bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of Altitude on P‐Wave and QT Duration and Dispersion
Authors: GUNTEKIN UNAL , GUNES YILMAZ , TUNCER MUSTAFA , GUMRUKCUOGLU HASAN ALI , KAYA YUKSEL 
Published: July 2008

Background: Short‐term and long‐term exposure to high altitude has been reported to change the surface electrocardiogram. We aimed to compare P‐wave and QT parameters between healthy people living at high altitude and sea level.
Methods: Twelve‐lead electrocardiographies of 38 healthy people living at sea level (Antalya,Turkey) and 38 healthy people living at high altitude (Van, Turkey; 1,700–1,800 m) were obtained. Minimum and maximum P‐wave durations, P‐wave dispersion, minimum and maximum corrected QT intervals, and corrected QT dispersion were calculated.
Results: There was no significant difference between the two groups in respect to heart rate and QT variables. Mean Pminimum values were slightly but significantly lower in the high altitude group (P = 0.029). Mean Pmaximum values tended to be lower at high altitude but did not reach statistical significance (P = 0.085). However, there was no significant difference in respect to P‐wave dispersion values.
Conclusions: In a sample of men and women living at high altitude in Turkey, significant reduction of Pminimum and borderline reduction of Pmaximum duration, but no significant change of P‐wave and QT dispersion, were observed.
Effect of Pacing for Soft Indications on Mortality and Heart Failure in the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial
Authors: KUTALEK STEVEN P. , SHARMA ARJUN D. , McWILLIAMS MICHAEL J. , WILKOFF BRUCE L. , LEONEN ANNA , HALLSTROM ALFRED P. , KUDENCHUK PETER J. ,   the DAVID Investigators
Published: July 2008

Background: The dual chamber and VVI implantable defibrillator (DAVID) trial demonstrated that dual chamber (DDDR) pacing in defibrillator candidates with impaired ventricular function and no established indication for pacing resulted in worsened congestive heart failure (CHF) or death. Many patients had abnormalities for which pacing is often advocated to improve the management of ventricular dysfunction.
Objectives: Evaluate the impact and interaction of nonessential but potentially justifiable reasons to pace (“soft indications”), together with pacing mode, on outcome.
Methods: DAVID patients were stratified by those with and without “soft indications” for pacing (rate < 60 beats/min or first‐degree atrioventricular block) (n = 169; n = 335, respectively). This analysis also stratified patients by normal and abnormal QRS conduction (QRS ≥ 110 ms), who were previously found to be affected differently by DDDR pacing. Groups were analyzed according to the combined endpoint of mortality or CHF hospitalization.
Results: When assigned to treatment that promoted pacing (DDDR), the incidence of death or CHF tended to be higher in patient subgroups with and without “soft indications,” consistent with results from DAVID. Patients with, compared to those without, these abnormalities neither benefited nor were less adversely affected when actively paced. The presence or absence of “soft indications” also provided no additional explanation for the differing outcomes in patient cohorts with and without abnormal QRS conduction.
Conclusions: Sinus bradycardia or first‐degree atrioventricular block did not ameliorate the poor outcomes associated with dual‐chamber compared with VVI pacing, and do not justify conventional dual‐chamber pacing in defibrillator recipients with ventricular dysfunction.
Magnetic Resonance Imaging of Implantable Cardiac Rhythm Devices at 3.0 Tesla
Authors: GIMBEL J. ROD 
Published: July 2008

