bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dialysis delivery of an adenosine A2Aagonist into the pontine reticular formation of C57BL/6J mouse increases pontine acetylcholine release and sleep
Authors: Coleman Christal G. , Baghdoyan Helen A. , Lydic Ralph 
Published: September 2006

AbstractIn vivomicrodialysis in C57BL/6J (B6) mouse was used to test the hypothesis that activating adenosine A2Areceptors in the pontine reticular formation (PRF) increases acetylcholine (ACh) release and rapid eye movement (REM) sleep. Eight concentrations of the adenosine A2Areceptor agonist 2‐p‐(2‐carboxyethyl)phenethylamino‐5′‐N‐ethylcarboxamidoadenosine hydrochloride (CGS 21680; CGS) were delivered to the PRF and ACh in the PRF was quantified. ACh release was significantly increased by dialysis with 3 μmCGS and significantly decreased by dialysis with 10 and 100 μmCGS. Co‐administration of the adenosine A2Areceptor antagonist 4‐(2‐[7‐amino‐2‐(2‐furyl)[1,2,4]triazolo[2,3‐a][1,3,5]triazin‐5‐ylamino]ethyl)phenol (ZM 241385; 30 nm) blocked the CGS‐induced increase in ACh release. In a second series of experiments, CGS (3 μm) was delivered by dialysis to the PRF for 2 h while recording sleep and wakefulness. CGS significantly decreased time in wakefulness (−51% in h 1; −54% in h 2), increased time in non‐rapid eye movement (NREM) sleep (90% in h 1; 151% in h 2), and increased both time in REM sleep (331% in h 2) and the number of REM sleep episodes (488% in h 2). The enhancement of REM sleep is consistent with the interpretation that adenosine A2Areceptors in the PRF of the B6 mouse contribute to REM sleep regulation, in part, by increasing ACh release in the PRF. A2Areceptor activation may promote NREM sleep via GABAergic inhibition of arousal promoting neurons in the PRF.
To What Extent Do Geriatricians Document the Most Bothersome Symptoms of Patients with Advanced Dementia?
Authors: Garrett Stephanie L. , Cox‐Hayley Déon , Hougham Gavin W. , Sachs Greg A. 
Published: September 2006

OBJECTIVES: To assess whether geriatricians documented the bothersome symptoms of patients with advanced dementia, proxy reports of the most‐bothersome symptoms affecting those patients (as elicited in research interviews) were compared with what geriatricians who had seen those patients in a proximate clinic visit documented in the medical record.DESIGN: Retrospective chart review.SETTING: Outpatient geriatrics clinic at the University of Chicago.PARTICPANTS: Fifty‐seven pairs of patients with dementia (Functional Assessment Staging Tool stage 6 or 7) and their proxies.MEASUREMENTS: Clinic notes were reviewed for documentation of patients' bothersome symptoms that proxies reported during research interviews. Proxy reports had been recorded in the previously established Palliative Excellence in Alzheimer Care Efforts database.RESULTS: The most‐bothersome symptom was documented at least once in 84.2% (48/57) of clinic notes. The second‐most‐bothersome symptom was documented in 70.3% (26/37) of clinic notes. Most symptoms were documented in the Assessment and Plan section of the note.CONCLUSION: Geriatricians identified and documented the vast majority of bothersome symptoms, as reported by proxies, of patients with moderate to severe dementia.
Preoperative Risk Assessment for Delirium After Noncardiac Surgery: A Systematic Review
Authors: Dasgupta Monidipa , Dumbrell Andrea C. 
Published: September 2006

