Overdiagnosis and overtreatment over time

Overdiagnosis and overtreatment are often thought of as relatively recent phenomena, influenced by a contemporary combination of technology, specialization, payment models, marketing, and supply-related demand. Yet a quick glance at the historical record reveals that physicians and medical manufacturers have been accused of iatrogenic excess for centuries, if not millennia. Medicine has long had therapeutic solutions that search for ever-increasing diagnostic problems. Whether the intervention at hand has been leeches and lancets, calomel and cathartics, aspirins and amphetamines, or statins and SSRIs, medical history is replete with skeptical critiques of diagnostic and therapeutic enthusiasm. The opportunity cost of this profusion shapes the other side of the coin: chronic persistence of underdiagnosis and undertreatment. Drawing from key controversies of the 19th and 20th centuries, we chart the enduring challenges of inter-related diagnostic and therapeutic excess. As the present critique of overdiagnosis and overtreatment seeks to mobilize resources from inside and outside of medicine to rein in these impulses, we provide an instructive historical context from which to act

Misdiagnosis, Mistreatment, and Harm - When Medical Care Ignores Social Forces.

The Case Studies in Social Medicine demonstrate that when physicians use only biologic or individual behavioral interventions to treat diseases that stem from or are exacerbated by social factors, we risk harming the patients we seek to serve

Science yield estimate with the Wide-Field Infrared Survey Telescope coronagraph

The coronagraph instrument (CGI) on the Wide-Field Infrared Survey Telescope will directly image and spectrally characterize planets and circumstellar disks around nearby stars. Here we estimate the expected science yield of the CGI for known radial-velocity (RV) planets and potential circumstellar disks. The science return is estimated for three types of coronagraphs: the hybrid Lyot and shaped pupil are the currently planned designs, and the phase-induced amplitude apodizing complex mask coronagraph is the backup design. We compare the potential performance of each type for imaging as well as spectroscopy. We find that the RV targets can be imaged in sufficient numbers to produce substantial advances in the science of nearby exoplanets. To illustrate the potential for circumstellar disk detections, we estimate the brightness of zodiacal-type disks, which could be detected simultaneously during RV planet observations

A New H I Survey of Active Galaxies

We have conducted a new Arecibo survey for H I emission for 113 galaxies with broad-line (type 1) active galactic nuclei (AGNs) out to recession velocities as high as 35,000 km/s. The primary aim of the study is to obtain sensitive H I spectra for a well-defined, uniformly selected sample of active galaxies that have estimates of their black hole masses in order to investigate correlations between H I properties and the characteristics of the AGNs. H I emission was detected in 66 out of the 101 (65%) objects with spectra uncorrupted by radio frequency interference, among which 45 (68%) have line profiles with adequate signal-to-noise ratio and sufficiently reliable inclination corrections to yield robust deprojected rotational velocities. This paper presents the basic survey products, including an atlas of H I spectra, measurements of H I flux, line width, profile asymmetry, optical images, optical spectroscopic parameters, as well as a summary of a number of derived properties pertaining to the host galaxies. To enlarge our primary sample, we also assemble all previously published H I measurements of type 1 AGNs for which can can estimate black hole masses, which total an additional 53 objects. The final comprehensive compilation of 154 broad-line active galaxies, by far the largest sample ever studied, forms the basis of our companion paper, which uses the H I database to explore a number of properties of the AGN host galaxies.Comment: To appear in ApJS; 31 pages. Preprint will full-resolution figures can be downloaded from http://www.ociw.edu/~lho/preprints/ms1.pd

Properties of Active Galaxies Deduced from H I Observations

We completed a new survey for H I emission for a large, well-defined sample of 154 nearby (z < 0.1) galaxies with type 1 AGNs. We make use of the extensive database presented in a companion paper to perform a comprehensive appraisal of the cold gas content in active galaxies and to seek new strategies to investigate the global properties of the host galaxies and their relationship to their central black holes (BHs). We show that the BH mass obeys a strong, roughly linear relation with the host galaxy's dynamical mass. BH mass follows a looser, though still highly significant, correlation with the maximum rotation velocity of the galaxy, as expected from the known scaling between rotation velocity and central velocity dispersion. Neither of these H I-based correlations is as tight as the more familiar relations between BH mass and bulge luminosity or velocity dispersion, but they offer the advantage of being insensitive to the glare of the nucleus and therefore are promising new tools for probing the host galaxies of both nearby and distant AGNs. We present evidence for substantial ongoing BH growth in the most actively accreting AGNs. In these nearby systems, BH growth appears to be delayed with respect to the assembly of the host galaxy but otherwise has left no detectable perturbation to its mass-to-light ratio or its global gas content. The host galaxies of type 1 AGNs, including those luminous enough to qualify as quasars, are generally gas-rich systems, possessing a cold interstellar medium reservoir at least as abundant as that in inactive galaxies of the same morphological type. This calls into question current implementations of AGN feedback in models of galaxy formation that predict strong cold gas depletion in unobscured AGNs. (Abridged)Comment: To appear in ApJ; 14 page

