bluuebunny/crossref_metadata_2025 huggingface dataset:
AI-2-dependent gene regulation in Staphylococcus epidermidis
Authors: Li Min , Villaruz Amer E , Vadyvaloo Viveka , Sturdevant Daniel E , Otto Michael
Published: January 2008

Background

Autoinducer 2 (AI-2), a widespread by-product of the LuxS-catalyzed S-ribosylhomocysteine cleavage reaction in the activated methyl cycle, has been suggested to serve as an intra- and interspecies signaling molecule, but in many bacteria AI-2 control of gene expression is not completely understood. Particularly, we have a lack of knowledge about AI-2 signaling in the important human pathogens Staphylococcus aureus and S. epidermidis.

Results

To determine the role of LuxS and AI-2 in S. epidermidis, we analyzed genome-wide changes in gene expression in an S. epidermidis luxS mutant and after addition of AI-2 synthesized by over-expressed S. epidermidis Pfs and LuxS enzymes. Genes under AI-2 control included mostly genes involved in sugar, nucleotide, amino acid, and nitrogen metabolism, but also virulence-associated genes coding for lipase and bacterial apoptosis proteins. In addition, we demonstrate by liquid chromatography/mass-spectrometry of culture filtrates that the pro-inflammatory phenol-soluble modulin (PSM) peptides, key virulence factors of S. epidermidis, are under luxS/AI-2 control.

Conclusion

Our results provide a detailed molecular basis for the role of LuxS in S. epidermidis virulence and suggest a signaling function for AI-2 in this bacterium.
Validity of self-reported criminal justice system involvement in substance abusing women at five-year follow-up
Authors: Jansson Irene , Hesse Morten , Fridell Mats
Published: January 2008

Background

Few studies have compared self-reported criminal behaviour with high-quality databases of criminal offences and judicial sanctions. Self-reported problems from drug abusers are generally believed to be valid. We assessed the validity of self-reported theft, drug offences and prison sentences from a five-year follow-up of female substance abusers who were originally treated in a compulsory care unit in Lund, run by the Swedish Board of Institutional Care.

Methods

Data from a total of 106 of a consecutive sample of 132 women inter-viewed in a five-year follow-up. All were thoroughly assessed for somatic complaints, psychiatric and psychological problems, background factors with standardized instruments. Data over the five years were linked to official records of judicial sanctions, retrieved from The National Council for Crime Prevention, Stockholm, Sweden. Register data have a full cover for the whole cohort. The current data base contain full data back to 1975 up to 2004.

Results

Agreement was assessed for each year, as well as for the total period. Statistical control was performed for other types of crimes and prison. Although statistically significant, agreement was modest, and in contrast to previous studies, patients under-reported violence charges.

Conclusion

The findings suggest that self-reports of criminal behaviour from women can be used with some caution, and that the validity of self-report may vary between types of criminal justice system involvement.
Presentations of patients of poisoning and predictors of poisoning-related fatality: Findings from a hospital-based prospective study
Authors: Lee Hsin-Ling , Lin Hung-Jung , Yeh Steve Ting-Yuan , Chi Chih-Hsien , Guo How-Ran
Published: January 2008

Background

Poisoning is a significant public health problem worldwide and is one of the most common reasons for visiting emergency departments (EDs), but factors that help to predict overall poisoning-related fatality have rarely been elucidated. Using 1512 subjects from a hospital-based study, we sought to describe the demographic and clinical characteristics of poisoning patients and to identify predictors for poisoning-related fatality.

Methods

Between January 2001 and December 2002 we prospectively recruited poisoning patients through the EDs of two medical centers in southwest Taiwan. Interviews were conducted with patients within 24 hours after admission to collect relevant information. We made comparisons between survival and fatality cases, and used logistic regressions to identify predictors of fatality.

Results

A total of 1512 poisoning cases were recorded at the EDs during the study period, corresponding to an average of 4.2 poisonings per 1000 ED visits. These cases involved 828 women and 684 men with a mean age of 38.8 years, although most patients were between 19 and 50 years old (66.8%), and 29.4% were 19 to 30 years. Drugs were the dominant poisoning agents involved (49.9%), followed by pesticides (14.5%). Of the 1512 patients, 63 fatalities (4.2%) occurred. Paraquat exposure was associated with an extremely high fatality rate (72.1%). The significant predictors for fatality included age over 61 years, insufficient respiration, shock status, abnormal heart rate, abnormal body temperature, suicidal intent and paraquat exposure.

Conclusion

In addition to well-recognized risk factors for fatality in clinical settings, such as old age and abnormal vital signs, we found that suicidal intent and ingestion of paraquat were significant predictors of poisoning-related fatality. Identification of these predictors may help risk stratification and the development of preventive interventions.
Oxaliplatin retains HMGB1 intranuclearly and ameliorates collagen type II-induced arthritis
Authors: Östberg Therese , Wähämaa Heidi , Palmblad Karin , Ito Norimasa , Stridh Pernilla , Shoshan Maria , Lotze Michael T , Harris Helena Erlandsson , Andersson Ulf
Published: January 2008

Introduction

High mobility group box chromosomal protein 1 (HMGB1) is a nuclear protein that acts as a pro-inflammatory mediator following extracellular release. The protein is aberrantly expressed extracellularly in the settings of clinical and experimental synovitis. Therapy based on HMGB1 antagonists has shown encouraging results in experimental arthritis and warrants further scientific exploration using independent methods. In the present study we asked whether nuclear sequestration of HMGB1 preventing HMGB1 release would be beneficial for synovitis treatment.

