bluuebunny/crossref_metadata_2025_split huggingface dataset:
“Globals” and the American Dream: A Survey of Student Aspirations in an American Studies Course
Authors: Hauhart Robert C. , Birkenstein Jeff 
Published: January 2013

AbstractThe American Dream is a powerful ideology that generates overwhelming support from our fairly typical group of American college students. In order to examine this phenomenon more carefully, we conducted a qualitative study of our team-taught, interdisciplinary undergraduate course, entitled “Chasing the American Dream.” Answers to an in-class student survey over two semesters confirmed and enlarged our understanding of the nature of The American Dream. We believe that the Dream seems to achieve its effect in part by its high level of abstraction and generality. Thus, the American Dream is, effectively, an empty basket into which any American can place his/her hopes and aspirations. One can, for example, conceive of an entirely traditional domestic American Dream or one can re-conceive of a twenty-first century globalist Dream. As one breaks down the level of abstraction, generality, and mystery regarding the Dream concept, the support for various features of the Dream—as well as one’s likely success in achieving the Dream—becomes less strong.
Impact of modifying priming components and fluid administration using miniaturized circuitry in neonatal cardiopulmonary bypass
Authors: Darling Edward , Harris-Holloway Sandra , Kern Frank H , Ungerleider Ross , Jaggers James , Lawson Scott , Shearer Ian 
Published: January 2013

Following a succession of changes in circuitry and priming additives between 1993 and 1998, a comprehensive re-evaluation of neonatal cardiopulmonary bypass (CPB) practice was undertaken. Samples from 10 infants (Group 1) undergoing CPB were evaluated for osmolality, oncotic pressure, total protein, hematocrit, glucose, and electrolytes (Na+, K+, iCa2+). These samples were tested at six measurement points: (1) after priming, (2) patient pre-CPB, (3) CPB-start, (4) CPB-mid, (5) CPB-end, and (6) post-modified ultrafiltration (MUF). Prime volumes were also carefully measured as well as the type and amount of volume given during CPB. After evaluating the initial data, changes in protocol regarding mannitol, calcium correction, and oncotic strength on CPB were made. Following implementation of these protocol changes, a second set (Group 2) of 10 infants was identically evaluated. Group 1 prime osmolality was 379 ± 44 mOsm/kg, while Group 2 prime osmolality was 324 ± 14 mOsm/kg ( p = 0.003). There were no differences in osmolality between groups during bypass and osmolality was unaffected by modified ultrafiltration. Ionized calcium levels were significantly different at the end of bypass between Group 1, 0.6 ± 0.1 mmol/l; and Group 2, 1.17 ± 0.24 mmol/l ( p < 0.001). In Group 1, there was a 40% drop ( p = 0.001) in colloid osmotic pressure (COP) levels from pre-CPB (13.3 ± 3.4 mmHg) to CPB-end (8.8 ± 1.2 mmHg). In Group 2, there were no differences in COP during CPB. COP levels of Group 1 and Group 2 at CPB-end were 8.8 ± 1.2 mmHg and 14 ± 1.9, respectively ( p < 0.0001). Total volume addition during bypass for Group 1 was 363.5 ± 148.7 ml and for Group 2 was 245.1 ± 92.2 ml ( p < 0.05). In conclusion, progressive changes in neonatal circuits and techniques can have potentially wide-ranging effects on electrolyte and osmotic/oncotic homeostasis. An audit of perfusion management through expanded laboratory tests is recommended, especially in periods of change.
A retrospective study on perfusion incidents and safety devices
Authors: Mejak Brian L , Stammers Alfred , Rauch Eric , Vang See , Viessman Tom 
Published: January 2013

