Introducing the GRACEnet/REAP Data Contribution, Discovery, and Retrieval System.

Difficulties in accessing high-quality data on trace gas fluxes and performance of bioenergy/bioproduct feedstocks limit the ability of researchers and others to address environmental impacts of agriculture and the potential to produce feedstocks. To address those needs, the GRACEnet (Greenhouse gas Reduction through Agricultural Carbon Enhancement network) and REAP (Renewable Energy Assessment Project) research programs were initiated by the USDA Agricultural Research Service (ARS). A major product of these programs is the creation of a database with greenhouse gas fluxes, soil carbon stocks, biomass yield, nutrient, and energy characteristics, and input data for modeling cropped and grazed systems. The data include site descriptors (e.g., weather, soil class, spatial attributes), experimental design (e.g., factors manipulated, measurements performed, plot layouts), management information (e.g., planting and harvesting schedules, fertilizer types and amounts, biomass harvested, grazing intensity), and measurements (e.g., soil C and N stocks, plant biomass amount and chemical composition). To promote standardization of data and ensure that experiments were fully described, sampling protocols and a spreadsheet-based data-entry template were developed. Data were first uploaded to a temporary database for checking and then were uploaded to the central database. A Web-accessible application allows for registered users to query and download data including measurement protocols. Separate portals have been provided for each project (GRACEnet and REAP) at nrrc.ars.usda.gov/slgracenet/#/Home and nrrc.ars.usda.gov/slreap/#/Home. The database architecture and data entry template have proven flexible and robust for describing a wide range of field experiments and thus appear suitable for other natural resource research projects.

Grief communication, grief reactions and marital satisfaction in bereaved parents.

This study examined if attitudes about grief communication are related to grief reactions and marital satisfaction in bereaved parents. The sample consisted of 36 couples who experienced the loss of a child. For the couple as a unit, the relation between attitudes about communication and grief changed over time, and the nature of the change was related to the level of communication; positive attitudes about open communication were related to high grief in the early stages of bereavement and to low grief in later stages. No relation to marital satisfaction was found. Spouses were correlated in their attitudes about communication, but women valued open communication significantly more than men. Positive attitudes about grief communication were related to men's grief reactions but not marital satisfaction; whereas for women, positive attitudes were related to marital satisfaction but not grief.

Reproducibility of left ventricular measurements with acoustic quantification: the influence of training.

Acoustic quantification (AQ) of two-dimensional (2-D) echocardiograms provides online estimation of left ventricular (LV) size and function. However, edge detection with AQ is influenced by gain settings and is therefore operator dependent. Our purpose was to compare AQ and conventional 2-D echo measurements of LV size and function obtained by different operators and to evaluate the influence of training on these measurements. A cardiac sonographer without previous experience with the AQ system was trained by an experienced operator. Twenty-two normal males (age, 28 +/- 4 years) participated in the study. Images were recorded with conventional 2-D and AQ echo from the short-axis and apical four-chamber views. During the initial training period, five subjects were imaged by the sonographer under the supervision of the trainer. At the initial study session, 12 subjects were imaged independently by the two operators. Following a second training period with five different subjects, the same initial 12 subjects were again imaged at a second study session. LV cavity areas were traced from the conventional 2-D echocardiograms and measured from the AQ waveforms at end-diastole and end-systole. Volumes were calculated using the single-plane area-length method. Ejection fraction (EF) was calculated from volumes. Reproducibility was determined by comparing the variability of AQ and conventional 2-D echo measurements obtained at the two sessions. A second training session reduced the operator variability only of the short-axis end-diastolic area measurement (17 +/- 11% vs 6 +/- 5%, P < 0.025). We conclude that a single training session may be adequate for the reproducible estimation of ventricular volumes with the AQ method.

Inhalation of amyl nitrite and the measurement of left ventricular outflow velocity: studies in normal, young adults.

