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Cerebral aneurysms are occasionally associated with anomalies of the cerebral arteries. Most reports on anomalies of the anterior cerebral artery have been concerned with hypoplasia, fenestration and the infra-optic course of the A1, variant A1 perforators or Heubner's artery, multi-channeled anterior communicating artery, and azygos anterior cerebral artery. Distal anterior cerebral artery (ACA) aneurysms are known to have a poor clinical course and prognosis compared to other supratentorial aneurysms. The presence of the unpaired, distal, postcommunicating (A2) segment of the ACA is very rare in adults. We describe a patient with a ruptured aneurysm arising from the proximal end of the azygos ACA, first surgically treated with clipping and then with endovascular coiling. A 37-year-old woman at 34 weeks' gestation was transferred to our emergency room with sudden onset of severe headache and vomiting. Computed tomography (CT) revealed subarachnoid hemorrhage in the basal cisterna and the sylvian and interhemispheric fissures. Cerebral angiography showed an azygos ACA, a saccular aneurysm at the junction of the azygos ACA and the right A1 segment. A right fronto-temporal craniotomy was performed in the day of admission, and the neck of the aneurysm was clipped. One year later, an angiographic control examination revealed a regrowth of the aneurysm. The patient underwent endovascular treatment with coiling. Aneurysms of the azygos ACA are rare and their pathogenesis and course are still a matter of discussion. Developmental abnormalities or dynamic vessel wall stresses can explain the high incidence of aneurysms in these cases. The association of a rare anatomical variant with an aneurysm in the same location may suggest an embryogenesis alteration in the Willis circulation.

Background— The identification and assessment of myocardial infarction (MI) are important for therapeutic and prognostic purposes, yet current recommended diagnostic strategies have significant limitations. We prospectively tested the performance of delayed-enhancement magnetic resonance imaging (MRI) with gadolinium-based contrast for the detection of MI in an international, multicenter trial. Methods and Results— Patients with their first MI were enrolled in an acute (≤16 days after MI; n=282) or chronic (17 days to 6 months; n=284) arm and then randomized to 1 of 4 doses of gadoversetamide: 0.05, 0.1, 0.2, or 0.3 mmol/kg. Standard delayed-enhancement MRI was performed before contrast (control) and 10 and 30 minutes after gadoversetamide. For blinded analysis, precontrast and postcontrast MRIs were randomized and then scored for enhanced regions by 3 independent readers not associated with the study. The infarct-related artery perfusion territory was scored from x-ray angiograms separately. In total, 566 scans were performed in 26 centers using commercially available scanners from all major US/European vendors. All scans were included in the analysis. The sensitivity of MRI for detecting MI increased with rising dose of gadoversetamide ( P P P Conclusions— Gadoversetamide-enhanced MRI using doses of ≥0.2 mmol/kg is effective in the detection and assessment of both acute and chronic MI. This study represents the first multicenter trial designed to evaluate an imaging approach for detecting MI.

The objective of this study is to investigate potential racial disparities in time to antibiotics among patients presenting to the emergency department (ED) with severe sepsis or septic shock. This was a retrospective observational study of adults >18 years with severe sepsis or septic shock presenting to a large, urban, academic ED and admitted to the ICU from 10/2005 to 2/2012. Time to antibiotic data was abstracted by ICU research staff; other data were abstracted by blinded trained research assistants using standardized abstraction forms. Time from ED arrival to antibiotics was compared in white vs. non-white patients using cumulative events curves followed by Cox proportional hazards regression, controlling for age, gender, ethnicity, source of infection, and SOFA score. Seven hundred sixty-eight patients were included; 19.5 % (n = 150) were non-white. Median minutes to antibiotics was 131 in white patients vs. 158 in non-white patients (p = 0.03, log-rank test). The unadjusted hazard ratio for non-white patients was 0.82 (95 %CI 0.58–0.98). After adjustment, the hazard ratio for race was not significant (0.90, 95 %CI 0.73–1.10). In a single-center sample of patients with severe sepsis or septic shock, adjustment for factors including age and infectious source eliminated the difference in time to antibiotics by race. Further research should investigate disparities in sepsis care between hospitals with differing patient populations.

Objective: Fluid responsiveness is proposed as a physiology-based method to titrate fluid therapy based on preload dependence. The objectives of this study were to determine if a fluid responsiveness protocol would decrease progression of organ dysfunction, and a fluid responsiveness protocol would facilitate a more aggressive resuscitation. Methods: Prospective, 10-center, randomized interventional trial. Inclusion criteria: suspected sepsis and lactate 2.0 to 4.0 mmol/L. Exclusion criteria (abbreviated): systolic blood pressure more than 90 mmHg, and contraindication to aggressive fluid resuscitation. Intervention: fluid responsiveness protocol using Non-Invasive Cardiac Output Monitor (NICOM) to assess for fluid responsiveness (>10% increase in stroke volume in response to 5 mL/kg fluid bolus) with balance of a liter given in responsive patients. Control: standard clinical care. Outcomes: primary—change in Sepsis-related Organ Failure Assessment (SOFA) score at least 1 over 72 h; secondary—fluids administered. Trial was initially powered at 600 patients, but stopped early due to a change in sponsor's funding priorities. Results: Sixty-four patients were enrolled with 32 in the treatment arm. There were no significant differences between arms in age, comorbidities, baseline vital signs, or SOFA scores (P > 0.05 for all). Comparing treatment versus Standard of Care—there was no difference in proportion of increase in SOFA score of at least 1 point (30% vs. 33%) (note bene underpowered, P = 1.0) or mean preprotocol fluids 1,050 mL (95% confidence interval [CI]: 786–1,314) vs. 1,031 mL (95% CI: 741–1,325) (P = 0.93); however, treatment patients received more fluids during the protocol (2,633 mL [95% CI: 2,264–3,001] vs. 1,002 mL [95% CI: 707–1,298]) (P

