bluuebunny/crossref_metadata_2025 huggingface dataset:
Recurrence of a dysgerminoma in Frasier syndrome
Authors: Mestrallet Guillaume , Bertholet‐Thomas Aurélia , Ranchin Bruno , Bouvier Raymonde , Frappaz Didier , Cochat Pierre
Published: April 2010

Mestrallet G, Bertholet‐Thomas A, Ranchin B, Bouvier R, Frappaz D, Cochat P. Recurrence of a dysgerminoma in Frasier syndrome. Pediatr Transplantation 2011: 15:e53–e55. © 2010 John Wiley & Sons A/S.

Abstract:  FS is an inherited disease characterized by male pseudohermaphroditism and glomerular involvement leading to end‐stage renal disease during adolescence or early adulthood (J Pediatr 1964:64:740). The FS phenotype in 46,XY patients consists of female external genitalia, gonadal dysgenesis, high risk of gonadoblastoma, and development of renal failure in the second decade of life. FS is caused by heterozygous mutation in intron 9 of the WT1 leading to a change in splicing that results in loss of three amino acids (+KTS isoform), thus disrupting the normal ratio of the +KTS/−KTS isoforms that is critical for proper gonadal and renal development (Nat Genet 1997:17:467; Hum Mol Genet 1998:7:709). We report on a patient followed for FS revealed by acute peritoneal syndrome because of ovarian dysgerminoma. Therapeutic options had led to an unusual course with recurrent neoplastic disease after renal transplantation.
High diagnostic yield from transbronchial biopsy of solitary pulmonary nodules using low‐dose CT‐guidance
Authors: HAUTMANN Hubert , HENKE Markus O. , BITTERLING Harro
Published: April 2010

Background and objective:  The diagnostic yield from fluoroscopy‐guided bronchoscopic transbronchial biopsy of small solitary pulmonary nodules is low. The hypothesis tested in the present study was that the diagnostic yield can be significantly increased by combining flexible bronchoscopy with CT‐guidance using a dedicated low‐dose protocol.

Methods:  CT‐guided transbronchial biopsies were performed in 15 patients with a newly diagnosed solitary peripheral pulmonary nodule and negative conventional bronchoscopic biopsies under fluoroscopic guidance. For imaging, a multi‐detector helical CT unit, adjusted at 120 kV, 15 mAs/slice, 4 × 5 mm collimation, 10 mm reconstructed slice thickness and a maximal scan length of 150 mm, was used. After advancing the biopsy forceps towards the lesion, a CT scan was obtained. When the tip of the forceps reached or penetrated the lesion a biopsy was taken, otherwise the procedure was repeated with a maximum of eight attempts. The effective radiation dose was calculated.

Results:  The average diameter of the nodules was 23 ± 6 mm (mean ± SD) with a maximum distance to the parietal pleura of 18 mm (mean 6.5 mm). A mean of 4.1 (range 2–8) CT scans was performed to localize the lesion. In four patients, the forceps only reached the periphery of the nodule. In one patient, the nodule was missed in all attempts. Histology was malignant in eight patients and benign in four patients. In three patients, biopsy results were false negative (benign or non‐specific instead of malignant). The overall diagnostic yield was 73%. Complications consisted of two pneumothoraces, one of which necessitated a chest tube. Mean effective radiation dose was 0.55 mSv (range 0.3–1.0).

Conclusions:  CT‐guided transbronchial biopsy can be a valuable diagnostic tool in evaluating solitary pulmonary nodules. This applies for selected patients when other diagnostic methods are either unavailable or inappropriate. The diagnostic yield is high and, when a low‐dose protocol is used, radiation exposure can be kept at a minimum.
Chromosomal imbalances in lung adenocarcinomas with or without mutations in the epidermal growth factor receptor gene
Authors: FONG Yao , LIN Yue‐Shan , LIOU Chiou‐Ping , LI Chien‐Fen , TZENG Ching‐Cherng
Published: April 2010

Background and objective:  Epidermal growth factor receptor (EGFR) mutations are common in lung adenocarcinomas of Asian patients, implying a good response to treatment with the EGFR tyrosine kinase inhibitors, gefitinib and erlotinib. However, the distinct chromosomal imbalances between lung adenocarcinomas with and those without EGFR mutations have not been fully elucidated.

Methods:  Seventy‐seven patients of surgically resected lung adenocarcinoma were analysed for the EGFR exon 19 deletion and the L858R mutation, using mutant‐enriched PCR, and for chromosomal imbalance alterations using comparative genomic hybridization.

Results:  EGFR mutations were detected in 42 (54.5%) patients, including 22 with the exon 19 deletion and 20 with the L858R mutation. The mean number of chromosomal arms with imbalance alterations was significantly higher in tumours with EGFR mutations than in those lacking these two mutations. The minimal regions with gain on 1q23–q31, 6p12–p21.1 and 7q11.2, and loss on 3p21, 8p22–p23, 9q33, 10q25 and 13q13, differed significantly between lung adenocarcinomas with or without EGFR mutations. However, neither EGFR mutations, nor any of the common chromosomal imbalance alterations alone, exhibited significant associations with tumour stage or disease‐specific survival of the patients.