Background: A relaxation of the prohibition of scanning cardiac rhythm device patients is underway, largely because of the growing experience of safe scanning events at 1.5T. Magnetic resonance imaging (MRI) at 3T is becoming more common and may pose a different risk profile and outcome of MRI of cardiac device patients.
Methods: No restrictions were placed on pacemaker dependency, region scanned, device type, or manufacturer. Sixteen scans at 3T were performed with an electrophysiologist present on 14 patients with a variety of devices from various manufacturers. An “MRI‐S” strategy was used. Multimodal monitoring was required. Device interrogation was performed prior to, immediately after, and 1–3 months after the MRI. For nonpacemaker‐dependent device patients, attempts were made to turn all device features off (with OOO programming the goal) conceptually rendering the device “invisible.” In pacemaker‐dependent patients, the device was programmed to asynchronous mode at highest output for the duration of the scan with the goal of rendering the device conceptually “invulnerable” to MRI effects. The specific absorption rate (SAR) was limited to 2W/kg.
Results: All patients were successfully scanned. No arrhythmias were noted. No significant change in the programmed parameters, pacing thresholds, sensing, impedance, or battery parameters was noted. The insertable loop recorder (ILR) recorded prolonged artifactual asystole during MRI. One patient noted chest burning during the scan.
Conclusions: Device patients may undergo carefully tailored 3T MRI scans when pre‐MRI reprogramming of the device occurs in conjunction with extensive monitoring, supervision, and follow‐up.
Mortality of Heart Failure Patients After Cardiac Resynchronization Therapy: Identification of Predictors
Authors: BAI RONG , BIASE LUIGI DI , ELAYI CLAUDE , CHING CHI KEONG , BARRETT CONOR , PHILIPPS KAREN , LIM PASCAL , PATEL DIMPI , CALLAHAN TOM , MARTIN DAVID O. , ARRUDA MAURICIO , SCHWEIKERT ROBERT A. , SALIBA WALID I. , WILKOFF BRUCE , NATALE ANDREA 
Published: July 2008

Introduction: A direct comparison of survival benefits between cardiac resynchronization therapy‐pacemaker (CRT‐P) and defibrillator (CRT‐D) was not yet performed, leaving clinicians to question whether CRT‐P alone is enough to protect congestive heart failure (CHF) patients from sudden cardiac death and whether CRT‐D should be implanted to all CHF patients indicated for biventricular pacing. This study attempts to make this type of comparison in a large CHF population and seeks to identify predictors of death in patients with different comorbidities. Methods and Results: Study population consisted of 542 consecutive patients who were implanted with either CRT‐P (N = 147) or CRT‐D (N = 395) between 1999 and 2005. Patients' clinical and follow‐up data were entered in a prospective registry and retrieved for analysis. The primary endpoint of this study was all‐cause mortality during follow‐up. Total all‐cause mortality was significantly lower among patients with CRT‐D (18.5% vs. 38.8% of CRT‐P, χ2= 25.11, P < 0.001). Patients with one of three comorbidities—chronic renal failure (OR = 4.885, P = 0.005), diabetes mellitus (OR = 4.130, P = 0.003), and history of atrial fibrillation (OR = 1.473, P = 0.036)—appeared to have higher risk of death, while treatment with beta‐blocker (OR = 0.330, P = 0.002) or CRT‐D device (OR = 0.334, P = 0.003) seemed to be associated with lower mortality. Conclusions: Data from this nonrandomized study indicate that CRT‐D has additional survival benefits over CRT‐P. Given these findings, CRT‐D should be recommended to most CHF patients with indications for biventricular pacing. After CRT implant, chronic renal failure, diabetes mellitus, and history of atrial fibrillation are strong independent predictors of death.
Endocardial Transcatheter Stimulation of the AV Nodal Fat Pad: Stabilization of Rapid Ventricular Rate Response During Atrial Fibrillation in Left Ventricular Failure
Authors: BIANCHI STEFANO , ROSSI PIETRO , SCALA ALBERTO DELLA , KORNET LILIAN 
Published: July 2008

Introduction: Recent acute studies demonstrated that atrioventricular (AV) node vagal stimulation during atrial fibrillation (AF) decreases the mean ventricular rate, thus improving hemodynamics. Methods and Results: We report a case of a woman with acute heart failure (HF), chronic AF with untreatable ventricular rapid response, in severe hypotensive state due to a cardiogenic shock. The patient underwent left ventricular (LV) pacemaker implantation and received 50 Hz AV node stimulation, delivered through a posteroseptal atrial lead, thus allowing a 100% pacing. Hemodynamics improvements allowed carvedilol titration; the rate was below 85 bpm after 4 days, then the atrial lead was removed. Conclusions: This novel strategy may allow controlling the rapid AV response in patients undergoing pacemaker implantation.
Milk Teeth and Jet Planes: Kin Relations in Families of Sri Lanka's Transnational Domestic Servants
Authors: GAMBURD MICHELE R. 
Published: July 2008