Despite the acceptance of extracorporeal circulation as an effective modality to facilitate cardiac surgery, patient outcomes can be negatively influenced by the occurrence of perfusion incidents. A perfusion survey was conducted to identify safety techniques and incidents related to cardiopulmonary bypass (CPB). An 80-question survey was mailed to chief perfusionists of all 1030 USA cardiac surgical centers using CPB. The survey was designed to examine practices and incidents that occurred during a 2-year period (July 1996 to July 1998). Five-hundred-and-fifty-two (54% response rate) surveys were returned, which accounted for 797 hospitals (79% of all cardiac centers) and 653 621 surgical procedures. Of the 27 identified CPB safety devices, the highest utilization was arterial line filters (98.5%) and the lowest arterial line bubble traps (3.4%). Of the reported cases, a CPB incident occurred once every 138 cases. The most common occurring incidents were protamine reactions (1:783), coagulation problems (1:771), and heater/cooler failures (1:1809). The rate of occurrence of an incident resulting in a serious injury or death was one for every 1453 procedures. Although techniques and safety devices create a relatively secure environment for CPB, lower incident rates may be achieved with further improvements in coagulation monitoring and incident reporting.
Endotoxin in pooled pericardial blood contributes to the systemic inflammatory response during cardiac surgery
Authors: Spanier Talia , Tector Kelly , Schwartz Graham , Chen Jonathan , Oz Mehmet , Beck James , Mongero Linda 
Published: January 2013

Although endotoxin has been implicated as an important contributor to the systemic inflammatory response (SIR) during cardiopulmonary bypass (CPB), its source remains unclear. While gut translocation has traditionally been perceived as the primary source of endotoxemia, accumulation of endotoxin in pooled pericardial blood may represent an additional source of endotoxin that is continually reinfused into the CPB circuit. Eighteen patients undergoing primary coronary revascularization procedures were prospectively evaluated. Shed blood pooled in the pericardial space was returned to the CPB circuit through cardiotomy suction catheters at 45 min after placement of the aortic crossclamp. Simultaneous samples of pooled pericardial and peripheral arterial blood were obtained and analyzed by a limulus amebocyte lysate assay for the determination of endotoxin concentration, and an enzyme-linked immonosorbert assay for tumor necrosis factor (TNF-α) levels. Significant elevations in endotoxin were demonstrated in pooled pericardial blood samples compared with arterial blood (3.5 ± 0.5 vs 0.8 ± 0.2 pg/ml; p < 0.05). TNF-α levels were below the limits of detection in both samples. These data implicate pooled pericardial blood as an important primary source of endotoxin that, when continually reinfused throughout CPB, may contribute to the overall SIR. Because endotoxemia has been identified as an important predictor of adverse outcomes following cardiac surgery, removal of endotoxin antigen in shed pericardial blood, prior to its reinfusion into the CPB circuit, may provide a directed means to improve perioperative outcome without compromising established blood conservation techniques.
The impact of normothermia on the outcome of aortic valve surgery
Authors: Tosson R , Buchwald D , Klak K , Laczkovics A 
Published: January 2013

The purpose of this study was to examine the effects of systemic perfusion temperature on the clinical outcome after aortic valve surgery. In this study, we examined 323 patients who underwent aortic valve surgery between January 1994 and April 1996. Forty-six patients were perfused in moderate hypothermia (28°C) and 277 patients in normothermia. Age and sex distribution of the patients were similar. There were no statistically significant differences between the groups regarding neurological, renal or cardiac complications. Patients in hypothermia required less catecholamine at the end of the operation ( p 0.00001), but there was no significant difference in the length of the stay in the intensive care unit between the groups. Cardiopulmonary bypass temperature did not influence early outcome after aortic valve surgery.
Autotransfusion in cardiac surgery
Authors: Cross M H 
Published: January 2013

There are a number of problems with allogeneic blood transfusion. Some of these problems are defined and can be quantified, such as the problem of rising cost or the risk of viral infection, but some of the problems are not well defined and it is only outcome data that point to allogeneic blood transfusion contributing to patient mortality and morbidity. Autotransfusion includes any technique in which the patient’s own blood is collected, processed and stored, followed by reinfusion when circumstances dictate. In the perioperative period of cardiac surgery, a number of techniques are recognized as useful in this context. Preoperative autologous donation, with or without erythropoietin supplementation, intraoperative acute normovolaemic haemodilution, intraoperative cell salvage, postoperative cell salvage (reinfusion of shed mediastinal blood) and platelet rich plasmapheresis are all techniques which are used with more or less enthusiasm to reduce the need for an allogeneic blood transfusion. Modification of the priming technique of the cardiopulmonary bypass circuit using an autologous blood prime is included in this review even though it does not fall strictly within the definition of autotransfusion. Although autotransfusion is not the answer to every problem, there is no doubt that it should play a significant part in the strategy of blood conservation.
Preoperative versus postoperative extracorporeal life support in neonatal cardiac patients
Authors: McKay Victor J , Stewart Dan L , Robinson Tonya W , Cook Larry N , Austin Erle H 
Published: January 2013