Amyl nitrite inhalation is useful in the identification of patients with provocable left ventricular (LV) outflow tract obstruction. However, there are no prospective studies that assess the normal change in LV outflow velocity during this intervention. Eighteen normal subjects (mean age, 34+/-5 years; 9 men and 9 women) inhaled amyl nitrite during measurement of LV outflow velocity. Peak velocity increased from 109+/-16 cm/s to 144+/-24 cm/s (P<0.001). There were no significant gender differences in velocity measurements at baseline or at peak. Our study provides prospective data that may be useful when evaluating young adults for LV outflow tract obstruction with Doppler echocardiography during amyl nitrite inhalation.

Clinical practice guidelines in unstable angina improve clinical outcomes by assuring early intensive medical treatment.

OBJECTIVES: To determine the influence of clinical practice guidelines on treatment patterns and clinical outcomes in unstable angina and the effectiveness of guideline reminders on implementing practice guidelines, two groups of medium and high risk patients with unstable angina were compared. BACKGROUND: New guidelines have been published by the Agency for Health Care Policy and Research (AHCPR) for evaluating and managing patients with unstable angina. The impact of these guidelines to improve the quality of care has never been tested. METHODS: Group 1 included 338 consecutive medium or high risk patients admitted before publication of the AHCPR guidelines, and group 2 consisted of 181 consecutive similar risk patients admitted after institution of the AHCPR guideline reminders at this institution. Dissemination of clinical practice guidelines was ensured by a grand rounds lecture and by posting guideline reminders on all group 2 patients' charts within 24 h of admission. RESULTS: The two groups were similar in terms of most baseline characteristics, including hypercholesterolemia, diabetes, hypertension, smoking history, baseline ST segment depression and previous coronary artery bypass graft surgery. Group 1 patients were older (68+/-13 vs. 63+/-16 years, p = 0.001) and more frequently had a previous myocardial infarction (39% vs. 22%, p = 0.001). Group 2 patients more frequently required intravenous nitroglycerin to control the index episode of chest pain (43% vs. 34%, p = 0.003). Group 2 patients more frequently received aspirin (96% vs. 88%, p = 0.009) during admission and underwent coronary angiography (71% vs. 58%, p = 0.006). More importantly, group 2 patients received oral beta-blockers (p = 0.008), aspirin and coronary angiography (p = 0.001) earlier than group 1 patients and experienced recurrent angina (29% vs. 54%) and myocardial infarction or death less frequently (3% vs. 9%, p = 0.028). CONCLUSIONS: In unstable angina, clinical practice guidelines were associated with greater use of aspirin and coronary angiography and greater use and earlier administration of beta-blockers. Variation in drug use over time was also reduced. Objective improvement in clinical outcome was also noted. Thus, practice guidelines improve the quality of care of patients with unstable angina.

Authentic religious experience or insanity?

This study examined how mental health professionals make judgments about the religious authenticity and mental health of behaviors motivated by religious ideation. Participants were presented with written vignettes of religiously motivated behavior. The context of religious behavior varied on 6 dimensions and also on 3 levels of conventionality. The results indicated that the determining factor in the ratings was not dimensions of religious experience, but the degree that the experience deviated from conventional religious beliefs and practices. The more unconventional the behavior, the less religiously authentic and mentally healthy it was deemed to be.

Improved risk stratification in unstable angina: identification of patients at low risk for in-hospital cardiac events by admission echocardiography.

