HOXA10 controls osteoblastogenesis by directly activating bone regulatory and phenotypic genes.

HOXA10 is necessary for embryonic patterning of skeletal elements, but its function in bone formation beyond this early developmental stage is unknown. Here we show that HOXA10 contributes to osteogenic lineage determination through activation of Runx2 and directly regulates osteoblastic phenotypic genes. In response to bone morphogenic protein BMP2, Hoxa10 is rapidly induced and functions to activate the Runx2 transcription factor essential for bone formation.

The Journal of Inebriety (1876-1914): history, topical analysis, and photographic images.

Aims: The publication of the Journal of Inebriety (1876-1914) chronicled the rise and fall of the first era of organized addiction medicine in the United States.

Methods: Findings from historical research, a content analysis of the Journal's 35 volumes and 141 issues and images from the Journal illustrate visually the medical treatment of addiction in the United States in the late 19th and early 20th centuries.

Results: Under the editorial direction of Dr T.

Matching patient-specific expectations with physician-specific outcomes: towards transparency in treatment decision-making and consent.

This article hypothesizes that while the principles of evidence-based practice should serve as a guiding ideal for physicians, the manner in which this practice style is commonly implemented may be insufficient to the provision of truly informed decision-making and consent - especially in cases where outcomes are inextricably tied to technique, such as in the surgical subspecialities. Specifically, current methods of 'shared decision making' fail to adequately incorporate patient-specific expectations and physician-specific outcomes. A 'next-step', aimed at matching such expectations with outcomes is suggested and a method for implementation is presented.

Structural mechanism of RPA loading on DNA during activation of a simple pre-replication complex.

We report that during activation of the simian virus 40 (SV40) pre-replication complex, SV40 T antigen (Tag) helicase actively loads replication protein A (RPA) on emerging single-stranded DNA (ssDNA). This novel loading process requires physical interaction of Tag origin DNA-binding domain (OBD) with the RPA high-affinity ssDNA-binding domains (RPA70AB). Heteronuclear NMR chemical shift mapping revealed that Tag-OBD binds to RPA70AB at a site distal from the ssDNA-binding sites and that RPA70AB, Tag-OBD, and an 8-nucleotide ssDNA form a stable ternary complex.

Patient preferences regarding spine surgical decision making.

Study Design: Patient surveys to determine preferences in surgical decision making.

Objective: To evaluate spine patient preferences regarding physician and patient roles in surgical decision making and to discuss the ethical considerations that arise.

Summary Of Background Data: Since the 1980s, there has been a push toward increasing patient autonomy and self-determination, and away from the paternalism of the past.

Guideposts to the future--an agenda for nursing informatics.

As new directions and priorities emerge in health care, nursing informatics leaders must prepare to guide the profession appropriately. To use an analogy, where a road bends or changes directions, guideposts indicate how drivers can stay on course. The AMIA Nursing Informatics Working Group (NIWG) produced this white paper as the product of a meeting convened: 1) to describe anticipated nationwide changes in demographics, health care quality, and health care informatics; 2) to assess the potential impact of genomic medicine and of new threats to society; 3) to align AMIA NIWG resources with emerging priorities; and 4) to identify guideposts in the form of an agenda to keep the NIWG on course in light of new opportunities.

The effects of governing board configuration on profound organizational change in hospitals.

This study extends the literature on governing boards and organizational change by examining how governing board configurations have influenced profound organizational change in U.S. hospitals, and the conditions under which such change occurs.

Difficult medical problems: on explanatory models and a pragmatic alternative.

Despite the significant improvements in the treatment of many pathologic processes witnessed over the past century, some particularly difficult medical problems persist. Some of these problems, perhaps best exemplified by chronic low back pain/degenerative disc disease, are characterized by unclear underlying etiologies and less than desirable outcomes of treatment in spite of considerable intellectual and financial investment. Faced with these disorders, many physicians rely on 'explanatory models', such as the traditional Biomedical model or the Biopsychosocial model, to provide a perspective from which to aim research, diagnosis, and treatment programs.

Recruiting participants to cancer prevention clinical trials: lessons from successful community oncology networks.

Purpose/objectives: To describe the organizational designs and task environments of community oncology networks with high accrual rates to cancer prevention clinical trials.

Design: Replicated case study design; structural contingency theory.

Setting: Local Community Clinical Oncology Programs (CCOPs) funded by the National Cancer Institute to test preventive and therapeutic interventions in community settings.

Nanosphere dispersed liquid crystals for tunable negative-zero-positive index of refraction in the optical and terahertz regimes.

An analysis of aligned nematic liquid crystal cells containing core-shell nanospheres shows that it is possible to devise a new type of metamaterial whose index of refraction is tunable from negative, through zero, to positive values. The design parameters for the constituents can be scaled for application in the optical as well as very long wavelength (e.g.

The effects of managed care and competition on community-based clinical research.

Background: The National Institutes of Health is developing practice-based clinical research networks (PBRNs) to expedite the pace of scientific discovery and improve care quality. Anecdotal evidence suggests managed care penetration and provider competition negatively affect PBRN clinical research.

Objective: The objective of this study is to examine the effects of environmental factors on clinical research performance in the National Cancer Institute's Community Clinical Oncology Program (CCOP).

Quality improvement implementation and hospital performance on patient safety indicators.

