Effects of Conflict-of-Interest Policies in Psychiatry Residency on Antidepressant Prescribing

Concerns about the pharmaceutical industry’s influence in academic medical centers and on medical education have led many medical schools and teaching hospitals to adopt conflict-of-interest (COI) policies. Although the restrictiveness of these policies differs, the goal is the same: to shield physicians-in-training from the persuasive aspects of pharmaceutical promotion. But do these policies work? This Issue Brief examines how COI policies affect the prescribing patterns of antidepressants, one of the most heavily promoted drug classes in the past decade. As such, it provides the first empirical evidence of the effects of COI policies in residency on the subsequent prescribing patterns of practicing physicians

Intermediate septal accessory pathways: Electrocardiographic characteristics, electrophysiologic observations and their surgical implications

AbstractIntermediate septal accessory pathways are located in close proximity to the atrioventricular (AV) node and His bundle, have unique features that distinguish them from typical anterior and posterior accessory pathways and have been associated with a high risk for unsuccessful pathway division and the production of complete AV block after surgery. Between July 1986 and May 1990, 4 of 70 patients (3 men and 1 woman; mean age 33 ± 13 years) undergoing surgery for accessory pathway division were found to have an intermediate septal accessory pathway. The presenting arrhythmia was atrial fibrillation with rapid anterograde conduction over the accessory pathway in two patients and recurrent orthodromic reciprocating tachycardia in two patients.In all patients, the delta wave on the electrocardiogram (ECG) was inversed in lead V1, but two patterns of delta wave configuration were observed. In three patients (type 1 intermediate septal accessory pathway), the delta wave was upright in lead II, inverted in lead III and isoelectric in lead aVF; the transition from a negative to an upright delta wave occurred in lead V2. The fourth patient exhibited a different delta wave pattern (type 2 intermediate septal accessory pathway). The delta wave was upright in each of leads II, III and aVF; the transition from a negative to an upright delta wave occurred at lead V3.Intraoperative electrophysiologic study localized the atrial insertion of type 1 pathways to the midpoint of Koch's triangle close to the AV node. In the one patient with a type 1 pathway in which both anterograde and retrograde accessory pathway conduction was present, preoperative catheter mapping demonstrated that earliest retrograde atrial activation occurred near the foramen ovale. Intraoperative mapping during anterograde conduction over the type 1 pathway demonstrated earliest epicardial ventricular activation to occur simultaneously at the crux and the base of the aorta. The atrial insertion of the type 2 intermediate septal accessory pathway was localized to the apex of Koch's triangle in close proximity to the bundle of His. Preoperative catheter mapping revealed that earliest retrograde atrial activation occurred on the His bundle electrogram. Intraoperative mapping during anterograde conduction over the type 2 pathway demonstrated that earliest epicardial ventricular activation occurred anteriorly at the base of the aorta.Intraoperative ablation of the intermediate septal accessory pathway was accomplished by cooling the endocardium at the site of pathway insertion on the atrial side of the tricuspid anulus with a 5 mm cryoprobe. Patients with a type 1 intermediate septal accessory pathway had preservation of AV conduction, but the patient with the type 2 pathway did not and required permanent pacing. At late follow-up study, no patient has had return of intermediate septal accessory pathway conduction. Distinguishing an intermediate septal accessory pathway close to the AV node (type 1) from one close to the His bundle (type 2) is useful to predict both surgical success and success without the production of permanent complete AV block

Genetic and systems level analysis of Drosophila sticky/citron kinase and dFmr1 mutants reveals common regulation of genetic networks

