bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in children's fatigue during the course of treatment for paediatric cancer
Authors: Perdikaris P. , Merkouris A. , Patiraki E. , Papadatou D. , Vasilatou‐Kosmidis H. , Matziou V. 
Published: November 2008

Background:  Fatigue is described as one of the most distressing symptoms of cancer therapy; yet it has received limited clinical attention. Children are suffering from a symptom that is under‐diagnosed during their treatment.Aim:  The aim of this study is: (a) to assess the change in fatigue scores during cancer treatment according to children's perspectives, and (b) to describe the possible causes of fatigue from children's points of view.Sample and methods:  The present study is part of an ongoing prospective study. The research group consisted of 40 (n = 40) children aged 7–12 years with cancer who are being followed up in the oncology clinic of a Greek children's hospital. After parental consent was obtained, data were collected using the Child Fatigue Scale and a sociodemographic data form.Results:  The children with cancer reported a statistically significant increase in fatigue scores during their treatment (F = 6.846, P = 0.003). Gender was the only demographic factor associated with a significant increase in the fatigue scores (F = 4.857, P = 0.034).Conclusions:  Cancer treatment was found significantly to increase children's fatigue levels. Medical procedures and the hospital environment seemed to be major causative factors of the fatigue experienced by children with cancer during their treatment.
Factors associated with viral rebound among highly treatment‐experienced HIV‐positive patients who have achieved viral suppression
Authors: Smith CJ , Phillips AN , Dauer B , Johnson MA , Lampe FC , Youle MS , Tyrer M , Staszewski S 
Published: November 2008

ObjectiveMore and more highly treatment‐experienced patients are achieving viral suppression. However, the durability of suppression remains unclear.MethodsPatients from Royal Free Hospital (London, UK) and JW Goethe University Hospital (Frankfurt, Germany) who had failed ≥1 antiretroviral (ARV) regimen in all three main drug classes and ≥3 previous ARV regimens and subsequently achieved viral load <50 HIV‐1 RNA copies/mL were included. They were followed until stopping pre‐combination antiretroviral therapy, end of follow‐up or viral rebound (two viral loads >400 copies/mL).ResultsTwo hundred and forty‐seven patients contributed 723 person‐years and 114 viral rebounds [rate=15.8 per 100 person‐years; 95% confidence interval (CI) 12.9–18.7]. More recent calendar years of viral suppression [relative risk (RR)=0.90 per year later; 95% CI 0.81–1.00; P=0.05] and greater number of ARVs in the regimen not previously failed (RR=0.78 per 1 ARV more; 95% CI 0.65–0.95; P=0.01) were associated with lower viral rebound rates. At 0–1, 1–2, 2–3 and >3 years after achieving suppression, the rebound rates were 30.9, 9.2, 4.3 and 3.5 per 100 person‐years, respectively. Compared to 0–1 years, the adjusted RRs (95% CIs) after 1–2, 2–3 and >3 years were 0.33 (0.18–0.58), 0.21 (0.09–0.48) and 0.14 (0.06–0.33), respectively (P<0.0001).ConclusionsAlthough rebound rates are high, especially in the first year after viral suppression, this risk reduces substantially if highly treatment‐experienced patients can maintain viral suppression.
Predictors of severe hepatic steatosis using abdominal ultrasound in HIV‐infected patients
Authors: Ryan P , Blanco F , García‐Gascó P , García‐Merchán JA , Vispo E , Barreiro P , Labarga P , González‐Lahoz J , Soriano V 
Published: November 2008

