bluuebunny/crossref_metadata_2025_split huggingface dataset:
Alcohol Consumption and Risk of Coronary Heart Disease in Older Adults: The Cardiovascular Health Study
Authors: Mukamal Kenneth J. , Chung Hyoju , Jenny Nancy S. , Kuller Lewis H. , Longstreth W.T. , Mittleman Murray A. , Burke Gregory L. , Cushman Mary , Psaty Bruce M. , Siscovick David S. 
Published: January 2006

OBJECTIVES: To evaluate several aspects of the relationship between alcohol use and coronary heart disease in older adults, including beverage type, mediating factors, and type of outcome.DESIGN: Prospective cohort study.SETTING: Four U.S. communities.PARTICIPANTS: Four thousand four hundred ten adults aged 65 and older free of cardiovascular disease at baseline.MEASUREMENTS: Risk of incident myocardial infarction or coronary death according to self‐reported consumption of beer, wine, and spirits ascertained yearly.RESULTS: During an average follow‐up period of 9.2 years, 675 cases of incident myocardial infarction or coronary death occurred. Compared with long‐term abstainers, multivariate relative risks of 0.90 (95% confidence interval (CI)=0.71–1.14), 0.93 (95% CI=0.73–1.20), 0.76 (95% CI=0.53–1.10), and 0.58 (95% CI=0.39–0.86) were found in consumers of less than one, one to six, seven to 13, and 14 or more drinks per week, respectively (P for trend=.007). Associations were similar for secondary coronary outcomes, including nonfatal and fatal events. No strong mediators of the association were identified, although fibrinogen appeared to account for 9% to 10% of the relationship. The associations were statistically similar for intake of wine, beer, and liquor and generally similar in subgroups, including those with and without an apolipoprotein E4 allele.CONCLUSION: In this population, consumption of 14 or more drinks per week was associated with the lowest risk of coronary heart disease, although clinicians should not recommend moderate drinking to prevent coronary heart disease based on this evidence alone, because current National Institute on Alcohol Abuse and Alcoholism guidelines suggest that older adults limit alcohol intake to one drink per day.
A Nonpharmacological Intervention to Improve Sleep in Nursing Home Patients: Results of a Controlled Clinical Trial
Authors: Ouslander Joseph G. , Connell Bettye Rose , Bliwise Donald L. , Endeshaw Yohannes , Griffiths Patricia , Schnelle John F. 
Published: January 2006

OBJECTIVES: To improve nighttime sleep in nursing home patients.DESIGN: Controlled clinical trial.SETTING: Eight community nursing homes enrolled two at a time.PARTICIPANTS: Of 1,077 patients assessed in the eight nursing homes, 638 (59%) were eligible, and consent was obtained for 273 (43% of those eligible). Of the 230 who underwent baseline assessments, 173 completed the immediate‐intervention phase of the trial (77 in the intervention group and 96 in the control group). A total of 160 subjects completed the intervention (77 in the immediate‐intervention group and 83 in the delayed‐intervention phase).INTERVENTION: Trained research staff provided the intervention, which included daytime physical activity and attempts to keep subjects out of bed, evening bright light exposure, a consistent bedtime routine, nighttime care routines designed to minimize sleep disruption, and strategies to reduce nighttime noise. Subjects from one nursing home received the intervention (Group 1), whereas subjects in the second nursing home served as a control group (Group 2); then Group 2 received the intervention.MEASUREMENTS: Primary outcomes included measures of sleep recorded using wrist actigraphy in all subjects and polysomnography in a subgroup of subjects. Secondary measures included assessments of mood and behavior using the Neuropsychiatric Inventory, the Geriatric Depression Scale, and behavioral observations.RESULTS: There were no significant differences in any of the primary actigraphic sleep outcome measures between the intervention and control group after the immediate‐intervention phase of the trial. In the 160 subjects who completed the intervention, there were no significant changes in any actigraphic measure of nighttime sleep, nor were there any significant changes in measures of sleep in the 45 subjects who had baseline and intervention polysomnography.CONCLUSION: This multicomponent, nonpharmacological intervention conducted by trained research staff had no effect on nighttime sleep in this sample of nursing home patients. Enhanced nonpharmacological interventions should be developed and tested and combined with environmental interventions to mitigate noise when feasible. Adjunctive drug therapy may be needed to improve sleep in a substantial proportion of this population and should be tested in addition to nonpharmacological interventions in rigorous clinical trials.
Prospective Multicenter Study of Acute Asthma in Younger Versus Older Adults Presenting to the Emergency Department
Authors: Banerji Aleena , Clark Sunday , Afilalo Marc , Blanda Michelle P. , Cydulka Rita K. , Camargo Carlos A. 
Published: January 2006