AbstractThis essay examines the confluence of local and global dynamics, exploring how transnational migration affects and is affected by gender roles, kinship relations, intergenerational obligations, and ideologies of parenthood. Journeying to the Middle East repeated on two‐year labor contracts, many of Sri Lanka's migrant housemaids leave behind their husbands and children. Women's long‐term absences reorganize and disrupt widely accepted gendered attributions of parenting roles, with fathers and female relatives taking over household tasks. Migrants say that economic difficulties prompt migration, and assess commitment to kin in financial terms. The government also benefits from remittances. Nevertheless, stakeholders (villagers, politicians, and the national media) worry about the social costs born by children. Drawing on interviews with the adult children of migrant mothers in four extended families in the Sri Lankan coastal village of Naeaegama, I examine the long‐term effects of transnational labor migration on local households. The case studies do not support media claims that children suffer abuse and neglect in their mothers’ absence, but do in part support survey information on reduced education, shifting marriage patterns, and paternal alcohol consumption.
Strategic Transnationalism: The Indian Diasporic Elite in Contemporary Bahrain
Authors: GARDNER ANDREW M. 
Published: July 2008

AbstractThis paper provides an ethnographic window into the lives of the middle and upper classes of the substantial Indian diaspora in Bahrain. Like all the Gulf States, Bahrain hosts an extraordinarily large contingent of guest workers. Through a variety of historical conjunctures, Indians have long predominated in the flow of foreigners to the small island. In this paper I consider the experiences of the elite minority of that diaspora. While many aspects of their day‐to‐day experiences differ from those of their impoverished diasporic countrymen and countrywomen, I argue that they also face a variety of noteworthy vulnerabilities and dilemmas unique to their class position. In the final accounting, members of this Indian diasporic elite deploy a strategic transnationalism against the systemic vulnerabilities rendered by the sponsorship system currently in place in Bahrain.
The Search for Miss Philippines Bahrain—Possibilities for Representation in Expatriate Communities
Authors: NAGY SHARON 
Published: July 2008

AbstractBased on participant observation within the organizing committee of a beauty pageant produced by the Filipino Club in Bahrain, this paper explores group interactions within Bahrain's multinational population. More specifically, the paper asks whether semi‐public events staged by expatriate community organizations serve as nodes of interaction across boundaries of nationality. The first half of the paper describes the transnational context and expatriate community organizations in Bahrain and the type of activities they host. An important distinction is made between activities hosted on the club premises and/or for club members and performance events that are potentially open to non‐members. The second half of the paper uses a beauty pageant organized by the Filipino Club to examine how semi‐public performance events provide a venue for both the construction of community identity and its potential presentation to other nationalities resident in Bahrain. By describing the range of activities organized by the Filipino Club—from professional networking to aromatherapy classes from Christmas parties to beauty pageants—this research expands our ideas of the nature of expatriate lives in the Gulf. The ethnographic analysis of the beauty pageant demonstrates that semi‐public events may not fulfill their potential for reciprocal inter‐group communication.
Emergency Medical Services Provider Perceptions of the Nature of Adverse Events and Near‐misses in Out‐of‐hospital Care: An Ethnographic View
Authors: Fairbanks Rollin J. , Crittenden Crista N. , O’Gara Kevin G. , Wilson Matthew A. , Pennington Elliot C. , Chin Nancy P. , Shah Manish N. 
Published: July 2008