BACKGROUND: Current protocols for risk stratification of patients with acute chest pain syndromes rely on clinical parameters and are oriented toward identification of patients at high risk for adverse cardiac events; however, this paradigm for risk stratification does not adequately address the observation that adverse cardiac events are relatively uncommon in this population. In an era of cost containment, consideration also should be given to identification of patients at low risk for adverse cardiac events, who may be safely discharged without expensive inpatient hospitalization. HYPOTHESIS: The purpose of this study was to develop echocardiographic predictors that identify unstable angina patients at low risk for adverse cardiac events and that discriminate between low- and high-risk patients. METHODS: The predictive accuracy of retrospectively determined echocardiographic predictors were compared in a population-based sample of 66 consecutive unstable angina patients undergoing echocardiography within 24 h of admission. RESULTS: Echocardiographic predictors of adverse events included wall motion score index > or = 0.2, ejection fraction < or = 40%, and mitral regurgitation severity > 2. One or more echocardiographic predictors of adverse events were present in 32 patients (48%). A composite echocardiographic predictor of adverse events was specific, had a high positive predictive value for the identification of high-risk patients, and discriminated between unstable angina patients at high and low risk for adverse cardiac events. CONCLUSION: Echocardiographic predictors of adverse events are specific and discriminate between unstable angina patients at high and low risk for adverse cardiac events.

Infant communication and the development of hypnotic responsivity.

The research on the development of hypnotic responsivity indicates that it emerges, ex nihilo, sometime after the age of 3. The measures used to assess hypnotic responsivity rely on complex verbal instructions, thus precluding investigation of infancy. Recent research on infancy, however, suggests that the ontogenesis of hypnotic responsivity is likely to be found in fundamental human capacities that emerge in the first weeks and months of life. The aims of the article are threefold: (a) to demonstrate that infants possess capacities on the nonverbal plane of communication that are analogous to those required for hypnosis; (b) to identify situations in infancy that are analogous to the hypnotic context; and (c) to examine dispositional and relational attributes in infancy that may account for later individual differences in hypnotic responsivity.

Assessment of small-diameter aortic mechanical prostheses: physiological relevance of the Doppler gradient, utility of flow augmentation, and limitations of orifice area estimation.

BACKGROUND: Noninvasive assessment of functionally stenotic small-diameter aortic mechanical prostheses is complicated by theoretical constraints relating to the hemodynamic relevance of Doppler-derived transprosthetic gradients. To establish the utility of Doppler echocardiography for evaluation of these valves, 20-mm Medtronic Hall and 19-mm St Jude prostheses were studied in vitro and in vivo. METHODS AND RESULTS: Relations between the orifice transprosthetic gradient (equivalent to Doppler), the downstream gradient in the zone of recovered pressure (equivalent to catheter), and fluid mechanical energy losses were examined in vitro. Pressure-flow relations across the 2 prostheses were evaluated by Doppler echocardiography in vivo. For both types of prosthesis in vitro, the orifice was higher than the downstream gradient (P<0.001), and fluid mechanical energy losses were as strongly correlated with orifice as with downstream pressure gradients (r2=0.99 for both). Orifice and downstream gradients were higher and fluid mechanical energy losses were larger for the St Jude than the Medtronic Hall valve (all P<0.001). Whereas estimated effective orifice areas for the 2 valves in vivo were not significantly different, model-independent dynamic analysis of pressure-flow relations revealed higher gradients for the St Jude than the Medtronic Hall valve at a given flow rate (P<0.05). CONCLUSIONS: Even in the presence of significant pressure recovery, the Doppler-derived gradient across small-diameter aortic mechanical prostheses does have hemodynamic relevance insofar as it reflects myocardial energy expenditure. Small differences in function between stenotic aortic mechanical prostheses, undetectable by conventional orifice area estimations, can be identified by dynamic Doppler echocardiographic analysis of pressure-flow relations.

Clinical predictors easily obtained at presentation predict resource utilization in unstable angina.