ObjectiveMultiple factors may lead to hepatic steatosis (HS) in HIV‐positive patients. HS may result in severe liver damage on its own and/or by accelerating the progression of chronic viral hepatitis B or C.MethodsThe sensitivity/specificity of liver ultrasound (US) to recognize severe HS is above 85%. A cross‐sectional case–control study of all HIV out‐patients who underwent liver US since 2004 was conducted at our institution.ResultsEight hundred and thirty (36.1%) out of 2300 HIV‐positive patients on regular follow‐up underwent liver US during the study period. Severe HS was diagnosed in 108 (13%) patients. A total of 117 matched HIV controls lacking HS were selected randomly. In patients with severe HS, we found significantly higher values of body mass index (BMI), plasma viral load, serum glucose, alkaline phosphatase, triglycerides and low‐density lipoprotein cholesterol, as well as significantly higher prevalence of diabetes, elevated alcohol consumption, lipohypertrophy and advanced liver fibrosis. Furthermore, a trend towards longer exposure to nucleoside analogues was noticed. In the multivariate analysis, only elevated alcohol consumption [odds ratio (OR) 7, P=0.013], lipohypertrophy (OR 5.3, P=0.008), plasma viral load (OR 2.1, P=0.02), BMI (OR 1.2, P=0.013) and serum glucose (OR 1.03, P=0.027) were significantly associated with severe HS.ConclusionsSevere HS in HIV‐positive patients is associated with predisposing factors that are similar to those of HIV‐negative individuals. However, its characteristic association with elevated plasma viral load might suggest a direct involvement of HIV in liver fat deposition. Therefore, the benefit of controlling HIV replication with antiretroviral therapy should be balanced against its effect of occasionally inducing metabolic abnormalities and lipodystrophy.
Low prevalence of insulin resistance among HIV‐infected children receiving nonnucleoside reverse transcriptase inhibitor‐based highly active antiretroviral therapy in Thailand
Authors: Lee B , Aurpibul L , Sirisanthana V , Mangklabruks A , Sirisanthana T , Puthanakit T 
Published: November 2008

BackgroundHighly active antiretroviral therapy (HAART) is reported to cause insulin resistance among adults, but effects on children are less clear. We attempted to describe the prevalence of insulin resistance among HIV‐infected children receiving HAART.MethodsInsulin resistance was assessed at 96 weeks of treatment with nonnucleoside reverse transcriptase inhibitor (NNRTI)‐based HAART (nevirapine or efavirenz with stavudine and lamivudine) among children in Chiang Mai, Thailand. Insulin resistance was defined as homeostasis model assessment for insulin resistance (HOMA‐IR) ≥3.16, fasting c‐peptide ≥4.40 ng/mL or fasting insulin ≥25.0 μU/mL. Impaired fasting glucose (IFG) was defined as glucose ≥110 mg/dL. Measurements were analysed for associations with age, lipodystrophy, treatment regimen and clinical data.ResultsThe prevalence of insulin resistance was 6.5%; no child had IFG. Those with insulin resistance were older with higher body mass index. Children ≥10 years had higher HOMA‐IR, c‐peptide and insulin, but no difference was seen in the frequency of insulin resistance. No associations between insulin resistance and lipodystrophy or treatment regimen were detected.ConclusionsInsulin resistance is uncommon among children receiving NNRTI‐based HAART and is unrelated to lipodystrophy.
Emergency Psychiatric Services for Individuals with Intellectual Disabilities: Caregivers’ Perspectives
Authors: Weiss Jonathan A. , Lunsky Yona , Gracey Carolyn , Canrinus Maaike , Morris Susan 
Published: November 2008

Background  Strains on the mental health system and inaccessible services for individuals with intellectual disabilities (ID) often force caregivers to bring individuals with ID to the emergency department (ED) when in psychiatric crisis. The purpose of this study was to understand the experience of caregivers and adults with ID and mental health issues, according to caregivers’ perspectives.Method  Focus groups were conducted with one group of unpaid caregivers (i.e. family members) and two groups of paid caregivers (i.e. staff from community agencies) from Ontario, Canada.Results  Caregivers identified a number of issues centering on a lack of services, on respect, on knowledge and on expertise. Diagnostic overshadowing and overmedication were also prevalent concerns.Conclusions  Input from caregivers points to deficiencies in the system that lead them to use the ED when other options have been exhausted. A number of recommendations can be implemented to improve the emergency psychiatric care of adults with ID in the ED.
Assessment of the influence of age on the rate of heart rate decline after maximal exercise in non‐athletic adult males
Authors: Dimkpa U. , Ibhazehiebo K. 
Published: November 2008