The aim of this study is to document our experience with the use of extracorporeal life support (ECLS) in the neonatal cardiac patient, to detect differences in the morbidity and mortality between patients who required ECLS preoperatively and those who required ECLS postoperatively, and to determine the long-term effects of these morbidities. A chart review was undertaken of all neonatal cardiac patients who required ECLS between May 1985 and July 1994 at Kosair Children’s Hospital, Louisville, Kentucky. Twenty-three neonatal cardiac patients had received preoperative or postoperative ECLS with an overall survival rate of 35%. Our preoperative and postoperative patients had similar demographics, diagnoses, decannulation rates and survival rates. However, patients receiving postoperative ECLS more frequently required more than two inotropes ( p < 0.001), had an increased incidence of renal failure ( p < 0.02), had more central nervous system abnormalities on brain imaging studies ( p < 0.004), and had a longer hospital stay ( p < 0.05). Follow-up testing of survivors yielded normal Bayley Scale of Infant Development (BSID) scores in half of the patients. Survival in the two groups was similar, but a significant difference in morbidity was found. Except for severe intracranial abnormalities, the morbidity was shown to be reversible on follow-up examination. We recommend the continued use of ECLS for neonatal cardiac patients who require preoperative or postoperative support even when severe renal failure ensues or minor abnormalities are detected on brain imaging studies.
Clinical evaluation of the new Pall leucocyte-depleting blood cardioplegia filter (BC1)
Authors: Heggie A J , Corder J S , Crichton P R , Hesford J W , Bingham H , Jeffries S , Hooper T L 
Published: January 2013

It is now widely acknowledged that autologous leucocytes are inappropriately activated during cardiopulmonary bypass (CPB). Removal of these activated leucocytes has been proposed as a clinical intervention. Several papers have recently reported benefits of systemic leucocyte depletion during CPB. There is also evidence that leucocyte-depleted blood cardioplegia is advantageous in the globally ischaemic human heart transplant setting. Recently, a new leucocyte-depleting filter for blood cardioplegia has been developed (Pall, BC1). In this paper, we report on the safety and efficiency of this device in the clinical situation. Fourteen patients undergoing routine cardiac surgery were recruited into this study. The BC1 blood cardioplegia filter was found to be an efficient leucocyte-depleting device, removing in excess of 70% ( p = 0.001) of white blood cells, on average, from up to 5.3 litres of blood cardioplegia. The filter removed a small proportion of platelets (typically 11.3%), however, this was not statistically significant and no bleeding problems were encountered. Red cell removal was negligible and was not statistically significant, and no evidence of haemolysis was noted. The filter offered a very low resistance to flow with a mean pressure drop (Δ P) of 10.8 mmHg at a mean flow rate of 315 ml/min. We conclude that the Pall BC1 filter is a safe and efficient device for use with blood cardioplegia.
Comparison of three plasma expanders used as priming fluids in cardiopulmonary bypass patients
Authors: Tigchelaar Izaak , Huet Rolf CG Gallandat , Boonstra Piet W , van Oeveren Willem 
Published: January 2013