OBJECTIVE: To determine if a risk prediction model for patients with unstable angina would predict resource utilization. METHODS AND RESULTS: Four hundred sixty-five consecutive patients admitted for unstable angina to a tertiary care university-based medical center were prospectively evaluated from June 1, 1992, to June 30, 1995. The proportion of patients receiving coronary angiography, coronary angioplasty, and coronary artery bypass grafting were analyzed according to four risk groups on the basis of a previously published model: Group 1, <2% risk of major complication; Group 2, 2.1% to 5% risk; Group 3, 5.1 % to 15% risk; and Group 4, >15.1 % risk. Hospital length of stay and estimated cost of hospitalization based on DRG and specific payer ratio of cost-to-charge were also compared between groups. Multiple linear regression analysis was used to determine the influence of estimated risk and procedures on hospital costs. The four groups were well matched for gender, hypertension, tobacco history, and previous percutaneous transluminal coronary angioplasty and myocardial infarction. Group 4 had a higher incidence of previous coronary bypass grafting (35% vs 10%, p=0.001) and triple vessel or left main coronary artery disease compared with Group 1 (44% vs 13%, p=0.041). Group 4 patients were more likely to be admitted to the coronary care unit compared with Group 2 or Group 1 patients (80% vs Group 1: 51% [p= 0.001]; and vs Group 2: 53% [p=0.001]), more likely to receive heparin (87% vs 71%, p=0.007), and more likely to receive a beta-blocker or calcium channel blocker (89% vs 74%, p=0.008) than Group 1. Coronary angioplasty rates were similar for all groups, but Group 4 patients were more likely to receive coronary bypass grafting than Group 2 or Group 1 (27% vs Group 2: 12%, p=0.004 and vs Group 1: 8%, p=0.002). Hospital length of stay was highest in Group 4 and lowest for Group 1. Average hospital costs were significantly less in Group 3 than in Group 4, but higher than in Group 1. Multivariate analysis determined a dependency of costs on risk group with Group 2 having costs 31.4% (95% CI=9.8 to 57.2), Group 3 46.7% (24, 3 to 73.1), and Group 4 75% (46.9 to 110.7) higher than Group 1. The use of procedures also significantly increased costs, with PTCA-treated patients having a 44.9% (26.7 to 65.7) increase in costs compared with medically treated patients, and surgically treated patients having a 204.7% increase in costs. CONCLUSION: Resource utilization as assessed by the use of revascularization procedures, length of stay, and hospital costs are influenced by patient acuity estimated from a prediction model on the basis of estimated risk of cardiac complications. The model exerts independent influence on cost even after adjustment for various procedures. The use of revascularization procedures, especially coronary artery surgery, remains a large determinant of hospital cost.

Hypnosis and human development: interpersonal influence of intrapersonal processes.

This article revisits the too-long-forgotten relation between hypnosis and development, illuminating common processes underlying both, and using research on one to provide insights into the other. Hypnosis is defined within a communications framework, and essential features of hypnosis are identified in the communicative exchanges of the first months of life. This forces a reconsideration of our understanding of the ontogenesis of hypnosis. Hypnosis, in turn, offers important insights into development. Four key features of hypnosis are identified and their developmental implications examined.

Depression and attribution in abused children and their nonoffending caregivers.

This study examined depression and attribution in 17 abused children and their nonoffending caregivers. Analysis indicated that negative attributions were significantly related to higher scores on depression of both children and caregivers, that depression scores of caregivers were unrelated to depression of their abused children, but that caregivers, nevertheless, assessed their children's self-reported depression as similar to their own self-reported depression.

Neuropsychological features and differential diagnosis of sleep apnea syndrome in children.

Recognizing the signs and effects of pediatric apnea is essential for accurate diagnosis and treatment of children with psychological difficulties. Sleep apnea can have serious deleterious effects on children's cognitive, behavioral, and physiological functioning. Diurnal effects include inattention, decreased academic performance, oppositionality, and restlessness, stemming from frequent nocturnal arousals, excessive daytime sleepiness, and hypoxia. Clinically, the effects of pediatric apnea appear similar to characteristics of other childhood disorders, most notably attention deficit hyperactivity disorder. Efforts to screen for sleep apnea should be regularly employed, especially for children who present with the symptoms discussed. Additional study of pediatric apnea is needed to heighten clinicians' awareness and improve diagnostic accuracy.

Intracardiac versus transthoracic echocardiographic imaging of translation and rotation of left ventricular center of cavity area in dogs.