OBJECTIVES: To describe acute asthma in younger versus older adults presenting to the emergency department (ED).DESIGN: Prospective cohort study. Asthmatic adults were divided into three age groups: 18 to 34, 35 to 54, and 55 and older. The analysis was restricted to never smokers and smokers with fewer than 10 pack‐years.SETTING: ED.PARTICIPANTS: Two thousand sixty‐four patients aged 18 and older with a physician diagnosis of asthma.MEASUREMENTS: Medications and peak expiratory flow.RESULTS: There were 1,158 (56%) subjects aged 18 to 34; 777 (37%) aged 35 to 54; and 129 (6%) aged 55 and older. Older patients were most likely to have a primary care provider (65%, 74%, and 91%, respectively; P< .001); most were not taking inhaled corticosteroids (39%, 55%, and 48%, respectively; P<.001). Older patients reported fewer ED visits for asthma (2, 2, and 1, respectively; P=.001) but were more likely to report asthma hospitalization (24%, 31%, and 37%, respectively; P<.001). All groups had severe exacerbations (initial percentage predicted peak flow: 47, 47, and 47, respectively; P=.50), but older patients were least likely to report severe symptoms (72%, 79%, and 67%, respectively; P=.001). Older patients did not respond as well to bronchodilators, even after controlling for other demographic factors, markers of asthma severity, and ED management (change between initial and final peak expiratory flow, using subjects aged 18 to 34 as reference: aged 35–54, β=–0.7 (95% CI=−9.4–8.0); aged ≥55, β=−18.4 (−31.9 to −4.9)). The smaller change in peak expiratory flow contributed most to older patients' greater likelihood of hospitalization.CONCLUSION: Older asthma patients were less responsive to emergency bronchodilation. This may reflect chronic undertreatment with inhaled corticosteroids.
Oral Care Provided by Certified Nursing Assistants in Nursing Homes
Authors: Coleman Patricia , Watson Nancy M. 
Published: January 2006

The purpose of this study was to describe the actual daily oral care provided by certified nursing assistants (CNAs) for dentate elderly nursing home (NH) residents who required assistance with oral care. The study was conducted in five nonrandomly selected NHs in upstate New York using real‐time observations of CNAs providing morning care to residents, retrospective chart review, and CNA screening interviews. Oral care standards developed and validated by a panel of 10 experts (dentists, dental hygienists, registered nurses) to be appropriate for dentate NH residents were used to evaluate the oral care provided by 47 primary dayshift CNAs to a convenience sample of 67 residents. CNAs were blinded to the study's specific focus on oral care. Adherence to individual standards was low, ranging from a high of 16% to a low of 0%. Teeth were brushed and mouths rinsed with water in 16% of resident observations. One resident had her tongue brushed.Standards never met were brushing teeth at least 2 minutes, flossing, oral assessment, rinsing with mouthwash, and wearing clean gloves during oral care. Most residents (63%) who received oral care assistance were resistive to CNA approaches. For most observations, oral care supplies were not evident. Actual oral care provided to residents contrasts sharply with CNAs' self‐reported practices in the literature and suggests that NH residents who need assistance receive inadequate oral health care.
Quality of Life in Prostate Cancer Patients Taking Androgen Deprivation Therapy
Authors: Dacal Kirsten , Sereika Susan M. , Greenspan Susan L. 
Published: January 2006