Ten per cent low molecular weight hydroxyethyl starch is a plasma substitute only recently used as priming solution in an extracorporeal circuit, in contrast to human albumin and gelatin. To evaluate the effect of priming solutions on haemodynamics and colloid osmotic pressure, we studied 36 patients elected for cardiopulmonary bypass (CPB). They were randomly assigned to 2.5% hydroxyethyl starch, 3% gelatin or 4% human albumin priming solution. Total blood loss (perioperative + intensive care unit period) was higher in the gelatin group than in the albumin and hydroxyethyl starch groups. During CPB, the colloid osmotic pressure was best preserved in the gelatin group, although no excessively low colloid osmotic pressures were measured in the other two groups. Due to the extended half-life and the additional postoperative colloid administration, the hydroxyethyl starch group had a higher colloid osmotic pressure in the postoperative phase. We conclude that, next to human albumin, 2.5% hydroxyethyl starch is a safe CPB priming solution additive and is effective as plasma substitute. Its somewhat longer half-life requires adaptation of the routine protocol for transfusion of colloids and blood products.
Expression of soluble endothelial adhesion molecules in clinical cardiopulmonary bypass
Authors: Galea Joseph , Rebuck Naomi , Finn Adam , Manché Alex , Moat Neil 
Published: January 2013

Soluble endothelial adhesion molecule expression in clinical cardiopulmonary bypass (CPB) was investigated. Neutrophil-mediated endothelial injury plays an important role in CPB-induced organ dysfunction. The adhesion of neutrophil to the endothelium is central to this process. It has been well documented that CPB induces neutrophil activation and changes in neutrophil adhesion molecule expression, but the effect of CPB on endothelial cell activation is not known. This study was designed to measure soluble endothelial adhesion molecules during CPB. We made serial measurements (by specific enzyme-linked immunoabsorbent assay) of plasma levels of the soluble endothelial adhesion molecules, ICAM-1 and E-selectin in patients undergoing routine CPB ( n =7) and in a control group (thoracotomy, n = 3). The results show an initial significant decrease during CPB followed by an increase in plasma E-selectin from 29.3 ± 5.1 ng/ml (mean ± SEM) prebypass to 34.0 ± 5.4 ng/ml at 48 h postbypass. Likewise, plasma ICAM-1 significantly decreased during CPB and then increased from 246.3 ± 38.0 ng/ml before bypass to 324.8 ± 25.0 ng/ml and 355.0 ± 23.0 ng/ml at 24 and 48 h after bypass, respectively. The rise in levels is statistically significant ( p < 0.05). This study shows a decrease in circulating ICAM-1 and soluble E-selectin during CPB and an increase in their levels at 48 h after CPB.
Inflammatory response to cardiopulmonary bypass using two different types of heparin-coated extracorporeal circuits
Authors: Baufreton Christophe , Moczar Madeleine , Intrator Liliane , Jansen Piet GM , te Velthuis Henk , Le Besnerais Paul , Farcet Jean Pierre , Wildevuur Charles RH , Loisance Daniel Y 
Published: January 2013

Previous reports have highlighted the disparity in biocompatibility of two differently engineered heparin coatings during the cardiopulmonary bypass (CPB) procedure. The aim of this prospective study was to evaluate the impact of the difference in haemocompatibility provided by either the Duraflo II equipment or the Carmeda equipment in the terminal inflammatory response observed after coronary artery surgery. Thirty patients were randomly allocated to two groups to be operated on using either Duraflo II equipment (group I) or Carmeda equipment (group 2) for extracorporeal circulation (ECC). Initial inflammatory response was assessed by terminal complement complex activation (SC5b-9). The late inflammatory response observed in the postoperative period was assessed by measuring cytokine production (tumour factor necrosis (TNFα), interleukin IL-6, interleukin IL-8) and circulating concentrations of adhesion molecules (ELAM-1, ICAM-1). The release of SC5b-9 after CPB and after protamine administration was lower in group 2 than in group 1 ( p = 0.0002 and p = 0.006, respectively). A significant production of cytokines was detected in both groups with peak values observed within the time range of 4-6 h after the start of CPB. However, no difference was observed between the groups except for the IL-8 level in group 2, which was lower 2 h after the start of CPB ( p = 0.01). Plasma levels of adhesion molecules were similar in both groups within the investigation period. Although the Carmeda equipment was more effective in reducing complement activation, the late inflammatory response was similar using either the Duraflo II or Carmeda equipment for extracorporeal circulation as reflected by the changes of cytokine and circulating adhesion molecule levels.
Clinical experience with the Sorin Monolyth Oxygenator at high altitude
Authors: Steinberg Carl , Dragan Robert 
Published: January 2013