Delirium is a common postoperative complication in older adults associated with adverse events including functional decline, longer lengths of stay, and risk of institutionalization. The purpose of this article is to systematically review preoperative risk factors associated with delirium following noncardiac surgery.A medical literature search was conducted using several bibliographic databases (PubMed, CINAHL, Cochrane, PsychInfo), supplemented by a manual search of the references of retrieved articles. Studies were retained for review after meeting strict inclusion criteria that included only operative patients with incident postoperative delirium diagnosed prospectively using criteria derived from the Diagnostic and Statistical Manual of Mental DisordersThird or Fourth Edition. Quantitative analyses included significance testing, homogeneity testing, and effect‐size pooling.Twenty‐five articles were included for review. The incidence of delirium ranged from 5.1% to 52.2%, with greater rates after hip fracture and aortic surgeries. This review found two scales, a clinical prediction rule, and a delirium risk classification system that were validated in other operative settings.Individual risk factor analysis suggested that cognitive impairment, older age, functional impairment, sensory impairment, depression, preoperative psychotropic drug use, psychopathological symptoms, institutional residence, and greater comorbidity were associated with postoperative delirium. Of the risk factors examined, evidence was most robust for an association between delirium and cognitive impairment or psychotropic drug use, with moderate effect sizes for both. Missing data and measurement differences did not allow for inferences to be made about other risk factors.Effect‐size pooling supports the concept that delirium is a heterogeneous disorder with multiple risk factors. More research is needed to better identify patients at risk for postoperative delirium and to develop preventive strategies.
Influence of Drive Cycle Length on Initiation of Ventricular Fibrillation During Implantable Cardioverter Defibrillator Threshold Testing
Authors: SANGHVI NEIL K. , LELORIER PAUL , GURURAJ ARJUN V. , MONAHAN KEVIN M. 
Published: September 2006

Background: Programmed electrical stimulation of the heart as a method to induce tachyarrhythmias has been described since the 1960s. To date, no study has examined optimal drive cycle length in the induction of ventricular fibrillation (VF) during defibrillation threshold testing after implantable cardioverter‐defibrillator placement. We hypothesized that longer drive cycle length, by means of the longer action potential duration, would promote intramyocardial phase 2 reentry and facilitate induction of VF.
Methods: Fifty consecutive implants were randomized in a prospective crossover format for this study. The group consisted of 40 men and 10 women, with each patient receiving either a 400 or 600 ms initial drive train prior to 1.2 J internal shock on the T wave with a goal to induce ventricular fibrillation. The timing of the T wave shock was determined by measuring the interval from the beginning of the QRS to the apex of the T wave in lead II. Successful inductions were defibrillated via the cardioverter defibrillator. Patients were then crossed over and the protocol repeated.
Results: Twenty of 23 (87%) patients were successfully induced into VF in the initial 400 ms drive train arm whereas 22 of 27 (81%) were successfully induced in the 600 ms arm. Thus, a total of 44 (88%) patients were successfully induced at 400 ms, 41 (82%) patients were successfully induced at 600 ms, and 2 (4%) patients were not inducible at either cycle length, but were inducible with 50 Hz ventricular stimulation. However, no significant difference was noted between the two groups.
Conclusion: No investigation to date has questioned whether a relationship exists between drive cycle length and initiation of ventricular fibrillation. Our study addresses this question, though negative for difference between 400 and 600 ms drive trains. Further research into optimal strategies for inducing ventricular fibrillation will minimize patient sedation time and discomfort while undergoing defibrillator threshold testing.
Anodal Capture in Cardiac Resynchronization Therapy Implications for Device Programming
Authors: TAMBORERO DAVID , MONT LLUIS , ALANIS ROBERTO , BERRUEZO ANTONIO , TOLOSANA JOSE MARIA , SITGES MARTA , VIDAL BARBARA , BRUGADA JOSEP 
Published: September 2006

Introduction: Right ventricular (RV) anodal capture (AC) has been reported in cardiac resynchronization therapy (CRT), when left ventricular (LV) pacing uses pseudobipolar (LV tip to RV proximal electrode) configuration. The aim of the study was to analyze the prevalence of AC and its implications for device programming.
Methods and Results: When AC occurred, the resulting QRS morphology was evaluated with the following pacing modes: (1) LV tip pacing plus RV AC, (2) Biventricular (BiV) pacing (i.e., both LV and RV tip pacing), and (3) BiV pacing plus RV AC. Several interventricular pacing (VV) intervals from 50 ms of LV preactivation to 30 ms of RV preactivation were tested in modes 2 and 3. From 38 consecutive patients, AC was achieved in 14 (in 74% of the pacemakers and in none of the defibrillators). LV tip pacing plus RV AC obtained narrower QRS than BiV pacing at all VV intervals in seven of the patients with AC (50%). When BiV pacing is combined with RV AC, it produced a ventricular depolarization through two wave fronts (one from the LV tip and the second from either the ring or the tip of the RV lead depending on the VV interval programmed).
Conclusions: AC obtained the narrowest QRS of all tested pacing modes in a significant proportion of patients undergoing CRT. Though the stimulus was delivered from three sites (BiV pacing plus RV AC mode), only two wave fronts of ventricular activation were seen by ECG.
Long‐Term Follow‐Up of Patients Supplied with Single‐Chamber or Dual‐Chamber Cardioverter Defibrillators
Authors: KOLB CHRISTOF , DEISENHOFER ISABEL , SCHMIEDER SEBASTIAN , BARTHEL PETRA , ZRENNER BERNHARD , KARCH MARTIN R. , SCHMITT CLAUS 
Published: September 2006

