Long-standing Beliefs Research Articles

Developmental Idealism and Cultural Models of the Family in Malawi.

This paper examines the extent to which developmental idealism has been disseminated in Malawi. Developmental idealism is a set of beliefs and values about development and the relationships between development and family structures and behavior. Developmental idealism states that attributes of societies and families defined as modern are better than attributes defined as traditional, that modern societies help produce modern families, that modern families facilitate the achievement of modern societies, and that the future will bring family change in the direction of modernity. Previous research has demonstrated that knowledge of developmental idealism is widespread in many places around the world, but provides little systematic data about it in sub-Saharan Africa or how knowledge of it is associated with certain demographic characteristics in that region. In this paper, we address this issue by examining whether ordinary people in two settings in Malawi, a sub-Saharan African country, have received and understood messages that are intended to associate development with certain types of family forms and family behaviors. We then examine associations between demographic characteristics and developmental idealism to investigate possible mechanisms linking global discourse about development to the grassroots. We analyze data collected in face-to-face surveys from two samples of Malawian men in 2009 and 2010, one rural, the other in a low-to-medium income neighborhood of a city. Our analysis of these survey data shows considerable evidence that many developmental idealism beliefs have been spread in that country and that education has positive effects on beliefs in the association between development and family attributes. We also find higher levels of developmental idealism awareness in the urban sample than we do in the rural sample, but once dissimilarities in education and wealth between the two samples are controlled, awareness levels no longer differed between urban and rural respondents. We explore how these beliefs intersect with longstanding local values and beliefs in Malawi.

The Impact of Childhood Physical Abuse and Age of Sexual Initiation on Women's Maladaptive Posttraumatic Cognitions

Child abuse survivors often exhibit long-standing maladaptive beliefs. Sexual risk-taking could contribute to the maintenance of such beliefs by reinforcing cognitions that originally resulted from child abuse. In this study, 64 community women, most with elevated posttraumatic stress disorder symptoms, completed measures of childhood abuse, sexual risk-taking, and posttraumatic cognitions. Age of first consensual sexual intercourse mediated the relationship between childhood physical abuse and maladaptive posttraumatic cognitions in adulthood. Thus, age of sexual intercourse initiation might play an important role in women's recovery from childhood physical abuse. Clinicians should consider the possible impact of women's sexual history when challenging their cognitions during trauma-based cognitive behavioral therapy. Further, decreasing risky sexual behavior might partially protect against the negative effects of trauma.

Shaken Spirits: Cherokees, Moravian Missionaries, and the New Madrid Earthquakes

From December 1811 through March 1812, a series of earthquakes rattled the eastern half of North America. This essay uses Cherokee and Moravian missionary interpretations of the earthquakes as windows into early nineteenth-century ideas about the links between natural and social disorder. It argues that in their mutual search for explanations of the disorder, Moravians and Cherokees came to emphasize their cultural and epistemological differences. Furthermore, as Cherokees gravitated to their own prophets’ calls for ritual and reform, Moravians increasingly seized on apocalyptic understandings of the tremors, disguising their concerns under a front of dismissal of Cherokee explanations. For the Cherokees, contemporary concerns, grounded in long-standing beliefs about the mechanisms responsible for natural disorder, framed a vigorous debate about how to respond not only to the earthquakes but to major geopolitical and cultural transformations. Cherokees embedded their debates within their efforts to check United States expansionism and determine the utility of white people and their goods in Cherokee country. Amid internal problems in mission governance and a lack of Cherokee receptiveness to their evangelism, Moravians grew uncertain about the tremors’ meaning over time. As the earth continued shaking, they began to ponder whether the end of the world was soon at hand. They masked their private fears about both the meaning of the earthquakes and the status of their mission by denouncing Cherokee prophets. Struggling to interpret the same disturbing phenomenon in mutually troubling times, Cherokees and Moravians rejected one another’s earthquake explanations and prescriptions for the future.

Preexisting Factors or Media Effect? Understanding the Third-Person Perception

Research on third-person perceptions has consistently yielded evidence of a perceptual gap in perceived media effects on self and others. Scholars have worked to understand the reasons behind this gap with mixed results. In this study, we consider how news story characteristics, such as depictions of who is affected and how they are affected, could have implications for individual assessments of the effects of video games on self and others. We further contextualize this experiment by considering the role of more stable beliefs such as maternalism, paternalism, and assessments of media vulnerability. Results indicate that more permanent factors superseded the effects of the news story manipulations. Ultimately, the data show limited influence of media coverage on effects perceptions and suggest that such person perceptions are driven more by long-standing beliefs.