OBJECTIVES: To examine the effect of androgen deprivation therapy (ADT) on health‐related quality of life (HRQOL), self‐reported HRQOL was compared in prostate cancer patients receiving short‐ (<6 months) or long‐term (≥6 months) ADT and healthy controls.DESIGN: Cross‐sectional study.SETTING: Academic medical center in Pittsburgh, Pennsylvania.PARTICIPANTS: Ninety‐six men, including those with prostate cancer receiving short‐term, long‐term, and no ADT and healthy controls. Men taking medications or having diseases known to affect bone mineral metabolism were excluded.MEASUREMENTS: The 36‐item Short Form Medical Outcomes Study Health Survey (an HRQOL assessment) and a comorbidity index were administered to each participant. Characteristics, including body composition (assessed using dual‐energy x‐ray absorptiometry) and gonadal status (serum total and free testosterone) were measured approximately 3 months or less before the HRQOL assessment.RESULTS: As expected, men receiving ADT had significantly lower levels of testosterone, free testosterone, and lean body mass, as well as greater body fat and comorbidity index (all P<.01) than men not receiving ADT (i.e., men with prostate cancer and healthy controls). Participants receiving ADT reported significantly poorer QOL in the areas of physical function (P<.001), general health (P<.001), and physical health component summary (P<.001) than men not receiving ADT. There were no significant differences in HRQOL outcomes between participants receiving short‐ or long‐term ADT. Comorbidity and testosterone levels were associated with several QOL scales. After controlling for the significant joint predictors of comorbidity and total testosterone using hierarchical regression analysis, ADT was no longer a significant predictor, and only comorbidity and total testosterone contributed to the explanation of the variance of the physical health component summary. Comorbidity alone contributed to the explanation of the variance in physical function, bodily pain, general health, and vitality.CONCLUSION: Patients with prostate cancer who were receiving ADT experience worse HRQOL than those not receiving ADT, but duration of ADT was not a contributing factor. After controlling for comorbidity, total testosterone level rather than ADT accounted for a small yet statistically significant percentage of the total variance of the physical health component summary. These findings have important clinical implications regarding the decision to treat prostate cancer patients with ADT.
Can High‐Risk Older Drivers Be Identified Through Performance‐Based Measures in a Department of Motor Vehicles Setting?
Authors: Ball Karlene K. , Roenker Daniel L. , Wadley Virginia G. , Edwards Jerri D. , Roth David L. , McGwin Gerald , Raleigh Robert , Joyce John J. , Cissell Gayla M. , Dube Tina 
Published: January 2006

OBJECTIVES: To evaluate the relationship between performance‐based risk factors and subsequent at‐fault motor vehicle collision (MVC) involvement in a cohort of older drivers.DESIGN: Prospective cohort study.SETTING: Motor Vehicle Administration (MVA) field sites in Maryland.PARTICIPANTS: Of the 4,173 older drivers invited to participate in the study, 2,114 individuals aged 55 to 96 agreed to do so. These analyses focus on 1,910 individuals recruited through MVA field sites.MEASUREMENTS: Gross Impairment Screening Battery, which included Rapid Pace Walk, Head/Neck Rotation, Foot Tap, Arm Reach, Cued Recall, Symbol Scan, Visual Closure subtest of the Motor Free Visual Perception Test (MVPT), Delayed Recall, and Trail Making Test with an Abbreviated Part A and standard Part B; Useful Field of View (UFOV®) subtest 2; a Mobility Questionnaire; and MVC occurrence.RESULTS: In drivers aged 55 and older with intact vision (20/70 far visual acuity and 140° visual field), age, sex, history of falls, and poorer cognitive performance, as measured using Trails B, MVPT, and UFOV subtest 2, were predictive of future at‐fault MVC involvement. After adjusting for annual mileage, participants aged 78 and older were 2.11 as more likely to be involved in an at‐fault MVC, those who made four or more errors on the MVPT were 2.10 times as likely to crash, those who took 147 seconds or longer to complete Trails B were 2.01 times as likely to crash, and those who took 353 ms or longer on subtest 2 of the UFOV were 2.02 times as likely to incur an at‐fault MVC. Older adults, men, and individuals with a history of falls were more likely to be involved in subsequent at‐fault MVCs.CONCLUSION: Performance‐based cognitive measures are predictive of future at‐fault MVCs in older adults. Cognitive performance, in particular, is a salient predictor of subsequent crash involvement in older adults. High‐risk older drivers can be identified through brief, performance‐based measures administered in a MVA setting.
Three‐Dimensional Analysis of Pulmonary Venous Ostial and Antral Anatomy: Implications for Balloon Catheter‐Based Pulmonary Vein Isolation
Authors: AHMED JAMEEL , SOHAL SANDEEP , MALCHANO ZACHARY J. , HOLMVANG GODTFRED , RUSKIN JEREMY N. , REDDY VIVEK Y. 
Published: January 2006