Motion of the left ventricular cavity center during the cardiac cycle was compared using transthoracic and intracardiac echocardiography. Rotation was comparable for the 2 methods, however, translation of the left ventricular cavity area center was greater with intracardiac echocardiography.

Spontaneous echocardiographic contrast in the true lumen of a dissected aortic aneurysm.

Spontaneous echocardiographic contrast may be seen in the false and true lumens of dissecting aortic aneurysms. Using transesophageal echocardiography, we identified the false lumen as the source of spontaneous echocardiographic contrast in the true lumen of a patient with an aortic dissection.

Parental divorce and intimate relationships of young adults.

This study examined associations among parental divorce, family conflict, sex, and young men's and women's achievement of intimacy. Analyses indicated that family conflict and sex, but not divorce, were significantly related to intimacy. Examination of those within the divorced group suggest that time of divorce, along with family conflict, were related to intimacy.

Evaluation of color kinesis, a new echocardiographic method for analyzing regional wall motion in patients with dilated left ventricles.

The recently developed echocardiographic technology of color kinesis (CK) displays endocardial motion in color layers on a single end-systolic 2-dimensional echocardiographic frame. Previous work using this method is promising for quantitation of regional function, but there is limited experience in patients with severely reduced left ventricular function. Twenty patients (age 59 +/- 10 years) with dilated cardiomyopathy (left ventricular ejection fraction 22 +/- 8%) underwent CK imaging. Endocardial motion was quantitated by measuring the distance of endocardial motion during the systolic interval and also by calculating the endocardial velocity. CK measurements were compared among 4 wall motion grades (i.e., normal, hypokinetic, akinetic, and dyskinetic) assessed by qualitative wall motion scoring. There was a significant overall difference (p < 0.0001) in the mean systolic endocardial inward motion (i.e., contraction) and outward motion (i.e., expansion) among wall motion grades. The mean endocardial outward distance was significantly greater for the dyskinetic segments than for the other grades (p < 0.001). There were also differences in the mean velocity of endocardial motion among the wall motion grades. In the presence of left bundle branch block, there was no difference in the mean endocardial inward distance of the hypokinetic, akinetic, and dyskinetic septal segments. We conclude that in the absence of left bundle branch block, normal, hypokinetic, akinetic, and dyskinetic ventricular wall segments may be distinguished in patients with dilated cardiomyopathy on the basis of endocardial motion measured with CK.

Comparison of heparin therapy for < or = 48 hours to > 48 hours in unstable angina pectoris.

Of 450 consecutive patients with unstable angina admitted to a tertiary care, university-based medical center over a 24-month period, 334 were administered heparin and aspirin for some length of time. Two groups of 98 patients matched for acuity and gender at baseline were treated with either < or = 48 hours (group 1) or > 48 hours (group 2) of heparin. The acuity model used in this study incorporates 6 factors: age, recent myocardial infarction, treatment with intravenous nitroglycerin, previous therapy with beta blockers or calcium antagonists, baseline ST depression, and diabetes. Despite similar risks and overall clinical outcome, group 2 had significantly more myocardial infarction or death after 48 hours than group 1 (p = 0.01). In part, this was due to a delay in the performance of coronary angiography (2.8 +/- 1.4 vs 3.5 +/- 15 days, p = 0.01), coronary intervention (2.7 +/- 1.8 vs 5.1 +/- 2.3 days, p = 0.01), and bypass surgery (3.8 +/- 3.6 vs 7.0 +/- 5.6 days, p = 0.02). There was no difference between groups regarding the success of coronary intervention (90% vs 88%, p = NS). Heparin duration was influenced by the finding of intracoronary thrombus or ulceration on angiography before revascularization, as each finding was seen more often in group 2 (thrombus, 12% vs 24%; ulceration, 38% vs 60%). These results suggest that the optimal duration of heparin therapy is up to 48 hours after admission in unstable angina; a longer time period is associated with increased adverse consequences.