Children as Global Citizens: A Socratic Approach to Teaching Character

Educators around the world are being challenged to promote positive global citizenship skills in the face of daily news concerning widespread discord, dissonance, injustice, and corruption. This article describes a Socratic approach to developing global citizenship. Recognizing the central role of teachers in educating future generations of a society, the authors highlight ways in which teachers can scaffold critical thinking skills among students. These skills could potentially help youth access global perspectives, challenge long-standing beliefs and norms, and build a common ground with people across the world. The Socratic seminars are designed to increase students' understanding and appreciation of social, cultural, and religious differences through critical thinking, careful listening, and thoughtful communication. Educators can universally employ such tools for positive character development among students as they help prepare responsible leaders of a global society.

No Dice The Resistance to Randomness

No Dice The Resistance to Randomness

Early Repolarization: A Rare Primary Arrhythmic Syndrome and Common Modifier of Arrhythmic Risk

Despite longstanding beliefs, early repolarization is not always a benign electrocardiographic observation. Its association with increased arrhythmic events has been observed in 2 strikingly different groups of individuals, retrospectively in young subjects with idiopathic ventricular fibrillation and in long-term cohort studies from the general population. This form of primary electrical disease is now referred to as the early repolarization syndrome and has mechanistically been demonstrated to occur secondary to a transmural gradient of early cellular repolarization, resulting in the presence of an ST-elevation pattern and J-waves merged within or offset from the terminal QRS complex. In addition to creating a milieu of increased arrhythmic risk in isolation, an increasing number of studies have highlighted that the presence of early repolarization and J-waves may provide a baseline electrical substrate that modifies the risk of malignant arrhythmias in other clinical settings, such as acute myocardial ischemia. The challenge ahead lies in discerning when early repolarization may represent an ominous ECG marker, as opposed to a benign entity.

Stress responses, vitagenes and hormesis as critical determinants in aging and longevity: Mitochondria as a "chi".

Understanding mechanisms of aging and determinants of life span will help to reduce age-related morbidity and facilitate healthy aging. Average lifespan has increased over the last centuries, as a consequence of medical and environmental factors, but maximal life span remains unchanged. Extension of maximal life span is currently possible in animal models with measures such as genetic manipulations and caloric restriction (CR). CR appears to prolong life by reducing reactive oxygen species (ROS)-mediated oxidative damage. But ROS formation, which is positively implicated in cellular stress response mechanisms, is a highly regulated process controlled by a complex network of intracellular signaling pathways. By sensing the intracellular nutrient and energy status, the functional state of mitochondria, and the concentration of ROS produced in mitochondria, the longevity network regulates life span across species by coordinating information flow along its convergent, divergent and multiply branched signaling pathways, including vitagenes which are genes involved in preserving cellular homeostasis during stressful conditions. Vitagenes encode for heat shock proteins (Hsp) Hsp32, Hsp70, the thioredoxin and the sirtuin protein systems. Dietary antioxidants, have recently been demonstrated to be neuroprotective through the activation of hormetic pathways, including vitagenes. The hormetic dose–response, challenges long-standing beliefs about the nature of the dose–response in a lowdose zone, having the potential to affect significantly the design of pre-clinical studies and clinical trials as well as strategies for optimal patient dosing in the treatment of numerous diseases. Given the broad cytoprotective properties of the heat shock response there is now strong interest in discovering and developing pharmacological agents capable of inducing stress responses. Here we focus on possible signaling mechanisms involved in the activation of vitagenes resulting in enhanced defense against energy and stress resistance homeostasis dysiruption with consequent impact on longevity processes.

King of the hill

PurposeThis article seeks to highlight patron‐driven acquisitions (PDA) of e‐books.Design/methodology/approachThe article discusses an important new book devoted to PDA. It also describes a PDA pilot in the author's library consortium, and discusses some of the early findings.FindingsThe article suggests that PDA has numerous benefits, but challenges longstanding practices and beliefs about traditional collection building. It also assumes that e‐book access will become increasingly accepted by users.Originality/valueThe article provides theories about the effects of sustained PDA programs.