Introduction: In patients who have an indication for an implantable cardioverter defibrillator (ICD) a dual‐chamber device is indicated in the case of concomitant significant sinus node disease or atrioventricular block. It is a matter of debate whether dual‐chamber ICD may be beneficial for patients with preserved sinus and atrioventricular nodal function as data from prospective randomized trials are limited. Mid‐ or long‐term follow‐up data are unavailable.
Methods and Results: One hundred patients (age 60 ± 12 years, 11 women) with the indication for the implantation of an ICD and without antibradycardia pacing indication were randomly assigned to either receive a dual‐chamber ICD (n = 52) or a single‐chamber ICD (n = 48). Patients were followed‐up for a mean of 52 ± 14 months. Mortality and arrhythmogenic morbidity were assessed. All‐cause mortality was 21% for single‐chamber and 31% for dual‐chamber ICD recipients, respectively (P = 0.26). Cardiovascular mortality was 13% for single‐chamber ICD recipients versus 21% in the dual‐chamber group (P = 0.25). Subgroup analysis using 35% of ventricular paced beats as cutoff value in the dual‐chamber ICD group revealed a 42% mortality rate for the patients with frequent ventricular pacing compared to 10% of patients with a low rate of ventricular pacing (P = 0.05, relative risk 4.21, 95% confidence interval: 0.9–19.8). As for arrhythmogenic morbidity, the difference in the ventricular tachyarrhythmia load was not different in both groups (single chamber: 23 ± 74 VT episodes, dual chamber: 54 ± 134 VT episodes, P = 0.17).
Conclusion: In ICD recipients without conventional indication for dual‐chamber pacing, dual chamber compared to single‐chamber ICD has no advantage concerning mortality and arrhythmogenic morbidity in a long‐term follow‐up. In these patients the implantation of a single‐chamber device is sufficient.
Effect of Right Ventricular Apex Pacing on the Tei Index and Brain Natriuretic Peptide in Patients with a Dual‐Chamber Pacemaker
Authors: ICHIKI HITOSHI , OKETANI NAOYA , HAMASAKI SHUICHI , ISHIDA SANEMASA , KATAOKA TETSURO , OGAWA MASAKAZU , SAIHARA KEISHI , OKUI HIDEKI , FUKUDOME TSUYOSHI , SHINASATO TAKURO , KUBOZONO TAKURO , NINOMIYA YUICHI , MATSUSHITA TAKEHIKO , OTSUJI YUTAKA , TEI CHUWA 
Published: September 2006

Background: Asynchronous electrical activation induced by right ventricular apex (RVA) pacing can cause various abnormalities in left ventricular (LV) function, particularly in the context of severe LV dysfunction or structural heart disease. However, the effect of RVA pacing in patients with normal LV and right ventricular (RV) function has not been fully elucidated. The aim of this study was to characterize the effects of RVA pacing on LV and RV function by assessing isovolumic contraction time and isovolumic relaxation time divided by ejection time (Tei index) and by assessing changes in plasma brain natriuretic peptide (BNP).
Methods: Doppler echocardiographic study and BNP measurements were performed at follow‐up (mean intervals from pacemaker implantation, 44 ± 75 months) in 76 patients with dual chamber pacemakers (sick sinus syndrome, n = 30; atrioventricular block, n = 46) without structural heart disease. Patients were classified based on frequency of RVA pacing, as determined by 24‐hour ambulatory electrocardiogram (ECG) that was recorded just before echocardiographic study: pacing group, n = 46 patients with RVA pacing ≥50% of the time, percentage of ventricular paced 100 ± 2%; sensing group, n = 30, patients with RVA pacing <50% of the time, percentage of ventricular paced 3 ± 6%.
Results: There was no significant difference in mean heart rate derived from 24‐hour ambulatory ECG recordings when comparing the two groups (66 ± 11 bpm vs 69 ± 8 bpm). LV Tei index was significantly higher in pacing group than in sensing group (0.67 ± 0.17 vs 0.45 ± 0.09, P < 0.0001), and the RV Tei index was significantly higher in pacing group than in sensing group (0.34 ± 0.19 vs 0.25 ± 0.09, P = 0.011). Furthermore, BNP levels were significantly higher in pacing group than in sensing group (40 ± 47 pg/mL vs 18 ± 11 pg/mL, P = 0.017). With the exception of LV diastolic dimension (49 ± 5 mm vs 45 ± 5 mm, P = 0.012), there were no significant differences in other echocardiographic parameters, including left atrium (LA) diameter (35 ± 8 mm vs 34 ±5 mm), LA volume (51 ± 27 cm3 vs 40 ± 21 cm3), LV systolic dimension (30 ± 6 mm vs 29 ± 7 mm), or ejection fraction (66 ± 9% vs 63 ± 11%), when comparing the two groups.
Conclusions: These findings suggest that the increase of LV and RV Tei index, LVDd, and BNP are highly correlated with the frequency of the RVA pacing in patients with dual chamber pacemakers.
The Promise and Pitfalls of Consensus Decision Making in School Management
Authors: Erbes Kristen 
Published: September 2006

