bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thirteen Dimensions of Health in Elderly Sri Lankans: Results from a National Sri Lanka Aging Survey
Authors: Østbye Truls , Malhotra Rahul , Chan Angelique 
Published: June 2009

OBJECTIVES: To explore age and sex differences in distribution of 13 health dimensions with a focus on self‐rated health (SRH) and the association between SRH and other health dimensions in elderly Sri Lankans.DESIGN: Sri Lanka Aging Survey, a nationally representative cross‐sectional survey.SETTING: Community based.PARTICIPANTS: Inhabitants of 13 districts in Sri Lanka aged 60 and older (N=2,413).MEASUREMENTS: Self‐reported SRH, hearing, activities of daily living (ADLs), instrumental activities of daily living (IADLs), mobility, physical disability, chronic diseases, stress and worry, mood, cognition, social participation, social support, and financial health.RESULTS: The prevalence of being “healthy” in most health dimensions, including SRH, declined with age. Men were more likely to report better SRH; independence in ADLs, IADLs, and mobility; absence of physical disability and chronic diseases; and good mental health. Absence of chronic diseases, independence in ADLs and IADLs, freedom from stress and worry, and absence of depression were associated with positive (excellent/very good/good) SRH. The male SRH advantage was not significant in adjusted analyses, and sex did not modify the association between SRH and other health dimensions.CONCLUSION: Several of the dimensions associated with positive SRH are to a certain extent modifiable and therefore provide a potential for improvement in SRH of elderly Sri Lankans. Differences between this study and studies from elsewhere in the associations between different health dimensions and SRH, and in how sex modifies these associations, suggest that some of the associations may depend on cultural context.
Computerized Decision Support to Reduce Potentially Inappropriate Prescribing to Older Emergency Department Patients: A Randomized, Controlled Trial
Authors: Terrell Kevin M. , Perkins Anthony J. , Dexter Paul R. , Hui Siu L. , Callahan Christopher M. , Miller Douglas K. 
Published: June 2009

OBJECTIVES: To evaluate the effectiveness of computer‐assisted decision support in reducing potentially inappropriate prescribing to older adults.DESIGN: Randomized, controlled trial.SETTING: An academic emergency department (ED) in Indianapolis, Indiana, where computerized physican order entry was used to write all medication prescriptions.PARTICIPANTS: Sixty‐three emergency physicians were randomized to the intervention (32 physicians) or control (31 physicians) group.INTERVENTION: Decision support that advised against use of nine potentially inappropriate medications and recommended safer substitute therapies.MEASUREMENTS: The primary outcome was the proportion of ED visits by seniors that resulted in one or more prescriptions for an inappropriate medication. The main secondary outcomes were the proportions of medications prescribed that were inappropriate and intervention physicians' reasons for rejecting the decision support.RESULTS: The average age of the patients was 74, two‐thirds were female, and just over half were African American. Decision support was provided 114 times to intervention physicians, who accepted 49 (43%) of the recommendations. Intervention physicians prescribed one or more inappropriate medications during 2.6% of ED visits by seniors, compared with 3.9% of visits managed by control physicians (P=.02; odds ratio=0.55, 95% confidence interval=0.34–0.89). The proportion of all prescribed medications that were inappropriate significantly decreased from 5.4% to 3.4%. The most common reason for rejecting decision support was that the patient had no prior problems with the medication.CONCLUSION: Computerized physican order entry with decision support significantly reduced prescribing of potentially inappropriate medications for seniors. This approach might be used in other efforts to improve ED care.Trial Registration: Clinical trials.gov Identifier: NCT00297869.
Prospective Study of Serum 25‐Hydroxyvitamin D Level, Cardiovascular Disease Mortality, and All‐Cause Mortality in Older U.S. Adults
Authors: Ginde Adit A. , Scragg Robert , Schwartz Robert S. , Camargo Carlos A. 
Published: June 2009

