bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cesarean Birth Trends in Chile, 1986 to 1994
Authors:   Licenciada en Sociología, F. Murray Susan , Pradenas Fanny Serani 
Published: August 2010

Background:Despite indications of high cesarean section rates in various parts of Latin America, relatively few comprehensive studies of national birth intervention trends have been conducted in that continent. Recent national statistics suggest that Chile may now have the highest reported cesarean section rate in the world. This paper examines cesarean birth trends in Chile with reference to changing patterns in health care financing.Methods:The growth in the national cesarean birth rate is analyzed, with reference to regional patterns, differences according to insurance coverage, and recent shifts in the financing pattern of health care provision, using insurance fund data and hospital reporting systems data for both public and private sector care from the mid‐1980s to mid‐1990s.Results:Chile had a cesarean birth rate of 37.2 percent for the 301,955 births covered by either the National Health Fund or private health insurance in 1994. This was a one‐third increase from the 1986 rate of 27.7 percent. The private health insurance sector revealed consistently far higher cesarean section rates than the National Health Fund sector (59% vs 28.8% in 1994); intrasectoral rates remained fairly stable over the 8‐year period.Conclusions:The overall increase in Chile's cesarean section rate correlates with the growth in the proportion of all births whose care was privately insured during these years (from 7.5% to 24.8%). This change may be partly explained by the doubling (to 32%) of the percentage of women with a personal obstetrician rather than a “duty” practitioner attending the birth of their baby. (BIRTH 24:4, December 1997)
Familial Lennox‐Gastaut syndrome in male siblings with a novel DCX mutation and anterior pachygyria
Authors: Lawrence Kate M. , Mei Davide , Newton Mark R. , Leventer Richard J. , Guerrini Renzo , Berkovic Samuel F. 
Published: August 2010

SummaryLennox‐Gastaut syndrome (LGS) has numerous causes, but only rarely has familial recurrence been observed. We studied a family in which three male members had severe epilepsy and intellectual disability. The proband had seizure onset at 7 years of age with atonic, myoclonic, atypical absence, and tonic seizures with slow spike‐wave on electroencephalography (EEG). One living sibling had a similar clinical pattern. One deceased sibling was known to have had seizures with intellectual disability. Neuroimaging revealed anterior predominant pachygyria. DNA sequencing of the gene doublecortin (DCX) on the X chromosome revealed a novel missense mutation in the two living affected male siblings. The occurrence of three affected male family members with proven or suspected LGS in this family was puzzling and only solved by a combination of magnetic resonance (MR) and molecular genetics evaluations. This finding provided essential information for genetic counseling.
An exploratory randomized controlled trial of immediate versus delayed withdrawal of antiepileptic drugs in patients with psychogenic nonepileptic attacks (PNEAs)
Authors: Oto Maria , Espie Colin A. , Duncan Roderick 
Published: August 2010

SummaryPurpose:  To determine whether withdrawal of antiepileptic drugs (AEDs) in patients with psychogenic nonepileptic attacks (PNEAs) improves outcome.Methods:  Randomized controlled trial of AED withdrawal in patients with PNEAs. Patients were randomized to immediate or delayed (9 months) withdrawal of AEDs. We recorded spell frequency, changes in work status, use of emergency medical services, and psychological status at baseline, 9 months, and 18 months.Results:  Of 193 patients screened, 38 fulfilled entry criteria, 13 declined participation, and 25 were randomized. Fourteen patients were randomized to immediate withdrawal (IW) and 11 patients to delayed withdrawal (DW). There was a significant reduction in spell frequency from baseline to 9 months in the IW group but not in the DW group (p = 0.028). There was a significantly greater reduction in use of rescue medication in the IW group compared to the DW group between baseline and 9 months (p = 0.002). Emergency health care utilization dropped to zero in both groups by the end of the study. Psychological measures reflecting internal locus of control increased significantly more in the IW group (p = 0.005).Discussion:  Stringent diagnostic criteria and an increasing tendency for patients to be referred before AED prescription limited the recruitment and the power of the study. Our data nonetheless provide evidence that some outcomes are improved by AED withdrawal in patients with PNEAs.
Continuous local intrahippocampal delivery of adenosine reduces seizure frequency in rats with spontaneous seizures
Authors: Van Dycke Annelies , Raedt Robrecht , Dauwe Ine , Sante Tom , Wyckhuys Tine , Meurs Alfred , Vonck Kristl , Wadman Wytse , Boon Paul 
Published: August 2010

