What Is Judicial Ideology, and How Should We Measure It?

Part I of this Article explores the theoretical problem that scholars use the term “judicial ideology” in the absence of any widespread agreement or clear understanding as to what the term means in the first place. It is difficult for scholars to devise appropriate and broadly acceptable measures of judicial ideology when they and their readers have different concepts—or perhaps no coherent concept at all—of “judicial ideology” in mind. As a result, bona fide intellectual disagreement over the nature of judicial behavior is too easily compounded by outright misunderstanding. Part II discusses three of the most significant and common practical obstacles to the measurement of judicial ideology. First, ideology is not a tangible phenomenon that can be directly observed. Second, judicial behavior is often open to multiple interpretations. Third, judicial ideology may be a multidimensional phenomenon, such that a judge who is liberal in one context may be moderate or conservative in another, or the labels “liberal,” “moderate,” and “conservative” may not seem applicable at all. Parts III and IV of this Article aim to address an important practical need of judicial behavior scholars. There are several ways in which one can measure judicial ideology, but little has been written about how researchers should go about choosing among these methods. Competing considerations of accuracy, convenience, and ease of interpretation make it difficult to know what measurementapproach is most appropriate to the task at hand. In Part III, the relative merits of three popular approaches are identified and discussed: the use of proxy measures, the assessment of judicial ideology based on the actual behavior of the judges in a particular context, and the transplantation of ideology measures developed in one context into other contexts involving partly or wholly different data. Finally, in Part IV, the real-world performance of different measurement approaches are compared, using data drawn from the federal courts of appeals and the Supreme Court

Decision analytic model for evaluation of suspected coronary disease with stress testing and coronary CT angiography.

RATIONALE AND OBJECTIVES: The aim of this study was to apply a decision analytic model for the evaluation of coronary artery disease (CAD) to define the optimal utilization of coronary computed tomographic angiography (cCTA) and stress testing. MATERIALS AND METHODS: The model tested in this study assumes that CAD is evaluated with a stress test and/or cCTA and that a patient with positive evaluation results undergoes cardiac catheterization. On the basis of values of sensitivity, specificity, and radiation dose from the published literature and test costs from the Medicare fee schedule, a decision tree model was constructed as a function of disease prevalence. RESULTS: The false-negative rate is lowest when cCTA is used as an isolated test. The false-positive rate is minimized when cCTA is used in combination with stress echocardiography. Effective radiation is minimized by use of stress electrocardiography or stress echocardiography alone or prior to cCTA. When the pretest probability of CAD is low, a strategy that uses stress echocardiography followed by cCTA minimizes the false-positive rate and effective radiation exposure, with relatively low imaging costs and with a false-negative rate only slightly higher than a strategy including stress myocardial scintigraphy. As the pretest probability of CAD increases above 20%, the false-negative rate of stress echocardiography followed by cCTA increases by \u3e5% relative to cCTA alone. CONCLUSION: Effective radiation dose and imaging costs for the workup of CAD may be minimized by an appropriate combination of stress testing and cCTA. A strategy that uses stress echocardiography followed by cCTA is most appropriate for the evaluation of low-risk patients with CAD with a pretest probability \u3c 20%, while cCTA alone may be more appropriate in intermediate-risk patients

Management of Iatrogenic Coronary Artery Dissections Failing to Prepare Is Preparing to Fail

CICAD is a rare but important complication of coronary angiography and PCI. Careful attention to preventative techniques and knowledge of effective treatment strategies will prepare operators well and facilitate successful outcomes in this potentially life-threatening complication

Reconstrucción mínimamente invasiva del ligamento anterolateral

ResumenIntroducciónLa inestabilidad anteroposterior y la laxitud rotatoria demostrada mediante test de pivot-shift severo podría estar causada por la combinación de lesión de ligamento cruzado anterior (LCA) y de estructuras laterales de la rodilla, particularmente del ligamento anterolateral (LAL). Este último actúa como estabilizador secundario, restringiendo la rotación interna y complementando el rol primario de estabilización del LCA.Material y métodosDescribir la técnica de reconstrucción mínimamente invasiva del LAL tras realizar una cirugía de revisión del LCA. Además, se ofrece una breve descripción de las indicaciones quirúrgicas, resultados y complicaciones.DiscusiónLa inestabilidad rotatoria persistente tras la reconstrucción de LCA indica que la reconstrucción intraarticular podría no ser suficiente para restaurar la estabilidad rotacional en un subgrupo específico de pacientes. Se han descrito numerosas técnicas de reconstrucción extraarticulares (mencionadas previamente), algunas de ellas con incisiones de gran tamaño, con los consiguientes problemas estéticos. Esta nota describe una técnica simple y mínimamente invasiva de reconstrucción de LAL, realizada tras una revisión del LCA con técnica anatómica, todo en el mismo procedimiento quirúrgico. Esta técnica está indicada en roturas agudas o exploraciones/revisiones del LCA que presenten pivot-shift severo, así como también en pacientes con roturas crónicas del LCA o en pacientes que sean hiperlaxos.A pesar de que esta técnica no ha demostrado ser superior a otras reconstrucciones extraarticulares del LAL, se presenta como una cirugía simple, confiable y rápida, con buenos resultados estéticos.AbstractIntroductionAnteroposterior instability and rotatory laxity demonstrated by severe pivot-shift test may be caused by combined lesions of the anterior cruciate ligament (ACL) and lateral structures of the knee, particularly the anterolateral ligament (ALL). This ligament acts as a secondary stabiliser that restrains internal rotation and supplements the primary stabilising role of the ACL.Materials and methodsTo describe a minimally invasive ALL reconstruction technique following anterior cruciate ligament revision surgery. Brief description of surgical indications, outcomes, and complications.DiscussionPersistent rotatory instability after ACL reconstruction suggests that intra-articular reconstruction may not be sufficient to restore rotational stability in a subgroup of patients. Numerous extra-articular reconstruction techniques have been described with long incisions and cosmetic issues. A description is presented of a simple, minimally invasive ALL reconstruction technique performed after anatomical ACL revision in a single procedure. This technique is indicated in patients with acute ACL injuries and revision ACL associated with a severe pivot-shift, chronic ACL injuries, and joint hyper-laxity. Although this technique has not proven to be superior to any other extra-articular anterolateral ligament reconstructions, it uses simple, reliable and cosmetic surgery, with good early results in a small series of patients

Does Discharge Pharmacy Affect Outcomes After Percutaneous Coronary Intervention?

Aims for Improvement To reduce the rate of this institution’s readmission rate in patients discharged after PCI, by identifying the current trends in readmission in relation to prescription and medication delivery practices over the past 1 year

Novel Approaches to Coronary Perforations: Everything But the Kitchen Sink.

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