Methods

Oxaliplatin-based therapy was evaluated in collagen type II-induced arthritis in DBA/1 mice by clinical scoring and immunostaining of articular tissue. Oxaliplatin is an antineoplastic platinum-based compound that generates DNA adducts which tightly bind HMGB1. Secretion and intracellular location of HMGB1 were assessed by a novel HMGB1-specific ELISPOT assay and immunofluorescent staining.

Results

Intraperitoneal injections of oxaliplatin in early collagen type II-induced arthritis trapped HMGB1 with a distinct biphasic response pattern. Oxaliplatin therapy showed beneficial results for approximately 1 week. Microscopic evaluation of synovitis during this period showed strong nuclear HMGB1 staining in the oxaliplatin treated animals with much lower quantities of extracellular HMGB1 when compared to control treated animals. Furthermore, cellular infiltration, as well as cartilage and bone damage, were all reduced in the oxaliplatin treated group. A dramatic and as yet unexplained clinical relapse occurred later in the oxaliplatin exposed animals, which coincided with a massive synovial tissue expression of extracellular HMGB1 in all treated animals. This rebound-like reaction was also accompanied by a significantly increased incidence of arthritis in the oxaliplatin treated group. These results indicate a distinct temporal and spatial relationship between the clinical course of disease and the cellular localization of HMGB1. Beneficial effects were noted when extracellular HMGB1 expression was low, while severe inflammation coincided with substantial extracellular synovial HMGB1 expression.

Conclusion

Therapeutic compounds like oxaliplatin and gold salts share a capacity to inhibit nuclear HMGB1 release and to ameliorate the course of synovial inflammation. These observations support the hypothesis that HMGB1 plays an important functional role in the pathogenesis of arthritis and may represent a novel target molecule for therapy.
Circulating RANKL is inversely related to RANKL mRNA levels in bone in osteoarthritic males
Authors: Findlay David , Chehade Mellick , Tsangari Helen , Neale Susan , Hay Shelley , Hopwood Blair , Pannach Susan , O'Loughlin Peter , Fazzalari Nicola
Published: January 2008

Introduction

The relationship of circulating levels of receptor activator of nuclear factor-κB ligand (RANKL) and osteoprotegerin (OPG) with the expression of these molecules in bone has not been established. The objective of this study was to measure, in humans, the serum levels of RANKL and OPG, and the corresponding levels in bone of mRNA encoding these proteins.

Methods

Fasting blood samples were obtained on the day of surgery from patients presenting for hip replacement surgery for primary osteoarthritis (OA). Intraoperatively, samples of intertrochanteric trabecular bone were collected for analysis of OPG and RANKL mRNA, using real time RT-PCR. Samples were obtained from 40 patients (15 men with age range 50 to 79 years, and 25 women with age range 47 to 87 years). Serum total RANKL and free OPG levels were measured using ELISA.

Results

Serum OPG levels increased over the age range of this cohort. In the men RANKL mRNA levels were positively related to age, whereas serum RANKL levels were negatively related to age. Again, in the men serum RANKL levels were inversely related (r = -0.70, P = 0.007) to RANKL mRNA levels. Also in the male group, RANKL mRNA levels were associated with a number of indices of bone structure (bone volume fraction relative to bone tissue volume, specific surface of bone relative to bone tissue volume, and trabecular thickness), bone remodelling (eroded surface and osteoid surface), and biochemical markers of bone turnover (serum alkaline phosphatase and osteocalcin, and urinary deoxypyridinoline).

Conclusion

This is the first report to show a relationship between serum RANKL and the expression of RANKL mRNA in bone.
CONTRAST: a discriminative, phylogeny-free approach to multiple informant de novogene prediction
Authors: Gross Samuel S , Do Chuong B , Sirota Marina , Batzoglou Serafim
Published: January 2008

We describe CONTRAST, a gene predictor which directly incorporates information from multiple alignments rather than employing phylogenetic models. This is accomplished through the use of discriminative machine learning techniques, including a novel training algorithm. We use a two-stage approach, in which a set of binary classifiers designed to recognize coding region boundaries is combined with a global model of gene structure. CONTRAST predicts exact coding region structures for 65% more human genes than the previous state-of-the-art method, misses 46% fewer exons and displays comparable gains in specificity.
Picoeukaryotic sequences in the Sargasso Sea metagenome
Authors: Piganeau Gwenael , Desdevises Yves , Derelle Evelyne , Moreau Herve
Published: January 2008

Background

With genome sequencing becoming more and more affordable, environmental shotgun sequencing of the microorganisms present in an environment generates a challenging amount of sequence data for the scientific community. These sequence data enable the diversity of the microbial world and the metabolic pathways within an environment to be investigated, a previously unthinkable achievement when using traditional approaches. DNA sequence data assembled from extracts of 0.8 μm filtered Sargasso seawater unveiled an unprecedented glimpse of marine prokaryotic diversity and gene content. Serendipitously, many sequences representing picoeukaryotes (cell size <2 μm) were also present within this dataset. We investigated the picoeukaryotic diversity of this database by searching sequences containing homologs of eight nuclear anchor genes that are well conserved throughout the eukaryotic lineage, as well as one chloroplastic and one mitochondrial gene.