SummaryPurpose:  Despite different treatment options for patients with refractory epilepsy such as epilepsy surgery and neurostimulation, many patients still have seizures and/or drug‐related cerebral and systemic side effects. Local intracerebral delivery of antiepileptic compounds may represent a novel strategy with specific advantages such as the option of higher local doses and reduced side effects. In this study we evaluate the antiepileptic effect of local delivery of adenosine in the kainic acid rat model, a validated model for temporal lobe epilepsy.Methods:  Fifteen rats, in which intraperitoneal kainic acid injection had induced spontaneous seizures, were implanted with a combination of depth electrodes and a cannula in both hippocampi. Cannulas were connected to osmotic minipumps to allow continuous hippocampal delivery. Rats were freely moving and permanently monitored by video‐EEG (electroencephalography). Seizures were scored during 2 weeks of local hippocampal delivery of saline (baseline), followed by 2 weeks of local adenosine (6 mg/ml) (n = 10) or saline (n = 5) delivery (0.23 μl/h) (treatment). In 7 of 10 adenosine‐treated rats, saline was also delivered during a washout period.Results:  During the treatment period a mean daily seizure frequency reduction of 33% compared to the baseline rate was found in adenosine‐treated rats (p < 0.01). Four rats had a seizure frequency reduction of at least 50%. Both nonconvulsive and convulsive seizures significantly decreased during the treatment period. In the saline‐control group, mean daily seizure frequency increased with 35% during the treatment period.Conclusions:  This study demonstrates the antiseizure effect of continuous adenosine delivery in the hippocampi in rats with spontaneous seizures.
Introduction
Authors: Jurkiewicz Carole L. 
Published: August 2010

Hurricane Katrina presents us with a rare, catastrophic opportunity to gain insight into crisis management and almost the entire field of public administration. The enormously destructive impact of this natural event on human life and organization has the potential for helping us understand what worked in the face of nature’s almost incomprehensible force, and how our ways of living together and governing our collective life need to change. As the articles in this special issue of  PAR reveal, Katrina called into question our ethics, the allocation of our resources, the ability of government at all levels to meet a great challenge, our capacity to maintain or restore the delivery of basic public services, as well as the roles of law enforcement, the military, medical systems, and other emergency response organizations. Katrina put us to a harsh and unyielding test about how prepared we are to deal with the extremes that human society must be able to face and overcome. She revealed our fragility as well as our strength, our perfidy as well as our honor. Katrina illuminated the depth of human caring and cooperation, and the darker side of our nature also. —Terry L. Cooper, University of Southern California There is a lot to be learned about the impact of Hurricane Katrina. In 2006, Public Works Management and Policy and Economic Development Quarterly jointly published focus issues on the impact of Katrina. The former focused on the impact on infrastructure and subsequent policy decisions. The latter concentrated on the economic impacts of large natural disasters. This issue of PAR adds to this work by covering the bases of administrative responsibility, local government response, and the impact on the victims of the disaster. Although all these articles deal with a specific situation, they all draw broader implications which can be used either by managers on the front lines in similar circumstances or by academics as they try to integrate these theoretical lessons learned into their scholarly work. This is “must” reading for everyone. —Claire L. Felbinger, American University
“So Poor and So Black”: Hurricane Katrina, Public Administration, and the Issue of Race
Authors: Stivers Camilla 
Published: August 2010

Does racism ever shape the way public administrators make decisions? The story of Hurricane Katrina is an opportunity to consider this neglected question. Discriminatory government policies and processes over decades ensured that African Americans were disproportionately harmed by the storm and its aftermath. In contrast to the literature on bureaucratic discretion, when the crisis came, administrators at all levels chose to take refuge in regulations rather than act creatively to save lives and reduce misery. Images of desperate black New Orleanians juxtaposed with massive government failures raise, even for skeptical observers, issues of race and racism that must no longer be ignored. The essay urges that we explore the extent to which “masked” racism affects the practice of public administration.
The Impartial Administration of Justice is the Foundation of Liberty.  —Inscription on the Orleans Parish Courthouse You simply get chills every time you see these poor individuals … so many of these people … are so poor and they are so black.  —Wolf Blitzer, CNN, September 1, 2005
Introduction
Authors: Jurkiewicz Carole L. 
Published: August 2010