Today’s communications economy is fundamentally different from the communications economy that characterized the previous “mass media era” in ways that dramatically affect the production, dissemination, and consumption of news and information critical to the effective functioning of democracy. As the traditional news business model has declined, big data, content farms, and new media platforms are serving as increasingly important mechanisms for analyzing, creating, and disseminating news and information. Yet these trends also exacerbate “one-way flows,” single-subject news models, audience fragmentation, and shifting tensions between large and small market journalism. The nature of the technological changes that have affected the news industry are interacting with certain fundamental economic characteristics of news content, news audiences, and the news marketplace as a whole.

Introduction: The association of intracranial aneurysms and autosomal-dominant polycystic kidney disease (ADPKD) is well recognized. The aim of this study was to assess the prevalence of asymptomatic intracranial aneurysms and to verify the presence of other cerebral abnormalities in patients with ADPKD by Magnetic Resonance Angiography screening. Materials and methods: From January 2009 to September 2013, 56 patients with ADPKD (25 M, 31 F; mean age 40 years, range 24- 63 years) underwent brain Magnetic Resonance Imaging including 3D time-of-flight MR angiography and T2-weighted Turbo-Spin-Echo axial sequences. Magnetic Resonance studies were examined by two experienced neuroradiologists (20 years). If an intracranial aneurysm was detected, cerebral Computed Tomography Angiography was recommended and further action were discussed with the interventional neuroradiologist. Results: Nine saccular intracranial aneurysms were detected in 56 patients, located in the anterior circulation (5 internal carotid arteries, 1 anterior communicating artery and 3 middle cerebral arteries). Four patients underwent endovascular treatment with flow-diverter devices. We additionally found internal carotid artery abnormal diameter and course (6), basilar artery hypoplasia (1), basilar artery dolichoectasia (1), asymmetric anterior cerebral (4) and vertebral (14) arteries, vascular anatomic variants (3), venous drainage anomaly (1), arachnoid cysts (6), large bilateral choroid plexus cysts (1) and mega cisterna magna (2). Conclusions: The prevalence of asymptomatic intracranial aneurysms (16.1%), higher compared to the general population (1%) and similar to literature reports in autosomal dominant polycystic kidney disease (6-16%), confirmed the importance of the Magnetic Resonance Angiography screening in these patients.

A common position amongst online content providers/aggregators is their resistance to being characterized as media companies. Companies such as Google, Facebook, BuzzFeed, and Twitter have argued that it is inaccurate to think of them as media companies. Rather, they argue that they should be thought of as technology companies. The logic of this position, and its implications for communications policy, have yet to be thoroughly analyzed. However, such an analysis is increasingly necessary as the dynamics of news and information production, dissemination, and consumption continue to evolve. This paper will explore and critique the logic and motivations behind the position that these content providers/aggregators are technology companies rather than media companies, as well as the communications policy implications associated with accepting or rejecting this position. In conducting this analysis, this paper first explores the importance of classification in communications policymaking. Drawing on examples from U.S. communications policy, this paper illustrates how and why disputes over the appropriate classification of communications technologies and services often have had profound policy implications. Examples to be discussed include the importance of the telecommunications service versus information service classification in network neutrality policymaking and the classification of multichannel video programming delivery (MVPD) services in relation to access to broadcast content. Next, this paper explores the meaning of a media company and its important points of distinction from the meaning of a technology company. This paper explores this distinction within the context of arguments from online content providers/aggregators that they are more appropriately classified as technology companies rather than media companies. Drawing upon a data set of position papers, trade press stories, conference presentations, and public relations/promotional materials in which this argument is put forth by representatives of a variety of online content providers/aggregators, this section examines and critiques this position. In considering these arguments, this section puts forth a set of parameters as to what constitutes a media company and illustrates how online content providers/aggregators fit within these parameters. The final section discusses why it is important that these online content providers/aggregators be understood as media companies by communications policymakers. As this section illustrates, the functionalities provided by many of these online service providers are increasingly overlapping and intersecting with those of traditional media companies, particularly in terms of the production, dissemination, and consumption of news and journalism; yet this has happened absent the normative governance frameworks that characterize other communications platforms that serve a significant journalistic function. The danger here is that the production, dissemination, and consumption of journalism will increasingly be dictated by institutions devoid of any governance structure oriented toward serving the public interest as it pertains to the role of journalism in a democracy. From this standpoint, should communications policymakers embrace the notion that these online content providers/aggregators are technology companies rather than media companies, the implications for how well the contemporary media ecosystem serves the information needs of citizens in a democracy could be profound.

One of the most distinctive characteristics of the media marketplace is the role and function of the audience. In the dual-product marketplace that characterizes media, in which content is sold (or given) to audiences and audiences are, in turn, sold to advertisers, audiences occupy the unique position of being the customer in one market and the product in the other market. This dynamic is further complicated by the ways that digital, interactive media are increasingly providing audiences with the opportunity to also serve as content producers, capable of producing content of significant value to other media consumers and to advertisers. This chapter will outline the key distinctive characteristics of audiences as product in the media marketplace and the implications of these distinctive characteristics for media management. This chapter will also examine audiences as both consumers and (increasingly) producers or creators of media products, with an emphasis on the unique management challenges and opportunities associated with the contemporary media audience.