Managing pathologic aggression in people with psychotic disorders

A 55-year-old man had longstanding paranoid beliefs that the police were responsible for his personal bankruptcy. He believed they wanted to kill him through actual or simulated suicide, and he often carried a revolver. After attempting suicide by firearm, delusional disorder and major depression were diagnosed and he started risperidone and citalopram. A few years later, he shot 5 people, killing 1. He believed he saw police officers at his former company and believed they were conspiring to kill him. An initial forensic assessment led to a diagnosis of schizophrenia, paranoid type, and depressive disorder not otherwise specified. He received a verdict of noncriminal responsibility owing to mental disorder. It was decided that he presented a significant threat to public safety owing to lack of insight into his chronic mental illness and that he would benefit from inpatient therapeutic care and psychotherapeutic feedback. His clinical condition improved with quetiapine and citalopram, but he remained actively paranoid, with increased irritability and defensiveness. He was physically aggressive on 2 occasions, once during a trial with adjunct of aripiprazole. Although he had been reluctant to use clozapine, he eventually consented, hoping that it might improve his quality of life and lead to community privileges. Clozapine was introduced and gradually increased. His condition greatly improved, with decreased paranoia, irritability, hostility and impulsivity. He was eventually allowed to enter the community, indirectly supervised, for specific purposes. Despite the introduction of new anti-psychotics in recent years, few studies compare their effectiveness in the management of pathologic aggression.1,2 Compared with conventional antipsychotics, clozapine has superior anti-aggressive effects in patients with schizophrenia or schizoaffective disorder,1,3–5 including treatment-resistant patients.6 A randomized, double-blind study assessing the effects of typical and atypical antipsychotics in the treatment of violent behaviour among in-patients with these disorders demonstrated that clozapine was more efficacious than olanzapine and halo-peridol in reducing aggressive behaviour.1 A subsequent study2 reported similar effects on aggressive behaviour, with no effects on cognitive functions.7 Treatment with clozapine can be complicated by many adverse effects, such as cardiac complications, nocturnal enuresis, hypersalivation and strong sedation.8–12 Seizures, cognitive deterioration/delirium, and obsessive–compulsive symptoms were also noted,12–15 and elevated blood cholesterol, weight gain and metabolic complications are common.16,17 Potentially life-threatening side effects of clozapine are agranulocytosis, cardiomyopathy, myocarditis, hypersalivation-induced aspiration pneumonia and acute myeloid leukemia.18–21 To minimize adverse effects and increase response to clozapine, up-titration should be slow, and patients should be treated with the lowest effective dose.22 Reducing the dose can improve many dose-dependent side effects. Important principles for the long-term management of violent patients are to ascertain the diagnosis, recognize the risk and not undertreat; the risk of nonintervention may be greater than that of intervention in this population. Persistently aggressive patients show less improvement in psychopathology,6 and their violent behaviour interferes with integration into the community. The Schizophrenia Patient Outcomes Research Team project provides updated treatment recommendations based on an extensive review of pharmacologic research. The latest update recommends a trial of clozapine in patients with schizophrenia with persistent symptoms of hostility and/or violent behaviour.23 Yet, we suspect that clozapine may be underused in this population. For example, we are associated with a modern urban mental health centre caring for patients with chronic psychiatric illness. Our schizophrenia and forensic psychiatry programs currently have a similar caseload (1475 v. 1480). In the schizophrenia program, 299 (20%) patients receive clozapine compared with 35 (2%) from the forensic psychiatry program. Although the exact number of patients with a diagnosis of schizophrenia or psychosis has not yet been determined, one suspects that most forensic psychiatric patients, especially those found not criminally responsible, have a major psychotic illness. Our case illustrates the benefit of clozapine in a psychiatric population at risk for pathologic or severe aggression. This raises the question of whether the use of clozapine should be expanded in the forensic psychiatric population, assuming we are dealing with a large number of psychotic individuals with severe aggression.

Writing to Read: A Meta-Analysis of the Impact of Writing and Writing Instruction on Reading

Reading is critical to students' success in and out of school. One potential means for improving students' reading is writing. In this meta-analysis of true and quasi-experiments,Graham and Herbert present evidence that writing about material read improves students' comprehension of it; that teaching students how to write improves their reading comprehension, reading fluency, and word reading; and that increasing how much students write enhances their reading comprehension. These findings provide empirical support for long-standing beliefs about the power of writing to facilitate reading.

