bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long‐term evaluation of a new ventriculoperitoneal shunt valve system in a dog
Authors: Filgueiras Richard da Rocha , De Souza Martins Christine , De Almeida Ricardo Miyasaka , Silva Rosana Marques , De Souza Teixeira da Rocha Martha , De Paula Firmino Fernanda , Maguilnik Samara , Medeiros Luíza Quintão 
Published: November 2009

AbstractObjective
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To report on the use of a new ventriculoperitoneal shunt (VPS) valve system utilized in a dog with hydrocephalus and to describe the clinical course over 20 months after implantation.Case Summary
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A 3‐month‐old female Lhasa Apso dog was presented with lateral strabismus, domed calvarium, and visual deficits. A lateral skull radiograph revealed a persistent fontanelle. Transfontanellar ultrasonographic examination and computed tomographic examination showed excessive accumulation of fluid within the ventricles. The owner had observed symptoms as early as 1 month after birth, suggesting congenital hydrocephalus. A VPS with a new valve system that inhibits cerebrospinal fluid overdrainage and obstruction of the catheter was implanted. The dog showed clinical improvement 48 hours after the procedure. Twenty days after shunt implantation, another computed tomography scan was performed that showed reduction in ventricle size. The evaluation of VPS patency was carried out 20 months after surgery and demonstrated that the system was working properly without obstruction.New or Unique Information Provided
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There are reports in the literature describing the use of several devices to perform VPS in dogs. A new device not previously described in the veterinary literature was used in this case report, and according to the manufacturer's description, this device inhibits proteinaceous build‐up, which is usually responsible for subsequent catheter obstructions.
Late and Middle Weichselian stratigraphy of Andøya, north Norway
Authors: VORREN KARL‐DAG 
Published: November 2009

BOREAS Vorren, K.‐D. 1978 03 01: Late and Middle Weichselian stratigraphy of Andøya, north Norway, Boreas, Vol. 7, pp. 19–38. Oslo. ISSN 0300–9483.Bio‐stratigraphy and 14C datings from Lake Endletvatn, 69o 44'N and 19o05'E, approx. 35 m above sea level, suggest that the lacustrine sedimentation started about 18,000 B.P. The Middle Weichselian vegetation was probably a dry arctic, partly barren, grassland type with abundant Draba spp. and perhaps also Braya spp. Two climatic ameliorations of this chronal substage, named Endletvatn thermomers 1 and 2 (ET 1 and 2), have been recorded. During ET 2, the beginning of which has been dated at about 15,000 B.P., a humid climate prevailed, with a July temperature probably not deviating much from the present one. The colonization by low alpine and subalpine species probably started in the Bølling Chronozone. During the early Allerød Chronozone, protocratic conditions with grasses RumexlOxyria, Papaver and Sagina of. saginoides prevailed. During the middle of the Allerød, stable soil and continuous vegetation was established at sheltered places. At the transition to the Younger Dryas Chronozone a climate favouring Artemisia changed this vegetational development. The middle of the Younger Dryas was cool and humid, probably with an upper low alpine vegetation. The end of this chronozone was characterized by a vegetation of low alpine heaths with Empetrum and Dryas.Diatom analysis (Foged 1978) suggests that there has been no direct marine influence in the basin. The marginal moraine stratigraphy, the marine limit and the climatic development are discussed.
Fragments of a Middle Weichselian fauna on Andøya, north Norway
Authors: FJELLBERG ARNE 
Published: November 2009

BOREAS Fjellberg, A. 1978 03 01: Fragments of a Middle Weichselian fauna on Andøya, north Norway. Boreas. Vol. 7. p. 39. Oslo. ISSN 0300–9483.Presence of the chironomid Corynocera ambigua Zett. and the carnivore Mustela erminea L. on Andøya about 15,000 B.P. is suggested. The oribatide mite Trichoribates cf. setiger (Träg.) has been recorded in 17–18,000 years old sediments on Andøya.
Impact of Nursing Unit Turnover on Patient Outcomes in Hospitals
Authors: Bae Sung‐Heui , Mark Barbara , Fried Bruce 
Published: November 2009