OBJECTIVES: To evaluate the association between serum 25‐hydroxyvitamin D (25(OH)D) levels and mortality in a representative U.S. sample of older adults.DESIGN: Prospective cohort from the Third National Health and Nutrition Examination Survey (NHANES III) and linked mortality files.SETTING: Noninstitutionalized U.S. civilian population.PARTICIPANTS: Three thousand four hundred eight NHANES III participants aged 65 and older enrolled from 1988 to 1994 and followed for mortality through 2000.MEASUREMENTS: Primary exposure was serum 25(OH)D level at enrollment. Primary and secondary outcomes were all‐cause and cardiovascular disease (CVD) mortality, respectively.RESULTS: During the median 7.3 years of follow‐up, there were 1,493 (44%) deaths, including 767 CVD‐related deaths. Median 25(OH)D level was 66 nmol/L. Adjusting for demographics, season, and cardiovascular risk factors, baseline 25(OH)D levels were inversely associated with all‐cause mortality risk (adjusted hazard ratio (HR)=0.95, 95% confidence interval (CI)=0.92–0.98, per 10 nmol/L 25[OH]D). Compared with subjects with 25(OH)D levels of 100 nmol/L or higher, the adjusted HR for subjects with levels less than 25.0 nmol/L was 1.83 (95% CI=1.14–2.94) and for levels of 25.0 to 49.9 nmol/L was 1.47 (95% CI=1.09–1.97). The association appeared stronger for CVD mortality (adjusted HR=2.36, 95% CI=1.17–4.75, for subjects with 25[OH]D levels<25.0 nmol/L vs those ≥100.0 nmol/L) than for non‐CVD mortality (adjusted HR=1.42, 95% CI=0.73–2.79, for subjects with 25[OH]D levels<25.0 nmol/L vs those ≥100.0 nmol/L).CONCLUSION: In noninstitutionalized older adults, a group at high risk for all‐cause mortality, serum 25(OH)D levels had an independent, inverse association with CVD and all‐cause mortality. Randomized controlled trials of vitamin D supplementation in older adults are warranted to determine whether this association is causal and reversible.
Effect of Fish Oil Supplementation on Quality of Life in a General Population of Older Dutch Subjects: A Randomized, Double‐Blind, Placebo‐Controlled Trial
Authors: Van De Rest Ondine , Geleijnse Johanna M. , Kok Frans J. , Van Staveren Wija A. , OldeRikkert Marcel G.M. , Beekman Aartjan T.F. , De Groot Lisette C.P.G.M. 
Published: June 2009

OBJECTIVES: To investigate the effect of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) supplementation on quality of life (QOL).DESIGN: Randomized, double‐blind, placebo‐controlled trial.SETTING: Independently living individuals from the general older Dutch population.PARTICIPANTS: Three hundred two individuals aged 65 and older without depression or dementia.INTERVENTION: 1,800 mg/d EPA‐DHA (n=96), 400 mg/d EPA‐DHA (n=100), or placebo capsules (n=106) for 26 weeks.MEASUREMENTS: QOL was assessed using the short version of the World Health Organization QOL questionnaire (WHOQOL‐BREF). The WHOQOL‐BREF covers four domains: physical health, psychological health, social relationships, and satisfaction with environment. The total score range is 26 to 130, with higher scores indicating a more favorable condition.RESULTS: Mean age of the participants was 70, and 55% were male. Plasma concentrations of EPA‐DHA increased 238% in the high‐dose and 51% in the low‐dose EPA‐DHA group, reflecting excellent adherence. Median baseline total WHOQOL scores ranged from 107 to 110 in the three groups and were not significantly different from each other. After 26 weeks, the mean difference from placebo was −1.42 (95% confidence interval (CI)=−3.40–0.57) for the high‐dose and 0.02 (95% CI=−1.95–1.99) for the low‐dose fish oil group. Treatment with 1,800 mg or 400 mg EPA‐DHA did not affect total QOL or any of the separate domains after 13 or 26 weeks of intervention.CONCLUSION: Supplementation with high or low doses of fish oil for 26 weeks did not influence the QOL of healthy older individuals.
Reversal of Sleep‐Disordered Breathing with Opioid Withdrawal
Authors: Ramar Kannan 
Published: June 2009