Background: Balloon ablation catheters using various energy sources are being developed to perform pulmonary vein (PV) isolation to treat atrial fibrillation. Prior evaluations of 2D CT/MR images are limited by the frequent elliptical shape of the PV ostia, the nonorthogonal orientation of the PVs to the left atrial (LA) chamber, and difficulty in appreciating through‐slice curvature. To provide anatomical data relevant to balloon catheter ablation, 3D surface reconstructions of LA‐PVs were generated and analyzed to define ostial architecture and size. Methods and Results: Using MRI datasets obtained from 101 paroxysmal AF patients, the LA‐PVs were segmented to generate 3D LA‐PV surface reconstructions. Using both external and endoluminal projections, the PV ostial and antral regions were identified and evaluated. In the left PVs, a common left‐sided ostium was identified in 94 patients, with an ostial circumference of 95 ± 15 mm. Branching of the left PVs occurred 0–5 mm away from the common left ostium in 43 patients (43%), 5–15 mm away from the common os in 37 patients (37%), and >15 mm away from the common os in 14 patients (14%). In patients with either distinct left PV ostia, or common os <15 mm (87 patients), the individual LSPV/LIPV ostial circumferences were 67 ± 12 mm and 58 ± 9 mm, respectively. Mean left antral circumference was 114 ± 17 mm. In the right PVs, the ostial circumferences of the RSPV/RIPV were 68 ± 11 mm and 66 ± 11 mm, respectively. Mean right antral circumference was 107 ± 19 mm. Assuming ideal deformation of the LA chamber anatomy, the minimal diameters of a balloon ablation catheter required to isolate 95% of the RSPV, RIPV, LSPV, LIPV, LCPV, left antrum, and right antrum are 29 mm, 28 mm, 29 mm, 24 mm, 40 mm, 46 mm, and 47 mm, respectively. Conclusion: Analysis of 3D surface reconstructions of LA‐PV anatomy reveals that balloon catheter‐based ablation of the PVs is likely feasible in most patients, but balloon ablation of the common PV antra would be problematic.
Effects of Right Bundle Branch Block on the Antidromic Circus Movement Tachycardia in Patients with Presumed Atriofascicular Pathways
Authors: STERNICK EDUARDO B. , RODRIGUEZ LUZ‐MARIA , TIMMERMANS CARL , SOSA EDUARDO , CRUZ FERNANDO E.S. , GERKEN LUIZ M. , FAGUNDES MÁRCIO , SCANAVACCA MAURÍCIO , WELLENS HEIN J.J. 
Published: January 2006

Background: The typical and most common tachycardia in patients with atriofascicular pathways is a macro reentrant tachycardia, with anterograde conduction over the decrementally conducting bypass tract and retrograde conduction over the right bundle branch‐His‐AV node axis resulting in a short V‐right bundle branch and short V‐H interval. Objectives: To report on changes in rate and QRS configuration when right bundle branch block (RBBB) develops spontaneously during antidromic tachycardia using an atriofascicular fiber. Methods: Three of 25 patients with an antidromic circus movement tachycardia using a right‐sided atriofascicular pathway showed episodes of right bundle branch block (RBBB) during ventriculo‐atrial conduction. Effect of retrograde RBBB on tachycardia rate and QRS configuration was studied using intracardiac and extracardiac recordings. Results: All 3 patients showed prolongation of their V‐A interval when retrograde RBBB occurred during tachycardia, resulting in a longer tachycardia cycle length. The VA time increase ranged from 85 to 100 msec, with a mean 346 ± 5 msec. Two of the 3 patients also showed a change in QRS configuration due to a more leftward shift of the frontal plane QRS axis. Conclusion: Rate changes in antidromic tachycardia in patients with atriofascicular fibers can be based on a shift in VA conduction from one bundle branch to the other. This may be accompanied by changes in the frontal plane QRS axis because of a change in ventricular activation sequence.
Electrocardiographic Events Preceding Onset of Atrial Fibrillation: Insights Gained Using an Implantable Loop Recorder
Authors: SCHWARTZMAN DAVID , BLAGEV DENITZA P. , BROWN MARK L. , MEHRA RAHUL 
Published: January 2006