This study analyzes the provision of local news programming on local television and its relation with station ownership characteristics and market conditions. The results show that station financial strength and market competition have a significant, positive relation with the quantity of local news programming. However, there is little evidence that ownership characteristics (e.g., duopoly ownership and ownership by one of the big 4 broadcast networks) contribute to local news production. The findings call into question one of the underlying rationales of the Federal Communication Commission's current policies toward more relaxed national and multiple ownership rules. This research was supported by grants from the Ford Foundation's Media, Arts, and Culture Unit, Fordham University's Graduate School of Business Summer Research Grant Program, and the Howard R. Marsh Center in the Department of Communication Studies at the University of Michigan.

HydroCoils are platinum helical coils coated with a layer of hydrophilic acrylic polymer (hydrogel), which on contact with blood causes disentanglement of polymer chains and expansion. We retrospectively reviewed a series of 29 patients harboring 29 cerebral aneurysms treated with the Hydrocoil Embolic System in the period 2004–2005, discussing the results of endovascular procedures in terms of safety and efficacy. The immediate post-procedure angiographic control demonstrated complete aneurysm occlusion in 21 cases (72.4%), near-complete occlusion in seven cases (24.1%), whereas in one case (3.4%) there was a procedure failure with major perfusion of the sac. Five patients (17.2%) experienced thromboembolic complications, including an asymptomatic lacunar stroke of the head of the caudate nucleus, a thalamic infarct following hypotension secondary to pulmonary edema, temporal ischemia secondary to vasospasm and a small right occipital ischemic lesion. Only one patient (3.4%) suffered a major ischemic accident. No other procedure-related complication occurred. Three-month follow-up control with MR angiography and 12-month follow-up angiography demonstrated no recurrence of aneurysms. Overall, after a mean follow-up of 12 months, the clinical outcome was good recovery in 26 patients (89.6%), moderate disability in three patients (10.3%) and no vegetative status or death. Our HydroCoil series supports the safety and midterm durability of hydrogel-coated aneurysm coils in the treatment of cerebral aneurysms.

Cardiology consensus guidelines recommend use of the DiamondForrester (DF) score in augmenting the decision to pursue stress testing. We have recently shown that it may have value in safely reducing stress utilization in an emergency department chest pain unit (CPU). However, full application necessitates demonstration of a good inter-rater reliability of the DF score in the CPU setting. We hypothesized that DF pretest probability would have good inter-rater reliability in CPU patients.This was a chart review of randomly selected patients from a previously collected prospective observational trial of admitted CPU patients in a large-volume academic urban emergency department. Inclusion criteria were: age18 years, American Heart Association low/intermediate risk, nondynamic electrocardiograms, and normal initial troponin I. Exclusion criteria were: age75 years with coronary artery disease. A DF score for likelihood of coronary artery disease was calculated on each patient by 2 trained chart abstractors using a standardized data abstraction instrument. Abstractors were trained to specifically categorize presenting symptoms as fitting 1 of 3 types of chest pain symptoms: nonanginal, atypical, or anginal based on previously published prespecified criteria. Approximately 20% of charts in a CPU registry were abstracted by 2 chart abstractors who were blind to each other's categorization, the patient outcomes, and the study hypothesis. The primary outcome was the kappa statistic for agreement between the 2 raters.The charts of 705 random patients were reviewed. The mean age was 55.1±11.8 years, 52% were female. Forty four percentage of patients received stress testing, and 2.4% of patients had acute coronary syndrome. The mean DF score was 39±24. There was good inter-rater agreement of chest pain characteristics (κ=0.77, 95% confidence interval, 0.72-0.81; P0.01).This study supports the use of the DF score as a reliable indicator of pretest probability in CPU patients by demonstrating that there is good inter-rater reliability. Prospective validation is necessary at the point of patient assessment, in conjunction with application of the DF score to augment stress utilization decision making.

This report describes endovascular approaches for occlusion of vertebro-vertebral arteriovenous fistula (W-AVF) in a series of three cases and a review of the literature. Complete neuroimaging assessment, including CT, MR and DSA was performed in three patients (two female, one male) with W-AVF. Based on DSA findings, the W-AVF were occluded by endovascular positioning of detachable balloons (case 1), coils (case 2), or a combination of both (case 3) with parent artery patency in two out of three cases. In this small series, endovascular techniques for occlusion of W-AVF were safe and effective methods of treatment. To date, there are no guidelines on the best treatment for W-AVF. Detachable balloons, endovascular coiling, combined embolization procedures could all be considered well-tolerated treatments.

This article examines how the contemporary communications policy-making environment (particularly in relation to media ownership) is one in which communications research can play an increasingly influential role. This article explores how the expanded analytical perspective being brought to bear on the media ownership issue is conducive to greater contributions from communications research. Specifically, this article illustrates how policymakers' efforts to assess the importance of individual media outlets in local media markets from a view-point diversity standpoint raise a host of analytical issues toward which a broad range of communications research traditions can make significant contributions.