Conclusions:  These results indicate that imbalance alterations at several chromosomal regions occur significantly more frequently in lung adenocarcinomas with EGFR mutations than in those without such mutations. Tumour growth‐related genes in these chromosomal regions should be further investigated to improve our understanding of the common genetic alterations in lung adenocarcinomas with EGFR mutations.
Tuberculosis, bronchiectasis and chronic airflow obstruction
Authors: JORDAN Toni S. , SPENCER Elspeth M. , DAVIES Peter
Published: April 2010

Both tuberculosis and bronchiectasis carry a significant burden worldwide in terms of morbidity and mortality, as well as financial, especially in the developing world. Epidemiological data for tuberculosis are now more readily available since the World Health Organisation declared it ‘a global emergency’ in 1993. The global prevalence of bronchiectasis, a recognized sequel of tuberculosis, is unknown, but is by no means insignificant. The pathophysiology of chronic airflow obstruction in both of these diseases is poorly understood, but it is associated with an accelerated rate of loss in pulmonary function. This article examines the global burden of tuberculosis and bronchiectasis, and focuses on the interrelation with chronic airflow obstruction.
Treatment of latent tuberculosis infection: An update
Authors: LOBUE Philip , MENZIES Dick
Published: April 2010

Isoniazid (INH) has been the mainstay of treatment of latent tuberculosis infection for almost 50 years. The currently recommended preferred regimen is 9 months daily self‐administered INH (9H); this has efficacy of more than 90% if completed properly. Unfortunately, INH is associated with serious adverse events, including hepatotoxicity. Although risk factors for this complication are well established, allowing for better selection of candidates for therapy, this complication still occurs, and is occasionally fatal. Hence close follow up of patients is necessary, increasing the cost and complexity of treatment. This problem, plus the lengthy duration, results in poor acceptance by patients and providers, and poor adherence by patients. As a result, many preventable cases of tuberculosis continue to occur, and the public health impact of latent tuberculosis infection treatment is suboptimal. These problems have spurred interest in finding shorter, safer and cheaper alternative regimens, with similar efficacy. Of the many regimens that have been examined, 2 months of rifampin and pyrazinamide has excellent efficacy—in experimental studies in mice and randomized trials, largely in HIV‐infected persons. However, while the safety of 2 months of rifampin and pyrazinamide appears acceptable in HIV‐infected persons and children, in non‐HIV‐infected adults this regimen is associated with an unacceptably high rate of severe liver toxicity. Three to four months of INH and rifampin has had equivalent effectiveness as 6 months INH in several randomized trials. However, completion of therapy and toxicity has been the same as with INH—possibly because two drugs are taken rather than one. The fourth commonly studied regimen is 4 months rifampin. This has been found to have significantly better completion than 9H, with significantly less toxicity, especially hepatotoxicity. However, only one trial has evaluated efficacy and effectiveness of mono‐rifampin therapy. In this trial, 3 months rifampin had somewhat better efficacy than either 3 months of isoniazid and rifampin (3HR) or 6 months isoniazid. Two large scale trials are ongoing; one is comparing efficacy and effectiveness of 9H with 4 months rifampin (both daily and self‐administered), while the second, which is nearing completion, compares daily self‐administered 9H with 3 months directly observed once weekly INH combined with rifapentine. The results of these two trials will likely shape future recommendations substantially.
Organotypic slice co‐cultures reveal that early postnatal hippocampal axons lose the ability to grow along the fimbria, while retaining the ability to invade and arborise in septal neuropil
Authors: Law Stuart , Raisman Geoffrey , Li Daqing
Published: April 2010

The failure of cut axons to grow along fibre tracts in the adult CNS contrasts with their ability to do so in development. Organotypic slices culture of a number of areas enables the time of failure to be pinpointed to around the second week of postnatal life in the rat. ‘Heterochronic’ co‐culture of slices above and below this age shows that the failure is due to the inability of the older axons to grow into either the same age or younger targets. Using hippocampo‐septal slices the present experiments show that this failure is due to an inability to recognise the glial pathway of the fimbria, even when this is of a younger age. However, the older hippocampal neurons retain the ability to grow axons into septal target tissue when they are placed in direct contact with it. This exactly mirrors the inability of cut central axons to regenerate along their previous fibre pathways while they retain their ability to reinnervate neuropil.
Lesions to the ventral, but not the dorsal, medial prefrontal cortex enhance latent inhibition
Authors: George David N. , Duffaud Anaïs M. , Pothuizen Helen H. J. , Haddon Josephine E. , Killcross Simon
Published: April 2010

The acquisition of a conditioned response to a stimulus when it is paired with a reinforcer is retarded if the stimulus has previously been repeatedly pre‐exposed in the absence of the reinforcer. This effect, called latent inhibition, has previously been found to be insensitive to lesions of the medial prefrontal cortex (mPFC) in rats. Using an on‐baseline conditioned emotional response procedure, which is especially sensitive to small variations in the absolute magnitude of latent inhibition, we found increased latent inhibition following excitotoxic lesions of the mPFC (Experiment 1) or the ventral mPFC alone (Experiment 2) as compared with sham‐operated control rats. Lesions restricted to the dorsal mPFC, however, were without effect (Experiment 2). These results are consistent with those of experiments employing another type of interference procedure, extinction. Together, these findings suggest that when different contingencies between a stimulus and a reinforcer are established in separate learning phases, lesions to the ventral mPFC result in increased interference between first‐learned and second‐learned contingencies. As a consequence, retrieval of the second‐learned contingency is impaired, and performance is dominated by the first‐learned contingency. These findings are discussed in light of the use of latent inhibition to model cognitive deficits in schizophrenia.
Surface Reconstruction Based on Hierarchical Floating Radial Basis Functions
Authors: Süßmuth J. , Meyer Q. , Greiner G.
Published: April 2010