Katrina was more than a disaster. Like other national catastrophes of the past three decades, it reflects our collective failure to come to grips with the need for governance systems that can deal with the multiple, diverse, and conflicting expectations imposed on the public sector. What we have here is another example of the modern tragedy of accountability.
—Mel Dubnick, University of New Hampshire
As the profession of emergency management in the United States today considers, in conjunction with FEMA’s National Emergency Center, the critical competencies to its becoming a true profession, this special issue of PAR gives those competencies relevance. We are learning from experience that responses to natural as well as intentional and technical catastrophes require progressive planning and an assurance that the highest possible degree of unity of effort among all levels of government and all elements of the community is operational so as to manage risk effectively. In order to do so, public managers as well as federal, state and local agencies need to be flexible and armed with collaborative and coordinated knowledge‐based approaches that are also comprehensive. To do so is no easy feat. It requires leadership and may truly represent the redefinition of public administration competencies in our intergovernmental system due to the interrelatedness of technical, economic and fiscal issues to effective or ineffective disaster response whether that be from terrorism, nuclear proliferation, natural disasters, or the spread of infectious diseases. That may be why the U.S. Government Accountability Office identified security threats as the first of seven key themes in its Forces That Will Shape America’s Future: Themes from GAO’s Strategic Plan 2007–2012, released in April of this year. In fact, this series of articles may represent the beginning of what the GAO calls for: a need to better assess how well governmental entities are performing and whether they are achieving the desired results through a comprehensive review of federal programs and policies that analyzes whether or not they are meeting their objectives based upon outcome‐based goals which have been developed using stakeholder and state, local governmental guidance.
—Christine Springer, University of Nevada, Las Vegas
Business “Not” as Usual: The National Incident Management System, Federalism, and Leadership
Authors: Lester William , Krejci Daniel 
Published: August 2010

Federal, state, and local governments did not work well together to provide an effective response to Hurricane Katrina. Some of this failure can be attributed to the power struggle between the federal and state governments. The National Incident Management System (NIMS) was designed to foster collaboration among governments and their departments and agencies. However, this system largely failed. To overcome this failure, many have proposed centralizing disaster response in the federal government. Centralized control would damage the basic federal structure of our government as the national government appeals to the ever‐present dangers of terrorism and natural disaster to gain permanent primacy in the relationship. The current federal system actually can work better than centralization if leadership and organizational transformation are stressed. The National Incident Management System has many elements in place that can make the federal system of disaster response work if the proper stress on organizational transformation and leadership is applied.
If we ignore the systemic issues and simply replace people or re‐assign responsibilities, we may simply fail again in the not too distant future with a different cast of characters. John R. Harrald, director of the Institute for Crisis, Disaster, and Risk Management,    George Washington University U.S. House Committee on Government Reform hearing, September 15, 2005
Use of an Intracardiac Electrogram Eliminates the Need for a Surface ECG during Implantable Cardioverter‐Defibrillator Follow‐Up
Authors: MICHAEL KEVIN A. , PETERSON BRETT J. , YUE ARTHUR M. , WILSON RYAN D. , WANG LI , OUSDIGIAN KEVIN , WILKOFF BRUCE , STERNS LAURENCE , MORGAN JOHN M. ,   for the Worldwide EMPIRIC investigators
Published: August 2010

Background:

A surface electrocardiogram (SECG) for pacing threshold measurements during routine implantable cardioverter‐defibrillator (ICD) follow‐up can be cumbersome. This study evaluated the use of an intrathoracic far‐field electrogram (EGM) derived between the Can and superior vena cava (SVC) electrode—the Leadless electrocardiogram (LLECG), in dual chamber ICDs in performing pacing threshold tests.
Methods:

The LLECG was evaluated prospectively during atrial and ventricular pacing threshold testing as a substudy of the Comparison of Empiric to Physician‐Tailored Programming of Implantable Cardioverter‐Defibrillators trial (EMPIRIC) in which dual chamber ICDs were implanted in 888 patients. Threshold tests were conducted at 1 volt by decrementing the pulse width. Follow‐up at three months compared pacing thresholds measured using LLECG with those using Lead I of the surface ECG (SECG). The timesaving afforded by LLECG was assessed by a questionnaire.
Results:

The median threshold difference between LLECG and SECG measurements for both atrial (0.00 ms, P = 0.90) and ventricular (0.00 ms, P = 0.34) threshold tests were not significant. Ninety percent of atrial and ventricular threshold differences were bounded by ± 0.10 ms and –0.10 to +0.04 ms, respectively. We found that 99% of atrial and ventricular thresholds tests at six and 12 months attempted using LLECG were successfully completed. The questionnaire indicated that 65% of healthcare professionals found LLECG to afford at least some timesaving during device follow‐ups.
Conclusion:

Routine follow‐up can be performed reliably and expeditiously in dual chamber Medtronic (Minneapolis, MN, USA) ICDs using LLECG alone, resulting in overall timesaving.
Correlation Between QTc Interval and Clinical Severity of Subarachnoid Hemorrhage Depends on the QTc Formula Used
Authors: COLKESEN A. YUCEL , SEN ORHAN , GIRAY SEMIH , ACIL TAYFUN , OZIN BULENT , MUDERRISOGLU HALDUN 
Published: August 2010

Objectives:

Subarachnoid hemorrhage (SAH) frequently prolongs QT interval in the acute phase. The purpose of our study is to investigate whether the correlation between electrocardiographic corrected QT interval and the clinical severity of SAH depends on QTc formula used.
Methods:

We retrospectively studied 52 consecutive subjects with nontraumatic SAH (extravasation of blood into the spaces covering the central nervous system that are filled with cerebrospinal fluid) who were admitted within the first day of SAH. QT intervals were measured on a standard 12‐lead electrocardiography and corrected by Bazett and Hodges formulae. All patients were evaluated according to clinical condition on admission by Hunt‐Hess grades. The patients were grouped in two different categories according to QT interval corrected by Bazett and Hodges and scored by Hunt‐Hess (HH) grades.
Results:

Mean age of the study patients was 54 ± 12 years and of those 31 (60%) were female. Mean values of heart rate and RR interval were 82 ± 21 bpm and 777 ± 163 msec, respectively. The mean QTc interval by Bazett and Hodges were 456 ± 59 msec and 438 ± 48 msec, respectively (P < 0.001). Twenty‐three patients according to Bazett and fifteen according to Hodges had prolonged QTc. Correlation analyses showed relation between HH and QTc and prolonged QTc by Bazett (r = 0.278, P = 0.04 and r = 0.314, P = 0.024; respectively). There was no correlation between HH and QTc and prolonged QTc by Hodges (r = 0.204, P = 0.14 and r = 0.115, P = 0.41; respectively).
Conclusions:

In our study, correlation between QTc interval and clinical severity of SAH depended on the QTc formula used.
Does the Age Affect the Fluoroscopy‐Guided Transseptal Puncture in Catheter Ablation of Atrial Fibrillation?
Authors: HU YU‐FENG , TAI CHING‐TAI , LIN YENN‐JIANG , CHANG SHIH‐LIN , LO LI‐WEI , WONGCHAROEN WANWARANG , UDYAVAR AMEYA R. , TUAN TA‐CHUAN , CHEN SHIH‐ANN 
Published: August 2010

Background:

The anatomical differences with age may raise difficulty in determining the proper positioning of the transseptal puncture site in the therapeutic left heart catheterization. This study investigated whether age affects the fluoroscopy‐guided transseptal puncture in the catheter ablation of atrial fibrillation.
Methods and Results:

Fifty patients (52 ± 12 years, 35 men) who underwent ablation for paroxysmal/persistent atrial fibrillation were included. The patients were divided into two groups according to their age (cut‐point 50 y/o): young group (n = 20) and old group (n = 30). In the 30° right anterior oblique view (RAO), the width between the transseptal puncture site and coronary sinus ostium (H N‐CSO) was longer in old‐age group (14.4 ± 9.4 vs 10.9 ± 10.4 mm, P = 0.034). In the 60° left anterior oblique view (LAO) view, the angle of the direction of the transseptal needle (N‐angle) was less in the old‐age group (56.0 ± 10.0° vs 58.4 ± 9.8°, P = 0.041). The ratio of the transseptal puncture site‐coronary sinus ostium (CSO) distance over the distance between the superior vena cava‐right atrial junction and CSO (VN‐CSO/VJ‐CSO) was significantly higher in the old‐age group (0.73 ± 0.12 vs 0.63 ± 0.2, P = 0.009).
Conclusion:

The transseptal puncture site in the RAO view moved higher and more posterior and the transseptal puncture angle in the LAO view decreased with age. These findings highlight the influence of age on the atrial anatomy and transseptal puncture site.
Two Cases of Short QT Interval
Authors: MORIYA MANABU , SETO SHINJI , YANO KATSUSUKE , AKAHOSHI MASAZUMI 
Published: August 2010

Background:

The epidemiology of short QT interval remains unclear. We attempted to determine the incidence and clinical characteristics of short QT interval in a longitudinal cohort study.
Methods:

A total of 19,153 subjects (7,525 male, 11,628 female) were enrolled in the study and all available electrocardiograms (ECGs) were investigated longitudinally from 1958 through 2003. We defined short QT interval as QTc of less than 350 ms.
Results:

Of the 19,153 subjects, two met the criteria of short QT interval and allowed for prevalence and incidence estimates for short QT interval as 0.01% and 0.39/100,000 person‐years, respectively. Both cases had neither a family history of sudden cardiac death, nor a history of drug use that might have affected for QT interval. Case 1 was a female with history of ischemic heart disease. Case 2 was a 60‐year‐old male who exhibited a short QT interval for the first time when he was 26 years of age. He had sick sinus syndrome as an underlying heart disease.
Conclusions:

Of the 19,153 subjects in this study, none were identified as having the short QT syndrome, with associated high risk of ventricular tachyarrhythmia, atrial fibrillation, and sudden death. Two subjects were identified as having QTc of less than 350 ms, and allowed prevalence and incidence estimates to be made of short QT interval. There observations were suggestive of clinical relationships between short QT interval and organic or electrophysiological heart disease.
Automatic Verification of Ventricular Stimulation: Fusion Management Algorithm
Authors: BERTINI MATTEO , BIFFI MAURO , ZIACCHI MATTEO , VALZANIA CINZIA , SAPORITO DAVIDE , BORIANI GIUSEPPE 
Published: August 2010

Background: Ventricular stimulation with automatic control and back‐up pulse warrants maximum safety for the patient and increases device longevity. Fusion phenomenon may hinder evoked response (ER) detection and cause unnecessary back‐up stimulation. We evaluated an automatic fusion beat management algorithm and its relationship with atrioventricular (AV) interval programming in a DDD/R pacemaker.
Methods: We analyzed 45 Holter registrations of patients implanted with an Insignia Ultra DR. Fusion beat classification, as performed automatically by the Fusion Management Algorithm, was compared to visual inspection by the analyzing physician. Fusions were classified as loss of capture (LOC), true fusions, or fusions classified as captured beats. Patients were divided into two groups according to AV interval programming: long AV delay (AVl)(>150 ms) short AV delay (AVs)(≤150 ms).
Results: Percentage of paced beats was on average 65%. Fusion beats resulted in 26% of the total. No and LOC was detected as a fusion beat by the algorithm. No useless back‐up pulses were delivered because of fusion. Misclassification of fusion beats as captured beats occurred at different rates depending on programmed AV delay. The accuracy in detecting true fusion was greatly improved by programming a long AV delay (P < 0.001 vs AVs).
Conclusions: Performance of fusion management algorithm (FMA) is improved by programming a long AV interval or with automatic search of intrinsic activity. Programming the AV interval to enhance intrinsic conduction does not hinder FMA performance.