bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sympathetic Overactivity in Patients with Pulmonary Stenosis and Improvement after Percutaneous Balloon Valvuloplasty
Authors: Alyan Omer , Ozdemir Ozcan , Kacmaz Fehmi , Topaloglu Serkan , Ozbakir Cemal , Gozu Ayfer , Korkmaz Sule , Toprak Nizamettin 
Published: July 2008

Objective: Percutaneous balloon valvulotomy (PBV) is the procedure of choice for the treatment of valvular pulmonary stenosis (PS) with similar results comparable to surgical valvotomy but less invasive. . Methods and Results: Twenty‐seven consecutive patients with PS being evaluated for PBV were enrolled in the study. Peak instantaneous transvalvular gradient, right ventricle (RV) diameter, mean atrial pressures, RV systolic pressure (RVSP), pro‐brain natriuretic peptide (proBNP) levels significantly decreased immediately after PBV. Regarding heart rate variability (HRV) parameters, mean HR (heart rate), LF (low frequency) day and night, LF/HF day and night significantly decreased and standard deviation of all NN intervals (SDNN), root mean square of successive differences (RMSSD), P number of NN intervals that differed by more than 50 ms from adjacent interval divided by the total number of all NN intervals (PNN50), HF (High frequency) day and night significantly increased 1 day after PBV and these changes were shown to be preserved at the first month. The increase in SDNN was correlated with the decrease in right atrial pressure (RAP) (r =−0.5, P = 0.04); the increase in standard deviation of the 5‐minute mean RR intervals (SDANN) was correlated with the decrease in proBNP (r =−0.4, P = 0.03). Conclusions: Sympathetic overactivity and increased proBNP levels were associated with the symptomatic status of patients with PS. Associated with a decrease in atrial pressures and proBNP levels, PBV yielded a decrease in adrenergic overactivity in the patients with PS.
Reproducibility and Gender‐Related Differences of Heart Rate Variability during All‐Day Activity in Young Men and Women
Authors: Sztajzel Juan , Jung Michel , Bayes de Luna Antonio 
Published: July 2008

Background: Only few data are available on reproducibility over time in healthy young men and women and the corresponding gender‐related changes of heart rate variability (HRV) measurements. Methods: We studied temporal and spectral HRV indices obtained from 24‐hour Holter recordings in 32 healthy volunteers (14 men and 18 women, mean age 29 ± 3 years) during 2 days of their usual all‐day activity. Results: Time‐domain measures and the spectral low‐frequency (LF) and high‐frequency (HF) components as well as the LF/HF ratio were comparable on both test days. Significantly higher values on test day 2 were observed only for the spectral very‐low‐frequency (VLF) component and for the resulting total power. Compared to men, women had higher day‐ and nighttime vagus‐associated HRV indices, including root mean square of successive differences (RMSSD), pNN50 (NN50 count divided by the total number of all NN intervals), and HF power, and lower day‐ and nighttime VLF and LF power with lower LF/HF ratio and total power. Conclusions: Temporal indices and the LF and HF spectral HRV measures are reproducible over usual all‐day activity in young healthy subjects. Young women have higher day‐and nighttime vagal tone than men with similar age range.
The Impact of Preinfarction Angina on Electrocardiographic Ischemia Grades in Patients with Acute Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention
Authors: Celik Turgay , Yuksel U. Cagdas , Iyisoy Atila , Kilic Selim , Kardesoglu Ejder , Bugan Baris , Isik Ersoy 
Published: July 2008