Abstract Purpose: The aim of this study was to examine how nursing unit turnover affects key workgroup processes and how these processes mediate the impact of nursing turnover on patient outcomes. Methods: A secondary data analysis was used to test the hypothesized model. This study used registered nurse and patient data from 268 nursing units at 141 hospitals collected as part of the Outcomes Research in Nursing Administration (ORNA II) project. Nursing units provided monthly nursing unit turnover rates for 6 consecutive months, and registered nurses completed questionnaires measuring workgroup processes (group cohesion, relational coordination, and workgroup learning). Patient outcome measures included unit‐level average length of patient stay, patient falls, medication errors, and patient satisfaction scores. Results: Nursing units with moderate levels of turnover were likely to have lower levels of workgroup learning compared to those with no turnover (p<.01). Nursing units with low levels of turnover were likely to have fewer patient falls than nursing units with no turnover (p<.05). Additionally, workgroup cohesion and relational coordination had a positive impact on patient satisfaction (p<.01), and increased workgroup learning led to fewer occurrences of severe medication errors (p<.05). Conclusions: The findings of this study provide specific information on the operational impact of turnover so as to better design, fund, and implement appropriate intervention strategies to prevent registered nurse exit from nursing units. Further investigation is needed to assess the turnover‐outcomes relationship as well as the mediating effect of workgroup processes on this relationship. Clinical Relevance: Managing nursing unit turnover within appropriate levels at the nursing unit is critical to delivering high‐quality patient care.
An International Survey on Advanced Practice Nursing Education, Practice, and Regulation
Authors: Pulcini Joyce , Jelic Monika , Gul Raisa , Loke Alice Yuen 
Published: November 2009

Abstract Purpose: To describe international trends on the developing role of the nurse practitioner‐advanced practice nurse (NP‐APN), including nomenclature, levels and types of NP‐APN education, practice settings, scope of practice, regulatory policies, and political environment. Design: A cross‐sectional, descriptive Web‐based survey sent in February and March 2008 to a total of 174 key informants and active members of the International Nurse Practitioner‐Advanced Practice Nursing Network of the International Council of Nurses. Methods: An international Web‐based survey preceded by a pilot survey. Findings: Ninety‐one nurses from 32 countries responded. Thirteen titles were identified on nomenclature for the NP‐APN in different countries. NP‐APN education was available in 71% of the 31 countries responding to this item, with 50% identifying the master's degree as the most prevalent credential. Twenty‐three countries had formal recognition of the NP‐APN role. Of these, 48% had licensure maintenance or renewal requirements for the NP‐APN, with most requiring continuing education or clinical practice. The greatest support for the NP‐APN role came from domestic nursing organizations (92%), individual nurses (70%), and the government (68%), while opposition came primarily from domestic physician organizations (83%) and individual physicians (67%). Conclusions: Interest in the NP‐APN role has been gaining ground worldwide. This study presents a snapshot of education, practice, and regulation for NP‐APNs as they develop their unique role in delivering health care in various countries. Areas that may require more support are highlighted. Clinical Relevance: The NP‐APN role in healthcare systems is expanding and will benefit from international networking and support.
Regional Brain Atrophy Is Associated With Physical Disability in Multiple Sclerosis: Semiquantitative Magnetic Resonance Imaging and Relationship to Clinical Findings
Authors: Bakshi Rohit , Benedict Ralph H. B. , Bermel Robert A. , Jacobs Lawrence 
Published: November 2009

ABSTRACT Objectibe. Brain atrophy may occur early in the course of multiple sclerosis (MS) and may be associated with disability. Brain magnetic resonance imaging (MRI) of 114 MS patients (group A) were analyzed for regional atrophy (vs age‐/gender‐matched controls) and T1 and T2 lesions using 4‐point rating systems. Thirty‐five separate patients (group B) were analyzed for cortical atrophy (ordinal scale), third ventricular width, and total T2 hyperintense lesion volume (computer assisted). In group A, regression modeling indicated that inferior frontal atrophy (P= .0003) and T2 lesions in the pons (P= .02) predicted physical disability (Expanded Disability Status Scale [EDSS] score). Secondary progressive (SP) versus relapsing patients were predicted by inferior parietal (P= .002), superior parietal (P= .006), temporal (P= .008), inferior frontal (P= .01), superior frontal (P= .01), cerebellum (P= .01), occipital (P= .01), and midbrain (P= .02) atrophy. SP patients were also predicted by total atrophy (P= .01) and third ventricular enlargement (P= .03) but not T1 or T2 lesions. In group B, the regression model predicting EDSS score included only superior frontal atrophy (r= 0.515, P= .002). Mean kappa coefficients of ordinal ratings were 0.9 (intraobserver) and 0.8 (interobserver). Ordinal ratings correlated well with quantitative assessments. The authors conclude that brain atrophy is closely associated with physical disability and clinical course in MS patients and can be appreciated using a semiquantitative MRI regional rating system.
Use of Exponential Diffusion Imaging to Determine the Age of Ischemic Infarcts
Authors: Engelter S. T. , Provenzale J. M. , Petrella J. R. , Alberts M. J. , DeLong D. M. , MacFall J. R. 
Published: November 2009