This study examines the association between scope of Quality Improvement (QI) implementation in hospitals and hospital performance on patient safety indicators. Secondary data sources included a 1997 survey of hospital QI practices, Medicare Inpatient Database, American Hospital Association's Annual Survey of Hospitals, the Bureau of Health Professions' Area Resource File, and two proprietary data sets. Using a sample of 1,784 community hospitals, the study employed two-stage instrumental variables estimation in which predicted values of four QI scope variables and control variables were used to estimate four patient safety indicators.

Integrated decision-making in response to weapons of mass destruction incidents: development and initial evaluation of a course for healthcare professionals.

Introduction: Standardized, validated training programs for teaching administrative decision-making to healthcare professionals responding to weapons of mass destruction (WMD) incidents have not been available. Therefore, a multidisciplinary team designed, developed, and offered a four-day, functional exercise, competency-based course at a national training center.

Objective: This report provides a description of the development and initial evaluation of the course in changing participants' perceptions of their capabilities to respond to WMD events.

Quality improvement implementation and hospital performance on quality indicators.

Objective: To examine the association between the scope of quality improvement (QI) implementation in hospitals and hospital performance on selected indicators of clinical quality.

Data Sources: Secondary data from 1997 mailed survey of hospital QI practices, Medicare Inpatient Database, American Hospital Association's Annual Survey of Hospitals, the Bureau of Health Professions' Area Resource File, and two proprietary data sets compiled by Solucient Inc. containing data on managed care penetration and hospital financial performance.

The role of organizational infrastructure in implementation of hospitals' quality improvement.

Quality improvement (QI) is an organized approach to planning and implementing continuous improvement in performance. Although QI holds promise for improving quality of care and patient safety, hospitals that adopt QI often struggle with its implementation. This article examines the role of organizational infrastructure in implementation of quality improvement practices and structures in hospitals.

Medical error identification, disclosure, and reporting: do emergency medicine provider groups differ?

Objectives: To determine if the three types of emergency medicine providers--physicians, nurses, and out-of-hospital providers (emergency medical technicians [EMTs])--differ in their identification, disclosure, and reporting of medical error.

Methods: A convenience sample of providers in an academic emergency department evaluated ten case vignettes that represented two error types (medication and cognitive) and three severity levels. For each vignette, providers were asked the following: 1) Is this an error? 2) Would you tell the patient? 3) Would you report this to a hospital committee? To assess differences in identification, disclosure, and reporting by provider type, error type, and error severity, the authors constructed three-way tables with the nonparametric Somers' D clustered on participant.

Transforaminal lumbar interbody fusion: an independent assessment of outcomes in a difficult patient population.

Background: Transforaminal lumbar interbody fusion is becoming increasingly popular for the surgical treatment of lumbar degenerative conditions. However, the outcomes following the procedure have only begun to be evaluated.

Material/methods: The authors reviewed all patients previously treated by TLIF at our tertiary center with minimum two year follow-up.

The effect of physician permission versus notification on research recruitment through cancer registries (United States).

Objective: To determine how physicians responded when investigators inquired about contacting patients identified through a central cancer registry, and to examine participation rates under physician permission versus notification approaches.

Methods: We analyzed existing data from seven observational epidemiologic studies conducted in North Carolina between 1993 and 2004, capitalizing on a 'natural experiment' that arose when the state registry changed from a policy requiring investigators to obtain physician permission to one requiring only physician notification.

Results: When a notification approach was used, physicians approved researcher contact with a higher proportion of patients, and a higher proportion of physicians approved contact with or provided eligibility information about all patients requested, compared with a permission approach.

Adapting clinical trials networks to promote cancer prevention and control research.

Background: Since 1987, cancer centers and clinical cooperative groups serving as 'research bases' for the National Cancer Institute's (NCI) Community Clinical Oncology Program (CCOP) have been required to design and conduct cancer prevention and control (CP/C) clinical trials in addition to therapeutic trials. The study describes the structural and strategic adaptations that CCOP research bases have made to incorporate CP/C research into their scientific agendas and operations.

Methods: Approaches to CP/C research in four cooperative groups with different scientific agendas were investigated: the Eastern Cooperative Oncology Group, the National Surgical Adjuvant Breast and Bowel Project, the North Central Cancer Treatment Group, and the Southwest Oncology Group.

Parental preferences for error disclosure, reporting, and legal action after medical error in the care of their children.

Objective: No data exist on parental preferences for disclosure, reporting, and seeking legal action after errors in the care of their children are disclosed. This study examined parental preferences for error disclosure and reporting; responses to error disclosure; and preferences and responses by race/ethnicity, gender, age, and insurance.

Methods: A 4-scenario survey instrument portraying a range of medical error was provided to a convenience sample of parents who presented with children to an emergency department.

Lateral lumbar disc herniations treated with a paraspinal approach: an independent assessment of longer-term outcomes.

In this independent review, at an average of 5.5 years after surgical excision of a lateral zone disc herniation using a paraspinal approach, 51 of 60 patients (85%) were satisfied with the results. Pain was eliminated in 36 (60%) and reduced in all but 3 (5%).

Area Health Education Centers: strengths, challenges, and implications for Academic Health Science Center leaders.

Drawing from the results of an empirical study, we discuss the strengths and challenges of Area Health Education Centers in three domains-mission, programs, and organization--and highlight their implications for Academic Health Science Center leaders.