare non‐ICD with ICD therapy in patients (age range: 10–75 years) with long QT syndrome (LQTS) and hypertrophic cardiomyopathy (HCM). In each disease entity patients were stratified into low‐risk (no known risk factors); high‐risk (known risk factors [primary prevention]); and very high‐risk (prior near‐fatal events [secondary prevention]). Net costs were defined as the difference between costs resulting from treatment of the disease and savings due to gained productivity attributable to prevention of sudden cardiac death. Outcome was defined as costs per quality‐adjusted life‐years saved.

Results:In LQTS, defibrillator therapy was shown to be cost effective in high‐risk male patients (incremental cost‐effectiveness ratio [ICER]=$3328 per quality‐adjusted‐life‐year saved), and cost saving in high‐risk females (ICER =$7102 gained per quality‐adjusted‐life‐year saved) and very high‐risk males and females (ICER =$15,483 and 19,393 gained per quality‐adjusted‐life‐year saved, respectively). In HCM, defibrillator therapy was cost saving in both male and female high‐risk (ICER =$17,892 and $17,526 gained per quality‐adjusted‐life‐year saved, respectively) and very high‐risk (ICER =$22,944 and $22,329 gained per quality‐adjusted‐life‐year saved, respectively) patients. Defibrillator therapy was not shown to be cost effective in low‐risk patients with either LQTS or HCM (ICER in the range of $400,000 to $600,000 lost per quality‐adjusted‐life‐year saved). Sensitivity analyses were consistent with the results in each risk group.

Conclusions:In appropriately selected patients with inherited cardiac disorders, early intervention with ICD therapy is cost‐effective to cost saving due to added years of gained productivity when the lifespan of an individual at risk is considered.
CRT‐D Therapy in Patients with Left Ventricular Dysfunction and Atrial Fibrillation
Authors: Pelosi Frank , Morady Fred
Published: October 2005

The number of patients with atrial fibrillation and congestive heart failure has steadily increased in the United States. The presence of atrial fibrillation increases morbidity and mortality for patients with left ventricular dysfunction. The emergence of cardiac resynchronization therapy to improve symptoms and survival from congestive heart failure may provide benefits for those with atrial fibrillation; we review the pathophysiology of atrial fibrillation in the presence of left ventricular dysfunction and the promise of cardiac resynchronization therapy to improve symptoms for the for these patients.
Cardiac Resynchronization Therapy: The MGH Experience
Authors: Singh Jagmeet P. , Ruskin Jeremy N.
Published: October 2005

Cardiac resynchronization therapy (CRT) has gained acceptance as a useful form of device therapy for patients with refractory congestive heart failure. Despite recent technical advances, a significant number of patients continue to remain unresponsive to this form of therapy. This article provides an overview of CRT, highlights several unresolved issues and describes ongoing research efforts to address some of these important questions.
Cardiac Resynchronization—A Heart Failure Perspective
Authors: Rivera Dee Ann , Bristow Michael R.
Published: October 2005

Over the past 15–20 years the development of new heart failure pharmacologic therapy has lowered mortality by 30–40% for this serious and prevalent clinical syndrome, within clinical trials conducted in patients with a dilated cardiomyopathy phenotype. However, over the past 5 years progress in the development of additional effective drugs has slowed, in part due to the success of neurohormonal inhibitors, on which background new therapies must be developed. That there is not an absolute ceiling on the development of new heart failure therapies has been convincingly recently demonstrated in electrophysiologic device trials, conducted on the background of maximal neurohormonal inhibition. Two trials, COMPANION and CARE‐HF, have demonstrated unambiguously that in advanced heart failure patients with a marker of mechanical intraventricular dyssynchrony, increased QRS duration, cardiac resynchronization therapy in the form of biventricular pacing can improve major clinical outcomes including mortality. In addition, COMPANION also demonstrated that the addition of an ICD further improved mortality reduction, by lowering the incidence of sudden death. These trials indicate that device/drug therapy is at least additive in the treatment of heart failure, and they herald a new era in the multi‐modality approach to therapeutics.
Sourcing Iron Age softstone artefacts in southeastern Arabia: results from a programme of analysis using Inductively Coupled Plasma‐Mass Spectrometry/Optical Emission Spectrometry (ICP‐MS/OES)
Authors: Magee Peter , Barber Don , Sobur Marta , Jasim Sabah
Published: October 2005

Iron Age softstone vessels manufactured in southeastern Arabia are widely distributed across that region and in lesser amounts throughout Western Asia. Results from a pilot programme of analysis using Inductively Coupled Plasma Mass Spectrometry/Optical Emission Spectrometry on vessel fragments from two southeast Arabian sites are presented. These results indicate the existence of geochemically distinct groups that are separated by both transition metals and rare earth elements. While this indicates the potential for the application of the provenance postulate in softstone analysis, these promising results need to be further tested by an expanded programme of analysis which includes quarry fragments.
Arg452 substitution of the erythroid‐specific 5‐aminolaevulinate synthase, a hot spot mutation in X‐linked sideroblastic anaemia, does not itself affect enzyme activity
Authors: Furuyama Kazumichi , Harigae Hideo , Heller Tom , Hamel Ben C. J. , Minder Elisabeth I. , Shimizu Toru , Kuribara Tadao , Blijlevens Nicole , Shibahara Shigeki , Sassa Shigeru
Published: October 2005