AbstractObstructive sleep apnea, central sleep apnea, sleep related hypoventilation, Biot's or ataxic breathing, and cluster breathing are some of the commonly described sleep disorders in patients who are on long‐term opioids. Continuous positive airway pressure that is commonly used to treat obstructive sleep apnea may not be effective in treating sleep‐disordered breathing in long‐term opioid users, and an adaptive servoventilator (ASV) may be needed. We present a 30‐year‐old woman with excessive daytime sleepiness and sleep‐disordered breathing for the past 4 years. Medical history was complicated by chronic osteomyelitis, periorbital abscess, and chronic facial pain requiring methadone for pain control for the last 4 years. In this case, ASV, though effective, was not tolerable due to chronic facial pain, and successful withdrawal of methadone at our pain rehabilitation center resolved the sleep‐disordered breathing and improved daytime sleepiness. This is to our knowledge the first case report of resolution of sleep‐disordered breathing and improvement in daytime sleepiness after withdrawal of long‐term opioid use.
Prevalence, Predictors, and Prognosis of Atrial Fibrillation Early After Pulmonary Vein Isolation: Findings from 3 Months of Continuous Automatic ECG Loop Recordings
Authors: JOSHI SANDEEP , CHOI ANDREW D. , KAMATH GANESH S. , RAISZADEH FARBOD , MARRERO DANIEL , BADHEKA APURVA , MITTAL SUNEET , STEINBERG JONATHAN S. 
Published: June 2009

Introduction:
Following pulmonary vein isolation (PVI) for atrial fibrillation (AF), early recurrences are frequent, benign and classified as a part of a “blanking period.” This study characterizes early recurrences and determines implications of early AF following PVI.
Methods and Results:
Seventy‐two consecutive patients (59.8 ± 10.7 years, 69% male) were studied following PVI for paroxysmal or persistent AF. Subjects were fitted with an external loop recorder for automatic, continuous detection of AF recurrence for 3 months. AF prevalence was highest 2 weeks after PVI (54%) and declined to an eventual low of 22%. A significant number (488, 34%) of recurrences were asymptomatic; however, all patients with ≥1 AF event had ≥1 symptomatic event. No clear predictor of early recurrence was identified. Forty‐seven (65%) patients had at least 1 AF episode, predominantly (39 of 47 patients, 83%) within 2 weeks of PVI. Of the 33 patients who did not experience AF within the first 2 weeks, 85% (28/33) were complete responders (P = 0.03) at 12 months. Recurrence at any time within 3 months was not associated with procedural success or failure.
Conclusions:
Early AF recurrence peaks within the first few weeks after PVI, but continues at a lower level until the completion of monitoring. A blanking period of 3 months is justified to identify patients with AF recurrences that do not portend procedure failure. Freedom from AF in the first 2 weeks following ablation significantly predicts long‐term AF freedom.
Genetic Modulation of Brugada Syndrome by a Common Polymorphism
Authors: LIZOTTE ERIC , JUNTTILA M. JUHANI , DUBE MARIE PIERRE , HONG KUI , BENITO BEGONA , DE ZUTTER MARC , HENKENS STEFAN , SARKOZY ANDREA , HUIKURI HEIKKI V. , TOWBIN JEFFREY , VATTA MATTEO , BRUGADA PEDRO , BRUGADA JOSEP , BRUGADA RAMON 
Published: June 2009

Background:
Brugada syndrome predisposes some subjects to ventricular tachyarrhythmias and sudden cardiac death. Mutations in SCN5A gene have been associated with ∼25% of Brugada syndrome patients. A common variant in SCN5A, H558R has shown to improve sodium channel activity in mutated channels. We studied whether common variant H558R has any clinical implications in the phenotype of Brugada syndrome.
Methods:
Our study population consisted of Brugada syndrome subjects 75 with SCN5A mutation and 92 without SCN5A mutation. Their mean age was 39 ± 15 and 42 ± 17 years, and 65% and 86% were male, respectively. We measured PR‐, QRS‐, QTc‐intervals from leads II and V2 of the 12‐lead ECG. We also evaluated J‐point amplitude from lead V2 and R‘/S ratio from lead aVR (the “aVR sign”). The H558R (A→G) genotype was detected with direct sequencing of the SCN5A gene.
Results:
The AA genotype carriers had longer QRS duration in lead II (P = 0.017) and higher J‐point elevation in lead V2 (P = 0.013), higher “aVR sign” (P = 0.005) and a trend toward more subjects with symptoms (P = 0.067) than G allele carriers. None of the results were significant in Brugada syndrome subjects without SCN5A mutation.
Conclusion:
The common variant H558R seems to be a genetic modulator of Brugada syndrome among carriers of a SCN5A mutation, in whom the presence of the less common allele G improves the ECG characteristics and clinical phenotype.
Transcranial Measurement of Cerebral Microembolic Signals During Endocardial Pulmonary Vein Isolation: Comparison of Three Different Ablation Techniques
Authors: SAUREN LOES D. , VAN BELLE YVES , DE ROY LUC , PISON LAURENT , LA MEIR MARK , VAN DER VEEN FREDERICK H. , CRIJNS HARRY J. , JORDAENS LUC , MESS WERNER H. , MAESSEN JOS G. 
Published: June 2009