Objective: Grade 3 ischemia (G3I) is defined as ST elevation with distortion of the terminal portion of the QRS (emergence of the J point >50% of the R wave in leads with qR configuration, or disappearance of the S wave in leads with an Rs configuration). Patients with G3I on the presenting electrocardiogram (ECG) had worse prognosis than the patients with lesser (grade 2‐G2I) ischemia. The aim of this study is to examine the effects of preinfarct angina (PIA) on electrocardiographic ischemia grades. Methods: One hundred forty‐eight consecutive patients with ST‐segment myocardial infarction (STEMI) were included in this study. All patients underwent primary percutaneous coronary intervention. The admission ECGs was analyzed retrospectively for electrocardiographic ischemia grades and compared with the presence of PIA. Results: Study population consisted of 110 patients with G2I (88 men, mean age = 63 ± 6 years) and 38 patients with G3I (32 men, mean age = 61 ± 8 years). Baseline characteristics of the groups were the same except for patients with G3I had significantly longer pain to balloon time and higher admission creatine kinase MB isoenzyme (CK‐MB) levels. Tissue myocardial perfusion grade (TMPG) was better in patients with G2I. While 18 patients (47%) with G3I had PIA, 81 patients (70%) with G2I had PIA (P = 0.005). Although pain to balloon time and admission CK‐MB were independent predictor of worse electrocardiographic ischemia grade (OR 1.69, 95% CI 1.09–2.62; P = 0.01; OR 1.01, 1.00–286 Conclusion: PIA is one of the most important clinical predictors of better ischemia grades especially when combined with the pain to balloon time, LVEF, and admission CK‐MB levels in patients with STEMI. This study provided another evidence for the protective effects of PIA.
Electrocardiographic Transmural Dispersion of Repolarization in Patients with Inherited Short QT Syndrome
Authors: Anttonen Olli , Väänänen Heikki , Junttila Juhani , Huikuri Heikki V. , Viitasalo Matti 
Published: July 2008

Background: Short QT syndrome (SQTS) carries an increased risk for sudden cardiac death. However, only a short QT interval does not express the risk of ventricular arrhythmias. Thus, additional evaluation of the repolarization abnormality in SQTS patients is essential. In experimental models of SQTS, increased transmural dispersion of repolarization (TDR) and its electrocardiographic counterpart T‐wave peak to T‐wave end interval (TPE) appeared critical for induction of polymorphic ventricular tachycardia (PMVT). In a clinical study with acquired long QT syndrome patients, TPE/QT ratio > 0.28 indicated arrhythmia risk. We hypothesized that the TPE/QT ratio would be greater in SQTS patients than in control subjects. Methods and Results: We compared the behavior of the electrocardiographic TDR in three seriously symptomatic SQTS patients of unknown genotype presenting baseline QTc values <320 ms and in nine healthy age‐matched control subjects. We determined QT and TPE intervals as well as TPE/QT ratio from 24‐hour ECG recordings using a computer‐assisted program. Diurnal average of TPE/QT ratio was 0.28 ± 0.03 in SQTS patients and 0.21 ± 0.02 in control subjects (P = 0.01). SQTS patients had also lesser capacity to change TPE intervals from steady‐state conditions to abrupt maximal values than control subjects. Conclusion: SQTS patients have increased and autonomically uncontrolled electrocardiographic TDR. According to experimental SQTS models, the present results may in part explain increased vulnerability of SQTS patients to ventricular arrhythmias.
Success of Ultrasound‐guided Peripheral Intravenous Access with Skin Marking
Authors: Resnick Jessica R. , Cydulka Rita K. , Donato Jessica , Jones Robert A. , Werner Sandra L. 
Published: July 2008

AbstractObjectives:  The most effective technique for ultrasound‐guided peripheral intravenous access (USGPIVA) is unknown. In the traditional short‐axis technique (locate, align, puncture [LAP]), the target vessel is aligned in short axis with the center of the transducer. The needle is then directed toward the target under real‐time ultrasound (US) guidance. Locate, align, mark, puncture (LAMP) requires the extra step of marking the skin at two points over the path of the vein and proceeding with direct visualization as in LAP. The difference in success between these two techniques was compared among variably experienced emergency physician and emergency nurse operators.Methods:  Subjects in an urban academic emergency department (ED) were randomized to obtain intravenous (IV) access using either LAP or LAMP after two failed blind attempts. Primary outcomes were success of the procedure and time to complete the procedure in variably experienced operators.Results:  A total of 101 patients were enrolled. There was no difference in success between LAP and LAMP, even among the least experienced operators. Of successful attempts, LAMP took longer than LAP (median 4 minutes, interquartile range [IQR] 4–10.5 vs. median 2.9 minutes, IQR 1.6–7; p = 0.004). Only the most experienced operators were associated with higher levels of success (first attempt odds ratio [OR] 6.64; 95% confidence interval [CI] = 2 to 22). Overall success with up to two attempts was 73%. Complications included a 2.8% arterial puncture rate and 12% infiltration rate.Conclusions:  LAMP did not improve success of USGPIVA in variably experienced operators. Experience was associated with higher rates of success for USGPIVA.
Relapse after Emergency Department Discharge for Acute Asthma
Authors: Rowe Brian H. , Villa‐Roel Cristina , Sivilotti Marco L.A. , Lang Eddy , Borgundvaag Bjug , Worster Andrew , Walker Allan , Ross Scott 
Published: July 2008