SummaryThis study investigated the influence of age on heart rate (HR) decline after exercise in non‐athletic adult males. One hundred and fourteen adult males (66 young, 25 ± 6·26 years; 48 old, 53 ± 8·54 years) participated in the study. Subjects performed maximum‐effort ergometer exercise in incremental stages. HR was measured at rest and continuously monitored during and after exercise. Maximum oxygen uptake (VO2max) was measured during the exercise using respiratory gas analyser. Body mass index (BMI) was computed from weight and height measurements, while rating of perceived exertion (RPE) was obtained immediately after the exercise. Results indicated age differences in the rate of HR decline with the young presenting significantly higher %HR decline (P<0·001) than old adults at both levels of recovery. When linearly correlated with age, the rate of HR decline in 1 and 3 min indicated variances of (52%,56%) in young adults, and (54%,49%) in the old adults. After controlling for VO2max, resting HR, BMI and RPE, the influence of age on rate of HR decline in the two phases of recovery disappeared in young. In the older adult group, it reduced greatly in the 1‐min recovery (r2 = 25%; P = 0·001) and disappeared in the 3‐min recovery. Pattern of HR recovery did not differ between the two age groups while age threshold was observed in HR recovery in 1 min. In summary, the influence that age appeared to have on the rate of HR decline could not hold when factors affecting HR recovery were taken into account.
Effects of logging on carbon dynamics of a jack pine forest in Saskatchewan, Canada
Authors: Howard Erica A. , Gower Stith T. , Foley Jonathan A. , Kucharik Christopher J. 
Published: November 2008

AbstractWe calculated carbon budgets for a chronosequence of harvested jack pine (Pinus banksianaLamb.) stands (0‐, 5‐, 10‐, and∼29‐year‐old) and a∼79‐year‐old stand that originated after wildfire. We measured total ecosystem C content (TEC), above‐, and belowground net primary productivity (NPP) for each stand. All values are reported in order for the 0‐, 5‐, 10‐, 29‐, and 79‐year‐old stands, respectively, for May 1999 through April 2000. Total annual NPP (NPPT) for the stands (Mg C ha−1 yr−1±1 SD) was 0.9±0.3, 1.3±0.1, 2.7±0.6, 3.5±0.3, and 1.7±0.4. We correlated periodic soil surface CO2fluxes (RS) with soil temperature to model annualRSfor the stands (Mg C ha−1 yr−1±1 SD) as 4.4±0.1, 2.4±0.0, 3.3±0.1, 5.7±0.3, and 3.2±0.2. We estimated net ecosystem productivity (NEP) as NPPTminusRH(whereRHwas calculated using a Monte Carlo approach as coarse woody debris respiration plus 30–70% of total annualRS). Excluding C losses during wood processing, NEP (Mg C ha−1 yr−1±1 SD) for the stands was estimated to be −1.9±0.7, −0.4±0.6, 0.4±0.9, 0.4±1.0, and −0.2±0.7 (negative values indicate net sources to the atmosphere.) We also calculated NEP values from the changes in TEC among stands. Only the 0‐year‐old stand showed significantly different NEP between the two methods, suggesting a possible mismatch for the chronosequence. The spatial and methodological uncertainties allow us to say little for certain except that the stand becomes a source of C to the atmosphere following logging.
Respiratory carbon use and carbon storage in mid‐rotation loblolly pine (Pinus taedaL.) plantations: the effect of site resources on the stand carbon balance
Authors: Maier Chris A. , Albaugh Timothy J. , Lee Allen H. , Dougherty Phillip M. 
Published: November 2008