ABSTRACT Objective. Diffusion‐weighted magnetic resonance imaging (DWI) detects acute ischemic infarcts with high lesion conspicuity. Determination of infarct age is difficult on DWI alone because infarct signal intensity (SIinfarct) on DWI is influenced by T2properties (“T2shine‐through”). Maps of the apparent diffusion coefficient (ADC) reflect pure diffusion characteristics without T2effects but have low lesion conspicuity. Thus, in clinical practice, combined use of DWI and ADC maps is required. Exponential DWI (eDWI) is an innovative means of MRI‐diffusion data analysis that merges the advantages of DWI and ADC maps. The authors hypothesized that SIinfarcton eDWI would correlate with infarct age. The authors studied 114 consecutive patients who had 120 ischemic strokes with clearly determined onset times and who underwent echo‐planar DWI. The eDWI were generated by dividing the signal intensity on DWI by that on the corresponding T2image on a pixel‐by‐pixel basis. SIinfarcton eDWI was measured in the lesion core and expressed as a percentage of contralateral control tissue. On eDWI, relative SIinfarctchanged significantly with infarct age (P < .0001). When patients were sorted in infarct‐age groups, no significant differences were found within the first 120 hours. However, for patients studied within 5 days, the mean relative SIinfarctwas significantly higher compared with patients studied ≥8 days after stroke (P < .05). For all infarcts up to 5 days old, the eDWI signal intensity was higher than control tissue (hyperintense appearance). All infarcts >10 days old had an eDWI signal intensity lower than control tissue (hypointense appearance). The authors concluded that the use of eDWI, as a single set of images, reliably differentiates acute infarcts (≤5 days old) from infarcts >10 days old. This feature would be expected to be helpful when the distinction between acute and nonacute infarction cannot be determined on clinical grounds.
Early Computed Tomography Hypodensity Predicts Hemorrhage After Intravenous Tissue Plasminogen Activator in Acute Ischemic Stroke
Authors: Dubey Neeraj , Bakshi Rohit , Wasay Mohammed , Dmochowski Jacek 
Published: November 2009

ABSTRACTParenchymal hypodensity is a proposed risk factor for hemorrhage after recombinant tissue plasminogen activator (TPA) thrombolysis for ischemic stroke. In Buffalo, NY, and Houston, TX, the authors reviewed 70 patients who were treated with intravenous TPA for acute middle cerebral artery (MCA) stroke. Two observers blinded to clinical outcome analyzed initial noncontrast head computed tomography (CT) scans. Basal ganglia CT hypodensity was quantitated in Hounsfield units (HUs). Contralateral‐ipsilateral difference in density was calculated using the asymptomatic side as a control. Ictus time to TPA averaged 2.5 hours. Six patients developed symptomatic intraparenchymal hematomas (2 fatal). The hemorrhage group had more severe basal ganglia hypodensity (mean 7.5 ± 1.4, range 6–10 HU) than the nonhemorrhage group (2.2 ± 1.4, range 0–9 HU) (P < .0001). The hemorrhage group had hypodensity of > 5 HU; the nonhemorrhage group had hypodensity of ≤4 HU, except 1 patient with hypodensity of 9 HU. In predicting hemorrhage, the positive predictive value of hypodensity > 5 HU was 86%; the negative predictive value was 100%. Prethrombolysis NIH Stroke Scale (NIHSS) deficit (P= .0007) and blood glucose (P= .005) were also higher in the hemorrhage group. Age, gender, smoking, hypertension, and ictus time to TPA infusion did not differ between the 2 groups. Logistic regression indicated that basal ganglia hypodensity was the best single predictor of hemorrhage. Hypodensity and NIHSS score together predicted all cases of hemorrhage. The authors conclude that basal ganglia hypodensity quantified by CT may be a useful method of risk stratification to select acute MCA stroke patients for thrombolytic therapy.
Reproducibility of Proton Magnetic Resonance Spectroscopy Imaging Measurements of Normal Human Hippocampus at 1.5 T: Clinical Implications
Authors: Maton B. , Londono A. , Sawrie S. , Knowlton R. , DenHollander J. , Kuzniecky R. 
Published: November 2009