Confirmed Beliefs or False Assumptions? A Study of Home Stay Experiences in the French Study Abroad Context

What has emerged from what might be called the second generation of study abroad research is the questioning of some of the most long-standing beliefs about the study abroad experience itself. The belief that: (1) the amount and frequency of contact that students have with native speakers will increase their language gain; (2) that study abroad assures immersion experiences for students; and (3) that homestay is the richest and most important source of L2 learning are what motivates this study. The purpose of the research described in this article is to help clarify the extent to which either prior assumptions or recent criticism, which casts doubt on these assumptions, may have been exaggerated or if indeed, there is a balance between the two.

Hormesis, cellular stress response and vitagenes as critical determinants in aging and longevity

Understanding mechanisms of aging and determinants of life span will help to reduce age-related morbidity and facilitate healthy aging. Average lifespan has increased over the last centuries, as a consequence of medical and environmental factors, but maximal life span remains unchanged. Extension of maximal life span is currently possible in animal models with measures such as genetic manipulations and caloric restriction (CR). CR appears to prolong life by reducing reactive oxygen species (ROS)-mediated oxidative damage. But ROS formation, which is positively implicated in cellular stress response mechanisms, is a highly regulated process controlled by a complex network of intracellular signaling pathways. By sensing the intracellular nutrient and energy status, the functional state of mitochondria, and the concentration of ROS produced in mitochondria, the longevity network regulates life span across species by co-ordinating information flow along its convergent, divergent and multiply branched signaling pathways, including vitagenes which are genes involved in preserving cellular homeostasis during stressful conditions. Vitagenes encode for heat shock proteins (Hsp) Hsp32, Hsp70, the thioredoxin and the sirtuin protein systems. Dietary antioxidants, such as carnosine, carnitines or polyphenols, have recently been demonstrated to be neuroprotective through the activation of hormetic pathways, including vitagenes. The hormetic dose–response, challenges long-standing beliefs about the nature of the dose–response in a lowdose zone, having the potential to affect significantly the design of pre-clinical studies and clinical trials as well as strategies for optimal patient dosing in the treatment of numerous diseases. Given the broad cytoprotective properties of the heat shock response there is now strong interest in discovering and developing pharmacological agents capable of inducing stress responses. In this review we discuss the most current and up to date understanding of the possible signaling mechanisms by which caloric restriction, as well hormetic caloric restriction–mimetics compounds by activating vitagenes can enhance defensive systems involved in bioenergetic and stress resistance homeostasis with consequent impact on longevity processes.

PERFORMING PROSPECTIVE MEMORY

The life narratives of cô Nht, a former communist guerilla fighter and political prisoner during the American War in Vietnam, illuminate a dynamic politics of iteration and innovation at play within each act of remembering. Cô Nht lives in Ho Chi Minh City and is part of a women veteran's civic association called the Former Women Political Prisoner Performance Group. She is also a national and international advocate against the use of chemical warfare and a supporter of people living with Agent Orange-related disabilities in Vietnam. Historical and contemporary political contexts in Vietnam – such as decades of colonial rule, brutal wars and communist revolution and governance – dramatically affect the shape of official history and collective memory, including cô Nht's narratives. The socialist realist stylization of her life stories may at first appear reified and overwhelmingly ideological. However, as cô Nh t demonstrates , it is possible to perform collective, state-sanctioned public memory in ways that simultaneously practice fidelity to her longstanding revolutionary beliefs while also conditioning possibilities for more open, socially equitable futures. Listening to cô Nht's narratives of surviving torture in prison, and to her reflexive views on her lifelong commitment to social engagement, prompts me to forward the idea of ‘prospective memory’. Prospective memory is a form of collective remembering that propels and compels the past into the present and future. Existing in and through performance, it is a culturally contextual, embodied, social endeavor of memory- and history-making. Critically for cô Nht, prospective remembering carries an ethical mandate: by her example, she insists that retelling the past be oriented towards imagining and enacting social relations that are notably more equitable and sustaining than those ‘captured’ by fixed memorialization.