This article presents a case study of the transition to a new market information regime, via an analysis of the transition to the BookScan system of measuring book sales and the potential impact of this new measurement system on how publishing industry decision makers perceive—and respond to—their competitive environment. This study critically examines the traditional systems of audience measurement—and their uses—in book publishing, as well as the diffusion process for the BookScan system. This study finds many similarities between the introduction and potential impact of BookScan and the introduction and impact of new audience measurement systems in other media, such as stronger resistance from content producers (e.g., publishers) than from other stakeholders (e.g., agents, retailers), as well as a likelihood that widespread usage of the new measurement system will contribute to greater fragmentation and greater volatility of the measured industry.

We describe the case of a 62-year-old woman who presented with a small fusiform left superior cerebellar artery (SCA) aneurysm. Aneurysms located on the SCA are uncommon and their presentation, natural history and clinical management are poorly understood. Reports on the endovascular or surgical management of SCA aneurysms are rare and usually incorporated in clinical series of basilar artery or posterior circulation aneurysms. The patient was treated by delivery of a flow-diverter Pipeline Embolization Device (PET) - Chestnut Medical/ev3) at the origin of vessel. She had no procedural complications and the aneurysm volume was reduced. This paper presents additional evidence to literature reports suggesting that the new endovascular flow-diverter devices are an effective and well-tolerated treatment for complex aneurysms. Our review contributes data on the incidence of recurrence as a measure of long-term efficacy of this therapeutic approach.

Facial nerve paralysis (Cranial Nerve VII, CN VII) can be a disfiguring disorder with profound impact upon the patient. The etiology of facial nerve paralysis may be congenital, iatrogenic, or result from neoplasm, infection, trauma, or toxic exposure. In the emergency department, the most common cause of unilateral facial paralysis is Bell's palsy, also known as idiopathic facial paralysis (IFP). We report a case of delayed presentation of unilateral facial nerve paralysis 3 days after sustaining a traumatic head injury. Re-evaluation and imaging of this patient revealed a full facial paralysis and temporal bone fracture extending into the facial canal. Because cranial nerve injuries occur in approximately 5-10% of head-injured patients, a good history and physical examination is important to differentiate IFP from another etiology. Newer generation high-resolution computed tomography (CT) scans are commonly demonstrating these fractures. An understanding of this complication, appropriate patient follow-up, and early involvement of the Otolaryngologist is important in management of these patients. The mechanism as well as the timing of facial nerve paralysis will determine the proper evaluation, consultation, and management for the patient. Patients with total or immediate paralysis as well as those with poorly prognostic audiogram results are good candidates for surgical repair.

Localism long has been a central guiding principle in communications policymaking, yet its specific meaning and objectives have not been well articulated by policymakers. This article attempts to bring greater clarity to the localism principle, through an examination of how the Federal Communications Commission has defined local programming. Policymakers have failed to establish a clear and stable definition of what constitutes local programming, which has contributed to the sense of ambiguity, uncertainty, and inconsistency that long has characterized localism policymaking. If localism policies are to reflect the rationales upon which they are based, the definition of local programming must be expanded to account not only for a program's point of origin, but for the nature of a program's content as well.

The use of tightly packed arrays of probes can achieve the much desirable goal of increasing the throughput of scanning probe devices. However the proximity of the probes induces coupling in their dynamics, which increases the complexity of the overall device. In this paper we analyze and model the behavior of a pair of electrostatically and mechanically coupled microcantilevers. For the common case of periodic driving voltage, we show that the underlying linearized dynamics are governed by a pair of coupled Mathieu equations. We provide experimental evidence that confirms the validity of the mathematical model proposed, which is verified by finite element simulations as well. The coefficients of electrostatic and mechanical coupling are estimated respectively by frequency identification methods and noise analysis. Finally, we discuss parametric resonance for coupled oscillators and include a mapping of the first order coupled parametric resonance region.

A rare case of segmental hypoplasia of the basilar artery is described in a 49-year-old man with transient vertebrobasilar ischemia, explored by magnetic resonance imaging (MRI) and digital angiography (DA). The embryology, clinical relevance and magnetic resonance findings of this arterial anomaly are discussed, with a review of six previously reported cases. Segmental aplasia was suggested in our case by magnetic resonance, and subsequently confirmed not only by time-of-flight magnetic resonance, but also by DA. Only ultrathin-slice T2-weighted images revealed the real finding of basilar artery hypoplasia. This sequence, not employed in previously reported cases, is mandatory to allow a clear differential diagnosis between basilar artery aplasia and hypoplasia.

Emergent conditions resulting from head and neck neoplasms and their treatment include acute airway obstruction, hemorrhage, spinal cord compression, bilateral vocal cord paralysis, and septic thrombophlebitis. These conditions require accurate diagnosis and rapid intervention to avoid severe permanent damage or death. Successful treatment requires a coordinated response by emergency medicine physicians, otolaryngologists, vascular surgeons, and radiologists. We review these head and neck oncological conditions, which present emergently, with a focus on radiological evaluation and interpretation.