Results

We found up to 41 distinct eukaryotic scaffolds, with a broad phylogenetic spread on the eukaryotic tree of life. The average eukaryotic scaffold size is 2,909 bp, with one gap every 1,253 bp. Strikingly, the AT frequency of the eukaryotic sequences (51.4%) is significantly lower than the average AT frequency of the metagenome (61.4%). This represents 4% to 18% of the estimated prokaryotic diversity, depending on the average prokaryotic versus eukaryotic genome size ratio.

Conclusion

Despite similar cell size, eukaryotic sequences of the Sargasso Sea metagenome have higher GC content, suggesting that different environmental pressures affect the evolution of their base composition.
The cytoplasmic domain of tissue factor in macrophages augments cutaneous delayed-type hypersensitivity
Authors: Apostolopoulos Jim , Hickey Michael J , Sharma Laveena , Davenport Piers , Moussa Leon , James Will G , Gregory Julia L , Kitching A Richard , Li Ming , Tipping Peter G
Published: January 2008

In addition to its procoagulant role, tissue factor (TF) has important coagulation-independent roles, including in inflammation. The cytoplasmic domain of TF has been implicated in some of these coagulation-independent roles, particularly cell signaling. To assess the contribution of the cytoplasmic domain of TF to cell-mediated adaptive immunity, the development of cutaneous delayed-type hypersensitivity (DTH) was studied in mice lacking the cytoplasmic domain of TF (TFδCT/δCT mice). DTH responses in sensitized mice were significantly attenuated in TFδCT/δCT mice, and leukocyte-endothelial cell interactions, assessed by intravital microscopy, were impaired significantly. Studies in chimeric mice, created by bone marrow transplantation, showed that the absence of the cytoplasmic domain of TF in leukocytes rather than endothelial cells was responsible for reduced DTH and leukocyte recruitment. DTH responses to OVA could be induced in wild-type mice but not in TFδCT/δCT mice by transfer of activated CD4+ OVA-specific TCR transgenic T cells, demonstrating that the defective DTH response in TFδCT/δCT mice was independent of any defect in T cell activation. Macrophage and neutrophil accumulation and expression of TNF-α mRNA and phospho-p38-MAPK were reduced significantly in TFδCT/δCT mice, and their macrophages had reduced P-selectin-binding capacity and reduced in vivo emigration in response to MCP-1. These results indicate that leukocyte expression of the cytoplasmic domain of TF contributes to antigen-specific cellular adaptive immune responses via effects on leukocyte recruitment and activation.
Long-Term Results of the AIEOP-ALL-95 Trial for Childhood Acute Lymphoblastic Leukemia: Insight on the Prognostic Value of DNA Index in the Framework of Berlin-Frankfurt-Muenster–Based Chemotherapy
Authors: Aricò Maurizio , Valsecchi Maria Grazia , Rizzari Carmelo , Barisone Elena , Biondi Andrea , Casale Fiorina , Locatelli Franco , Lo Nigro Luca , Luciani Matteo , Messina Chiara , Micalizzi Concetta , Parasole Rosanna , Pession Andrea , Santoro Nicola , Testi Anna Maria , Silvestri Daniela , Basso Giuseppe , Masera Giuseppe , Conter Valentino
Published: January 2008

Purpose

Between May 1995 and August 2000 the Associazione Italiana di Ematologia Oncologia Pediatrica conducted the ALL-95 study for risk-directed, Berlin-Frankfurt-Muenster (BFM) –oriented therapy of childhood acute lymphoblastic leukemia, aimed at exploring treatment reduction in standard-risk patients (SR) and intensification during continuation therapy in intermediate-risk patients (IR) as randomized questions and treatment intensification in high-risk patients (HR). The prognostic value of DNA index was explored in this setting.

Patients and Methods

A total of 1,744 patients were enrolled (115, SR; 1,385, IR; and 244, HR). SR patients (DNA index ≥ 1.16 and < 1.60; age, 1 to 5 years; and WBC < 20,000, non–T-immunophenotype, with no high-risk features) received a reduced induction therapy (no anthracyclines); IR patients were randomly assigned to receive or not receive vincristine and dexamethasone pulses during maintenance; HR therapy was based on a conventional BFM schedule intensified with three chemotherapy blocks followed by a double reinduction phase.

Results

The event-free survival and overall survival probabilities at 10 years for the entire group were 72.5% (SE, 1.3) and 83.6% (SE, 0.9); 85.0% (SE, 3.4) and 95.5% (SE, 2.0) in SR, 75.1% (SE, 1.5) and 87.5% (SE, 0.9) in IR, and 51.0% (SE, 3.2) and 57.2% (SE, 3.3) in HR patients, respectively. Patients with a favorable DNA index had superior EFS in both IR (83.8% [2.7%] v 73.9% [1.7%]) and in HR (67.8% [9.4%] and 49.6% [3.5%]). Of the six patients with DNA index less than 0.8, only one remained in remission.