In this paper we address the problem of optimal centre placement for scattered data approximation using radial basis functions (RBFs) by introducing the concept of floating centres. Given an initial least‐squares solution, we optimize the positions and the weights of the RBF centres by minimizing a non‐linear error function. By optimizing the centre positions, we obtain better approximations with a lower number of centres, which improves the numerical stability of the fitting procedure. We combine the non‐linear RBF fitting with a hierarchical domain decomposition technique. This provides a powerful tool for surface reconstruction from oriented point samples. By directly incorporating point normal vectors into the optimization process, we avoid the use of off‐surface points which results in less computational overhead and reduces undesired surface artefacts. We demonstrate that the proposed surface reconstruction technique is as robust as recent methods, which compute the indicator function of the solid described by the point samples. In contrast to indicator function based methods, our method computes a global distance field that can directly be used for shape registration.
Spinal ischaemic stroke: clinical and radiological findings and short‐term outcome
Authors: Kumral E. , Polat F. , Güllüoglu H. , Uzunköprü C. , Tuncel R. , Alpaydın S.
Published: April 2010

Background and purpose:  The mechanism and pathogenesis of ischemic spinal stroke remain largely undetermined because most clinical studies have included mostly patients without a systematic study of associated vascular and concomitant disease of the vertebral body. Therefore, we assessed the pathogenetic mechanisms and short‐term outcomes of the patients with spinal stroke based on clinical data and magnetic resonance imaging findings.

Methods:  We studied clinical, imaging, and outcome data for 36 patients with acute spinal stroke admitted between 1998 and 2008. There were 16 men and 20 women (mean age 73, range 56–85 years).

Results:  Twelve patients (33%) had anterior spinal artery patterns, 8 (22%) had anterior and 6 (17%) had posterior unilateral infarct, 5 (14%) had posterior spinal artery infarct pattern, 3 (8%) had central involvement, and 2 (5%) had transverse syndrome. Twelve patients (33%) had no cause of stroke. Patients with central infarct and transverse infarct had a high frequency of peripheral vascular disease and prolonged hypotension, and one patient each had a chronic spinal disease. The onset of all other infarcts was associated with mechanical triggering movements in 12 patients (41%, P < 0.05), and with diseases of the spine in 19 (66%; P < 0.001), with the clinical picture suggesting root involvement at the level of the spinal cord ischemia. The short‐term outcomes were favorable in two‐thirds of patients, while 25% of them did not show any recovery on leaving the hospital.

Conclusion:  The most common type of spinal cord ischemia is bilateral or unilateral anterior spinal artery infarcts due to radicular artery disease with acute or chronic spinal disease and followed by central and transverse infarcts due to extensive spinal cord hypoperfusion and arteriopathy.
Abnormal cardiovascular responses to carotid sinus massage also occur in vasovagal syncope – implications for diagnosis and treatment
Authors: Humm A. M. , Mathias C. J.
Published: April 2010

Background and purpose:  Carotid sinus massage (CSM) is commonly used to identify carotid sinus hypersensitivity (CSH) as a possible cause for syncope, especially in older patients. However, CSM itself could provoke classical vasovagal syncope (VVS) in pre disposed subjects.

Methods:  Retrospective analysis of CSM, cardiovascular autonomic function tests (including tilt table testing) and medical history in 388 patients with recurrent syncope to identify and characterize patients in whom an abnormal response to CSM was more likely to reflect VVS than CSH.

Results:  CSM was abnormal in 79 patients. In 53 patients (77.2 ± 8.7 years), CSH was the likely cause of syncope. VVS was the more likely diagnosis in 26 younger patients (59.7 ± 12.6 years) with longstanding syncope from youth, in whom fear or pain was as a trigger; 7/26 suffered from intense chronic or intermittent neck pain and one exacerbation of syncopal attacks followed a physical and emotional trauma to the neck. In VVS, 4/26 had spontaneous VVS during head‐up tilt, another six after venepuncture (performed in 17/26). In 6/26, the abnormal response to CSM was delayed, occurring 62.8 ± 28.4 s after completion of CSM. The response to CSM was predominantly of the mixed type (20/26) and abnormal on both sides in 14/26.

Conclusions:  An abnormal response to CSM may not indicate syncope caused by CSH and needs to be considered in the light of the patient’s age, duration of syncopal episodes and detailed history of provocative stimuli. Differentiating CSH from VVS with an abnormal response to CSM has various implications from advice on driving to treatment strategies.
EFNS guideline on the treatment of cerebral venous and sinus thrombosis in adult patients
Authors: Einhäupl K. , Stam J. , Bousser M. ‐G. , De Bruijn S. F. T. M. , Ferro J. M. , Martinelli I. , Masuhr F.
Published: April 2010

Background:  Cerebral venous and sinus thrombosis (CVST) is a rather rare disease which accounts for <1% of all strokes. Diagnosis is still frequently overlooked or delayed as a result of the wide spectrum of clinical symptoms and the often subacute or lingering onset. Current therapeutic measures which are used in clinical practice include the use of anticoagulants such as dose‐adjusted intravenous heparin or body weight‐adjusted subcutaneous low‐molecular‐weight heparin (LMWH), the use of thrombolysis and symptomatic therapy including control of seizures and elevated intracranial pressure.