As a preliminary approach to define the object of larger case-control studies, the distribution of potential risk factors coming from environmental pollution among patients affected by superficial bladder cancer (TCCB) has been analyzed. Material e Methods. The analysis included only patients affected by medium risk superficial TCCB. Forty Italian urological centres joined the study. Detailed information about age, sex, residency, employment, active and passive cigarette smoking, water resource, hair-dye use were centralized. All patients underwent TUR and early intravesical chemotherapy. The distribution of the above mentioned environmental factors was related to tumor characteristics such as multiplicity and previous natural history. Results. Until today 474 patients have been recruited, 182 (38.4%) with primary tumors and 293 (61.8%) with multiple lesions. Over 80% of the patients lived in urban areas, 20% were employed in industry at risk for bladder cancer and 8% used hair dye. Forty percent of the patients were smokers, with a median smoking period of 30 years. Bottled water was the only water resource in 42% of cases. At multivariate statistical analysis a significant correlation between tumor multiplicity and employment in industry (p

We present a mathematical model for the dynamics of an electrostatically actuated micro-cantilever. For the common case of cantilevers excited by a periodic voltage, we show that the underlying linearized dynamics are those of a periodic system described by a Mathieu equation. We present experimental results that confirm the validity of the model, and in particular, illustrate that parametric resonance phenomena occur in capacitively actuated micro-cantilevers. We propose a system where the current measured is used as the sensing signal of the cantilever state and position through a dynamical observer. By investigating how the best achievable performance of an optimal observer depends on the excitation frequency, we show that the best such frequency is not necessarily the resonant frequency of the cantilever.

This paper examines the relationship between television station ownership characteristics and local news and public affairs programming through an expanded analysis of data from the Federal Communication's Commission (FCC's) recent study of Big Four broadcast network affiliates. The results indicate that the FCC's conclusion that network‐owned and operated stations provide more local news and public affairs programming than other affiliates, and that stations with newspaper holdings provide more local news and public affairs programming than stations without newspaper holdings holds up only when these two program types are analyzed in combination. When these two program types are analyzed independently, and when additional explanatory factors are taken into consideration, these ownership characteristics are positively related to news programming, but not to public affairs programming.

Purpose To evaluate the safety of OptiMARK® (gadoversetamide injection) administered via power injector. Materials and Methods The study population included 144 healthy volunteers aged 18 years or older randomly assigned to one of seven treatment groups (N = 20/group). The safety assessment was based on changes in physical examination, vital signs, electrocardiograms (ECGs), standard clinical laboratory tests, and adverse events (AEs) through a 24-hour postinjection period. Results OptiMARK caused no serious AEs or unexpected changes in physical examinations or laboratory parameters. The changes observed in vital signs and ECG intervals did not vary with changes in injection rate and were not significantly (P < 0.05) different from those elicited by saline administration at the same rates. Conclusion This study demonstrated the safety of OptiMARK when administered via a power injector at rates of 2, 4, and 6 mL/second. J. Magn. Reson. Imaging 2004;19:133–140. © 2003 Wiley-Liss, Inc.

This article examines public perceptions of the news and information sector in Bosnia-Herzegovina. Since the signing of the Dayton Peace Accord in late 1995, the international community has donated millions of dollars to foster free and fair media. This research explores the media transition in Bosnia through a four-year longitudinal study. The research design measured public perceptions ( N = 1689) of the realism, importance and credibility of news outlets in the two major media centers: Banja Luka and Sarajevo. The findings suggest that over time Bosnians are relying less on politically motivated news outlets. Moreover, some independent media have emerged as both important and credible sources for news and information.

Amidst all the discussion of digital television issues, such as transition deadlines, mandatory tuners, and must-carry provisions, one very important issue has fallen off of policymakers' radar screens. That is the issue of the public interest obligations of digital broadcasters. Back in 1997, this issue was front and center in the digital television policy arena. Unfortunately, today the public interest obligations issue has been forced aside by changes in the political climate and by a variety of persistent technical and economic complications. However, given the time, resources, and effort being devoted to completing the digital television transition, policymakers must regain their focus on the public interest obligations issue if the video service is to make a meaningful contribution to the media system and to American political and cultural life. In March 1997, the Clinton Administration established the Advisory Committee on the Public Interest Obligations of Digital Television Broadcasters. The Committee--a mix of industry executives, academics, and public interest advocates--was charged with the task of "determining how the principles of public trusteeship that have governed broadcast television for more than 70 years should be applied in the new television environment" (Advisory Committee on the Public Interest Obligations of Digital Television Broadcasters, 1998, p. 136). The Committee met eight times over the next 15 months in different venues around the country to solicit input from the general public and from outside experts, and ultimately produced a set of recommendations that was submitted to the White House. These recommendations addressed a variety of issues, such as disability access, the promotion of diversity, disaster warnings, funding for public broadcasting, and the establishment of a voluntary code of conduct for broadcasters. The Committee's report did not, for the most part, move very far beyond the regulatory framework and requirements that have been in place for analog broadcasters, and generally avoided providing specific details in regards to its recommendations. The report, however, did include the very controversial recommendation that digital broadcasters be required to provide five minutes of free air time to political candidates each night during the 30 days before an election. With its combination of well-established and radical new public interest recommendations, the Advisory Committee's report represented an important starting point for a meaningful examination and reassessment of how broadcast television could better contribute to American political and cultural life. The Committee's report prompted an FCC Notice of Inquiry (NOI) on digital broadcasters' public interest obligations (Federal Communications Commission, 1999). Then-FCC Chairman William Kennard originally had planned to issue a Notice of Proposed Rule Making (NPRM) that included the Advisory Committee's free air time proposal. Congress reacted negatively to the free air time proposal, going so far as to threaten to cut the FCC's budget. Congress' reaction led Chairman Kennard to introduce a more tentative Notice of Inquiry instead of the NPRM. In the NOI, the Commission sought comment on a wide variety of issues, including the free air time proposal and most of the Advisory Committee's other proposals as well, but did not propose specific rules. This NOI led to an NPRM that focused specifically on children's television obligations for digital broadcasters (Federal Communications Commission, 2000). The FCC has issued no further decisions or rules on the variety of public interest obligation issues raised in the NOI and the children's television NPRM. The last official word on the public interest obligations issue came from then-Chairman Kennard's (2001) Report to Congress on the Public Interest Obligations of Television Broadcasters as they Transition to Digital Television. In this report, Kennard presented a variety of recommendations, including a minimum public affairs programming requirement (Napoli, 2001b), the reinstitution of community ascertainment requirements, and a five-minute free air time requirement for political candidates. …