Conclusion

Favorable DNA index was associated with a better prognosis in IR and HR patients defined by presenting clinical criteria and treatment with a BFM-oriented chemotherapy.
Modeling the Cost Effectiveness of Secondary Febrile Neutropenia Prophylaxis During Standard-Dose Chemotherapy
Authors: Timmer-Bonte Johanna N.H. , Adang Eddy M.M. , Termeer Evelien , Severens Johan L. , Tjan-Heijnen Vivianne C.G.
Published: January 2008

Purpose

Current guidelines (ie, by the American Society of Clinical Oncology and the European Organisation for Research and Treatment of Cancer) do not recommend secondary infection prophylaxis, whereas, in contrast, caregivers prefer secondary prophylaxis to chemotherapy dose reduction after an episode of febrile neutropenia (FN). Because granulocyte colony-stimulating factor (G-CSF) is expensive, this study investigates the economic consequences of secondary prophylactic use of different prophylactic strategies (antibiotics, antibiotics plus G-CSF, and a combined sequential approach) in a population at risk of FN, using a Markov model.

Methods

The input for the model is mainly based on the clinical outcome and patient-based cost data set (adopting the health care payer's perspective for the Netherlands) derived from a randomized study on primary prophylaxis in small-cell lung cancer (SCLC) patients; establishing mean cost of an episode FN of €3,290 and prophylaxis of €79 (antibiotics) ± €1,616 (G-CSF) per cycle. The economic analysis was analyzed probabilistically using first- and second-order Monte Carlo simulation. The incremental cost-effectiveness ratio (ICER) was defined as cost per FN-free cycle.

Results

Secondary prophylaxis with antibiotics was the least expensive strategy (mean, €4,496/patient). The strategy antibiotics plus G-CSF was most expensive (mean, € 8,998/patient). Comparison of these two strategies resulted in an unacceptably high ICER (€343,110 per FN-free cycle) in the Dutch context. In scenarios using higher FN-related costs (as found in the United States), the strategies are less distinct in their monetary effects, but still favor antibiotics.

Conclusion

This model-based economic analysis demonstrates that in the Netherlands and most likely also in the United States, if secondary prophylaxis is preferred, the strategy with antibiotics is recommended.
Is There an Association Between Meningioma and Hormone Replacement Therapy?
Authors: Blitshteyn Svetlana , Crook Julia E. , Jaeckle Kurt A.
Published: January 2008

Purpose

Molecular and clinical observations suggest a role of sex steroid hormones in the occurrence of meningioma. However, there is limited and often conflicting data on the use of hormone replacement therapy (HRT) as a possible risk factor for meningioma. The goal of this study was to investigate whether there is an association between a diagnosis of meningioma and either current or past HRT use in women.

Methods

We retrospectively reviewed records in the Mayo Clinic Jacksonville electronic patient database between 1993 and 2003 to identify women with a diagnosis of either symptomatic or incidentally discovered, clinically silent meningioma. Records were also searched to identify women with a documented history of either current or past HRT use.

Results

Of the 355,318 women, ages 26 to 86, evaluated for any medical issue, 18,037 (5%) were documented as current or past HRT users. A total of 1,390 women with a history of symptomatic or incidentally discovered meningiomas were identified, 156 (11%) of whom were either current or past HRT users. A logistic regression analysis, adjusted for age, demonstrated a positive association between a diagnosis of meningioma and HRT use, with an odds ratio of 2.2 (95% CI, 1.9 to 2.6; P < .0001). The frequency of meningioma in women with either current or past HRT use was 865 in 100,000, whereas the frequency of meningioma in women without the history of HRT use was 366 in 100,000.

Conclusion

The study provides evidence of a positive association between HRT use and diagnosis of meningioma, and therefore, HRT use may be a risk factor for meningioma.
The Future of the Veterans' Health Care System
Authors: Lipsky Michael , McCray Lawrence , Prottas Jeffrey , Sapolsky Harvey
Published: January 2008

The probable adoption of a national health insurance system in the near future makes the Veterans Administration's health care program vulnerable to change. The last major turning point in the program occurred at the end of World War II when a decision was made to link VA hospitals to medical schools. This linkage in large measure has been responsible for the program's focus on acute care. The VA professional staff prefers an even greater interaction of the program with medical education. Others suggest its termination. The authors propose instead that the VA become a model system for the care of the chronically ill, the alcoholic, and the aged whose needs tend to be neglected by the overall health system.
An Analysis of Congressional Health Policy Voting in the 1970s
Authors: Mueller Keith J.
Published: January 2008

This paper analyzes nine health policy votes in the U.S. House of Representatives. The votes all occurred between 1973 and 1980 and include such issues as health planning, health maintenance organizations, cost containment, and professional standards review organizations. The objective of this analysis is to examine the independent contribution of variables indigenous to health issues while controlling for party identification and ideology. The influence of health providers, measured by the effect of the number of state medical association members in each state, is significant in the findings. The state and local share of Medicaid expenses is also significant in explaining several votes. Contributions from political action committees were not important until 1979, when the rising costs of campaigns gave them more influence, and when our measures of their influence improved. By the time Congress voted in 1979 on hospital cost containment legislation, the PAC variable surpassed even the AMA variable in importance.
Bad Debts and Hospital Rate-Setting
Authors: Pauly Mark V.
Published: January 2008