AbstractObjectives:  The objectives were to examine the perceptions of emergency medical services (EMS) providers regarding near‐misses and adverse events in out‐of‐hospital care.Methods:  This study uses qualitative methods (focus groups, interviews, event reporting) to examine the perceptions of EMS providers regarding near‐misses and adverse events in out‐of‐hospital care. Results were reviewed by five researchers; analytic domains were assigned and emerging themes were identified. Descriptive statistics were calculated.Results:  Fifteen in‐depth interviews (73% advanced life support [ALS], 40% volunteer, and 87% male) resulted in 50 event descriptions. Eleven additional event reports were obtained from the anonymous reporting system. Of the 61 total events, 27 (44%) were near‐misses and 34 (56%) were adverse events. Fourteen (23%) involved a child (<19 years). Types of error included 33 clinical judgment (54%), 13 skill performance (21%), 9 medication event (15%), 3 destination choice (5%), and 3 others (5%). For the 21 cases where the provider discussed the event, 10 (48%) were reported to a physician, and 9 (43%) to a supervisor; 4 (19%) were not reported, and none were reported to the patient. Focus groups supported interview and event report data. Emerging themes included a focus on the errors of others and a “blame‐and‐shame” culture.Conclusions:  Adverse events and near‐misses were common among the EMS providers who participated in this study, but the culture discourages sharing of this information. Participants attributed many events to systems issues and to inadequacies of other provider groups. Further study is necessary to investigate whether these hypothesis‐generating themes are generalizable to the EMS community as a whole.ACADEMIC EMERGENCY MEDICINE 2008; 15:1–8 © 2008 by the Society for Academic Emergency Medicine
Race, Ethnicity, and Management of Pain from Long‐bone Fractures: A Prospective Study of Two Academic Urban Emergency Departments
Authors: Bijur Polly , Bérard Anick , Esses David , Calderon Yvette , John Gallagher E. 
Published: July 2008

AbstractObjectives:  The objective was to test the hypothesis that African American and Hispanic patients are less likely to receive analgesics than white patients in two academic urban emergency departments (EDs).Methods:  This was a prospective observational study of a convenience sample of patients with long‐bone fractures from April 2002 to November 2006 in two academic urban EDs. Eligibility criteria were age 18–55 years, isolated long‐bone fracture, and race and ethnicity (Hispanic, African American, and white). The primary outcome was receipt of analgesics; secondary outcomes included receipt of opioids, dose, route, time to first analgesic, and change in pain. Logistic regression was used to adjust the risk of receiving analgesics for patients’ initial rating of pain and demographic characteristics.Results:  Of 1,239 patients with suspected long‐bone fractures, 345 patients were eligible: 177 (51%) were Hispanic, 98 (28%) were African American, and 70 (20%) were white. Administration of analgesics was not associated with race or ethnicity. Sixteen percent (95% confidence interval [CI] = 11% to 22%) of Hispanic, 15% (95% CI = 10% to 24%) of African American, and 14% (95% CI = 8% to 24%) of white patients did not receive any analgesics. Seventy‐four percent of Hispanic (95% CI = 67% to 80%), 66% of African American (95% CI = 57% to 75%), and 69% (95% CI = 57% to 78%) of white patients received opioid analgesics. After adjustment for covariates, there was no evidence of an association between receipt of analgesics or opioid analgesics and the race or ethnicity of the patients. There were no significant differences in time to treatment, dose, route, or change in pain.Conclusions:  Receipt of analgesics for pain from long‐bone fractures was not associated with patient race or ethnicity in two academic urban EDs.ACADEMIC EMERGENCY MEDICINE 2008; 15:589–597 © 2008 by the Society for Academic Emergency Medicine
A Rapid Qualitative Test for Suspected Ethylene Glycol Poisoning
Authors: Long Heather , Nelson Lewis S. , Hoffman Robert S. 
Published: July 2008