Methods:  We searched MEDLINE (National Library of Medicine), the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Library to review the strength of evidence to support these interventions and the preparation of recommendations on the therapy of CVST based on the best available evidence. Review articles and book chapters were also included. Recommendations were reached by consensus. Where there was a lack of evidence but consensus was clear we stated our opinion as good practice points.

Results and conclusions:  Patients with CVST without contraindications for anticoagulation (AC) should be treated either with body weight‐adjusted subcutaneous LMWH or with dose‐adjusted intravenous heparin (level B recommendation). Concomitant intracranial haemorrhage (ICH) related to CVST is not a contraindication for heparin therapy. The optimal duration of oral anticoagulant therapy after the acute phase is unclear. Oral AC may be given for 3 months if CVST was secondary to a transient risk factor, for 6–12 months in patients with idiopathic CVST and in those with “mild” thrombophilia, such as heterozygous factor V Leiden or prothrombin G20210A mutation and high plasma levels of factor VIII. Indefinite AC should be considered in patients with recurrent episodes of CVST and in those with one episode of CVST and ‘severe’ thrombophilia, such as antithrombin, protein C or protein S deficiency, homozygous factor V Leiden or prothrombin G20210A mutation, antiphospholipid antibodies and combined abnormalities (good practice point). There is insufficient evidence to support the use of either systemic or local thrombolysis in patients with CVST. If patients deteriorate despite adequate AC and other causes of deterioration have been ruled out, thrombolysis may be a therapeutic option in selected cases, possibly in those without large ICH and threatening herniation (good practice point). There are no controlled data about the risks and benefits of certain therapeutic measures to reduce an elevated intracranial pressure (with brain displacement) in patients with severe CVST. However, in severe cases with impending herniation craniectomy can be used as a life‐saving intervention (good practice point).
Neurobehavioral symptoms in ALS are negatively related to caregivers’ burden and quality of life
Authors: Chiò A. , Vignola A. , Mastro E. , Giudici A. Dei , Iazzolino B. , Calvo A. , Moglia C. , Montuschi A.
Published: April 2010

Objective:  To evaluate the frequency of neurobehavioral symptoms related to FTLD in a consecutive series of amyotrophic lateral sclerosis (ALS) patients and to assess their influence on patients’ and caregivers’ mood, burden, and quality of life.

Methods:  A total of 70 couples of ALS patients and their caregivers consecutively seen in our ALS clinic were separately interviewed using a battery of tests assessing frontotemporal‐related neurobehavioral symptoms, emotional status, and quality of life. Patients’ behavioral abnormalities were assessed with the Frontal Systems Behavior Scale (FrSBe). Caregiver burden was assessed with the Caregiver Burden Inventory (CBI).

Results:  According to caregivers’ evaluations, 34 (48.6%) patients had FrSBe pathological scores at the time of the interview. According to patients’ evaluation, 9 (12.9%) patients had pathological scores at the time of the interview. In caregivers’ assessment, at the time of the interview the most commonly impaired neurobehavioral domain was apathy (39 patients, 55.7%), followed by executive dysfunction (32, 45.7%) and disinhibition (18, 25.7%). Neurobehavioral symptoms were related to the presence of bulbar symptoms at the time of the interview, but not to patients’ age, gender, or physical status (ALS‐FRS score). Patients’ neurobehavioral symptoms were significantly related to lower caregivers’ quality of life, highest depression, and highest burden, both in univariate and in multivariable analyses.

Conclusions:  Neurobehavioral symptoms were present in 50% of our ALS patients and were related to bulbar symptoms. They have a profound negative impact on caregivers’ psychological status and were highly related with caregivers’ burden.
Social consequences of multiple sclerosis: clinical and demographic predictors – a historical prospective cohort study
Authors: Pfleger C. C. H. , Flachs E. M. , Koch‐Henriksen N.
Published: April 2010

Background:  Time to disability pension is one of the endpoints to be used to determine the prognosis of multiple sclerosis (MS) in prospective studies.

Objective:  To assess the time to cessation of work and receiving disability pension in MS, and how it may depend on gender, type of work and age and symptom at onset.

Method:  A total of 2240 Danes with onset of definite/probable MS 1980–1989, identified from the Danish MS‐Registry, were included. Information on social endpoints was retrieved from Statistics Denmark. Cox regression analyses were used with onset as starting point.

Results:  Afferent onset symptoms [hazard ratio (HR 0.57)] and non‐physical type of work (HR 0.70) were favourable prognostic factors compared with high age at onset, physical work and efferent symptoms at onset. The mean time to disability pension was 13 years for patients with afferent/brainstem onset symptom but 8.7 years for those with efferent onset symptoms (P < 0.0001). The effect of onset symptom was reduced and the effect of sex became significant when all covariates and age at onset were included in multivariate Cox regression.