AbstractObjectives:  The objectives were to determine patient and treatment‐response factors associated with relapse after emergency department (ED) treatment for acute asthma.Methods:  Subjects aged 18–55 years who were treated for acute asthma in 20 Canadian EDs prospectively underwent a structured ED interview and telephone contact 2 weeks later.Results:  Of 695 enrolled patients, 604 (86.9%) were discharged from the ED; follow‐up was available in 529 (87.5%); 63% were female and the median age was 29 years. Most patients were discharged on oral (70.8%) and inhaled (60.1%) corticosteroids (CS); 2‐week treatment adherences were 93.3 and 80.9%, respectively. Relapse occurred in 9.2% at 1 week (95% confidence interval [CI] = 7.1% to 12.0%) and 13.9% (95% CI = 11% to 17%) at 2 weeks. In multivariable modeling, factors associated with relapse were ethnicity (risk ratio [RR] white = 0.66; 95% CI = 0.52 to 0.83); female gender (RR = 1.57; 95% CI = 1.14 to 2.09); any ED visits in the past 2 years (RR = 1.47; 95% CI = 1.18 to 1.80); ever admitted for asthma treatment (RR = 1.83; 95% CI = 1.09 to 2.84); use of combined inhaled CS plus long‐acting β2‐agonists (RR = 1.39; 95% CI = 1.07 to 1.78) and of oral CS (RR = 1.35; 95% CI = 1.12 to 1.59) at the time of ED presentation.Conclusions:  Ethnicity (white), female gender, prior ED visits and admissions for asthma, and recent treatments (especially oral CS) were associated with asthma relapse, which remains relatively common. Future research is required to target this high‐risk group.
Educational and Research Implications of Portable Human Patient Simulation in Acute Care Medicine
Authors: Kobayashi Leo , Patterson Mary D. , Overly Frank L. , Shapiro Marc J. , Williams Kenneth A. , Jay Gregory D. 
Published: July 2008

AbstractAdvanced medical simulation has become widespread. One development, the adaptation of simulation techniques and manikin technologies for portable operation, is starting to impact the training of personnel in acute care fields such as emergency medicine (EM) and trauma surgery. Unencumbered by cables and wires, portable simulation programs mitigate several limitations of traditional (nonportable) simulation and introduce new approaches to acute care education and research.Portable simulation is already conducted across multiple specialties and disciplines. In situ medical simulations are those carried out within actual clinical environments, while off‐site portable simulations take place outside of clinical practice settings. Mobile simulation systems feature functionality while moving between locations; progressive simulations are longer‐duration events using mobile simulations that follow a simulated patient through sequential care environments. All of these variants have direct applications for acute care medicine.Unique training and investigative opportunities are created by portable simulation through four characteristics: 1) enhancement of experiential learning by reframing training inside clinical care environments, 2) improving simulation accessibility through delivery of training to learner locations, 3) capitalizing on existing care environments to maximize simulation realism, and 4) provision of improved training capabilities for providers in specialized fields. Research agendas in acute care medicine are expanded via portable simulation’s introduction of novel topics, new perspectives, and innovative methodologies.Presenting opportunities and challenges, portable simulation represents an evolutionary progression in medical simulation. The use of portable manikins and associated techniques may increasingly complement established instructional measures and research programs at acute care institutions and simulation centers.
Promoting Teamwork: An Event‐based Approach to Simulation‐based Teamwork Training for Emergency Medicine Residents
Authors: Rosen Michael A. , Salas Eduardo , Wu Teresa S. , Silvestri Salvatore , Lazzara Elizabeth H. , Lyons Rebecca , Weaver Sallie J. , King Heidi B. 
Published: July 2008