ABSTRACTThe authors investigate the reproducibility of metabolite signals measured with proton magnetic resonance spectroscopy1H‐MRS) acquired from the human hippocampus in controls and in a phantom. Two1H‐MRS studies separated by 3 weeks were performed in 8 healthy volunteers and in a phantom. N‐acetyl compounds (NA), choline (Ch), and creatine (Cr) peak areas and ratios were measured and compared using percentage variation, and Pearson Correlation Coefficient at the level of every voxel, the level of 1 hippocampus (5 voxels), and the level of 2 hippocampi (10 voxels). Sensitivity for observing clinically significant between‐session1H‐MRS changes was evaluated using the reliable change index. Reproducibility measures for metabolite peak areas were only moderately concordant with percentage variation ranging from 14% to 20% for NA, Cho, and Cr. Stability was much improved when NA ratios and sum of multiple voxels were considered. Between‐session NA/(Cho + Cr) changes greater than 22%, 12%, and 10% in one given participant can be detected with a 90% confidence interval when considered at the single‐voxel level, the level of a single hippocampus, or the level of both hippocampi, respectively. Left‐right asymmetry indices showed similar and limited interhemispheric asymmetry in repeated examination. This study suggests that1H‐MRS reproducibility performance is adequate for the study and monitoring of human hippocampus function when NA ratios and the sum of multiple voxels are considered. Individual metabolite peaks and single‐voxel measurements have low reproducibility at 1.5 T and should be used only with clearly established statistical parameters.
Possible Short‐term Amelioration of Basilar Plaque by High‐Dose Atorvastatin: Use of Reductase Inhibitors for Intracranial Plaque Stabilization
Authors: Callahan A. S. , Berger Brian L. , Beuter Matthew J. , Devlin Thomas G. 
Published: November 2009

ABSTRACTRegression of symptomatic intracranial atherostenosis is not known to be a common occurrence. In this case, delay of basilar reconstruction by endovascular means permitted serial angiographic assessment of plaque change. The use of high‐dose atorvastatin over a 2‐week period was associated with marked angiographic improvement. Medical programs of plaque stabilization may provide adjunctive benefit in patients with symptomatic intracranial disease.
In Vivo 1H Magnetic Resonance Spectroscopic Measurement of Brain Glycine Levels in Nonketotic Hyperglycinemia
Authors: Gabis Lidia , Parton Patricia , Roche Patricia , Lenn Nicholas , Tudorica Alina , Huang Wei 
Published: November 2009

ABSTRACTNonketotic hyperglycinemia (NKH) is an autosomal recessive disorder of glycine metabolism. Defective glycine cleavage causes elevated concentrations of glycine in plasma, urine, and cerebrospinal fluid. A longitudinal study using magnetic resonance imaging (MRI) and single‐voxel1H magnetic resonance spectroscopy (MRS) was performed on an infant with the typical clinical picture of NKH. He was examined twice during the course of treatment with sodium benzoate and dextromethorphan. At the age of 10 months, MRI showed normal brain structure, while MRS detected a prominent glycine peak in the brain. Repeat MRS at the age of 13 months showed a small increase in glycine peak and a prominent glutamate/glutamine peak not previously detected. The MRS measurements were consistent with the slight increase in blood glycine level and the elevation in glutamine level, indicating that1H MRS can be a valuable tool in the diagnosis and monitoring of treatment effects in patients with NKH.
A Broad Diagnostic Battery for Bedside Transcranial Doppler to Detect Flow Changes With Internal Carotid Artery Stenosis or Occlusion
Authors: Christou Ioannis , Felberg Robert A. , Demchuk Andrew M. , Grotta James C. , Burgin W. Scott , Malkoff Marc , Alexandrov Andrei V. 
Published: November 2009