Conclusions:  Onset age, type of onset symptom and work are robust predictors of disability pension in MS. Disability pension proves to be a reliable milestone in estimation of the prognosis of MS.
Exploring the association between cardiovascular and other disease‐related risk factors in the psoriasis population: the need for increased understanding across the medical community
Authors: Menter A , Griffiths CEM , Tebbey PW , Horn EJ , Sterry W ,   on behalf of the International Psoriasis Council
Published: April 2010

There is abundant and accumulating evidence on the classification of psoriasis as a systemic disease that exhibits a host of co‐morbidities. As a consequence, the second Interdisciplinary Conference on Co‐morbidities and Lifestyle Modification, convened by the International Psoriasis Council, has concluded that specialist physicians, primary care physicians and dermatologists are faced with an opportunity to impact, not just psoriasis disease understanding and management, but overall patient well‐being. The conference panel was represented by the disciplines of dermatology, cardiology, rheumatology, epidemiology, endocrinology, hepatology and gastroenterology, and medical specialists with particular expertise in obesity, diabetes mellitus, inflammation and genetics. The multiple co‐morbidities associated with psoriasis were reviewed with a view to identify possible mechanisms linking psoriatic disease with obesity, metabolic syndrome, diabetes, cardiovascular disease and non‐alcoholic fatty liver disease. Consensus was established on the association of psoriasis with other co‐morbidities and disease states. Consequently, there is a significant opportunity for specialist and primary care physicians to collaborate with dermatologists in the management of the overall health of psoriasis patients. First, there is an important need for physicians to routinely screen psoriasis patients for the multiple susceptibility risk factors and co‐morbidities associated with psoriasis. Second, the design and implementation of lifestyle modification plans including exercise, diet and the limitation of alcohol and tobacco intake, will not only benefit their general medical health but also their psoriasis.
Evolution of the spatial distribution of MAP1B phosphorylation sites in vertebrate neurons
Authors: Tymanskyj Stephen R. , Lin Shen , Gordon‐Weeks Phillip R.
Published: April 2010

The microtubule‐associated protein MAP1B has important roles in neural development, particularly in migrating and differentiating neurons. MAP1B is phosphorylated by glycogen synthase kinase 3β (GSK‐3β) at a site that requires prior phosphorylation by another kinase four amino acid residues downstream of the GSK‐3β site, a so‐called primed site, and at non‐primed sites that have no such requirement. In developing mammalian neurons, MAP1B phosphorylated by GSK‐3β at primed and non‐primed sites is distributed in spatially distinct patterns. Non‐primed GSK‐3β‐phosphorylated MAP1B sites are only expressed in axons and are present in the form of a gradient that is highest distally, towards the growth cone. In contrast, primed GSK‐3β‐phosphorylated MAP1B sites are present throughout the neuron including the somato‐dendritic compartment and uniformly throughout the axon. To examine the function of these two sites, we explored the evolutionary conservation of the spatial distribution of GSK‐3β primed and non‐primed sites on MAP1B in vertebrate neurons. We immunostained spinal cord sections from embryonic or newly hatched representatives of all of the main vertebrate groups using phospho‐specific antibodies to GSK‐3β primed and non‐primed sites on MAP1B. This revealed a remarkable evolutionary conservation of the distribution of primed and non‐primed GSK‐3β‐phosphorylated MAP1B sites in developing vertebrate neurons. By analysing amino acid sequences of MAP1B we found that non‐primed GSK‐3β sites are more highly conserved than primed sites throughout the vertebrates, suggesting that the latter evolved later. Finally, distinct distribution patterns of GSK‐3β primed and non‐primed sites on MAP1B were preserved in cultured rat embryonic cortical neurons, opening up the possibility of studying the two sites in vitro.
Electronic Medical Records, Nurse Staffing, and Nurse‐Sensitive Patient Outcomes: Evidence from California Hospitals, 1998–2007
Authors: Furukawa Michael F. , Raghu T. S. , Shao Benjamin B. M.
Published: April 2010

Objective. To estimate the effects of electronic medical records (EMR) implementation on medical‐surgical acute unit costs, length of stay, nurse staffing levels, nursing skill mix, nurse cost per hour, and nurse‐sensitive patient outcomes.

Data Sources. Data on EMR implementation came from the 1998–2007 HIMSS Analytics Databases. Data on nurse staffing and patient outcomes came from the 1998–2007 Annual Financial Disclosure Reports and Patient Discharge Databases of the California Office of Statewide Health Planning and Development (OSHPD).

Methods. Longitudinal analysis of an unbalanced panel of 326 short‐term, general acute care hospitals in California. Marginal effects estimated using fixed effects (within‐hospital) OLS regression.

Principal Findings. EMR implementation was associated with 6–10 percent higher cost per discharge in medical‐surgical acute units. EMR stage 2 increased registered nurse hours per patient day by 15–26 percent and reduced licensed vocational nurse cost per hour by 2–4 percent. EMR stage 3 was associated with 3–4 percent lower rates of in‐hospital mortality for conditions.