AbstractWe used estimates of autotrophic respiration (RA), net primary productivity (NPP) and soil CO2evolution (Sff), to develop component carbon budgets for 12‐year‐old loblolly pine plantations during the fifth year of a fertilization and irrigation experiment. Annual carbon use inRAwas 7.5, 9.0, 15.0, and 15.1 Mg C ha−1in control (C), irrigated (I), fertilized (F) and irrigated and fertilized (IF) treatments, respectively. Foliage, fine root and perennial woody tissue (stem, branch, coarse and taproot) respiration accounted for, respectively, 37%, 24%, and 39% ofRAin C and I treatments and 38%, 12% and 50% ofRAin F and IF treatments. Annual gross primary production (GPP=NPP+RA) ranged from 13.1 to 26.6 Mg C ha−1. The I, F, and IF treatments resulted in a 21, 94, and 103% increase in GPP, respectively, compared to the C treatment. Despite large treatment differences in NPP,RA, and carbon allocation, carbon use efficiency (CUE=NPP/GPP) averaged 0.42 and was unaffected by manipulating site resources.Ecosystem respiration (RE), the sum ofSff, and above groundRA, ranged from 12.8 to 20.2 Mg C ha−1 yr−1.Sffcontributed the largest proportion ofRE, but the relative importance ofSffdecreased from 0.63 in C treatments to 0.47 in IF treatments because of increased abovegroundRA. Aboveground woody tissueRAwas 15% ofREin C and I treatments compared to 25% ofREin F and IF treatments. Net ecosystem productivity (NEP=GPP‐RE) was roughly 0 in the C and I treatments and 6.4 Mg C ha−1 yr−1in F and IF treatments, indicating that non‐fertilized treatments were neither a source nor a sink for atmospheric carbon while fertilized treatments were carbon sinks. In these young stands, NEP is tightly linked to NPP; increased ecosystem carbon storage results mainly from an increase in foliage and perennial woody biomass.
Earlier nesting by loggerhead sea turtles following sea surface warming
Authors: Weishampel John F. , Bagley Dean A. , Ehrhart Llewellyn M. 
Published: November 2008

AbstractThe onset of spring, noted by the timing of wildlife migratory and breeding behaviors, has been occurring earlier over the past few decades. Here, we examine 15 years of loggerhead sea turtle, Caretta caretta, nesting patterns along a 40.5 km beach on Florida's Atlantic coast. This small section of beach is considered to be the most important nesting area for this threatened species in the western hemisphere. From 1989 to 2003, the annual number of nests fluctuated between 13 000 and 25 000 without a conspicuous trend; however, based on a regression analysis, the median nesting date became earlier by roughly 10 days. The Julian day of median nesting was significantly correlated with near‐shore, May sea surface temperatures that warmed an average of 0.8°C over this period. This marine example from warm temperate/subtropical waters represents another response of nature to recent climate trends.
Assessment of the National Eco‐Industrial Park Standard for Promoting Industrial Symbiosis in China
Authors: Geng Yong , Zhang Pan , Côté Raymond P. , Fujita Tsuyoshi 
Published: November 2008

SummaryEco‐industrial park (EIP) projects have become more prevalent in China. In order to evaluate the performance of such innovative projects, the State Environmental Protection Administration (SEPA) has set up a new national standard for EIPs, the first of its kind globally. This article examines the applicability and feasibility of the indicator system established in the standard. It first presents the details of this new standard. Then benefits and challenges in the standard's application are analyzed. The analysis shows that the new indicators are eco‐efficiency‐oriented and do not address the essence of the EIP. In the future, there will be a need to revise this set of indicators by considering the principles of eco‐industrial development and local realities in order to ensure that the indicators are indeed used to promote sustainable development of industrial parks.
In Search of Distress Risk
Authors: CAMPBELL JOHN Y. , HILSCHER JENS , SZILAGYI JAN 
Published: November 2008

