Reducing obstetric litigation through alterations in practice patterns.

Objective: To estimate the extent to which obstetric malpractice claims might be reduced by adherence to a limited number of specific practice patterns.

Methods: We examined all 189 closed perinatal claims between 2000 and 2005 from a single, large, professional liability insurer. Each case was subjected to three separate analyses: 1) whether the adverse outcome was caused by substandard care, 2) what changes in practice likely would have avoided the adverse outcome, regardless of standard-of-care considerations, and 3) to what extent did substandard documentation lead to payment in cases in which there was no objective evidence of substandard care.

Directional evolution of stockiness coevolves with ecology and locomotion in lizards.

Although studied in many taxa, directional macroevolution remains difficult to detect and quantify. We present an approach for detecting directional evolution in subclades of species when relatively few species are sampled, and apply it to studying the evolution of stockiness in Phrynosomatine lizards. Our approach is more sensitive to detecting the tempo of directional evolution than other available approaches.

Sensitivity to brain dysfunction of the Halstead-Reitan vs an ability-focused neuropsychological battery.

We compared the sensitivity to brain dysfunction of an ability focused neuropsychological battery (AFB), as a proxy for the core of a flexible battery, to the Halstead-Reitan Battery (HRB). The AFB was designed to represent constructs of language function, fine motor skill, working memory, processing speed, verbal and visual memory, and verbal and visual abstraction and problem solving. Receiver operating characteristic analysis (ROC) yielded an area under curve (AUC) of.

Detecting malingering in traumatic brain injury and chronic pain with an abbreviated version of the Meyers Index for the MMPI-2.

Meyers, Millis, and Volkert [Meyers, J. E., Millis, S.

Electromyography and the evolution of motor control: limitations and insights.

Electromyography (EMG), or the study of muscle activation patterns, has long been used to infer central nervous system (CNS) control of the musculoskeletal system and the evolution of that control. As the activation of the muscles at the level of the periphery is a reflection of the interaction of descending influences and local reflex control, EMG is an important tool in integrated investigations of the evolution of coordination in complex, musculoskeletal systems. Yet, the use of EMG as a tool to understand the evolution of motor control has its limitations.

Highly efficient drug delivery with gold nanoparticle vectors for in vivo photodynamic therapy of cancer.

A highly efficient drug vector for photodynamic therapy (PDT) drug delivery was developed by synthesizing PEGylated gold nanoparticle conjugates, which act as a water-soluble and biocompatible "cage" that allows delivery of a hydrophobic drug to its site of PDT action. The dynamics of drug release in vitro in a two-phase solution system and in vivo in cancer-bearing mice indicates that the process of drug delivery is highly efficient, and passive targeting prefers the tumor site. With the Au NP-Pc 4 conjugates, the drug delivery time required for PDT has been greatly reduced to less than 2 h, compared to 2 days for the free drug.

Serum leptin concentrations and markers of immune function in overweight or obese postmenopausal women.

Experimental studies and case reports suggest a multifunctional role of leptin in immune function. However, clinical studies of leptin in healthy individuals with a comprehensive assessment of immunity are lacking. This study investigated associations between serum leptin concentrations and multiple biomarkers of cellular immunity and inflammation among 114 healthy postmenopausal, overweight, or obese women.

Does a continuous measure of handedness predict reading processes and reading-related skills across the lifespan?

The purpose of this research was to investigate the relationship between handedness, reading skills, and reading-related cognitive processes. Although lateralised differences in brain functioning are well known, research regarding handedness, specific reading skills, and reading-related cognitive processes is ambiguous at best because handedness is often measured as a dichotomous variable rather than a continuous variable. This methodological difference contributes to the diverse research findings, therefore the present investigation addressed these methodological limitations.

Simple inhibitors of histone deacetylase activity that combine features of short-chain fatty acid and hydroxamic acid inhibitors.