AbstractThe growing complexity of patient care requires that emergency physicians (EPs) master not only knowledge and procedural skills, but also the ability to effectively communicate with patients and other care providers and to coordinate patient care activities. EPs must become good team players, and consequently an emergency medicine (EM) residency program must systematically train these skills. However, because teamwork‐related competencies are relatively new considerations in health care, there is a gap in the methods available to accomplish this goal. This article outlines how teamwork training for residents can be accomplished by employing simulation‐based training (SBT) techniques and contributes tools and strategies for designing structured learning experiences and measurement tools that are explicitly linked to targeted teamwork competencies and learning objectives. An event‐based method is described and illustrative examples of scenario design and measurement tools are provided.
Dizziness Presentations in U.S. Emergency Departments, 1995–2004
Authors: Kerber Kevin A. , Meurer William J. , West Brady T. , Mark Fendrick A. 
Published: July 2008

AbstractObjectives:  The objectives were to describe presentation characteristics and health care utilization information pertaining to dizziness presentations in U.S. emergency departments (EDs) from 1995 through 2004.Methods:  From the National Hospital Ambulatory Medical Care Survey (NHAMCS), patient visits to EDs for “vertigo‐dizziness” were identified. Sample data were weighted to produce nationally representative estimates. Patient characteristics, diagnoses, and health care utilization information were obtained. Trends over time were assessed using weighted least squares regression analysis. Multivariable logistic regression analysis was used to control for the influence of age on the probability of a vertigo‐dizziness visit during the study time period.Results:  Vertigo‐dizziness presentations accounted for 2.5% (95% confidence interval [CI] = 2.4% to 2.6%) of all ED presentations during this 10‐year period. From 1995 to 2004, the rate of visits for vertigo‐dizziness increased by 37% and demonstrated a significant linear trend (p < 0.001). Even after adjusting for age (and other covariates), every increase in year was associated with increased odds of a vertigo‐dizziness visit. At each visit, a median of 3.6 diagnostic or screening tests (95% CI = 3.2 to 4.1) were performed. Utilization of many tests increased over time (p < 0.01). The utilization of computerized tomography and magnetic resonance imaging (CT/MRI) increased 169% from 1995 to 2004, which was more than any other test. The rate of central nervous system diagnoses (e.g., cerebrovascular disease or brain tumor) did not increase over time.Conclusions:  In terms of number of visits and important utilization measures, the impact of dizziness presentations on EDs is substantial and increasing. CT/MRI utilization rates have increased more than any other test.
Age Estimation from the Human Os Coxa: A Test on a Documented Italian Collection*
Authors: Hens Samantha M. , Rastelli Elisa , Belcastro Giovanna 
Published: July 2008

Abstract:  Current standards for age at death estimation from the pelvis are based on Americans of European and African ancestry. Our limited understanding of population variability hampers our efforts to apply these techniques to the various skeletal populations around the world, especially in global forensic contexts. However, documented skeletal samples are rare, limiting our ability to test our techniques. This study tested the Suchey‐Brooks pubic symphysis aging method and the auricular surface method originally developed by Lovejoy et al. on a large sample (n = 404) of known sex and age from the Sassari Collection, housed at the Museum of Anthropology at the University of Bologna, Italy. The results indicate that for both methods, bias and inaccuracy increased with age and actual age tended to be underestimated over the age of 40. The auricular surface method performed slightly better, exhibiting slightly lower levels of bias and inaccuracy, especially for males.
Development of Microplitis croceipes as a biological sensor
Authors: Tomberlin J. K. , Rains G. C. , Sanford M. R. 
Published: July 2008