ABSTRACTThis paper explores the determinants of corporate failure and the pricing of financially distressed stocks whose failure probability, estimated from a dynamic logit model using accounting and market variables, is high. Since 1981, financially distressed stocks have delivered anomalously low returns. They have lower returns but much higher standard deviations, market betas, and loadings on value and small‐cap risk factors than stocks with low failure risk. These patterns are more pronounced for stocks with possible informational or arbitrage‐related frictions. They are inconsistent with the conjecture that the value and size effects are compensation for the risk of financial distress.
Alleviation of Pulmonary Hypertension by Cardiac Resynchronization Therapy is Associated with Improvement in Central Sleep Apnea
Authors: YIU KAI‐HANG , LEE KATHY LAI‐FUN , LAU CHU‐PAK , SIU CHUNG‐WAH , MIU KIN‐MAN , LAM BING , LAM JAMIE , IP MARY SAU MAN , TSE HUNG‐FAT 
Published: November 2008

Background: Recent studies have demonstrated that cardiac resynchronization therapy (CRT) reduces sleep apnea in heart failure (HF); however, the mechanism of benefit remains unclear.
Methods: Overnight polysomnography (PSG) was performed in consecutive HF patients who were scheduled for CRT implant. Patients with sleep apnea defined by an apnea‐hypopnea index (AHI) of >10/hour were recruited and underwent echocardiogram examination at baseline and 3 months after CRT.
Results: Among 37 HF patients screened, 20 patients (54%) had sleep apnea and 15 of them consented for the study. After 3 months of CRT, there was a significant improvement in New York Heart Association functional class (3.1 ± 0.1 vs 2.1 ± 0.1, P < 0.01), quality‐of‐life (QoL) score (62.9 ± 3.3 vs 56.1 ± 4.5, P = 0.02), left ventricular ejection fraction (LVEF, 28.8 ± 2.5% vs 38.1 ± 2.3%, P < 0.01), and reduction in pulmonary artery systolic pressure (PASP, 41.0 ± 2.7 vs 28.6 ± 2.2 mmHg; P < 0.01) compared with baseline. Repeated PSG after CRT demonstrated a reduction in the duration of arterial oxygen desaturation ≤95% (251.2 ± 36.7 vs 141.0 ± 37.1 minutes), AHI (27.5 ± 4.7 vs 18.1 ± 3.0, P = 0.05), and number of central sleep apnea (CSA) (7.8 ± 2.6 vs 3.0 ± 1.3/hour, P = 0.03), but not number of obstructive sleep apnea (OSA, 8.6 ± 3.3 vs 7.2 ± 2.3/hour, P = 0.65) compared to baseline. Percentage change in PASP was significantly correlated with percentage changes in LVEF (r=−0.57, P = 0.04), AHI (r = 0.5, P = 0.05), and number of CSA episodes (r = 0.55, P = 0.02).
Conclusions: The results demonstrated that CRT significantly reduces CSA in patients with HF. Importantly, we have noted a decrement of PASP correlated to drop in CSA which maybe one of the mechanisms explaining this observation. Future studies are required to confirm our finding and elucidate other possible mechanisms in this regard.
Circadian and Infradian Rhythms of Vasovagal Syncope in Young and Middle‐Aged Subjects
Authors: ZOGHI MEHDI , DUYGU HAMZA , GUNGOR HASAN , NALBANTGIL SANEM , OZERKAN FILIZ , AKILLI AZEM , AKIN MUSTAFA 
Published: November 2008