This study employs participant observation methodology to examine the U.S. broadcast industry’s cognitions of its external environment. Previous research has documented a tendency among industry participants to operate under outdated mental models of their environment. This tendency - labeled ‘cognitive inertia’ - provides the analytical framework for this study. The results provide indications that broadcasters operate under what appear to be outdated mental models of their external environment, with broadcasters appearing to pay inadequate attention to competing program sources and failing to account for the changing demographic composition of the television audience. However, these conclusions are tempered by the broadcast industry’s dual product marketplace characteristics, wherein cognitions that would appear to reflect inadequate assessment of the content market may in fact reasonably reflect the contemporary realities of the audience market.

BACKGROUND Fluid responsiveness is a measure of preload dependence and is defined as an increase in cardiac output due to volume expansion. Recent publications have suggested that variation in amplitude of the pulse oximetry waveform may be predictive of fluid responsiveness. The pleth variability index (PVI) was developed as a noninvasive bedside measurement of this variation in the pulse oximetry waveform. OBJECTIVES To measure the discriminatory value of PVI for predicting fluid responsiveness as measured by pulmonary artery catheter thermodilution in patients after cardiothoracic surgery. METHODS A prospective observational study of hemodynamically stable postoperative cardiac surgery patients with pulmonary artery catheters. A fingertip sensor was used to measure PVI. Vital signs, PVI, and cardiac index were measured before, during, and after passive leg raise. Fluid responsiveness was defined by increase in cardiac index of greater than 15% during passive leg raise. The discriminatory value of PVI was assessed by using the Wilcoxon method to measure the area under the receiver operating curve. RESULTS In 13 months, 47 patients (24 receiving mechanical ventilation, 23 spontaneously breathing) were enrolled. Fluid responsiveness was noted in 42% of intubated patients and 48% of spontaneously breathing patients. PVI was not adequate to discriminate fluid responsiveness in intubated patients (area under curve, 0.63; P = .16) or spontaneously breathing patients (area under curve, 0.41; P = .75). CONCLUSIONS Among postoperative cardiac surgery patients, PVI is not reliable for predicting fluid responsiveness as measured by pulmonary artery catheter thermodilution, regardless of ventilatory status.

Background: Patients with a clinical diagnosis of transient ischemic attack (TIA) who have imaging evidence of infarction portend a high risk of short-term recurrent stroke. Emergency Department Observation Units (EDOU) offer an alternative to hospital admission and are becoming increasingly utilized for acute cerebrovascular emergencies. Hypothesis: We sought to determine whether an EDOU protocol emphasizing etiologic determination and individualized secondary prevention could be a safe alternative to hospital admission for suspected TIA patients with and without brain infarction. Methods: We prospectively studied 189 patients admitted to the TIA EDOU of a single tertiary care academic medical center. There was no ABCD2 cutoff for eligibility and exclusion criteria included persistent deficits or another diagnosis warranting hospitalization. Patients underwent DW-MRI/MRA of the head and neck unless contraindicated, transthoracic echocardiogram and bedside neurologist evaluation. Etiologic subtyping was determined using the Causative Classification System (CCS). 30-day follow-up was performed on all patients by telephone and/or review of medical records. This study was approved by the hospital IRB. Results: Acute ischemic stroke was diagnosed in 31 (16%) of patients, including 30 with DWI lesions and 1 in whom MRI was contraindicated, but had clinical worsening while in the EDOU. An evident or probable etiology was determined by CCS subtyping in 38% of strokes and 32% of TIAs (17% atherosclerosis, 12% cardioembolism, 5% small vessel). Of the total cohort, 84% were discharged from the EDOU including 16 (52%) with confirmed stroke. Median LOS was 22 hours (IQR: 17-25). At 30 days, one patient was found to have a small recurrent stroke (0.7%). There was 1 non-stroke related death. Twenty (11%) overall returned to the ED, the vast majority (70%) from the non-stroke cohort. Conclusions: Not all ischemic stroke patients require hospitalization. An EDOU is a safe and effective alternative for the complete diagnostic evaluation and management of patients with transient neurologic symptoms. Further study of cost and quality effectiveness in warranted.

In United States media policy, issues of media pluralism and diversity have been tightly intertwined with the issue of media ownership. In the US, the media ownership issue involves not only concerns about ownership concentration and its anti-competitive effects in the economic marketplace and in the marketplace of ideas; but also concerns about the levels of media ownership amongst historically disadvantaged groups such as women and minorities. In this regard, then, the media ownership issue in the US becomes interconnected with pluralism and diversity-related concerns about a robust marketplace of ideas and minority and gender representation in both the structure and content of the media system. And, of course, these social and political dimensions coexist with economic concerns about the relationship between the ownership structure of media markets and the economic functioning of these markets. From a policy standpoint, all of these concerns need to be addressed within a media environment that has, over the past two decades, been in a period of tremendous volatility and ongoing technological change.