This paper examines the economic foundations for mandatory discounts for insurers based on differences in bad debts experience. It considers critically the arguments Blue Cross plans use in several states. On both equity and efficiency grounds, discounts for actual bad debts are shown to be inappropriate. In contrast, it is shown that there are equity and efficiency reasons to grant a discount for insurance policies which avert bad debt, but that the appropriate discount is less than the amount of bad debt averted. The appropriate discount depends on the size of the subsidy needed to bring about purchase of debt-averting coverage. In some circumstances, this subsidy equals the underwriting loss on the coverage minus any tax subsidy the insurer receives.
Per Case Prospective Payment for Psychiatric Inpatients: An Assessment and Alternatives
Authors: Frank Richard G. , Lave Judith R.
Published: January 2008

Psychiatric hospitals and clinics are exempted from the Medicare prospective payment system. In this paper we examine the appropriateness of the DRG classification system for psychiatric patients and argue that, using this system as the basis of payment, two types of problems are likely to arise. We categorize these problems as “risks to hospitals” and “risks to patients” and examine the existing literature to determine whether these risks are likely to be significant. We propose a different approach to paying prospectively for psychiatric care, and suggest modifications that could be made to the structure of PPS to mitigate negative incentives embedded in the current system. Although the main focus of the paper is on the unit of payment, we also make some observations about issues arising in connection with the level of payment.
Response to Freeman—the Stony Brook Perspective
Authors: Newman George
Published: January 2008

It has been my attitude up until this point to discuss only those medical aspects of the case which were required by legal proceedings. I have considered this essentially a private matter for the parents. However, there is some additional information that I would now like to bring to light, because some of the things that Dr. Freeman has said reflect certain inaccuracies which undoubtedly are present because he did not have access to all of the information. I would like to bring forth some additional facts, not only about the medical aspects, but also about the manner in which this case was handled. My hope is that I can convince Dr. Freeman that, in fact, the process that was undertaken in this case was a correct one.
A Proposal to Regulate the Manner of Tobacco Advertising
Authors: Arbogast Rebecca
Published: January 2008

If the U.S. is to achieve the goal of reducing the initiation of smoking among adolescents, it must implement a system of tobacco advertising regulation as one component of a comprehensive prevention program. This paper proposes a system of advertising regulation which is grounded in the relevant legal, information processing, and media effects theories.
Hard Choices: Targeting Long-Term Care to the “At Risk” Aged
Authors: Weissert William G.
Published: January 2008

Recent expansion of Medicaid coverage to home-and community-based long-term care moves that payment program away from its traditional institutional bias. But tension over the appropriate role of home care and fears of budget-busting have caused the current administration to set goals for the states that may be impossible to achieve.
Proposal for a Future Delivery Market for Transplant Organs
Authors: Schwindt Richard , Vining Aidan R.
Published: January 2008

Improvements in surgical procedures and immunosuppressive practices have greatly increased the range and success rate of organ transplants. Unfortunately, supply does not meet demand, and demand is increasing. This paper documents the current level of unsatisfied demand for several transplantable organs, and argues that the extant system of altruistic organ donation is unlikely ever to provide adequate supply because of lack of incentives to donate and the ambiguity surrounding property rights over transplantable organs. A greater reliance on markets would help attenuate these problems. However, unorganized private spot markets for human organs are likely to be both inefficient and inequitable, and are perceived as morally offensive. A feasible alternative is an organized. publicly operated future delivery market, wherein an individual can contract, for valuable consideration, with a government agency for delivery of a specific organ upon death. The implementation of such a market would encounter difficult (but not intractable) problems such as price determination, the selection of a medium of exchange, and contractual issues, particularly the role of minors in such a system. Finally, it is argued that such a market is superior to the much-discussed compulsory expropriation alternative.
The Performance of Medical Malpractice Review Panels
Authors: Shmanske Stephen , Stevens Tina
Published: January 2008

In this paper we present the results of an empirical study of Arizona's medical malpractice review panels. We compare insurance company claim files data from before and after the implementation of panels to analyze the effects of the panel system. The data indicate that although the frequency and average amount of recovery are not affected by the panel system, the system leads to an increase in the number of disputes seeking formal adjudication, an increase in the cost of the process, and a lengthening of the time within which disputes are resolved.
Health Manpower Programs to Affect Physicians' Location: A Regional Analysis
Authors: Wendling Wayne R. , Werner Jack L. , Budde Norbert W.
Published: January 2008

The purpose of this study is to examine the relative effectiveness of three health manpower programs–loan forgiveness, preceptorship and community recruitment–at inducing physicians into shortage counties in four census regions. Descriptive statistics suggest that the relative unattractiveness of shortage counties varies so that alternative regional strategies to redistribute physician resources are needed.
Professional Standards Review Organizations and Confidentiality: The Question of Public Access to Medical Peer Review Data Through the Freedom of Information Act
Authors: Hastings Douglas A.
Published: January 2008

The degree of confidentiality to be accorded data gathered and analyzed by Professional Standards Review Organizations (PSROs) in the course of their medical peer review activities is a crucial and controversial issue in health policy. In late 1977, a consumer organization in Washington, D.C. sought access to data in the hands of the local PSRO through a lawsuit under the Freedom of Information Act, touching off a continuing debate throughout the country. That lawsuit is now on appeal.