Conclusions. Our results suggest that advanced EMR applications may increase hospital costs and nurse staffing levels, as well as increase complications and decrease mortality for some conditions. Contrary to expectation, we found no support for the proposition that EMR reduced length of stay or decreased the demand for nurses.
The Relationship between Health Plan Performance Measures and Physician Network Overlap: Implications for Measuring Plan Quality
Authors: Maeng Daniel D. , Scanlon Dennis P. , Chernew Michael E. , Gronniger Tim , Wodchis Walter P. , McLaughlin Catherine G.
Published: April 2010

Objective.To examine the extent to which health plan quality measures capture physician practice patterns rather than plan characteristics.

Data Source.We gathered and merged secondary data from the following four sources: a private firm that collected information on individual physicians and their health plan affiliations, The National Committee for Quality Assurance, InterStudy, and the Dartmouth Atlas.

Study Design.We constructed two measures of physician network overlap for all health plans in our sample and linked them to selected measures of plan performance. Two linear regression models were estimated to assess the relationship between the measures of physician network overlap and the plan performance measures.

Principal Findings.The results indicate that in the presence of a higher degree of provider network overlap, plan performance measures tend to converge to a lower level of quality.

Conclusions.Standard health plan performance measures reflect physician practice patterns rather than plans' effort to improve quality. This implies that more provider‐oriented measurement, such as would be possible with accountable care organizations or medical homes, may facilitate patient decision making and provide further incentives to improve performance.
A Case of Hailey–Hailey Disease in an Infant with a New ATP2C1 Gene Mutation
Authors: Xu Zhe , Zhang Lixin , Xiao Yuanyuan , Li Li , Lin Zhimiao , Yang Yong , Ma Lin
Published: April 2010

Abstract:  Familial benign chronic pemphigus or Hailey–Hailey disease (OMIM 169600) is an autosomal‐dominant blistering disease. Here we present a rare case of familial benign chronic pemphigus in a Chinese infant. The 5‐month‐old proband, who showed diffusely distributed skin lesions, is the youngest patient of Hailey–Hailey disease ever reported. The detection of an ATP2C1 gene mutation in this infant confirmed the diagnosis. His mother carried the same mutation, but with no history of skin lesions.
A Case of Pityriasis Rosea Concurrent with the Novel Influenza A (H1N1) Infection
Authors: MUBKI THAMER F. , BIN DAYEL SALAMAN A. , KADRY RAZAN
Published: April 2010

Abstract:  Pityriasis rosea is a common skin disease with a self‐limiting course. Multiple etiologies including viruses, bacteria, and fungi have been investigated in an attempt to confirm a casual association. Pityriasis rosea has not been associated with influenza virus, but has been associated with herpes simplex virus types 6 and 7. We encountered a case of a proven pandemic H1N1 infection associated with a clincopathological diagnosis of pityriasis rosea. We conclude that influenza A (H1N1) virus could either be a primary cause of pityriasis rosea or a trigger for reactivation of other viral causes.
Colophony, a Hidden Allergen on ECG Electrodes in a Boy After Cardiovascular Surgery
Authors: Machovcova Alena
Published: April 2010

Abstract:  We report on the first case identifying colophony as a hidden allergen in declared acrylate‐based conductive and adhesive foam electrodes. This surgery was followed by continuous electrocardiogram monitoring. The patch tests showed strong positive reactions to colophony. The presence of colophony on the electrocardiogram electrodes was not declared, but it was used in the soldering process during manufacture, which deposited a small amount that was sufficient to induce sensitization.
β‐Endorphin Mediates Behavioral Despair and the Effect of Ethanol on the Tail Suspension Test in Mice
Authors: Barfield Elizabeth T. , Barry Sarah M. , Hodgin Hali B. , Thompson Brittany M. , Allen Stephani S. , Grisel Judith E.
Published: April 2010

Background: The opioid peptide β‐endorphin (β‐E) is synthesized and released in response to stressful stimuli as well as acute alcohol administration. The release of β‐E following exposure to an inescapable aversive situation may mediate behaviors that contribute to allostasis of the stress response. The present study examines the effects of β‐E on immobility in assays involving inescapable stress, both under basal conditions and after acute administration of EtOH.

Methods: Female and male transgenic mice with varying capacities to translate β‐E were subjected to either the forced swim (FST, Experiment 1) or the tail suspension test (TST, Experiment 2). In Experiment 3, mice were divided into three groups based on hormonal status (male, female‐estrous, and female‐nonestrous) and injected with either 1 g/kg EtOH or equivolume saline 14 minutes prior to behavioral assessment on the TST.

Results: Experiments 1 and 2 demonstrated a direct relationship between β‐E levels and immobility. There were also sex differences in behavior in these tests, with males displaying more immobility than females. A main effect of genotype in Experiment 3 replicated findings in Experiments 1 and 2. There was also an effect of EtOH (increasing immobility) and a significant interaction reflecting a particularly robust effect of the drug in mice with low β‐E. In addition, there were interactions between β‐E, EtOH effects, and hormonal status.