Introduction:
Isolation of the pulmonary veins (PVI) using high ablation energy is an effective treatment for atrial fibrillation (AF) with a success rate of 50–95%; however, postoperative neurological complications still occur in 0.5–10%. In this study the incidence of cerebral microembolic signals (MES) as a risk factor for neurological complications is examined during 3 percutaneous endocardial ablation procedure strategies: segmental PVI using a conventional radiofrequency (RF) ablation catheter, segmental PVI using an irrigated RF tip catheter, and circumferential PVI with a cryoballoon catheter (CB).
Methods and Results:
Thirty patients underwent percutaneous endocardial PVI. Ostial isolation was performed in 10 patients with a conventional 4‐mm RF catheter (CRF) and in 10 patients with a 4‐mm irrigated RF catheter (IRF). A circumferential PVI was performed in 10 patients with a CB. Transcranial Doppler (TCD) monitoring was used to detect MES in the middle cerebral arteries.The total number of cerebral MES differs significantly among the 3 PVI groups; 3,908 cerebral MES were measured with use of the CRF catheter, 1,404 cerebral MES with use of the IRF catheter, and 935 cerebral MES with use of the CB catheter.
Conclusion:
This study demonstrates a significant difference in cerebral MES during PVI with 3 different ablation procedures. The use of an irrigated RF and a cryoballoon produces significantly fewer cerebral MES than the use of conventional RF for a PVI procedure, suggesting a higher risk for neurologic complications using conventional RF energy during a percutaneous PVI procedure.
Reduction in Atrial Flutter Ablation Time by Targeting Maximum Voltage: Results of a Prospective Randomized Clinical Trial
Authors: GULA LORNE J. , REDFEARN DAMIAN P. , VEENHUYZEN GEORGE D. , KRAHN ANDREW D. , YEE RAYMOND , KLEIN GEORGE J. , SKANES ALLAN C. 
Published: June 2009

Background: Radiofrequency ablation (RFA) of the cavotricuspid isthmus (CTI) is an established therapy for typical atrial flutter. Previous studies have demonstrated that the CTI is often composed of discrete muscle bundles, and evidence has suggested that these bundles correlate with high‐voltage local electrograms in the tricuspid isthmus. This randomized, multicenter clinical trial was designed to prospectively compare the hypothesis that a maximum voltage‐guided (MVG) technique targets critical conducting bundles in the isthmus, as reflected by a reduction in ablation requirements compared to the anatomical approach to atrial flutter ablation. Methods: Bidirectional block was achieved in patients undergoing ablation for typical atrial flutter using 1 of 2 randomly assigned methods. The anatomical approach produced a contiguous line of ablation lesions from the inferior aspect of the tricuspid annulus to the inferior vena cava using a standard method. The MVG technique sequentially targeted the maximum voltage local electrograms in the CTI along a similar line. Results: Sixty‐nine patients were randomized, with mean age 63 ± 10 and 58 (84%) male. Among patients in the anatomic group (n = 34), mean ablation time was 11.2 ± 7.5 minutes compared to 5.9 ± 3.3 in the MVG group (n = 35) (P = 0.0026). A mean of 14.2 ± 9.7 ablation lesions were created in the anatomic group, and 7.9 ± 4.8 in the MVG group (P = 0.0042). Conclusions: Ablation for atrial flutter using an MVG technique results in significantly less ablation requirements than the traditional approach, potentially by concentrating ablation lesions on the muscle bundles responsible for transisthmus conduction.
The New World of Crises and Crisis Management: Implications for Policymaking and Research
Authors: Boin Arjen 
Published: June 2009

AbstractIn recent years, we have witnessed a series of spectacular crises and disasters: 9/11, Madrid and London, the Asian tsunami, the Mumbai attacks, the implosion of the financial system—the world of crises and disasters seems to be changing. This special issue explores how these crises and disasters are changing and what governments can do to prepare. This opening article defines critical concepts, sketches a theoretical perspective, offers key research findings, and introduces the contributions to the special issue.
The Public Management of Risk: The Case for Deliberating among Worldviews
Authors: Lodge Martin 
Published: June 2009

