Titin--springing back to youth?

Mutations in the muscle protein titin have been linked to dilated cardiomyopathy, a condition in which the heart chambers are enlarged and blood is ineffectively pumped, in humans and in animal models. This protein, which is a component of sarcomeres, provides essential scaffolding for other muscle proteins and acts as a spring to confer passive elasticity on the cardiomyocyte. Several titin isoforms exist, and they display varying size and degrees of elasticity. We review two interesting reports that show how variations in titin isoforms might be implicated in cardiac failure.     

The right-to-die movement: extrapolating from the National Hemlock Society U.S.A. membership survey

A national membership survey of Hemlock Society USA was conducted by Fox and Kamakahi (1995). Respondents (N=6398) were asked a variety of questions, but in this paper we perform a longitudinal analysis of the characteristics of Hemlock Society USA members. Hemlock Society USA members are divided into three 5-year cohorts: Early Joiners (11 or more years of membership), Middle Joiners (6 to 10 years membership), and Late Joiners (5 or fewer years of membership). Differences between cohorts are examined and extrapolations made regarding Hemlock Society USA and the Right-to-Die Movement. A series of one-way ANOVAs were used with Scheme post-hoc comparisons as heuristic tools for assessing between-cohort differences. Late Joiners are different from earlier members, but are more like other Hemlock Society USA members than the adult U.S. population at large. Hemlock Society USA members are essentially societal "elites" (based on socio-demographic variables) who work in social environments that are decidedly split on the issue of voluntary suicide and euthanasia.     

Physician behavior at the e-technology/learning intersection: an interview with Elliott Masie. Interview by Richard L. Reece

Richard L. Reece, MD, interviewed Elliott Masie on January 16, 2001, to talk about the Internet learning world--that vast intersection of e-technology, learning, and human behavior. He describes how he looks beyond the hype of technology into how human beings behave and what they crave in social experiences. The real question, he says, is how do we have knowledge experiences and blend them with social experiences to achieve the optimal mix? Masie emphasizes, "The magic of learning is in the mix--what happens online and then what happens informally when we have a cup of coffee with a colleague." He continues, "Many of the capital market folks hate to hear about the human element, because they want to believe we'll be able to do everything from our PCs. But that's not how humans behave. It's the mixture that gets results. That's where the real excitement occurs."     

Leading beyond the bottom line, Part 4. The questions it has raised

The Leading Beyond the Bottom Line article series has received an overwhelming response from ACPE members, mostly in enthusiastic support of this new leadership concept. Some of the important questions raised by members are presented with answers from the authors. This article also explores the moral challenge of leadership and why health care is more than a business. In recent years, there's been confusion about the role of the health care enterprise, its leadership and its management. We have lost our way about the "moral" thing, the "right" thing, because we have no philosophy to guide us. To manage or lead in this "business" of health care, a philosophy is required that recognizes the multiple elements to which the leader has responsibility and obligations: the customers, community, employees, and, certainly, the financial assets.     

What is it like to work for a pharmaceutical company? Interview by Barbara J. Linney

Is working for a pharmaceutical company a career option you've thought about pursuing? In this column, Barbara Linney interviews physician executive Edward A. Kaufman, MD, about his 20-year experience working in the pharmaceutical industry. He talks about how he held a series of jobs for SmithKline Beecham's clinical labs business and lived in a number of places. He describes his background and how it made him an attractive candidate for the position, why he sought out the pharmaceutical industry, the nature of the work, and some of the projects that he has been involved in. He gives examples of physicians who have joined the executive ranks at GlaxoSmithKline and what made them such high-caliber candidates for top leadership positions.     

Economic potential and entry into marriage and cohabitation

This article explores the relationship between economic potential and rates of entry into marriage and cohabitation. Using data from the 1990 census and the 1980-1992 High School and Beyond (Sophomore Cohort), we developed a method for explicitly estimating five time-varying measures of earnings potential. The analyses of union formation are based on an intergenerational panel study of parents and children, to which our measures of earnings potential were appended. The results indicate that all five measures of earnings potential strongly and positively influence the likelihood of marriage for men, but not for women. Earnings potential does not affect entry into cohabiting unions for either men or women.     

An attribution model of public discrimination towards persons with mental illness

In this study, we build on previous work by developing and estimating a model of the relationships between causal attributions (e.g., controllability, responsibility), familiarity with mental illness, dangerousness, emotional responses (e.g., pity, anger, fear), and helping and rejecting responses. Using survey data containing responses to hypothetical vignettes, we examine these relationships in a sample of 518 community college students. Consistent with attribution theory, causal attributions affect beliefs about persons' responsibility for causing their condition, beliefs which in turn lead to affective reactions, resulting in rejecting responses such as avoidance, coercion, segregation, and withholding help. However, consistent with a danger appraisal hypothesis, the effects of perceptions of dangerousness on helping and rejecting responses are unmediated by responsibility beliefs. Much of the dangerousness effects operate by increasing fear, a particularly strong predictor of support for coercive treatment. The results from this study also suggest that familiarity with mental illness reduces discriminatory responses.     

A "good death" for whom? Quality of spouse's death and psychological distress among older widowed persons

Ethicists, policy makers, and care providers are increasingly concerned with helping the dying elderly to experience a "good death." A "good death" is characterized by physical comfort, social support, acceptance, and appropriate medical care, and it should minimize psychological distress for the dying and their families. I identify the predictors of death quality and evaluate how the quality of an older adult's death affects the surviving spouse's psychological adjustment six months after the loss. Analyses use Changing Lives of Older Couples (CLOC) data, a prospective study of married persons ages 65 and older. Positive spousal relationships during the final days increase survivors' yearning yet reduce their anger. Having a spouse die a painful death is associated with elevated anxiety, yearning, and intrusive thoughts. The perception of physician negligence is associated with elevated anger. These findings suggest that improved end-of-life care and pain management will benefit both the dying and their bereaved spouses.