Conclusions: These findings support the contention that β‐E moderates behavioral responses to stressful stimuli and suggest a role for this peptide in coping behavior. Furthermore, the effects of EtOH on the response to stress may be mediated by β‐E. Sex differences in this influence may contribute to sex differences in disease susceptibility and expression.
Regression Versus Causation, Revisited
Authors: Cox, Jr. Louis Anthony (Tony)
Published: April 2010

I recently discussed pitfalls in attempted causal inference based on reduced‐form regression models. I used as motivation a real‐world example from a paper by Dr. Sneeringer, which interpreted a reduced‐form regression analysis as implying the startling causal conclusion that “doubling of [livestock] production leads to a 7.4% increase in infant mortality.” This conclusion is based on: (A) fitting a reduced‐form regression model to aggregate (e.g., county‐level) data; and (B) (mis)interpreting a regression coefficient in this model as a causal coefficient, without performing any formal statistical tests for potential causation (such as conditional independence, Granger‐Sims, or path analysis tests). Dr. Sneeringer now adds comments that confirm and augment these deficiencies, while advocating methodological errors that, I believe, risk analysts should avoid if they want to reach logically sound, empirically valid, conclusions about cause and effect. She explains that, in addition to (A) and (B) above, she also performed other steps such as (C) manually selecting specific models and variables and (D) assuming (again, without testing) that hand‐picked surrogate variables are valid (e.g., that log‐transformed income is an adequate surrogate for poverty). In her view, these added steps imply that “critiques of A and B are not applicable” to her analysis and that therefore “a causal argument can be made” for “such a strong, robust correlation” as she believes her regression coefficient indicates. However, multiple wrongs do not create a right. Steps (C) and (D) exacerbate the problem of unjustified causal interpretation of regression coefficients, without rendering irrelevant the fact that (A) and (B) do not provide evidence of causality. This reply focuses on whether any statistical techniques can produce the silk purse of a valid causal inference from the sow's ear of a reduced‐form regression analysis of ecological data. We conclude that Dr. Sneeringer's analysis provides no valid indication that air pollution from livestock operations causes any increase in infant mortality rates. More generally, reduced‐form regression modeling of aggregate population data—no matter how it is augmented by fitting multiple models and hand‐selecting variables and transformations—is not adequate for valid causal inference about health effects caused by specific, but unmeasured, exposures.
The O. J. Simpson Criminal Trial Verdict: Racism or Status Shield?
Authors: Skolnick Paul , Shaw Jerry I.
Published: April 2010

A simulation study investigated the factors that may have led the jury in the O. J. Simpson criminal trial to an acquittal verdict. Black and White mock jurors read a transcript of a murder trial that varied the defendant's race (Black or White) and celebrity status (high or low). Results confirmed a “Black racism” hypothesis, since Black jurors favored Black over White defendants by voting not guilty more often, recommending more lenient sentences and judging them more positively. In contrast, White jurors did not differentiate between Black and White defendants. The defendant's celebrity status did not affect verdicts or sentencing but did influence evaluative judgments. These results suggest that race rather than celebrity status more likely influenced the Simpson verdict. Limitations of the findings of this mock jury study are discussed.
Giving the People What They Want? The Distribution of Earmarks in the U.S. House of Representatives
Authors: Lazarus Jeffrey
Published: April 2010

The common wisdom in journalistic accounts of earmarking is that Congress distributes earmarks on a purely political basis, without any consideration for the demand for federal spending. Academic accounts similarly argue that factors internal to Congress are preeminent in determining where earmarks go, even more than for other types of pork‐barrel spending. Using earmarks appearing in the fiscal year 2008 Appropriations bills, I search for both chamber‐based and demand‐side determinants of the distribution of earmarks. I find that both types of factors are significantly related to the number of earmarks that a House member receives. This result indicates that even while earmarking, members of Congress are at least minimally responsive to voter preferences and calls into question whether earmarks should be treated as an outlier within the universe of spending allocation mechanisms.
Party Strength, the Personal Vote, and Government Spending
Authors: Primo David M. , Snyder, Jr. James M.
Published: April 2010

“Strong” political parties within legislatures are one possible solution to the problem of inefficient universalism, a norm under which all legislators seek large projects for their districts that are paid for out of a common pool. We demonstrate that even if parties have no role in the legislature, their role in elections can be sufficient to reduce spending. If parties in the electorate are strong, then legislators will demand less distributive spending because of a decreased incentive to secure a “personal vote” via local projects. We estimate that spending in states with strong party organizations is at least 4% smaller than in states where parties are weak. We also find evidence that strong party states receive less federal aid than states with weak organizations, and we theorize that this is because members of Congress from strong party states feel less compelled to secure aid than members from weak party states.
The Separation of Powers and Supreme Court Agenda Setting
Authors: Owens Ryan J.
Published: April 2010

This study employs the first systematic, empirical analysis that relies on archival data to examine whether the separation of powers influences justices' agenda votes. It spatially models how justices set the Court's agenda under a sincere approach as well as an SOP approach and compares the competing expectations derived therefrom. The results suggest that legislative and executive preferences fail to influence justices' votes. Across every model tested, the data show justices uninfluenced by the separation of powers. These results provide a strong rejoinder to SOP models, since the Court's agenda stage is the most likely stage of the decision‐making process to show signs of an SOP effect.
The World Wide Web and the U.S. Political News Market
Authors: Nie Norman H. , Miller, III Darwin W. , Golde Saar , Butler Daniel M. , Winneg Kenneth
Published: April 2010