Abstract: Mutations of the erythroid‐specific 5‐aminolaevulinate synthase (ALAS2) gene are known to be responsible for X‐linked sideroblastic anaemia (XLSA). An amino acid (AA) substitution for arginine at the 452 AA position of the ALAS2 protein is the most frequent mutation, which has been found in approximately one‐quarter of patients with XLSA. Despite its high frequency, there has been no report on the enzymatic activity of Arg452 mutant proteins. In this study, we examined enzymatic activity in vitro of two Arg452 mutants, Arg452Cys and Arg452His, which were found in two new pedigrees of XLSA. While these mutations must be responsible for the clinical phenotype of XLSA in patients, the enzymatic activity and stability of these mutant proteins studied in vitro are indistinguishable from those of the wild type protein. These findings suggest that the Arg452 mutation of the ALAS2 gene by itself does not decrease the enzymatic activity or the stability in vitro, and that there may be an additional factor(s) in the bone marrow, which ensures the full ALAS2 activity in vivo.
Serum insulin‐like growth factor is not elevated in patients with early B‐cell chronic lymphocytic leukemia but is still a prognostic factor for disease progression
Authors: Molica Stefano , Vitelli Gaetano , Mirabelli Rosanna , Digiesu Giovanna , Giannarelli Diana , Cuneo Antonio , Ribatti Domenico , Vacca Angelo
Published: October 2005

Abstract:  Objectives: Insulin‐like growth factor 1 (IGF‐1) is an important growth and anti‐apoptotic factor for the cancer cells in several malignancies and in multiple myeloma recent studies support the hypothesis of a role for IGF‐1 in disease progression; however, clinico‐biological relevance of IGF‐1 was never studied in B‐cell chronic lymphocytic leukemia (CLL). Patients and methods: Using a quantitative sandwich immunoassay technique (ELISA) (Quantikine®, Human IGF‐1 and IGFBP‐3, R&D Systems), we measured the concentration of IGF‐1 and its major binding protein IGF‐binding protein 3 (IGFBP‐3) in serum drawn at the time of diagnosis from 77 Binet stage A CLL patients. Results: Either IGF‐1 or IGFBP‐3 were significantly decreased compared with healthy age‐ and sex‐matched controls (P < 0.0001 for both; Mann–Whitney test). Serum levels of IGF‐1 and IGFBP‐3 paralleled each other (P = 0.002); in contrast, no significant correlation was found between serum levels of IGF‐1 and clinico‐hematological variables including age (P = 0.253), sex (P = 0.270), Rai clinical substages (P = 0.140), lactate dehydrogenase (P =0.956), β2‐microglobulin (P = 0.368), lymphocyte count (P = 0.703) and lymphocyte doubling time (LDT, P = 0.233). When correlation were attempted with circulating levels of angiogenic cytokines such as vascular endothelial growth factor (P = 0.971), basic fibroblastic growth factor (P = 0.695), angiogenin (P = 0.282) or adhesion molecules such as vascular cell adhesion molecule‐1 (P = 0.318), intercellular adhesion molecule‐1 (P = 0.883) and platelet endothelial cell adhesion molecule‐1 (P = 0.772) similar results were found. Serum levels of IGF‐1 were further evaluated as a dichotomous variable with respect to progression‐free survival (PFS), an endpoint surrogate for overall survival in early B‐cell CLL. The best separation of curves was seen with the cutoff point at the 75th percentile of IGF‐1 levels (i.e., 93 pg/mL). Median PFS was 63 months in the patient group with low IGF‐1, compared with a median PFS of 40 months in the remaining patients (P = 0.03). In the multivariate analysis performed including variables significant at univariate analysis [i.e. Rai substage (P = 0.002); LDT (P = 0.004), IGF‐1 (P = 0.01)], only Rai substage retained prognostic significance (P = 0.006). However, after removing from analysis LDT (only six of 77 had an LDT < 12 months), either IGF‐1 or Rai substage entered the model at a significant level (P = 0.03 and P = 0.01, respectively). Conclusions: IGF‐1 did not correlate with markers of tumor burden or clinical status in CLL thus suggesting that levels of this cytokine do not reflect the intrinsic malignancy of disease. Results of the present study highlight, however, its involvement in mechanisms of disease progression in early CLL.
Infectious episodes before and after a marathon race
Authors: Ekblom B. , Ekblom Ö. , Malm C.
Published: October 2005

The aim of this study was to investigate the incidence of self‐reported infectious episodes (IE) during 3 weeks before (pre‐IE) and 3 weeks after (post‐IE) a marathon race and relate these figures to training status, running time, socioeconomic and demographic factors. Two questionnaires, including questions about important factors for IE incidence, were given to a representative cohort of 1694 runners (17% of all finishers) in the Stockholm Marathon 2000.