Resolution of Primary Lymphedema: A Case Report

Summary: Primary lymphedema is a rare, progressive disease that typically affects the lower extremity. The condition is not curable, and the limb enlarges over time because of subcutaneous fibroadipose deposition. We present a patient with clinical and radiographical evidence of resolution of primary lymphedema. This observation may provide greater insight into the pathophysiology of the disease

Dynamical Measurements of Black Hole Masses in Four Brightest Cluster Galaxies at 100 Mpc

We present stellar kinematics and orbit superposition models for the central regions of four Brightest Cluster Galaxies (BCGs), based upon integral-field spectroscopy at Gemini, Keck, and McDonald Observatories. Our integral-field data span radii from < 100 pc to tens of kpc. We report black hole masses, M_BH, of 2.1 +/- 1.6 x 10^10 M_Sun for NGC 4889, 9.7 + 3.0 - 2.6 x 10^9 M_Sun for NGC 3842, and 1.3 + 0.5 - 0.4 x 10^9 M_Sun for NGC 7768. For NGC 2832 we report an upper limit of M_BH < 9 x 10^9 M_Sun. Stellar orbits near the center of each galaxy are tangentially biased, on comparable spatial scales to the galaxies' photometric cores. We find possible photometric and kinematic evidence for an eccentric torus of stars in NGC 4889, with a radius of nearly 1 kpc. We compare our measurements of M_BH to the predicted black hole masses from various fits to the relations between M_BH and stellar velocity dispersion, luminosity, or stellar mass. The black holes in NGC 4889 and NGC 3842 are significantly more massive than all dispersion-based predictions and most luminosity-based predictions. The black hole in NGC 7768 is consistent with a broader range of predictions.Comment: 24 pages, 18 figures. Accepted for publication in Ap

Fuzzy Spheres in pp Wave Matrix String Theory

The behaviour of matrix string theory in the background of a type IIA pp wave at small string coupling, g_s << 1, is determined by the combination M g_s where M is a dimensionless parameter proportional to the strength of the Ramond-Ramond background. For M g_s << 1, the matrix string theory is conventional; only the degrees of freedom in the Cartan subalgebra contribute, and the theory reduces to copies of the perturbative string. For M g_s >> 1, the theory admits degenerate vacua representing fundamental strings blown up into fuzzy spheres with nonzero lightcone momenta. We determine the spectrum of small fluctuations around these vacua. Around such a vacuum all N-squared degrees of freedom are excited with comparable energies. The spectrum of masses has a spacing which is independent of the radius of the fuzzy sphere, in agreement with expected behaviour of continuum giant gravitons. Furthermore, for fuzzy spheres characterized by reducible representations of SU(2) and vanishing Wilson lines, the boundary conditions on the field are characterized by a set of continuous angles which shows that generically the blown up strings do not ``close''.Comment: 45 pages REVTeX 4 and AMSLaTeX. 1 figure. v2: references added. Figure redrawn using LaTe

The economic impact of Staphylococcus aureus infection in New York City hospitals.

We modeled estimates of the incidence, deaths, and direct medical costs of Staphylococcus aureus infections in hospitalized patients in the New York City metropolitan area in 1995 by using hospital discharge data collected by the New York State Department of Health and standard sources for the costs of health care. We also examined the relative impact of methicillin-resistant versus -sensitive strains of S. aureus and of community-acquired versus nosocomial infections. S. aureus-associated hospitalizations resulted in approximately twice the length of stay, deaths, and medical costs of typical hospitalizations; methicillin-resistant and -sensitive infections had similar direct medical costs, but resistant infections caused more deaths (21% versus 8%). Community-acquired and nosocomial infections had similar death rates, but community-acquired infections appeared to have increased direct medical costs per patient ($35,300 versus$28,800). The results of our study indicate that reducing the incidence of methicillin-resistant and -sensitive nosocomial infections would reduce the societal costs of S. aureus infection