AbstractSchool/Community‐Based Management (SCBM) advocates insisted that changing the bureaucratic structure of governance, moving from top‐down decision making to a shared decision making at the local level, would revolutionize schools and result in higher student achievement. Many schools have struggled with shared decision‐making processes. This article examines one high school's attempt to implement a dress code using consensus‐based decision‐making. Organizations that strive to make decisions by consensus should be aware of the pitfalls that may occur and work to address them if they arise.
Survival and Institutionalization of an Idea: The Rapid Rise of Intelligent Vehicle‐Highway Systems
Authors: Lindquist Eric 
Published: September 2006

AbstractChanges in existing institutions and/or the creation of new institutions often follow changes in political agendas and the acceptance of new ideas as viable policy solutions. This article describes the rise of a new policy solution in the early 1990s, an integrated set of transportation technologies—initially referred to as “intelligent vehicle‐highway systems” (IVHS)—and its subsequent survival and institutionalization. As a theoretical contribution, this article expands on the agenda‐setting framework of Kingdon (1995) and the subsequent work of Baumgartner and Jones (1993) on the nexus between agenda access and institutions. Tracing changes in existing institutions within the transportation policy domain, as well as the creation of a new institution devoted to the advocacy of this technology, this study illustrates the significance of ideas and institutions in the public policy process.
Direct Democracy Paradox: State Fiscal Policies in the United States and the Threat of Direct Initiatives
Authors: Saeki Manabu 
Published: September 2006

AbstractMany studies have argued that the initiative process in U.S. state governments strengthened the proximity between the citizens' preferences and policy output. In contrast, this study hypothesizes that the direct initiative process weakens, rather than strengthens, the link between citizen preferences and state fiscal policy. Governments respond to the threat of initiatives but only those of conservative agendas. The results show that while the level and the progressivity of tax rates in the states without direct initiatives are influenced by citizen preferences, those in states with direct initiatives are more conservative than those without direct initiatives and the former are insulated from the influence of the citizen preferences.
Quantum Change in the Fragmented Metropolis: Political Environment and Homeless Policy in New York City
Authors: Main Thomas J. 
Published: September 2006

AbstractThe dominant paradigm for understanding urban policy change has long been that of “incrementalism.” The incrementalist argument is that institutional fragmentation reduces coordination, and thus discourages what might be called “nonincremental” or “quantum” change. This article seeks to test the incrementalist understanding of urban political change. Is it possible that under certain circumstances fragmentation can encourage quantum change? We will test this possibility with an analysis of homeless policy in New York City. Briefly put, over the last 25 years homeless policy in New York City has developed in a series of quantum jumps with dramatic, short‐term changes in funding, administration, and policy “philosophy.” Policy change followed this trajectory even though New York City's political environment is notoriously fragmented. This pattern contradicts what incrementalism would predict, and therefore suggests that that paradigm must be modified. Urban politics, this study suggests, can sometimes display the nonincremental, entrepreneurial, and “ideational” characteristics that have been identified as typical of the national “new politics of public policy.”
The treatment of negative symptoms and deficit states of chronic schizophrenia: olanzapine compared to amisulpride and placebo in a 6‐month double‐blind controlled clinical trial
Authors: Lecrubier Y. , Quintin P. , Bouhassira M. , Perrin E. , Lancrenon S. 
Published: September 2006