The courts, the Congress, and the Department of Health and Human Services have all been involved in the ongoing controversy. PSROs, practicing physicians, and health care consumers all have an interest in the outcome. This article analyzes the PSRO program and its data confidentiality problems, examines in detail the lawsuit that sparked the controversy, and assesses the overall impact of this case on the PSRO program and on federal regulation of the health care system in general.
The Rights of Nursing Home Patients: Possibilities and Limitations of Federal Regulation
Authors: Caldwell Janice M. , Kapp Marshall B.
Published: January 2008

Using as their point of departure the proposed nursing home standards recently published by the U.S. Department of Health and Human Services, the authors discuss the dilemma of regulating for human rights. Provisions considered for inclusion in the regulations are discussed in light of positions taken by regulators, providers and consumers. By highlighting the trade-offs involved, the authors point out the limitations of regulation in this emotion-laden area.

Former Secretary Patricia Roberts Harris approved a final version of human rights provisions on her last day in office. However, in his first official act, her successor withdrew that approval.
A Block Grant to the States for Long-Term Care
Authors: Hudson Robert B.
Published: January 2008

This article addresses the policy issues and outcomes associated with the block grant option in long-term care (LTC). Block grants are being considered in a number of human service areas currently, especially in the wake of the 1980 elections. The article assumes that Medicaid and other LTC-related policies would be consolidated in a formula-based, capped block grant. The potential advantages are in the areas of responsiveness, coordination and institution-building at the state level. Potential problems include new organizational demands on the designated LTC state agency; political dislocations caused by disaffected agency and provider groups; and unequal competition for LTC resources resulting from the removal of legislative safeguards and hierarchical support. The article concludes on the note that proponents of the block grant option have not addressed a number of the major shortcomings that may accompany an LTC block grant.
Values and Policy Conceptions of Health Policy Elites in the United States, the United Kingdom, and the Federal Republic of Germany
Authors: Lockhart Charles
Published: January 2008

This essay presents data on the thinking of health policy elites in the United States, the United Kingdom and the Federal Republic of Germany. These three national groups are compared in terms of the values they perceive health policy should serve and their conceptions of appropriate policies for realizing these values. The different values and policy conceptions are then related to various propositions as to why social policies differ across nations, particularly to the hypothesis that social policies differ as a consequence of elite values and attitudes.
Civil Commitment as a “Street-Level” Bureaucracy: Case-Load, Professionalization, and Administration
Authors: Wunsch James S. , Teply Larry L. , Zimmerman Joel , Peters Geoffrey W.
Published: January 2008

This article applies street-level bureaucracy theories to “coping” patterns of behavior that developed in an involuntary commitment system. Daily procedures and routines of five Nebraska county boards of mental health and the attitudes of their members were studied. The results showed that the urban, high case-load, professionally-oriented board informally modified statutory procedures significantly to reduce face-to-face client contact, limit the scope of its decisions, and displace responsibility for the most ambiguous decisions to the treatment facility and board psychiatrist. Rural, low case-load, less professionally-specialized boards also modified the statutory procedures, but conducted the commitment process in a far more ambiguous, open-ended, and tense system with substantial face-to-face client contact. Both urban and rural boards had multi-faceted role definitions; rural boards, however, had a more open-ended perception of their functions, and attempted more actively to modify antisocial behavior and redirect board subjects to sources of social counseling. Therefore, understanding street-level “coping” behavior in an actual commitment context is important to develop realistic changes in civil commitment systems and to preclude informal procedures that reduce a commitment system's effectiveness or undermine a proposed patient's rights.
Prospects for the Contra Costa Health Plan: A Public Sector Health Maintenance Organization
Authors: Meier Gitta
Published: January 2008

This article reviews the five-year experience of the Key Plan, a county-operated, prepaid health plan for certain persons eligible for Medicaid. Reasons for the Plan's failure to increase enrollment and to reach financial self-sufficiency are analyzed. Prospects for the Contra Costa Health Plan, a health maintenance organization evolving from the Key Plan, are discussed in light of this experience.
Computers, Medical Records, and the Right to Privacy
Authors: Hiller Marc D. , Beyda Vivian
Published: January 2008

Recent advances in computer technology permit the accumulation, analysis, and storage of an unlimited quantity of medical record information, thereby seriously compounding existing controversies surrounding patient confidentiality and privacy. This article surveys both benefits and problems arising from this increased availability of medical records. It examines legal and ethical dilemmas arising from the conflict between the usefulness of medical records for a variety of purposes, and the needs and interests of patients, in particular their right to privacy. The article suggests guidelines for insuring fair and balanced health information policies.
The Teaching of Health Law in 1980: Results of a Survey
Authors: Schramm Carl J. , Hencke Mary S.
Published: January 2008