Butyric acid and trichostatin A (TSA) are anti-cancer compounds that cause the upregulation of genes involved in differentiation and cell cycle regulation by inhibiting histone deacetylase (HDAC) activity. In this study we have synthesized and evaluated compounds that combine the bioavailability of short-chain fatty acids, like butyric acid, with the bidentate binding ability of TSA. A series of analogs were made to examine the effects of chain length, simple aromatic cap groups, and substituted hydroxamates on the compounds' ability to inhibit rat-liver HDAC using a fluorometric assay.

Modulation, individual variation and the role of lingual sensory afferents in the control of prey transport in the lizard Pogona vitticeps.

Most organisms feed on a variety of food items that may differ dramatically in their physical and behavioural characteristics (e.g. mobility, mass, texture, etc.

Classification accuracy of MMPI-2 validity scales in the detection of pain-related malingering: a known-groups study.

The purpose of this study was to determine the accuracy of Minnesota Multiphasic Personality Inventory 2nd edition (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) validity indicators in the detection of malingering in clinical patients with chronic pain using a hybrid clinical-known groups/simulator design. The sample consisted of patients without financial incentive (n = 23), nonmalingering patients with financial incentive (n = 34), patients definitively determined to be malingering based on published criteria ( n = 32), and college students asked to simulate pain-related disability (n = 26). The MMPI-2 validity scales differentiated malingerers from nonmalingerers with a high degree of accuracy.

Reaching teen farm workers with health and safety information: an evaluation of a high school ESL curriculum.

While childhood agricultural injury has long been recognized as an important public health issue, most research has focused on family farms and there have not been many interventions targeting hired youth. This study evaluated the impact of a high school English as a Second Language (ESL) curriculum, designed to provide teen agricultural workers with the knowledge and tools to protect their health and safety in the fields. Using a quasi-experimental design, the research consisted of two intervention groups and a comparison group, and included over 2,000 students from communities that lead California in agricultural production.

Improved outcomes, fewer cesarean deliveries, and reduced litigation: results of a new paradigm in patient safety.

In a health care delivery system with an annual delivery rate of approximately 220,000, a comprehensive redesign of patient safety process was undertaken based on the following principles: (1) uniform processes and procedure result in an improved quality; (2) every member of the obstetric team should be required to halt any process that is deemed to be dangerous; (3) cesarean delivery is best viewed as a process alternative, not an outcome or quality endpoint; (4) malpractice loss is best avoided by reduction in adverse outcomes and the development of unambiguous practice guidelines; and (5) effective peer review is essential to quality medical practice yet may be impossible to achieve at a local level in some departments. Since the inception of this program, we have seen improvements in patient outcomes, a dramatic decline in litigation claims, and a reduction in the primary cesarean delivery rate.

Maternal death in the 21st century: causes, prevention, and relationship to cesarean delivery.

Objective: We sought to examine etiology and preventability of maternal death and the causal relationship of cesarean delivery to maternal death in a series of approximately 1.5 million deliveries between 2000 and 2006.

Study Design: This was a retrospective medical records extraction of data from all maternal deaths in this time period, augmented when necessary by interviews with involved health care providers.

TIM-4 expressed on APCs induces T cell expansion and survival.

TIM (T cell, Ig, mucin) proteins can regulate T cell immune responses. Tim-4 mRNA is not expressed in T cells, but exclusively in APCs. Tim-4 is a ligand for Tim-1 and Tim-4.

Experimental approaches to microarray analysis of tumor samples.

Comprehensive measurement of gene expression using high-density nucleic acid arrays (i.e. microarrays) has become an important tool for investigating the molecular differences in clinical and research samples.

Persistence of HIV in gut-associated lymphoid tissue despite long-term antiretroviral therapy.