ABSTRACT Background and Purpose. The authors establish accuracy parameters of a broad diagnostic battery for bedside transcranial Doppler (TCD) to detect flow changes due to internal carotid artery (ICA) stenosis or occlusion. Methods. The authors prospectively studied consecutive patients with stroke or transient ischemic attack referred for TCD. TCD was performed and interpreted at bedside using a standard insonation protocol. A broad diagnostic battery included major criteria: collateral flow signals, abnormal siphon or terminal carotid signals, and delayed systolic flow acceleration in the middle cerebral artery. Minor criteria included a unilateral decrease in pulsatility index (≤ 0.6 or ≤ 70% of contralateral side), flow diversion signs, and compensatory velocity increase. Angiography or carotid duplex ultrasound (CDU) was used to grade the degree of carotid stenosis using North American criteria. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of TCD findings were determined. Results. Seven hundred and twenty patients underwent TCD, of whom 517 (256 men and 261 women) had angiography and/or CDU within 8.8 ± 0.9 days. Age was 63.1 ± 15.7 years. For a 70% to 99% carotid stenosis or occlusion, TCD had sensitivity of 79.4%, specificity of 86.2%, PPV of 57.0%, NPV of 94.8%, and accuracy of 84.7%. For a 50% to 99% carotid stenosis or occlusion, TCD had sensitivity of 67.5%, specificity of 83.9%, PPV of 54.5%, NPV of 90.0%, and accuracy of 81.6%. TCD detected intracranial carotid lesions with 84.9% accuracy and extracranial carotid lesions with 84.4% accuracy (sensitivity of 88% and 79%, specificity of 85% and 86%, PPV of 24% and 54%, and NPV of 99% and 95%, respectively). The prevalence of the ophthalmic artery flow reversal was 36.4% in patients with ≥ 70% stenosis or occlusion. If present, this finding indicated a proximal ICA lesion location in 97% of these patients. Conclusions. In symptomatic patients, bedside TCD can accurately detect flow changes consistent with hemodynamically significant ICA obstruction; however, TCD should not be a substitute for direct carotid evaluation. Because TCD is sensitive and specific for ≥ 70% carotid stenosis or occlusion in both extracranial and intracranial carotid segments, it can be used as a complementary test to refine other imaging findings and detect tandem lesions.
Magnetic Resonance Analysis of Postsurgical Temporal Lobectomy
Authors: Alsaadi Taoufik M. , Ulmer John L. , Mitchell Michael J. , Morris George L. , Swanson Sara J. , Mueller Wade M. 
Published: November 2009

ABSTRACT Background and Purpose. The effect of temporal lobe transection area, volume of postoperative gliosis, and surgical technique on patients' seizure‐free outcome is unknown. The authors studied the effects of these variables on patients' seizure‐free outcome. Methods. A retrospective review of magnetic resonance imaging examinations acquired 3 to 18 months after temporal lobe resection was carried out for 18 patients with intractable temporal lobe seizures and known postsurgical outcomes for more than 2 years. The total volume of radiologically probable gliosis evident on axial proton‐density‐weighted images was calculated for each patient using software on an independent console. The total area of temporal lobe surface transected by the scalpel was calculated as well, using sagittal T1‐weighted images. The total volume of gliosis, the total area of transected temporal lobe, and the specific type of surgery (sparing vs no sparing of the superior temporal gyrus) were then correlated with the postsurgical outcome of the patients. An examiner with no prior knowledge of the patients' postsurgical outcomes carried out the above calculations and measurements. The patients' postoperative outcome was defined using Engel classifications, and patients were divided into two groups: group A with Engel class 1 (n= 9) and group B with Engel classes 2–4 (n= 9). Results. The mean volumes of postoperative gliosis were not significantly different between group A (3592.3 mm3) and group B (4270 mm3). The mean area of transected temporal lobe was also similar between group A (1865.2 mm2) and group B (1930 mm2). With regard to surgical technique, there were 5 subjects who had the superior temporal gyrus resected and 13 who did not. Eighty percent of patients with the superior temporal gyrus resected were Engel class 1 or 2, whereas only 20% were of Engel class 3 or 4. Conclusion. The authors found no clear association between postoperative outcome and residual temporal lobe gliosis, the surgical technique, or the total area of temporal lobe transected by the scalpel.