High altitude combined with low barometric pressure can present unique challenges during cardiopulmonary bypass (CPB), not only for the perfusionist, but also for the oxygenator. Manufacturers of cardiopulmonary devices have responded to the requests from the perfusion community with a variety of oxygenators which balance low priming volumes and low pressure drops against high gas transfer. This paper will feature the first author’s clinical studies using the Sorin Monolyth Oxygenator in a selected group of patients at an altitude of approximately 5200 feet and an average barometric pressure of 634 mmHg (sea level is 760 mmHg). A review of the 47 charts on patients requiring CPB and who met the selection criteria was performed retrospectively. To qualify for this study, the patient needed to weigh more than 91 kg. The data reviewed included type of surgery, age, weight, bypass time, crossclamp time, pump flows (l/min/m2), hematocrits pre- and post-CPB, and pressure drop across the membrane. The PaO2, PaCO2, FiO2 and sweep gas flow at hypothermia and normothermia were recorded. Data concerning oxygen transfer were obtained from the manufacturer’s report to the Food and Drug Administration. All patients had adequate blood gases while on CPB. We feel that the design of the Sorin Monolyth Oxygenator met our criteria for an oxygenator: low priming volume, low pressure drop, and sufficient gas transfer to provide safe oxygenation of all patients at high altitude.
Assessing Student Pharmacist Impact on Patient Over-the-Counter Medication Selection
Authors: McConaha Jamie L. , Finoli Lauren M. , Heasley Jennifer E. , Lunney Philip D. 
Published: January 2013

Objective: To evaluate the financial and clinical outcomes of an over-the-counter (OTC) medication consultation performed by doctorate of pharmacy student pharmacists in a community pharmacy. Design: Cross-sectional survey. Setting: Independent and chain community pharmacy locations in Pittsburgh, Pennsylvania. Participants: Fourth professional year (PY4) advanced experiential student pharmacists on community rotations at the designated settings who performed OTC consultations and the participants of these encounters. Main Outcome Measured: Financial and clinical impact of an OTC consultation performed by student pharmacists on rotation. Results: A total of 559 OTC consultations were offered in 5 participating community pharmacy settings over a period of 1 year. Student pharmacists initiated 62.4% of all documented interactions and 60.5% of all participants accepted the consultation offer. The student pharmacists’ OTC recommendations resulted in significant cost savings to the participant. Those participants accepting consultation reported being more likely to consult with a pharmacist in the future. PY4 students were also able to demonstrate capability in impacting clinical outcomes on several occasions by implementing OTC medication changes due to patient safety concerns. Conclusion: Student pharmacist OTC consultations have the potential to positively impact both financial and clinical outcomes associated with the use of OTC medications.
Detection of Heavy Metals Concentration Due to Leather Tanning Industry and Prevalent Disease Pattern in Kasur, Pakistan
Authors: Abbas Moneeza , Rahman M. Atiq ur , Safdar Asma 
Published: January 2013

Leather tanning industry is the third largest export earning industry of Pakistan. Kasur is second largest leather producing city in Punjab. It is among Pakistan’s most contaminated cities due to discharge of highly toxic industrial effluent into open fields. This study aims to identify the level of toxicity of the soil in terms of heavy metals in different parts of Kasur city. Seventy (70) soil samples were collected from seven different locations including city centre, evacuated ponds and agriculture fields being fed with the recycled water from the wastewater treatment plant. In this study, the presence of three heavy metals, that is, Chromium (Cr), Manganese (Mn) and Nickel (Ni) were measured by using Atomic Absorption Spectrophotometer. The overall mean value of these metals (Cr 3.859 ± 0.510 mg/Kg, Mn 0.5243 ± 0.0691 mg/Kg and Ni 0.4759 ± 0.0318 mg/Kg, respectively) in Kasur was found higher as compared to control samples (Cr 0.2622 ± 0.033 mg/Kg, Mn 0.1701 ± 0.016 mg/Kg and Ni 0.1817 ± 0.021 mg/Kg, respectively). The results reflect that the areas which are in contact with tannery effluents have high levels of Cr, Mn and Ni as compared to other sites and control samples. It was seen that majority of the city population is facing diseases associated with drinking water, soil and air pollution caused by tanning industry.