Pre‐IE incidence in the cohort was 17% with no difference between women and men. Post‐IE incidence in the whole cohort was 19% with no significant (P>0.05) difference between women and men. The post‐IE incidence in runners without a pre‐IE was 16% (P>0.05 to pre‐IE incidence). In the group of runners with pre‐IE, 33% experienced an IE after the race also (P<0.05 to Pre‐IE incidence). A logistic regression analysis showed that younger age and pre race health status and, for men only, experienced nausea during and after the race were depended factors explaining post‐IE incidence. Younger runners were more prone to experience IE both before and after the race. There was no relation between training volume 6 months before the race, finishing time and socioeconomic and demographic factors and pre‐IE or post‐IE.

This study does not support the theory of increased infection rate after exhaustive long‐distance running (“The Open Window Theory”) in recreational runners, but suggests that the sometimes experienced increased rate of infections among athletes can be caused by strenuous exercise too soon after an infection.
Progressive resistance training temporarily alters hamstring torque–angle relationship
Authors: Kilgallon M. , Donnelly A. E. , Shafat A.
Published: October 2005

To examine the effects of eccentric and concentric progressive resistance training on muscle torque–angle relationship, 30 young adults were randomly allocated into three groups of 10, control (CTL), eccentric training (ECC) and concentric training (CON). The ECC and CON groups performed seven sessions over 3 weeks of progressive resistance training of the right hamstrings muscle, using a standard barbell and a leg curl machine. Torque–angle relationship was measured before and 4, 11 and 18 days after the end of training. Voluntary isometric torque was recorded at seven test angles, with the subject prone (20–80°; 0° is full extension). In the CON group, the angle of peak isometric torque increased from 46.0±5.2° pre‐training to 53.0±14.9° on day 4 following training (P<0.05). In the ECC group, peak torque was increased over baseline on days 4 and 11 post‐training, particularly at extended knee angles (P<0.05). The angle at which peak torque occurred was decreased on day 4 (50.0±8.2° pre‐training, 29.0±7.4° on day 4) and on day 11 (both P<0.01), but was similar to baseline 18 days after training. ECC therefore induced a temporary change in torque–angle relationship.
Effect of stretching on agonist–antagonist muscle activity and muscle force output during single and multiple joint isometric contractions
Authors: McBride J. M. , Deane R. , Nimphius S.
Published: October 2005

Eight moderately active male subjects where tested for peak force in an isometric knee extension test and peak force and rate of force development in an isometric squat test. Both tests where performed at a 100° knee angle and average integrated electromyography (IEMG) was measured from the vastus medialis (VM), vastus lateralis (VL) and biceps femoris (BF) muscles. Subjects performed the two conditions, stretching (S) or control (C) in a randomized order. Subjects where tested for baseline strength measures in both the isometric knee extension and isometric squat and then either stretched or sat quietly for 10 min. Following S or C subjects where then tested at six time points. Following S peak force in the isometric knee extension was significantly (P≤0.05) less than C at 1, 2, 8 and 16 min post. No significant difference in peak force was found between S and C in the isometric squat. However, following S the rate of force development in the isometric squat was significantly less than C at immediately post. No significant differences where observed in IEMG of the VM or VL between S and C in either the isometric knee extension or isometric squat. However, IEMG significantly decreased in the BF at 1 min post after S in comparison with C in both the isometric knee extension and isometric squat. Stretching appears to decrease muscle force output in a single joint isometric contraction and rate of force development in a multiple joint isometric contraction. Possible changes in agonist–antagonist muscle activity patterns need to be further examined.
Effects of an intermittent exercise fatigue protocol on biomechanics of soccer kick performance
Authors: Kellis E. , Katis A. , Vrabas I. S.
Published: October 2005

The purpose of this study was to examine the effects of fatigue on biomechanical indices of soccer kick performance. Ten male amateur soccer players performed maximal instep kicks prior to, in the middle and after the implementation of a 90 min intermittent exercise protocol. Three‐dimensional data, ground reaction forces (GRFs) and segmental moments were measured during the kick while blood lactate and ammonia concentrations were monitored throughout the protocol. Analysis of variance designs with repeated measures indicated a significant increase in ammonia (P<0.01) and lactate levels (P<0.01) following fatigue. The GRFs and joint displacement curves during the kick remained unaltered after fatigue (P>0.01). However, post‐fatigue maximum angular velocity of the shank, the net moments acting on the shank and the resultant joint moments were significantly lower compared with the corresponding pre‐exercise values (P<0.01). The velocity of the ball was 24.69 m/s prior to the protocol and significantly decreased to 21.78 m/s after (P<0.01). Similarly, the ball/foot speed ratio significantly (P<0.01) declined from 1.40±0.12 (pre‐fatigue) to 1.33±0.18 (post‐fatigue). The present results suggest that an exercise protocol that simulates soccer game conditions results in significant impairment of soccer kick performance. This could be attributed to alterations of the function of the neuromuscular system and force generation capacity, which may have altered the mechanics of soccer kick performance.