We propose a framework for understanding how the Internet has affected the U.S. political news market. The framework is driven by the lower cost of production for online news and consumers' tendency to seek out media that conform to their own beliefs. The framework predicts that consumers of Internet news sources should hold more extreme political views and be interested in more diverse political issues than those who solely consume mainstream television news. We test these predictions using two large datasets with questions about news exposure and political views. Generally speaking, we find that consumers of generally left‐of‐center (right‐of‐center) cable news sources who combine their cable news viewing with online sources are more liberal (conservative) than those who do not. We also find that those who use online news content are more likely than those who consume only television news content to be interested in niche political issues.
Civic Engagements: Resolute Partisanship or Reflective Deliberation
Authors: MacKuen Michael , Wolak Jennifer , Keele Luke , Marcus George E.
Published: April 2010

Why do people practice citizenship in a partisan rather than in a deliberative fashion? We argue that they are not intractably disposed to one type of citizenship, but instead adopt one of two different modes depending on the strategic character of current circumstances. While some situations prompt partisan solidarity, other situations encourage people to engage in open‐minded deliberation. We argue that the type of citizenship practiced depends on the engagement of the emotions of anxiety and aversion. Recurring conflict with familiar foes over familiar issues evokes aversion. These angry reactions prepare people for the defense of convictions, solidarity with allies, and opposition to accommodation. Unfamiliar circumstances generate anxiety. Rather than defend priors, this anxiety promotes the consideration of opposing viewpoints and a willingness to compromise. In this way, emotions help people negotiate politics and regulate the kinds of citizenship they practice.
Diversionary Despots? Comparing Autocracies' Propensities to Use and to Benefit from Military Force
Authors: Pickering Jeffrey , Kisangani Emizet F.
Published: April 2010

This article adds to recent research that has begun to systematically analyze the varied conflict propensities of autocracies. Using political incentive theory, we develop hypotheses on the diversionary proclivities of three distinct types of autocratic regimes that contradict conventional wisdom and the findings of recent empirical studies. To provide a full rendering of autocracies' diversionary tendencies, we test our hypotheses with Generalized Method of Moments (GMM) models that capture reciprocal relationships among external military force and four of its potential domestic causes from 1950 to 2005. Although our results provide only partial support for political incentive theory, they demonstrate the utility of using properly identified reciprocal models and of analyzing refined conceptualizations of autocratic regimes. We find that certain types of autocracies are more prone to use diversionary force and to benefit from it than others.
Information, Agreement Design, and the Durability of Civil War Settlements
Authors: Mattes Michaela , Savun Burcu
Published: April 2010

Civil war is usually examined from the perspective of commitment problems. This approach provides considerable insight regarding which civil war agreement provisions reduce the chance of renewed fighting. Yet, additional insight can be gained by examining information asymmetries as a potential cause of civil war recurrence. We argue that significant uncertainty regarding military capabilities may persist after fighting ends and that this uncertainty may lead to the breakdown of peace. However, carefully designed peace agreements can guard against renewed civil war by calling for international monitoring, making the belligerents submit military information to third parties, and providing for verification of this information. Our empirical analysis of 51 civil war settlements between 1945 and 2005 shows that these provisions significantly reduce the risk of new civil war. Encouraging the adoption of these provisions may be a useful policy in the international community's effort to establish peace in civil‐war‐torn societies.
Causal Inference with Differential Measurement Error: Nonparametric Identification and Sensitivity Analysis
Authors: Imai Kosuke , Yamamoto Teppei
Published: April 2010

Political scientists have long been concerned about the validity of survey measurements. Although many have studied classical measurement error in linear regression models where the error is assumed to arise completely at random, in a number of situations the error may be correlated with the outcome. We analyze the impact of differential measurement error on causal estimation. The proposed nonparametric identification analysis avoids arbitrary modeling decisions and formally characterizes the roles of different assumptions. We show the serious consequences of differential misclassification and offer a new sensitivity analysis that allows researchers to evaluate the robustness of their conclusions. Our methods are motivated by a field experiment on democratic deliberations, in which one set of estimates potentially suffers from differential misclassification. We show that an analysis ignoring differential measurement error may considerably overestimate the causal effects. This finding contrasts with the case of classical measurement error, which always yields attenuation bias.
Clinical Utility of aVR—The Neglected Electrocardiographic Lead
Authors: Kireyev Dmitriy , Arkhipov Mikhail V. , Zador Stephen T. , Paris Joseph A. , Boden William E.
Published: April 2010

Background: Several studies suggest that electrocardiographers tend to neglect lead aVR during the reading of electrocardiograms (ECGs). Our objective was to provide a systematic review of the most important diagnostic and prognostic uses of lead aVR.

Methods: We performed a thorough review of the literature about the lead aVR using PubMed, MEDLINE and the archives of the University at Buffalo libraries.

Results: We found that lead aVR may provide important additional information in the diagnosis of coronary artery disease. It may provide a clue to the location of a lesion as well as the possibility of three vessel disease during an acute coronary syndrome. Lead aVR was found useful in the locus of arrhythmias and in differentiation of narrow and wide QRS complex tachycardias. It provides useful prognostic information for patients with the Brugada syndrome and tricyclic antidepressant toxicity. Lead aVR provides alternative criteria for the electrocardiographic diagnosis of left ventricular hypertrophy and left anterior fascicular block.

Conclusion: Lead aVR provides very important additional diagnostic and prognostic information in multiple cardiac conditions and can be used either alone or in conjunction with other electrocardiographic leads.

Ann Noninvasive Electrocardiol 2010;15(2):175–180