<p>Abstract</p> <p>Background</p> <p>In <it>Drosophila</it>, the genes <it>sticky </it>and <it>dFmr1 </it>have both been shown to regulate cytoskeletal dynamics and chromatin structure. These genes also genetically interact with Argonaute family microRNA regulators. Furthermore, in mammalian systems, both genes have been implicated in neuronal development. Given these genetic and functional similarities, we tested <it>Drosophila sticky </it>and <it>dFmr1 </it>for a genetic interaction and measured whole genome expression in both mutants to assess similarities in gene regulation.</p> <p>Results</p> <p>We found that <it>sticky </it>mutations can dominantly suppress a <it>dFmr1 </it>gain-of-function phenotype in the developing eye, while phenotypes produced by RNAi knock-down of <it>sticky </it>were enhanced by <it>dFmr1 </it>RNAi and a <it>dFmr1 </it>loss-of-function mutation. We also identified a large number of transcripts that were misexpressed in both mutants suggesting that <it>sticky </it>and <it>dFmr1 </it>gene products similarly regulate gene expression. By integrating gene expression data with a protein-protein interaction network, we found that mutations in <it>sticky </it>and <it>dFmr1 </it>resulted in misexpression of common gene networks, and consequently predicted additional specific phenotypes previously not known to be associated with either gene. Further phenotypic analyses validated these predictions.</p> <p>Conclusion</p> <p>These findings establish a functional link between two previously unrelated genes. Microarray analysis indicates that <it>sticky </it>and <it>dFmr1 </it>are both required for regulation of many developmental genes in a variety of cell types. The diversity of transcripts regulated by these two genes suggests a clear cause of the pleiotropy that <it>sticky </it>and <it>dFmr1 </it>mutants display and provides many novel, testable hypotheses about the functions of these genes. As both of these genes are implicated in the development and function of the mammalian brain, these results have relevance to human health as well as to understanding more general biological processes.</p

Microplastic contamination has limited effects on coral fertilisation and larvae

Microplastics are ubiquitous throughout the world's oceans and contaminate coral reef ecosystems. There is evidence of microplastic ingestion by corals and passive contact with coral tissues, causing adverse health effects that include energy expenditure for particle removal from the tissue surface, as well as reduced growth, tissue bleaching, and necrosis. Here, it was examined whether microplastic contamination impairs the success of gamete fertilisation, embryo development and larval settlement of the reef-building coral Acropora tenuis. Coral gametes and larvae were exposed to fifteen microplastic treatments using two types of plastic: (1) weathered polypropylene particles and (2) spherical polyethylene microbeads. The treatments ranged from five to 50 polypropylene pieces L-1 and 25 to 200 microbeads L-1. Fertilisation was only negatively affected by the largest weathered microplastics (2 mm2), but the effects were not dose dependent. Embryo development and larval settlement were not significantly impacted by either microplastic type. The study shows that moderate-high levels of marine microplastic contamination, specifically particles <2 mm2, will not substantially interfere with the success of critical early life coral processes

Effects of Autism Spectrum Disorder Insurance Mandates on the Treated Prevalence of Autism Spectrum Disorder

Key Findings: State mandates requiring commercial health plans to cover services for children with autism spectrum disorder increased the number of children diagnosed with the disorder. However, diagnosis rates remain much lower than community estimates, suggesting that many commercially insured children with ASD remain undiagnosed or are insured through public plans

Slit1 and Slit2 Cooperate to Prevent Premature Midline Crossing of Retinal Axons in the Mouse Visual System

AbstractDuring development, retinal ganglion cell (RGC) axons either cross or avoid the midline at the optic chiasm. In Drosophila, the Slit protein regulates midline axon crossing through repulsion. To determine the role of Slit proteins in RGC axon guidance, we disrupted Slit1 and Slit2, two of three known mouse Slit genes. Mice defective in either gene alone exhibited few RGC axon guidance defects, but in double mutant mice a large additional chiasm developed anterior to the true chiasm, many retinal axons projected into the contralateral optic nerve, and some extended ectopically—dorsal and lateral to the chiasm. Our results indicate that Slit proteins repel retinal axons in vivo and cooperate to establish a corridor through which the axons are channeled, thereby helping define the site in the ventral diencephalon where the optic chiasm forms

Adjuvant Chemotherapy Use and Health Care Costs After Introduction of Genomic Testing in Breast Cancer

Genomic testing in patients with early-stage breast cancer is associated with decreased use of chemotherapy and lower costs in younger patients, and slightly increased use of chemotherapy and higher costs in older patients. Genomic testing in actual practice may “rule out” chemotherapy in younger women, and “rule in” chemotherapy in older women