AbstractObjectives:  Many hospitals must send out ethylene glycol (EG) samples to a reference laboratory, and delays in diagnosis and treatment may occur. A qualitative colorimetric test (ethylene glycol test [EGT] kit), already in use by veterinarians, gives results in 30 minutes with little expertise or cost. The EGT reliably detects the presence of EG in spiked human serum samples. The objective of this study was to prospectively assess the sensitivity and specificity of the EGT kit in actual clinical samples submitted for EG testing by the criterion standard gas chromatography (GC).Methods:  Blood samples from patients with suspected toxic alcohol poisoning submitted to a reference laboratory were tested by GC. An investigator blinded to the GC results tested the same sample with the EGT kit following the manufacturer’s instructions and using the internal control. Three physicians also blinded to the GC results categorized the sample as positive for EG, negative, or inconclusive. Interrater reliability was assessed with a kappa statistic (κ). Results of the EGT kit testing were then compared to those from GC testing.Results:  Data are reported on 24 samples submitted. By GC, 15 samples were confirmed for EG (range 27–281 mg/dL), 5 were confirmed for methanol (ME; range 64–101 mg/dL), and 4 were negative for both alcohols. The EGT was unanimously positive in all confirmed EG samples and negative in all ME samples. In one of the negative samples, an ambiguous result occurred and was counted as a false‐positive. Interobserver agreement with the EGT was high (κ = 0.909; 95% confidence interval [CI] = 0.735 to 1.0). Sensitivity and specificity were 100% (95% CI = 70% to 100%) and 88.8% (95% CI = 52% to 100%), respectively.Conclusions:  The EGT appears to be a reliable qualitative test in cases of suspected human EG poisoning.ACADEMIC EMERGENCY MEDICINE 2008; 15:1‐3 © 2008 by the Society for Academic Emergency Medicine
Alignment of Emergency Medicine Research Efforts with Clinical and Translational Science Awards
Authors: Miller Chadwick D. , Kumar Rita , Storrow Alan B. 
Published: July 2008

AbstractThe Clinical and Translational Science Awards (CTSA) represent a major new funding pathway for health science investigators seeking National Institutes of Health (NIH) funds. This new pathway provides institutional‐level support for clinical and translational research and is not tied to one organ system or disease process, fitting well with emergency medicine (EM) research needs. These awards open unique opportunities for advancing EM research. The CTSA mechanism provides institutional support from the NIH to promote both clinical and translational science. Of the 60 expected awards, 38 sites are currently funded. EM investigators can benefit the institutions applying for these awards and simultaneously gain from involvement. Some opportunities for participation provided by the CTSA include research training programs, joining multidisciplinary research teams, seed grant funding, and use of the CTSA‐developed research infrastructure. Involvement of EM can benefit institutions by enhancing acute care research collaboration both within and among institutions. Emergency medicine researchers at institutions either planning to submit a CTSA application or with funded CTSA grants are encouraged to become actively involved in CTSA‐related research programs.ACADEMIC EMERGENCY MEDICINE 2008; 15:1–5 © 2008 by the Society for Academic Emergency Medicine
Safety of Paramedics with Extended Skills
Authors: Mason Suzanne , Knowles Emma , Freeman Jenny , Snooks Helen 
Published: July 2008

AbstractBackground:  The role of paramedics with extended skills is evolving, enabling them to assess and treat patients in the community. A United Kingdom service led by extended‐role paramedic practitioners (PPs) is aimed at managing minor acute illness and injury among older people in the home when appropriate, avoiding unnecessary transfer to the emergency department (ED).Objectives:  The objectives were to evaluate the safety of clinical decisions made by PPs operating within the new service.Methods:  As part of a cluster‐randomized controlled trial, patients aged >60 years contacting the emergency medical services (EMS) with a minor injury or illness were included in the study. The safety of the new PP intervention was compared with standard practice of EMS transfer and ED treatment. Outcomes included unplanned ED attendance within 7 days of the index episode. Clinical records were rated independently by two senior ED clinicians to identify related episodes, avoidable subsequent episodes, and suboptimal care.Results:  Of the 2,025 patients included in this analysis, 219 (10.9%) went on to have an unplanned ED attendance within 7 days. Of these, 162 (74.0%) re‐presented with a condition related to their index episode. The independent raters agreed on suboptimal care 83.4% of the time. There were 16 agreed upon episodes related to suboptimal care (0.80%). No significant differences were found between intervention and control groups in relation to re‐presentation at hospital within 7 days for a related condition or rates of assessed suboptimal care.Conclusions:  This study suggests that appropriately trained paramedics with extended skills treating older people with minor acute conditions in the community are as safe as standard EMS transfer and treatment within the ED.ACADEMIC EMERGENCY MEDICINE 2008; 15:607–612 © 2008 by the Society for Academic Emergency Medicine