Spatial variation of QT intervals in normal persons and patients with acute myocardial infarction

The QT interval is a clinically important electrocardiographic measurement. This study attempted to determine 1) whether this interval was spatially distributed in a physiologically meaningful way on the torso of normal subjects, and 2) if these spatial patterns were altered in patients with acute myocardial infarction. To do so, 30 patients were studied within 72 hours of the onset of acute myocardial infarction (15 with an anterior and 15 with a posterior lesion) along with 50 normal control subjects. Electrocardiographic signals were registered from 150 torso electrodes; the QT interval in each lead was determined by a combined automated-manual method, and the durations displayed as “isointerval maps.”In the normal subjects, the difference between the longest and shortest interval in each case was 59.4 ± 12.9 ms. Long QT intervals were spatially located over the left lateral torso and short QT intervals were found over the right inferior chest. Acute infarction modified this distribution in relation to lesion location; the longest QT intervals were centrally positioned in anterior infarction and caudally located in inferior infarction. Thus, QT intervals in normal and abnormal states have distinctive spatial distributions that are consistent with known regional myocardial electrophysiology

Natural history of chronic mitral insufficiency: Relation of peak systolic pressure/end-systolic volume ratio to morbidity and mortality

The ratio of peak systolic pressure to end-systolic volume (PSP/ESV) is a measure of contractility that is relatively independent of loading conditions. To define the relation of this index to the natural history of chronic mitral insufficiency, follow-up studies were performed in 76 patients. All had isolated mitral insufficiency and were followed up for an average of 48 months. None underwent surgery. Cardiac volumes, ejection fraction and PSP/ESV ratio were calculated and Cox multiple regression analyses were performed to determine the relation of functional status, ejection fraction and PSP/ESV ratio to morbidity and mortality.Twenty-three patients died during follow-up; in 70% of those who died, the PSP/ESV ratio was reduced below the 20th percentile. However, as an independent predictor of mortality, this ratio was less sensitive (p>0.05) than ejection fraction (p < 0.01). Similarly, functional status change was predicted more accurately by ejection fraction (p < 0.01) than by the PSP/ESV ratio (p>0.05). Thus, although a decreased PSP/ESV ratio was associated with a higher mortality rate, other clinical and laboratory variables were superior to this index for determining morbidity and mortality in patients with isolated mitral insufficiency

Baker Center Journal of Applied Public Policy, Vol. III No. I

Welcome to the third issue of the Baker Center Journal for Applied PublicPolicy. I am pleased that this issue, as its predecessors, evidences the vibrancy of the Baker Center’s governance and public policy programs and makes a contribution to our collective understanding about a variety of policy issues currently being discussed in America. Relating to our system of governance, Jess Hale Jr. examines a proposal for a uniform state approach to reining in renegade presidential electors and Professor Glenn Reynolds reviews Jack Goldsmith’s book The Terror Presidency: Law and Judgment Inside the Bush Administration. Relating to media and foreign affairs and the role of the media in political life, Dr. Mike Fitzgerald and two of his students provide us with “A Comparative Study of Images Created by Press Coverage of the United States and the Republic of Belarus.” Relating to health policy, Dr. David Mirvis, recently appointed as a Senior Fellow for Health Policy at the Center, explores the public policy implications of viewing health as an engine of economic growth. Relating to energy and environmental policy, Drs. Bruce Tonn and Amy Gibson and Baker Scholars Stephanie Smith and Rachel Tuck explore U.S. Attitudes and Perspectives on National Energy Policy. I am also very pleased that this issue includes a report of an excellent conference – “Formulation of a Bipartisan Energy and Climate Policy: Toward and Open and Transparent Process “- that was co-sponsored by the Baker Center and the Woodrow Wilson International Center for Scholars. This issue also includes the result ofanother successful collaboration between the Baker and Wilson Centers that focused on “Five Public Policy Ideas for Building Obama’s New Economy.” I look forward to further productive collaborations between the Baker and Wilson Centers. Relating to global security policy, this issue includes a Student Symposium onNational Security. Although the Baker Center Journal has provided an outlet for publication of student scholarship since its inception, I am particularly pleased that the student co-editors - Baker Scholars Elizabeth Wilson Vaughan and Bradford A. Vaughan - took the initiative to expand upon the efforts of their predecessors and to provide us with an expanded set of excellent students essays each of which addresses an important national security policy issue. It is an important part of the Baker Center’s mission to engage UTK students in the political and public policy process, and I applaud our student authors fortheir contributions to this symposium. I hope you find this issue of the Baker Center Journal for Applied Public Policy to be both interesting and thought-provoking and that it will encourage you to participate in America’s unique and wonderful political and policy processes

Choosing a medical specialty: the difference between what students want and what society needs

The choice of a specialty by medical students is a complex one that has significant implications for the future supply of physician manpower. The study by Weissman et al. portrays this choice as reflecting the degree of congruence between a student’s needs and values and his or her perception of the characteristics of the various specialties. The existing shortages in the supply of various specialists in Israel may be interpreted as signifying a lack of alignment of student needs and perceptions. This commentary will extend the implications of this work to include the connection between students’ choices and the physician manpower needs of society, and will focus on primary care physician shortages in the United States as but one example of the implications of these relationships

Rural Hospitals: Economic and Health Implications in Mississippi

The healthcare delivery and financing systems in the United States are evolving rapidly, and the impact on small rural hospitals is made evident by increasingly common news of closures or employee layoffs. Since 2010, 58 rural hospitals have closed nationally, mostly in the South, including two in Mississippi. Another 283 hospitals nationwide have been identified as “vulnerable,” with 22 of those in Mississippi. As a percentage of all rural hospitals in the state, Mississippi has the highest proportion of its rural hospitals classified as “vulnerable.” The Center for Mississippi Health Policy commissioned a study by researchers from the Social Science Research Center (SSRC) at Mississippi State University to examine the economic impact of rural hospitals on Mississippi communities. The detailed SSRC Report and an Issue Brief summarizing the Report and outlining policy options are available for downloading from the links on the side bar to the left. SSRC identified nine “most at risk” hospitals around the state. The economic impact analysis determined that the closure of all nine “most at risk” hospitals would lead to a loss of an estimated 2,600 jobs, approximately $8.6 million in state and local tax revenue, and a total economic impact of$289.2 million. A variety of factors has made it increasingly more difficult for small rural hospitals to survive and thrive. Federal payment policies have been foundational to the financial status of these hospitals. Congress has taken several policy actions in the past that were designed to support small rural hospitals, but many of these provisions are scheduled to expire or have been targeted for change. Many hospitals have sought technical assistance in making operational improvements to assist in adapting to the changing environment, and some have demonstrated success in these efforts. Often the strategies employed are focused on increasing revenue to improve the hospital’s financial condition, which may or may not be consistent with meeting the key health care needs of the community. Better alignment of economic and health incentives would help hospitals adapt more effectively

The Economics of Prevention in a Post-Managed-Care Environment

Economic-implications, Health-education, Managed-care