Summary of: Antibiotic prophylaxis in dentistry: part I. A qualitative study of professionals' views on the NICE guideline

Background The NICE guideline for antibiotic prophylaxis before dental treatment has made a substantive change and fundamental departure from previous practice that affects long-standing beliefs and practice patterns. There is potential difficulty for healthcare professionals explaining the new guidance to patients who have long believed that they must receive antibiotics before their dental treatment. Aim To explore clinicians' attitudes towards the NICE guidance on antibiotic prophylaxis, their use of the guideline in clinical practice, barriers to the implementation of the guideline, and how best to overcome any perceived barriers. Methods In-depth interviews were conducted with seven dental care professionals, two cardiologists and a cardiac care nurse. The data were analysed using the framework method to extract central themes and opinions. Results Clinicians generally perceived that initially patients would be reluctant to follow the NICE guidance. This was felt to be particularly true of the patient cohort that had previously been prescribed prophylactic antibiotics. They found it difficult to explain the new guidance to patients who have had infective endocarditis and have long believed that they must receive antibiotics before their dental treatment. Concerns were also raised about the legal position of a clinician who did not follow the guidance. Clinicians generally suggested that the provision of accurate information in the form of leaflets and valid websites would be the best way to advise patients about the new guidance. Conclusions Clinicians anticipated difficulties in explaining to patients the change in clinical practice necessitated by adherence to the NICE guidance, most notably for patients with a history of infective endocarditis or where the patient's cardiologist did not agree with the NICE guidance. They placed particular emphasis on the provision of accurate information in order to reassure patients.

Antibiotic prophylaxis in dentistry: part I. A qualitative study of professionals' views on the NICE guideline

The NICE guideline for antibiotic prophylaxis before dental treatment has made a substantive change and fundamental departure from previous practice that affects long-standing beliefs and practice patterns. There is potential difficulty for healthcare professionals explaining the new guidance to patients who have long believed that they must receive antibiotics before their dental treatment. To explore clinicians' attitudes towards the NICE guidance on antibiotic prophylaxis, their use of the guideline in clinical practice, barriers to the implementation of the guideline, and how best to overcome any perceived barriers. In-depth interviews were conducted with seven dental care professionals, two cardiologists and a cardiac care nurse. The data were analysed using the framework method to extract central themes and opinions. Clinicians generally perceived that initially patients would be reluctant to follow the NICE guidance. This was felt to be particularly true of the patient cohort that had previously been prescribed prophylactic antibiotics. They found it difficult to explain the new guidance to patients who have had infective endocarditis and have long believed that they must receive antibiotics before their dental treatment. Concerns were also raised about the legal position of a clinician who did not follow the guidance. Clinicians generally suggested that the provision of accurate information in the form of leaflets and valid websites would be the best way to advise patients about the new guidance. Clinicians anticipated difficulties in explaining to patients the change in clinical practice necessitated by adherence to the NICE guidance, most notably for patients with a history of infective endocarditis or where the patient's cardiologist did not agree with the NICE guidance. They placed particular emphasis on the provision of accurate information in order to reassure patients.

Poverty in small-scale fisheries

Using a new framework combining vulnerability and exclusion as two central dimensions of poverty, this article revisits some of the long-standing beliefs about poverty in small-scale fisheries. We argue that the issue of poverty in fish-dependent communities cannot be reduced to a simple correlation between income poverty and fishery dependence. A more thorough analysis is required that must account for the diversity of fishing-related livelihoods and the complexity of causes of poverty, both inside and outside the sector. The article highlights how poverty in fishing communities often relates to a wide range of socio-institutional factors other than income, including landownership, debt, access to health, education and financial capital, and marginalisation from political decision making. The empirical examples used in this article refer to inland capture fisheries from the Volta and Mekong basins but, arguably, the analysis applies to other fisheries (inland and coastal) in developing countries.

Factors hindering ‘larger’ representation of women in parliament: the case of Seychelles

Female legislative representation in some sub-Saharan African countries surpasses that of most other countries on the Inter-Parliamentary Union's 187 country list by exceeding 20 per cent. While almost all of those African countries achieved such level of representation by implementing gender quotas, Seychelles achieved that level without gender quotas. Its female parliamentary representation, however, is far short of the 50 per cent target set for 2015 by the African Union. This study, therefore, examines the factors hindering ‘larger’ representation of women in the Seychellois parliament. It concludes that the dual burden of women, the longstanding traditional beliefs about women's role, the lukewarm commitment of political parties to nominate women, the authoritarian nature of Seychellois politics, and parliamentarians' financial contributions expected by constituents are the key variables hindering ‘larger’ female legislative representation in Seychelles.