Objective:  The aim of the study was to evaluate the efficacy of olanzapine (5 and 20 mg/day) over a 6‐month period in chronic schizophrenic patients experiencing predominantly negative symptoms.Method:  Two hundred and forty‐four patients participated in a 6‐month multicenter double‐blind trial of placebo (n = 34), olanzapine 5 mg/day (n = 70), olanzapine 20 mg/day (n = 70), or amisulpride 150 mg/day (n = 70). Primary measure was the scale for the assessment of negative symptoms.Results:  Olanzapine 5 mg/day showed significantly greater improvement than placebo in negative symptoms and in the Positive and Negative Syndrome Scale total score. Baseline positive symptoms were low at baseline and changed minimally. The neurological tolerance of olanzapine, amisulpride and placebo were comparable.Conclusion:  Olanzapine 5 mg/day was effective in treating negative symptoms in a group of schizophrenic with predominantly negative symptoms during the stabilization phase. Improvement in positive symptoms or extrapyramidal symptoms (EPS) was unlikely to explain this result while improvement in depression may have partially contributed.
Full‐mouth ultrasonic debridement and risk of disease recurrence: a 1‐year follow‐up
Authors: Tomasi Cristiano , Bertelle Alberto , Dellasega Ester , Wennström Jan L. 
Published: September 2006

AbstractAim: To evaluate the incidence of disease recurrence following a full‐mouth pocket/root debridement approach with ultrasonic instrumentation versus that following a traditional approach of quadrant‐wise scaling and root planing (Q‐SRP) performed with hand instrumentation.Methods: Thirty‐seven patients were re‐examined 1 year after the completion of a 6‐month clinical trial comparing two different treatment protocols: a 1‐h session of full‐mouth ultrasonic debridement (UD – 19 patients) or four sessions of Q‐SRP with hand instruments (Q‐SRP – 18 patients). At 3 months, re‐instrumentation was performed of pockets showing a remaining probing pocket depth (PPD) of 5 mm using the same type of instruments as used during the initial treatment phase. The clinical examinations comprised assessments of plaque, bleeding on probing (BoP) and PPD. The primary outcome variable was the incidence of recurrent diseased sites (i.e., sites showing PPD5 mm and BoP+) between the post‐treatment and 1‐year follow‐up examinations. All sites that were healed (PPD4 mm and BoP−) at the post‐treatment examination were included in the study sample, with a mean number of sites per patient of 23.5.Results: In the UD group, 29 (7%) out of 430 initially healed sites showed disease recurrence at the 1‐year follow‐up examination compared with 47 (11%) of 440 sites in the Q‐SRP group (p>0.05). Twelve patients (63%) in the UD group presented recurrent diseased pockets, compared with 14 patients (78%) in the Q‐SRP group. Two or more recurrent, diseased pockets were observed in nine patients in the UD group versus 11 in the Q‐SRP group. All but one of the smokers belonged to the group of patients presenting recurrences. A tendency towards a higher mean plaque score was observed for the patients with recurrent sites.Conclusion: The study revealed no significant difference in the incidence of recurrence of diseased periodontal pockets between the full‐mouth UD approach and the traditional approach of Q‐SRP.
Prognostic factors in the treatment of generalized aggressive periodontitis: II. Effects of smoking on initial outcome
Authors: Hughes Francis J. , Syed Mahnaz , Koshy Bindhu , Bostanci Nagihan , McKay Ian J. , Curtis Michael A. , Marcenes Wagner , Croucher Raymond E. 
Published: September 2006

AbstractAims: The aim of this study was to investigate the effects of smoking on the response to non‐surgical treatment for aggressive periodontitis.Methods: Seventy‐nine patients with generalized aggressive periodontitis were included in the study; 20 were smokers. All patients received a course of non‐surgical periodontal therapy and outcomes assessed 10 weeks post‐operatively. Non‐responding patients were designated if they had 30% or more non‐responding deep sites.Results: At baseline, bleeding scores were lower in smokers. There was no difference in baseline plaque, pocket depth (PD), recession or clinical attachment levels (CALs); when sites were selected by equal levels of CAL, increased recession was seen in smokers. Outcomes were poorer in smokers (mean PD change 1.75±0.56 versus 2.23±0.87 mm). The odds ratio for 30% of sites not responding in smokers was 2.9; for 40% non‐responding it was 5.9. Smoking altered the distribution of site‐specific responses to increase specifically the number of non‐responding sites. There was no significant difference in responses between ex‐smokers and never‐smokers.Conclusions: The results demonstrate that smoking is a major risk factor for poor response to initial treatment and emphasize the importance of smoking cessation in periodontal therapy.