Background: The most cardiovascular physiological and pathophysiological events show a circadian rhythm. It is thought that the autonomic nervous system and biologic factors play a key role in the pathogenesis of vasovagal syncope (VVS). In this study, we investigated the circadian and infradian variation of VVS.
Methods: A prospective consecutive series of 246 patients (142 women; mean age 36 ± 7 years) with recurrent syncope and with a positive head‐up tilt testing (HUT) were included in this study. The daily and weekly distributions of the syncopal episodes were investigated. The assessments of episodes were done according to the days of the week and three time periods of the day (6 a.m.–12 noon, 12 noon–6 p.m., 6 pm–12 midnight).
Results: According to the results of HUT, 76 patients (31%) had cardioinhibitory, 62 patients (25%) had vasodepressor, and 108 patients (44%) had mixed type of VVS. During the initial passive phase, 40% of patients (99/246) showed positive response. Time to syncope was 20 ± 2 minutes during HUT. The mean number of syncopal episodes was 4 ± 2/years. In all, 1,070 episodes were evaluated. The distribution of the episodes in 6‐hour intervals was significantly different from uniform occurrence (38%, 33%, and 29%, respectively) (P = 0.02). The frequency of episodes was higher in the morning (P = 0.045) and in the middle of the week (P = 0.046). A significant difference was found between week and weekend days in terms of the frequency of episodes (75.5% vs 24.5%, P = 0.01).
Conclusion: VVS may show a circadian and infradian rhythm.
Ablation of Polymorphic Ventricular Tachycardias in Patients with Structural Heart Disease
Authors: BODE KERSTIN , HINDRICKS GERHARD , PIORKOWSKI CHRISTOPHER , SOMMER PHILIPP , JANOUŠEK JAN , DAGRES NIKOLAOS , ARYA ARASH 
Published: November 2008

Background and Objectives:

Monomorphic ventricular premature beats (VPB) originating from the Purkinje network can induce polymorphic ventricular tachycardia (PMVT) and ventricular fibrillation (VF) storm. We hereby report the results of targeted ablation to treat PMVT/VF storms initiated by monomorphic VPB in seven patients with structural heart disease and left ventricular (LV)‐dysfunction (n = 4 with
coronary artery disease (CAD), n = 2 with chronic and remote myocarditis, n = 1 after aortic valve replacement).
Methods and Results:

Pace‐mapping and activation mapping was used to identify optimal ablation targets. Earliest activation during mapping was found midseptal of LV in three patients, midinferoseptal of LV in two patients. One patient with myocarditis showed earliest activation at free wall of right ventricle, the other one basal midseptal of LV. Local ventricular electrograms at the successful ablation sites were preceded by short, high frequency, low amplitude potentials by 22–90 ms (median 35 ms). The same local potentials were seen in sinus rhythm. Cycle lengths of VT ranged between 200 and 360 ms (median 245 ms). A median of nine radiofrequency (RF)‐ablations (range 3–19) were necessary to abolish all local Purkinje potentials at the site of earliest activation. Two patients with CAD died due to refractory heart failure. The other five patients had no recurrence of PMVT and VF during follow up (median 10 months, range 1–27 months).
Conclusion:

The distal Purkinje network plays an important role in triggering PMVT/VF in patients with structural heart disease. Ablation of the triggering VPB originating from the Purkinje arborization is feasible; prevents recurrence in a long‐term follow up; and is potentially life saving in patients with severe LV‐dysfunction after myocardial infarction, in patients after aortic valve replacement, or in patients with myocarditis particularly when medical treatment, including antiarrhythmic drugs, failed to suppress electrical storms.
Correlative Anatomy and Electrophysiology for the Interventional Electrophysiologist:
Authors: ASIRVATHAM SAMUEL J. 
Published: November 2008

The cavotricuspid isthmus (CVTI) is the well‐established location of atrial tissue critical for the maintenance of typical atrial flutter. The CVTI begins at the electrically inert tricuspid valve and includes the atrial myocardium up to the inferior vena cava (IVC).In this article, we discuss relevant CVTI and right atrial anatomy of interest to the electrophysiologist. Critical questions that are considered include why ablation is sometimes difficult across the CVTI and how best to deal with anatomic variation including sub‐Eustachian pouches or large pectinate muscles encroaching onto the isthmus. Important electroanatomic features of the right atrium (RA) including sites for naturally occurring conduction block and the anatomy of the “lower loop” are reviewed.Following this discussion on the impact of the underlying anatomy for right atrial flutter ablation, an approach to dealing with difficulty when mapping or ablating this common arrhythmia is presented.