Cellular Stress Responses, Mitostress and Carnitine Insufficiencies as Critical Determinants in Aging and Neurodegenerative Disorders: Role of Hormesis and Vitagenes

The widely accepted oxidative stress theory of aging postulates that aging results from accumulation of oxidative damage. A prediction of this theory is that, among species, differential rates of aging may be apparent on the basis of intrinsic differences in oxidative damage accrual. Although widely accepted, there is a growing number of exceptions to this theory, most contingently related to genetic model organism investigations. Proteins are one of the prime targets for oxidative damage and cysteine residues are particularly sensitive to reversible and irreversible oxidation. The adaptation and survival of cells and organisms requires the ability to sense proteotoxic insults and to coordinate protective cellular stress response pathways and chaperone networks related to protein quality control and stability. The toxic effects that stem from the misassembly or aggregation of proteins or peptides, in any cell type, are collectively termed proteotoxicity. Despite the abundance and apparent capacity of chaperones and other components of homeostasis to restore folding equilibrium, the cell appears poorly adapted for chronic proteotoxic stress which increases in cancer, metabolic and neurodegenerative diseases. Pharmacological modulation of cellular stress response pathways has emerging implications for the treatment of human diseases, including neurodegenerative disorders, cardiovascular disease, and cancer. A critical key to successful medical intervention is getting the dose right. Achieving this goal can be extremely challenging due to human inter-individual variation as affected by age, gender, diet, exercise, genetic factors and health status. The nature of the dose response in and adjacent to the therapeutic zones, over the past decade has received considerable advances. The hormetic dose-response, challenging long-standing beliefs about the nature of the dose-response in a lowdose zone, has the potential to affect significantly the design of pre-clinical studies and clinical trials as well as strategies for optimal patient dosing in the treatment of numerous diseases. Given the broad cytoprotective properties of the heat shock response there is now strong interest in discovering and developing pharmacological agents capable of inducing stress responses, including carnitines. This paper describes in mechanistic detail how hormetic dose responses are mediated for endogenous cellular defense pathways, including the possible signaling mechanisms by which the carnitine system, by interplaying metabolism, mitochondrial energetics and activation of critical vitagenes, modulates signal transduction cascades that confer cytoprotection against chronic degenerative damage associated to aging and neurodegenerative disorders.

What is optimal flow using a mini-bypass system?

The purpose of this study is to determine the appropriate arterial pump flow /cardiac index (CI) utilizing a mini-bypass system. The unique feature of most mini-bypass systems is that the centrifugal pump combines the function of kinetic venous drainage with arterial pump flow. Therefore, if drainage is reduced, arterial pump flow is also reduced. Managing this system can present challenges to the clinical perfusionist. We reviewed fifteen cases, using the Medtronic Resting Heart System (RHS). This retrospective study examined the arterial pump flow, measured as cardiac index (CI), mean arterial pressure, inlet venous saturation, urine output, vasopressor use, and lactate production during routine cardiac surgery. The mean cardiac index for all patients was 1.90 +/- 0.14, range 1.63-2.08 L/min/m(2). The mean hemoglobin on cardiopulmonary bypass (CPB) was 10.6 +/- 1.2, with a range of 9.2-13.3 g/dL. The lactate produced on CPB was 2.03 +/-0.67 with a range of 1.5-3.5 mmol/L. The mean change in lactate measured from pre CPB to post CPB was 0.85 +/- 0.71 with a median lactate of 0.6 mmol/L. The venous saturation was 65.53 +/- 6.03% with a median of 65% and a range of 57-82%. The mean arterial pressure was 67.04 +/- 10.45 mmHg with a median of 62.5 mmHg. The median urine output was 125 mls. The vasopressor median was 2200 microg. All patients were maintained on CPB with a mean nasopharyngeal temperature of 35.43 degrees Celsius. Despite using lower than predicted flows, it would appear that adequate perfusion is provided. The higher hemoglobin content achieved through reduced hemodilution and reduced inflammation appears to enable this system to deliver adequate flow and perfusion at reduced cardiac indices. This research provides evidence which challenges longstanding beliefs that a cardiac index of 2.4 L/min/m(2) is required for all cases.