In 2009, The Knight Commission released a report identifying access to credible and relevant information as a key requisite for healthy communities (Knight Commission, 2009). This report subsequently led to a comprehensive assessment by the Federal Communications Commission of how community information needs are being met in the broadband era (Waldman, 2011), as well as further exploration by the Commission into how this issue could be researched in ways that could inform policymaking (Friedland et al., 2012). The present research seeks to continue this line of inquiry by developing and testing a set of scalable performance metrics that could serve as analytical tools for assessing variations in the health of local journalism ecosystems across communities or over time; or as components of more comprehensive assessments of the relationship between the health of local journalism and other vital measures of community health, engagement, and political participation. This research compares online local news ouput for three communities that vary in important ways, such as their average household income, average level of education, and broadband penetration. To assess the health of the local journalism ecosystems, four researchers first identified all possible outlets for journalism (both digital and “traditional”) in each of the three communities. The online presence of each outlet – websites as well as social media – was then determined; virtually all outlets within each community had an online presence. Content from one constructed week of social media (Twitter and Facebook), and one continuous week of website news stories was then coded for several key variables, including: originality, whether it addressed a pre-determined “critical information need” (Friedland et al., 2012), and whether it was about the target community. The quantity of information produced by these outlets was controlled for the size of the population, by calculating for each community the number of journalism stories and social media postings produced in the given week per 10,000 capita; per capita measurements (as well as strict percentages) were also used to assess the outputs according to the key normative criteria outlined above (originality, about community, addressing critical information needs). In addition, output concentration (the extent to which the production of stories/social media posts was concentrated within a limited number of local journalism sources) was computed for each community across all of these categories of journalistic output using the Herfindahl-Hirschman Index. The results show drastic differences in the availability and quality of local online journalism, which seem to mirror existing structural inequalities. The community with higher household income, level of education, and broadband penetration was remarkably better served than the poorest and least educated community. The third community, which falls in the middle in terms of education and wealth, but is markedly more diverse, also fared poorly relative to the highest-income community. These findings point to the possibility of pronounced “digital divides” separating communities of different types in relation to the per capita output of local journalism. The authors recommend several specific ways in which further research could supplement and further validate these results, and discuss the implications for communications policy in the digital age.

In the United States (U.S.), diversity, rather than pluralism, has traditionally been one of the overriding goals of media policy (Napoli 1999). The concept of diversity overlaps to some extent with the concept of pluralism in a variety of ways (see Karppinen 2013), as will likely become clear in the discussion that follows. Diversity policy — and diversity measurement — have a long history in the U.S. At various times, policymakers in the U.S. have emphasized a variety of different dimensions of diversity, ranging from the diversity of sources and viewpoints, to the diversity of program types, to the demographic diversity of the employees within media organizations (Napoli 1999).

This study examines the factors that affect the value of radio station audiences, with an emphasis on whether, and to what extent, minority composition affects the value of radio audiences. The results indicate that the prominence of minorities (both African-American and Hispanic) is negatively related to the value of radio station audiences. These results suggest that policymakers seeking to promote source and content diversity may need to look beyond seeking means of promoting the establishment of new minority media outlets and also consider means of preserving the viability of existing media outlets.

Background Emergency department observation units (EDOUs) represent an opportunity to efficiently manage patients with common conditions requiring short-term hospital care. Understanding which patients are ultimately admitted to the hospital after care in an EDOU may enhance patient selection for EDOU care. Methods We conducted a retrospective analysis of US emergency department visits resulting in admission to observation status using the National Hospital Ambulatory Care Survey (NHAMCS) from 2009 to 2010, a nationally representative sample. We used survey-weighted logistic regression to identify predictors at the patient level, visit level, and hospital level for inpatient hospital admission after EDOU care. Results Between 2009 and 2010, there were 4.65 million patient visits (95% confidence interval [CI], 3.68-5.63) to EDOUs in the United States. Of those evaluated in an EDOU, 40.4% (95% CI, 34.5%-46.6%) were admitted to the hospital after EDOU care. Progressively older patient age was a strong predictor of hospital admission: patients age older than 65 years were more than 5 times more likely to be admitted than patients age younger than 18 years (odds ratio, 5.36; 95% CI, 2.26-12.73). The only other visit-level factor associated with admission was a reason for visit of chest pain; this was associated with a lower rate of hospital admission (odds ratio, 0.61; 95% CI, 0.41-0.91). Conclusion Across the United States in 2009 to 2010, older patient age was a strong predictor of admission after EDOU care, suggesting that older patients are more likely to require inpatient hospital services after EDOU care than younger patients.

Significant sex and gender differences in both physiology and psychology are readily acknowledged between men and women; however, data are lacking regarding differences in their responses to injury and treatment and in their ultimate recovery and survival. These variations remain particularly poorly defined within the field of cardiovascular resuscitation. A better understanding of the interaction between these important factors may soon allow us to dramatically improve outcomes in disease processes that currently carry a dismal prognosis, such as sudden cardiac arrest. As part of the 2014 Academic Emergency Medicine consensus conference “Gender-Specific Research in Emergency Medicine: Investigate, Understand, and Translate How Gender Affects Patient Outcomes,” our group sought to identify key research questions and knowledge gaps pertaining to both sex and gender in cardiac resuscitation that could be answered in the near future to inform our understanding of these important issues. We combined a monthly teleconference meeting of interdisciplinary stakeholders from largely academic institutions with a focused interest in cardiovascular outcomes research, an extensive review of the existing literature, and an open breakout session discussion on the recommendations at the consensus conference to establish a prioritization of the knowledge gaps and relevant research questions in this area. We identified six priority research areas: 1) out-of-hospital cardiac arrest epidemiology and outcome, 2) customized resuscitation drugs, 3) treatment role for sex steroids, 4) targeted temperature management and hypothermia, 5) withdrawal of care after cardiac arrest, and 6) cardiopulmonary resuscitation training and implementation. We believe that exploring these key topics and identifying relevant questions may directly lead to improved understanding of sex- and gender-specific issues seen in cardiac resuscitation and ultimately improved patient outcomes.