AbstractThis article argues that the public management of risk faces inherent “wicked issue” problems which are further accentuated in the context of the contemporary regulatory state. It is suggested that in order to overcome these limitations and inevitable trade‐offs, there needs to be a more conscientious effort in setting out distinct components of any public management of risk, which should be considered and discussed through the lens of distinct worldviews contrasting interpretations and solutions, as well as potential “black‐spots.” It is only by acknowledging limitations of any one strategy and by considering plural solutions that there is less likelihood of disappointment when dealing with crises and disasters.
European Cooperation on Future Crises: Toward a Public Good?
Authors: Rhinard Mark 
Published: June 2009

AbstractAs crises grow more transnational in origin and effect, managing them effectively will require international cooperation. This article explores the dilemmas inherent to producing common crisis management capacities across national governments. Drawing on the literature related to “international public goods,” the article builds an approach for understanding these dilemmas through the lens of collective action and the perverse incentives associated therein. The article applies this approach to cooperation in Europe on an issue that typifies the transnational crisis—the spread of communicable disease—and highlights obstacles to European Union ambitions to build a robust system for disease surveillance and control. Having isolated the obstacles, the article then identifies solutions to facilitate cooperation toward more effectively producing the good in question.
Preventing Transboundary Crises: The Management and Regulation of Setbacks
Authors: Roe Emery 
Published: June 2009

AbstractSetbacks—unanticipated, unwanted, and often sudden checks on moving forward—are common in crisis prevention. Managing setbacks, however, is rarely discussed. Even less discussed is the central role that setback management can play in preventing transboundary crises across interdependent critical infrastructures for electricity, water, transportation, and financial services. With a focus on the ongoing financial crisis and on strategies for resilience and anticipation, the article draws out implications for crisis prevention as the first, rather than last, line of defense in managing future crises.
Melting Down and Scaling Up: Stabilizing Climate Change by Promoting Private Sector Technology Development
Authors: Perusse Brian , Riggins Matthew , Rodgers Jeff , Zimring Maury 
Published: June 2009

AbstractThis paper will examine the role the private sector plays in researching, developing, and deploying technology that has the potential to deter or decrease the impacts of global warming. It will explore the degree to which the private sector can have an impact on global warming by focusing on four specific technologies: aircraft engines, wind turbines, solar energy, and clean coal technologies. We will compare the environmental impact of these technologies with the business case for pursuing each, specifically related to profitability and market maturity. We conclude that the business case alone is not sufficiently compelling to stimulate meaningful industry investment in these areas. Consequently, specific government involvement is needed for CO2 reduction. This analysis will shed light on the role that government must play in order to more effectively engage potential private sector players in the global warming challenge.
Medication changes based on echocardiography in dialysis patients
Authors: CHONG Chun K. , MUZOORA Michael , ECKERT George J. , KAMALESH Masoor , MOE Sharon M. 
Published: June 2009

AbstractKidney/Disease Outcome Quality Initiative (K/DOQI) guidelines recommend baseline echocardiography at the initiation of dialysis and every 3 years thereafter in patients for early detection of cardiac disease to optimize medical therapy. Because dialysis patients are at increased cardiovascular risk and thus most are already on cardioprotective medications, we hypothesize that serial screening echocardiography will not alter cardioprotective medications in dialysis patients. Retrospective analysis of medication administration of 231 dialysis patients was conducted. Patients were divided into 2 groups, those with and those without echocardiograms. Medication changes post echocardiography were compared with subjects without echocardiograms at comparable time points. The primary end point was the number of medication class changes that occurred in 2 months post echocardiography. Medication classes examined were β blockers (BB), angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB), nitrates, calcium channel blockers (CCB), and statins. In the Echo group, there were 29 (19%) subjects with at least 1 medication class change post echocardiography, compared with 121 (81%) subjects without change. The number of patients on specific medication classes before and after echocardiography were BB (90 [60%] vs. 97 [65%], P=0.05), ACEI/ARB (74 [49%] vs. 82 [55%], P=0.01), nitrates (34 [23%] vs. 33 [22%], P=0.56), CCB (77 [51%] vs. 79 [53%], P=0.56), and statins (69 [46%] vs. 70 [47%], P=0.71). When compared with the No Echo group, there was no significant change in number of any medication classes. The occurrence of medication changes post echocardiography in dialysis patients is low and is not different than changes in routine care of dialysis patients without echocardiograms. Thus, serial screening echocardiography may not have added benefit to optimizing medical management of cardiovascular disease in dialysis patients. Further studies are warranted to demonstrate evidence for the use of serial screening echocardiography in this high‐risk population.