Presuming that law schools have been faced with increased student interest in legal approaches to issues related to health care, the authors conducted a survey of all law schools in the United States. This article briefly presents the findings.
Improving Health Care Policy Research
Authors: Shortell Stephen M. , Solomon Marian A.
Published: January 2008

Interest in health care policy research has grown significantly over the past decade. This paper makes a number of suggestions for improving the quality of health care policy research and its influence on policymaking. These include suggestions for: 1) improving the way in which problems are identified and defined; 2) merging qualitative and quantitative approaches to study design, data collection, and analysis; 3) developing more integrative strategies for disseminating research results; 4) changing the reward structure to encourage health policy research; and 5) developing a stronger standby research capability. Specific examples of each of the above are presented. Throughout, the need for greater interaction among researchers, analysts, policymakers and practitioners is emphasized, along with specific suggestions for ways of bringing this about.
Research Note: Differences by Sex in Economic Returns Associated with Physician Specialization
Authors: Langwell Kathryn M.
Published: January 2008

Women comprised only 8.8 percent of active physicians in the United States in 1977. However, recent trends in the sex composition of medical school classes indicate that women will make up at least one-fourth of total physician supply in the future. Consequently, the effect of sex-composition changes on the supply of physicians' services is of importance, especially since much current federal policy is based upon assumptions about physician behavior drawn from observation of the current stock of physicians. This article explores the issue of differences by sex in lifetime earnings associated with alternative specialty choices. Economic incentives to specialize rather than enter general/family practice are examined initially. Then the incentives influencing the decision to specialize in either primary care or non-primary care fields are considered. Findings are reviewed and implications for future trends in specialty distribution of physicians, as well as implications for current and future federal policy affecting physicians' specialty decisions, are discussed.
Effective Aerobic Oxidation of Alcohols over Chromium Containing Mesoporous Molecular Sieve Catalyst with Supercritical Carbon Dioxide and Polyethylene Glycol Biphasic Reaction System
Authors: Dapurkar Sudhir E , Kawanami Hajime , Suzuki Toshishige M , Yokoyama Toshirou , Ikushima Yutaka
Published: January 2008

Aldehyde and ketone were selectively obtained by aerobic oxidation of alcohols over mesoporous CrMCM-41 catalyst with supercritical carbon dioxide and polyethylene glycol (scCO2/PEG) as a biphasic reaction system.
Removal of Phenols by an Organically Modified Layered Niobate K4Nb6O17 through an Adsorption–photocatalytic Degradation Process
Authors: Wei Qingming , Nakamura Koichiro , Endo Yosuke , Kameyama Miyuki , Nakato Teruyuki
Published: January 2008

An organically modified layered niobate was applied to remove phenol and 2,4-dichlorophenol from aqueous solution through an adsorption–photocatalytic degradation process. It showed different performances and structural responses on removal of these two phenols due to their difference in hydrophobicity.
Using Geoinformatics to Identify Suitable Middle to Long Distance Athletics' Training Sites in Kenya
Authors: Kiema John , Kipkemei Adam , Karanja Faith , Musyoka Sammy
Published: January 2008

Kenyan athletes have continued to dominate middle and long distance running in the global arena for a very long time now. In this study the use of geoinformation in selecting suitable training sites for endurance running was investigated. The study area chosen was Keiyo district within the Rift Valley province in Kenya, where a considerable number of the top Kenyan athletes reside and train. Different geospatial data sources were used and relevant criteria selected. Geographic Information Systems (GIS) was employed as the basic tool for modeling and analysis. For each of the 11 regions within the study area, weights were allocated to each of the multiple criteria identified. The Analytical Hierarchy Process (AHP) was used to determine the overall suitability-ranking index. From the results and analysis performed the regions of Iten, Tambach, Kaptarakwa and Kapkenda respectively were ranked as suitable areas for High-Low training. Kamwosor, Chepkorio, Iten and Kaptarakwa respectively were identified as ideal regions for altitude training. Nyaru and Metkei were determined to be unsuitable for both High-Low and altitude training regimens. The approach formulated in this study can be applied to other areas to enable athletes and coaches to identify suitable training sites.
Drugs in Sport: A Cure Worse Than the Disease?
Authors: Rushall Brent S. , Jones Max
Published: January 2008

That drugs are used in sport cannot be denied. However, that use must be qualified particularly with relevance to scientific fact rather than belief. The anti-doping movement has reacted in a manner that warrants criticism. It has introduced a standard of worldwide accusation, judgment, and sentencing; procedures that are reminiscent of the days of the Inquisition and witch hunts. This article looks at the inconsistencies in drug classifications, unacceptable sampling and analytical procedures, and violations of basic human rights demonstrated by the anti-doping movement. The question is posed as to whether it is better to protect innocents or have a large number of innocent athletes branded and ‘destroyed’ in a somewhat vain attempt to catch a few athletes who might be taking drugs, despite the likelihood of those drugs having no performance benefit other than restoring world-class athletes to their normal state of abnormally good health.
Social Theory for Coaches: A Foucauldian Reading of One Athlete's Poor Performance
Authors: Denison Jim
Published: January 2008