AbstractClassical conditioning, a form of associative learning, was first described in the vertebrate literature by Pavlov, but has since been documented for a wide variety of insects. Our knowledge of associative learning by insects began with Karl vonFrisch explaining communication among honeybees, Apis mellifera L. (Hymenoptera: Apidae). Since then, the honey bee has provided us with much of what we understand about associative learning in insects and how we relate the theories of learning in vertebrates to insects. Fruit flies, moths, and parasitic wasps are just a few examples of other insects that have been documented with the ability to learn. A novel direction in research on this topic attempts to harness the ability of insects to learn for the development of biological sensors. Parasitic wasps, especially Microplitis croceipes (Cresson) (Hymenoptera: Braconidae), have been conditioned to detect the odors associated with explosives, food toxins, and cadavers. Honeybees and moths have also been associatively conditioned to several volatiles of interest in forensics and national security. In some cases, handheld devices have been developed to harness the insects and observe conditioned behavioral responses to air samples in an attempt to detect target volatiles. Current research on the development of biological sensors with insects is focusing on factors that influence the learning and memory ability of arthropods as well as potential mathematical techniques for improving the interpretation of the behavioral responses to conditioned stimuli. Chemical detection devices using arthropod‐based sensing could be used in situations where trained canines cannot be used (such as toxic environments) or are unavailable, electronic devices are too expensive and/or not of sufficient sensitivity, and when conditioning to target chemicals must be done within minutes of detection. The purpose of this article is to provide a brief review of the development of M. croceipes as a model system for exploring associative learning for the development of biological sensors.
Efficacy of an oral health promotion intervention in the prevention of early childhood caries
Authors: Plutzer Kamila , Spencer A. John 
Published: July 2008

Abstract –  Objective:  Despite a marked improvement in oral health of Australian children over the last 30 years, severe early childhood caries (S‐ECC) affects up to 17% of 2‐ to 3‐year‐old children with some requiring hospitalization and invasive treatment. This provided a compelling rationale to develop and test an oral health promotion programme which aimed to reduce this unnecessary suffering. The purpose of this study was to test the efficacy of an oral health promotion programme for the parents of infants, starting during the pregnancy, using a randomized controlled trial.Methods:  A programme was developed around the provision of anticipatory guidance to nulliparous women (women expecting their first child) in Adelaide. Mothers in the test group received oral health promotion information during pregnancy, and later when the child reached 6 and 12 months of age. After the second round of information the test group mothers were randomized again. The information was reinforced in one of the test subgroups through a telephone consultation. There was no contact with mothers in the control group after enrolment. At the age of 20 ± 2.5 months all test and control group children were examined by a dentist. The case definition of an incidence of S‐ECC was one or more upper incisor teeth being carious at the level of a cavitated or noncavitated lesion. The differences in S‐ECC incidence between the test and control groups, and the test subgroups were analysed.Results:  Of 649 women enroled in the programme (test group 327, control group 322), 441 had their child examined at follow‐up. The incidence of S‐ECC in the test group was 1.7% and in the control group 9.6% (P < 0.001).Conclusion:  An oral health promotion programme based on repeated rounds of anticipatory guidance initiated during the mother’s pregnancy was successful in reducing the incidence of S‐ECC in these very young children.
N1421K mutation in the glycoprotein Ib binding domain impairs ristocetin‐ and botrocetin‐mediated binding of von Willebrand factor to platelets
Authors: Lanke Elsa , Kristoffersson Ann‐Charlotte , Isaksson Christina , Holmberg Lars , Lethagen Stefan 
Published: July 2008

Abstractvon Willebrand disease (VWD) is a common inheritable bleeding disorder caused by deficiency of von Willebrand Factor (VWF), which is involved in platelet adhesion and aggregation. We report a family consisting of three patients with VWD characterized by an apparently normal multimeric pattern, moderately decreased plasma factor VIII (FVIII) and VWF levels, and disproportionately low‐plasma VWF:RCo levels. The patients were found to be heterozygous for the novel N1421K mutation, caused by a 4263C > G transversion in exon 28 of the VWF gene coding for the A1 domain. Botrocetin‐ and ristocetin‐mediated binding of plasma VWF to GPIb were reduced in the patients. In vitro mutagenesis and expression in COS‐7 cells confirmed the impairment of the mutant in botrocetin‐ and ristocetin‐mediated VWF binding to GPIb. VWF collagen binding capacity was unaffected in plasma from the heterozygous individuals as well as in medium from transfected COS‐7 cells. Our findings indicate that the N1421K substitution in the VWF affects the GPIb binding site or a recognition element by a conformational change of the A1 domain.