Introduction: Previous reports demonstrate that individual patients may have distinctive electrocardiographic patterns preceding atrial fibrillation (AF) onset. However, these observations are based on single recordings, and are thus limited by their “snapshot” derivation; it is unclear whether patterns observed on these recordings are consistent over time. We hypothesized that the use of an implantable loop recorder (ILR) would be feasible for serial, long‐term characterization of electrocardiographic events preceding AF onset. Methods and Results: An ILR was implanted in 29 patients with AF. Patients were instructed to activate the device immediately upon experiencing AF symptoms. Analysis focused on the electrocardiographic segment immediately preceding AF; each segment was classified as one of six patterns: short/long, normal sinus rhythm, absolute sinus bradycardia, relative sinus bradycardia, absolute sinus tachycardia, or relative sinus tachycardia. From a total of 318 device activations, 105 AF onsets were suitable for analysis, acquired from 21 patients over a mean follow‐up interval of 7 months. Although AF was frequently triggered by an atrial premature beat that emerged during normal sinus rhythm, most patients demonstrated a variety of onset patterns. Degeneration of uniform atrial tachycardia to AF was rare. Significant delay in device activation relative to AF onset was common, as was activation in the absence of AF. Conclusions: Using the ILR, serial, long‐term characterization of electrocardiographic events preceding AF onset was feasible, and typically demonstrated a varied pattern within individuals. There was significant incongruity between symptomatic and electrocardiographic AF burden. As described here, ILR technology is inadequate for the purpose of accurate characterization of AF burden.
Effects of Sildenafil Citrate on Defibrillation Efficacy
Authors: SHINLAPAWITTAYATORN KREKWIT , SUNGNOON RATTAPONG , CHATTIPAKORN SIRIPORN , CHATTIPAKORN NIPON 
Published: January 2006

Introduction: Although fatal arrhythmia and sudden death have been reported in patients taking sildenafil citrate, its effect on defibrillation efficacy has not been investigated. The aim of this study was to test the hypothesis that sildenafil citrate increases the shock strength required to successfully defibrillate during ventricular fibrillation (VF). Methods and Results: A total of 26 pigs (20–25 kg) were randomly assigned into three groups. In each group, the defibrillation threshold (DFT) was determined at the beginning of the study using a three‐reversal up/down protocol. Each shock (RV‐SVC, biphasic) was delivered after 10 seconds of VF. Group 1 (n = 10) received 50 mg and group 2 (n = 10) received 100 mg of sildenafil citrate intravenously at a rate of 2 mL/minute for 50 minutes. Group 3 (n = 6) received 100 mL of saline intravenously at the same rate as in group 1. The DFT was determined again after the drug (drug‐DFT) and saline (saline‐DFT) administration. For 100‐mg sildenafil citrate infusion, the DFT (483 ± 39 V, 18 ± 3 J) was significantly (P < 0.003 and P < 0.01, respectively) higher than the control‐DFT (407 ± 123 V, 13 ± 7 J). This sildenafil citrate infusion increased the DFT ∼19% by voltage, and ∼38% by total energy. After 50‐mg sildenafil citrate infusion, the DFT (454 ± 28 V, 15 ± 2 J) was not different than the control DFT (449 ± 28 V, 15 ± 2 J). Saline infusion (391 ± 18 V, 12 ± 1 J) did not alter the control DFT (399 ± 22 V, 12 ± 1 J). Conclusion: The 100‐mg sildenafil citrate infusion, representing a supra‐therapeutic plasma level, significantly increased the DFT. This finding indicates that VF occurring during supra‐therapeutic sildenafil citrate treatment would require a stronger shock to successfully defibrillate.
Lethal and sublethal effects of Brevibacillus laterosporus on the housefly (Musca domestica)
Authors: Ruiu Luca , Delrio Gavino , Ellar David J. , Floris Ignazio , Paglietti Bianca , Rubino Salvatore , Satta Alberto 
Published: January 2006

AbstractSporulated cultures of an isolate of the entomopathogenic bacterium Brevibacillus laterosporus (Laubach) from soil in Sardinia (Italy) were highly toxic by ingestion to both adults and juveniles of the housefly, Musca domestica L. (Diptera: Muscidae). Toxicity was associated with spores as the culture supernatant was not toxic and no parasporal inclusions were observed. The level of toxicity varied with the concentration of spores, the time of exposure to the treated diet, and the stage of insect development. Comparative LC50 values were 0.72 × 108 and 1.75 × 108 spores per gram of diet for 1st and 2nd instar larvae, respectively, and 3.84 × 108 spores per gram for adults. A significant increase in larval development time and reductions in pupal weight and emergence rate were observed when larvae were fed on diets containing sublethal concentrations of spores. Adults surviving after feeding on a sublethal diet showed a significant reduction in fecundity and longevity. Similarly, adults from treated larvae exhibited a lower fecundity, although their longevity was not influenced. A relationship between pupal weight and adult fecundity was found. Pupal stage duration and egg eclosion were not significantly affected.