Human immunodeficiency virus (HIV) persists in peripheral blood mononuclear cells despite sustained, undetectable plasma viremia resulting from long-term antiretroviral therapy. However, the source of persistent HIV in such infected individuals remains unclear. Given recent data suggesting high levels of viral replication and profound depletion of CD4(+) T cells in gut-associated lymphoid tissue (GALT) of animals infected with simian immunodeficiency virus and HIV-infected humans, we sought to determine the level of CD4(+) T cell depletion as well as the degree and extent of HIV persistence in the GALT of infected individuals who had been receiving effective antiviral therapy for prolonged periods of time.

A comparative study of adolescent risk assessment instruments: predictive and incremental validity.

Promising new adolescent risk assessment tools are being incorporated into clinical practice but currently possess limited evidence of predictive validity regarding their individual and/or combined use in risk assessments. The current study compares three structured adolescent risk instruments, Youth Level of Service/Case Management Inventory (YLS/CMI), Structured Assessment of Violence Risk in Youth (SAVRY), and Psychopathy Checklist: Youth Version (PCL:YV), for both predictive and incremental validity with respect to general and violent recidivism. Receiver operating characteristic and hierarchical logistic regression analyses revealed that the risk tools predicted general and violent recidivism to varying degrees of accuracy, but the SAVRY offered the most in incremental validity.

A novel competitive repopulation strategy to quantitate engraftment of ex vivo manipulated murine marrow cells in submyeloablated hosts.

Objective: Standard competitive repopulation assays have proven valuable in evaluating engraftment potential in ablated hosts, permitting comparisons between various test cell populations. However, no similar method exists to compare engraftment of test cells in submyeloablated hosts, which would be helpful given the applications of reduced-intensity conditioning for hematopoietic gene-replacement therapy and other cellular therapies. Here, we developed a novel assay to quantitate engraftment of hematopoietic stem cells in submyeloablated hosts.

Implementation of a conservative checklist-based protocol for oxytocin administration: maternal and newborn outcomes.

Objective: The purpose of this study was to examine the effects of a conservative and specific checklist-based protocol for oxytocin administration on maternal and newborn outcome. The protocol was based on maternal and fetal response to oxytocin rather than infusion rate.

Study Design: This was a retrospective chart review and data extraction of the last 100 patients receiving oxytocin before implementation of the protocol and the first 100 patients receiving oxytocin after protocol implementation.

High-field magnetic resonance imaging of the response of human prostate cancer to Pc 4-based photodynamic therapy in an animal model.

Introduction: High-field magnetic resonance imaging (MRI) is an emerging technique that provides a powerful, non-invasive tool for in vivo studies of cancer therapy in animal models. Photodynamic therapy (PDT) is a relatively new treatment modality for prostate cancer, the second leading cause of cancer mortality in American males. The goal of this study was to evaluate the response of human prostate tumor cells growing as xenografts in athymic nude mice to Pc 4-sensitized PDT.

New directions for studying selection in nature: studies of performance and communities.

Natural and sexual selection are crucial factors in the evolutionary process, yet recent reviews show that researchers have focused narrowly on this topic, with the majority of research centered on the morphological traits of single species. However, in the past several years, several bodies of work have emerged that have examined both selection on performance capacity and selection in a community context, and our goal is to highlight these two growing areas and point toward future directions. Recent studies of selection on performance capacity point toward directional selection favoring high levels of performance, and we detected less evidence for selection favoring intermediate (i.

Detection of the host immune response to Burkholderia mallei heat-shock proteins GroEL and DnaK in a glanders patient and infected mice.

We examined, by enzyme-linked immunosorbent assay and Western blot analysis, the host immune response to 2 heat-shock proteins (hsps) in a patient and mice previously infected with Burkholderia mallei. The patient was the first reported human glanders case in 50 years in the United States. The expression of the groEL and dnaK operons appeared to be dependent upon a sigma(32) RNA polymerase as suggested by conserved heat-shock promoter sequences, and the groESL operon may be negatively regulated by a controlling invert repeat of chaperone expression (CIRCE) site.