This paper explores my “sense making” when a male cross-country runner was coaching performed below expectation. My initial understanding of his poor performance was to blame him for “lacking” the appropriate mental toughness. As a result, I located the “problem” within him and subsequently ignored many of my own taken-for-granted coaching practices as perhaps contributing to his poor performance. In this paper, provide an alternative reading of my judgement of this athlete's poor performance through Michel Foucault's theory of disciplinary power. conclude by suggesting that many everyday coaching practices may have a number of “hidden” or problematic consequences attached to them that coaches should consider in an effort to evaluate the effectiveness of their coaching and to enhance their athletes' performances.
Performance Implications of Firm Resource Interactions in the Acquisition of R&D-Intensive Firms
Authors: King David R. , Slotegraaf Rebecca J. , Kesner Idalene
Published: January 2008

We explore the role of resource interactions in explaining firm performance in the context of acquisitions. Although we confirm that acquisitions do not lead to higher performance on average, we do find that complementary resource profiles in target and acquiring firms are associated with abnormal returns. Specifically, we find that acquiring firm marketing resources and target firm technology resources positively reinforce (complement) each other; meanwhile, acquiring and target firm technology resources negatively reinforce (substitute) one another. Implications for management theory and practice are identified.
Dealing with the Paradox of Embeddedness: The Role of Contracts and Trust in Facilitating Movement Out of Committed Relationships
Authors: Lazzarini Sergio G. , Miller Gary J. , Zenger Todd R.
Published: January 2008

When there are constantly new, valuable opportunities to transact with alternative partners—a situation we refer to as exchange value uncertainty—long-term or committed transactions among the same individuals are discouraged. However, when opportunism creates exchange hazards, which escalate in nonrecurring transactions, individuals will be reluctant to take full advantage of the gains from switching to more valuable partners, thereby leading to “overembedded” exchanges. Instead of embracing new, valuable exchanges with strangers whose propensity to cooperate is uncertain, individuals may prefer to preserve recurring ties with familiar actors. Two mechanisms may encourage movement out of committed relationships in those conditions. First, formal contracts should serve as a safeguard to market participants, in the sense that they limit potential losses due to opportunistic behavior. Second, trust in general others (as opposed to trust in familiar people) reduces participants' perception of hazards in market exchanges, and hence promotes transactions among strangers. By increasing the propensity to initiate new exchanges, general trust also diminishes the role of contracts in causing movement out of committed relationships. In this paper, we present experimental evidence largely consistent with this theory of the interplay between formal and informal mechanisms in the determination of social mobility.
Augmented Renal Vascular nNOS and Renin Protein Expression in Angiotensin Type 1 Receptor Null Mice
Authors: Park Sungmi , Harrison-Bernard Lisa M.
Published: January 2008

The present study was performed to determine the influence of absence of angiotensin type 1A (AT1A) and/or AT1B receptor feedback regulation of kidney neuronal nitric oxide synthase (nNOS) and renin protein expression. Kidneys were harvested from wildtype (WT), AT1A−/-, AT1B−/-, and AT1A−/-AT1B−/- mice and immunostained for nNOS and renin protein localization. AT1A−/- and AT1A−/-AT1B−/- kidneys demonstrated an increase in the percentage of glomeruli with nNOS-positive afferent and interlobular arterioles compared with WT mice. Density of vascular nNOS immunostaining was 20-fold higher in kidneys of AT1A−/- and AT1A−/-AT1B−/- compared with WT mice. Density of macula densa nNOS immunostaining was 7-fold higher in AT1A−/-AT1B−/- than in WT mice. Percent of glomeruli positive for juxtaglomerular (JG) cell renin was 3-fold higher, whereas the density of JG cell renin immunostaining was 15-fold higher in kidneys of AT1A−/- and AT1A−/-AT1B−/- compared with WT mice. Kidneys of AT1A−/- and AT1A−/-AT1B−/- mice displayed recruitment of renin protein expression along afferent and interlobular arterioles. Absence of AT1 receptor signaling resulted in enhanced nNOS protein expression in both microvascular and tubular structures. Enhanced NO generation may contribute to the reduced renal vascular tone and blood pressure observed with blockade of the renin–angiotensin system.
The Rise and Fall of the Common Disease–Common Variant (CD–CV) Hypothesis: How the Sickle Cell Disease Paradigm Led Us All Astray (Or Did It?)
Authors: Mayo Oliver
Published: January 2008

The common disease–common variant (CD–CV) hypothesis requires an explanation for the origin of the variation observed, since substantial neutral, but not deleterious, variation, that is, several alleles each at moderate to high frequency, can be maintained at any gene/locus by mutation. It is argued here that the guiding principle, not always stated, has been balancing selection, influenced by the wellestablished cases of deleterious alleles maintained through heterozygous advantage in the face of strong malarial selection against normal alleles. It is further argued that, although balanced polymorphisms have indeed arisen and reduced population loss through infectious disease, the history of balance in other contexts should have prevented acceptance of any hypothesis that generalized such a specific mechanism. Finally, it is suggested that in the present state of knowledge no single hypothesis for the genetical contribution to common disorders is justifiable.