Still the Economy, Stupid: Economic Voting in the 2004 Presidential Election

Given President Bush's popularity among relatively poor rural residents and lack thereof among wealthier urban dwellers in the 2004 presidential election, analysts have suggested that voters contradicted their economic self-interests. We investigate whether this conventional wisdom implied an absence of economic voting. Using exit poll data, we estimate whether a change in previous four-year financial status affected the propensity to vote for Bush. The main econometric concern is that underlying preferences for Bush might dictate financial status change responses. Beyond income and several other demographic variables, therefore, the regressions hold constant indicators for state and congressional district, religious affiliation, political philosophy and party, and Iraq war support. Even further controlling for approval of Bush's job performance, economic voting is statistically and quantitatively significant. Effects are asymmetric, with status worsening hurting Bush more than status improvement helped, and persist even among subgroups that provided particularly strong or weak support for Bush.

Vulnerability to Stroke: Implications of Perinatal Programming of the Hypothalamic-Pituitary-Adrenal Axis

Chronic stress is capable of exacerbating each major, modifiable, endogenous risk factor for cerebrovascular and cardiovascular disease. Indeed, exposure to stress can increase both the incidence and severity of stroke, presumably through activation of the hypothalamic-pituitary-adrenal (HPA) axis. Now that characterization of the mechanisms underlying epigenetic programming of the HPA axis is well underway, there has been renewed interest in examining the role of early environment on the evolution of health conditions across the entire lifespan. Indeed, neonatal manipulations in rodents that reduce stress responsivity, and subsequent life-time exposure to glucocorticoids, are associated with a reduction in the development of neuroendocrine, neuroanatomical, and cognitive dysfunctions that typically progress with age. Although improved day to day regulation of the HPA axis also may be accompanied by a decrease in stroke risk, evidence from rodent studies suggest that an associated cost could be increased susceptibility to inflammation and neuronal death in the event that a stroke does occur and the individual is exposed to persistently elevated corticosteroids. Given its importance in regulation of health and disease states, any long-term modulation of the HPA axis is likely to be associated with both benefits and potential risks. The goals of this review article are to examine (1) the clinical and experimental data suggesting that neonatal experiences can shape HPA axis regulation, (2) the influence of stress and the HPA axis on stroke incidence and severity, and (3) the potential for neonatal programming of the HPA axis to impact adult cerebrovascular health

Does Presenting Patients’ BMI Increase Documentation of Obesity?

Purpose: Despite the associated health consequences, obesity is infrequently documented as a problem in medical charts. The purpose of this study is to determine whether a simple intervention (routine listing of the BMI on the medical chart) will increase physician documentation of obesity in the medical record. Methods: Participants were resident physicians in a family medicine residency program. Participants were randomly assigned to either an experimental group or a control group. For experimental group physicians, the Body Mass Index was listed alongside other vital signs of patients seen in an ambulatory setting. Physician documentation of patient obesity was assessed by chart review after patient visits. Documentation was defined as inclusion of obesity on the problem list or in the progress note. Results: The intervention did not significantly increase the rate of documentation of obesity in the medical chart. Several reasons for the lack of change are explored, including the difficulty of treating obesity successfully

To Tube or Not to Tube? The Role of Intubation during Stroke Thrombectomy.

In the 10 years since the FDA first cleared the use of endovascular devices for the treatment of acute stroke, definitive evidence that such therapy improves outcomes remains lacking. The decision to intubate patients undergoing stroke thrombectomy impacts multiple variables that may influence outcomes after stroke. Three main areas where intubation may deleteriously affect acute stroke management include the introduction of delays in revascularization, fluctuations in peri-procedural blood pressure, and hypocapnia, resulting in cerebral vasoconstriction. In this mini-review, we discuss the evidence supporting these limitations of intubation during stroke thrombectomy and encourage neurohospitalists, neurocritical care specialists, and neurointerventionalists to carefully consider the decision to intubate during thrombectomy and provide strategies to avoid potential complications associated with its use in acute stroke

Vulnerable Victims: Guaranteeing Procedural Protections to Child and Developmentally Disabled Victims in Establishing Probable Cause for Search and Arrest Warrants

Congress has enacted legislation delineating the rights of child victims and witnesses during formal trials. In limiting its protections to this context, however, Congress ignores the reality that much of the child testimony upon which the legal system relies takes place outside of court during the pre-trial stages of an investigation. Further, Congress has failed to consider the growing numbers of children who are diagnosed with developmental disabilities and the issues that arise when these children are victims or witnesses of crime. The federal approach to these issues currently consists of a mishmash of standards that vary from circuit to circuit. This Comment argues that, to reduce this unpredictability and inconsistency, Congress should adopt a clear federal standard to evaluate the sufficiency of child testimony to establish probable cause for search and arrest warrants. Such a standard would also balance the vulnerability of child victims, including those with developmental disabilities, against the constitutional protections afforded to criminal defendants. The proposed legislation consists of three major elements: (1) a flexible factor test to determine the sufficiency of the child\u27s testimony; (2) a provision eliminating corroboration requirements; and (3) an exception from the rule against hearsay. Justice is not served by discounting the testimony of victims merely due to youth or disability, and a concise federal standard would ensure that the federal system adequately serves these vulnerable victims