The addition of perfluorohexyl iodide to allyl chloride leads to the formation of 3-(perfluorohexyl)prop-1-ene in addition to the expected iodine-containing adduct. This reaction was studied under different conditions in order to determine their influence on the formation of the polyfluoro-olefin. The reaction conditions varied in the experiments were: molar ratio of reactants, weight percent of initiator, temperature and reaction time, and their effect on the formation of 3-(perfluorohexyl)prop-1-ene and by-products was determined.

This article investigates possible determinants of forecasting error for new prime-time network television programs. Each season, advertising industry forecasters attempt to predict the audience shares for new fall programs. Advertising expenditures are made on the basis of these projections, though historically these forecasts have been very inaccurate. Through an integration of audience behavior theory and decision—making theory, this paper attempts to identify factors that explain the magnitude of uncertainty, and hence the magnitude of forecasting error, surrounding the predictions for new programs. The results indicate that the presence of a returning network lead-in or lead-out significantly reduces the amount of forecasting error. In addition, the results indicate that forecasting error has increased significantly over time. The overall explanatory power of the model suggests that content and audience characteristics must be incorporated into the analytical framework as well.

This study inves ti gates whether mar ket con di tions affect the pro vi sion of pub lic affairs pro gram ming by tele vi sion broad cast ers. The study exam ined a ran dom sam ple of 112 com mer cial broad cast sta tions in order to deter mine whether sta tion char ac ter is tics, mar ket size and demo graph ics, and com pet i tive con di tions affect the quan tity of pub lic affairs pro gram ming pro vided. The results sug gest that mar ket con di tions have very lit tle effect on the quan tity of pub lic affairs pro gram ming pro vided by indi vid ual broad cast sta tions and that if reg u la tors wish to increase the amount of pub lic affairs pro gram ming in the dig i tal broad cast ing realm, spe cific gov ern ment-man dated pro gram ming require ments may be nec es sary. A prom i nent debate within the media pol icy arena revolves around whether the mar ket place effec tively pro motes the pro duc tion of cer tain forms of pro gram ming. Media reg u la tion in the United States has moved away from explicit pro gram ming require ments for broad cast ers and toward a model in which a dereg u lated, com pet i tive mar ket place is seen as the pri mary mech a nism for ensur ing suf fi cient avail abil ity of diverse forms of con tent (Fowler and Brenner 1982; Horwitz 1989; Napoli 1999a, 1999b, 2001). The ques tion remains, how ever, whether mar ket place incen tives are indeed suf fi cient for encour ag ing the pro duc tion of cer tain forms of pro gram ming, spe cif i cally, pro gram ming with pre dom i nantly edu ca tional, polit i cal, or pub lic affairs ori en ta tions (Baker 1997; Benton Foun da tion 1998; Brennan 1983). Pro po nents of the mar ket place approach to media reg u la tion argue that dereg u lated mar kets pro vide suf fi cient incen tives for the ful fill ment of a diver sity of con tent inter ests, pro vided that there are numer ous com pet i tors par tic i pat ing in the mar ket (Fowler and Brenner 1982). Those who ques tion the effi cacy of mar ket place incen tives often argue that media indus tries and media

(2001). Social responsibility and commercial broadcast television: An assessment of public affairs programming. International Journal on Media Management: Vol. 3, No. 4, pp. 226-233.

Audiences are the primary product manufactured and sold by advertisersupported media. In selling audiences to advertisers, media firms deal in human attention, which resists the type of exact verification and quantification typical of transactions in other industries (Napoli forthcoming). Verifying the presence of human attention to media generally requires entering people’s living rooms, bedrooms and cars, and monitoring their behaviour. For such monitoring to be maximally effective requires audience members’ explicit permission and cooperation to turn something as abstract as attention into tangible data that can be sold in the marketplace. In addition, the audience product is produced from raw materials (consumers) that the producers (media organizations and audience measurement firms) can not control (Berry & Waldfogel 1999). Since the production of audiences is not controlled by the manufacturers, any efforts to bring predictability and rationality to the process of producing audiences must draw upon a sophisticated understanding of the essentially uncontrollable, yet somewhat predictable, behaviour of media audiences. Thus, the economics of advertising-supported media revolve around efforts to predict and measure the behaviour of media consumers. Such efforts persist because greater effectiveness in audience prediction and audience measurement brings greater efficiency and greater revenues to the audience marketplace (Barnes & Thomson 1988, 1994; Fournier & Martin 1983). By the same token, conditions that undermine such efforts damage the audience marketplace. Ongoing changes in the media environment have the potential to cause such damage. The purpose of this article is to identify the key means by which the new media environment is threatening to undermine the audience marketplace. By focusing on such issues, this article is intended to serve as a counterweight to the prominent discourse emphasizing the opportunities and benefits the new media environment offers advertisers and content providers. This analysis is organized around a conceptual model in which the audience product is separated into three interrelated components: (a) the predicted audience; (b) the measured audience; and (c) the actual audience. As this article will illustrate, the new media environment is increasing the disconnects between these components of the audience product.