MMP12, Lung Function, and COPD in High-Risk Populations
A variant of MMP12 is associated with increased lung function in children with asthma and in adult smokers. It is also associated with a decreased risk of chronic obstructive pulmonary disease in adult smokers.
Published Online December 16, 2009 (DOI: 10.1056/NEJMoa0904006)
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Genomewide Association Study of Leprosy
This study implicates variation in genes encoding molecules in the NOD2 signaling pathway (which regulates innate immunity) in susceptibility to infection with Mycobacterium leprae and leprosy.
Published Online December 16, 2009 (DOI: 10.1056/NEJMoa0903753)
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Household Transmission of 2009 H1N1 Influenza
This study shows that when a member of the household became infected with the 2009 H1N1 influenza virus, household contacts less than 18 years of age were twice as susceptible to an acute respiratory illness as were those 19 to 50 years of age, whereas contacts older than 50 years were less susceptible.
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Outbreak of 2009 H1N1 Influenza at a New York City School
Once introduced into a high school in New York City, the 2009 H1N1 virus spread quickly among students and staff, with an influenza-like illness developing in more than 800 people during a 2-week period in April 2009.
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Public Reporting of Discharge Planning and Rates of Readmissions
Health policy experts are focusing on the prevention of hospital readmissions as a way to improve quality and reduce costs. This study showed wide variation in hospital readmission rates but only a weak association between discharge planning and readmission.
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Activated Protein C for Sepsis
A 55-year-old man presents with a small-bowel perforation, and sepsis develops. Treatment with recombinant human activated protein C is recommended. The clinical benefit and recommendations for use of recombinant human activated protein C are controversial.
CME Exam
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A Boy with Hypothermia and Frostbite
A 16-year-old boy was admitted to the hospital after being found unconscious in a snowbank at 6 a.m. on New Year’s Day, approximately 7 hours after leaving a party at which alcohol was being served. The rectal temperature was 31.3°C. Both hands and the right foot were cold and hard to palpation; the left foot was cold but soft.
CME Exam
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Molecular Control of Age-Related Diseases
Female mice deficient in a molecule downstream of the TOR (target of rapamycin, now known as sirolimus) pathway not only have longer lives than control mice but also are protected against age-related decline that affects bone, muscle, and immunity.
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Launching HITECH
This week, the government took several critical steps toward a nationwide and secure electronic health information system. Dr. David Blumenthal, National Coordinator for Health Information Technology, describes the key elements of the HITECH Act.
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 December 30, 2009 (DOI: 10.1056/NEJMp0912825)
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“Play-or-Pay” Insurance Reforms for Employers — Confusion and Inequity
One prominent feature of the current health care reform bills is a “play-or-pay” rule for employers. Bradley Herring and Mark Pauly argue that this method results in confusion and could add further inequities to our system.
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December 30, 2009 (DOI: 10.1056/NEJMp0911920)
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Implementation and Enforcement of Health Care Reform — Federal versus State Government
Timothy Jost writes that the essential frameworks of the House and Senate bills are quite similar. Yet their approaches to oversight and enforcement, and in particular to the respective roles of the federal and state governments, differ substantially.
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 December 30, 2009 (DOI: 10.1056/NEJMp0911636)
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Carrots, Sticks, and Health Care Reform — Problems with Wellness Incentives
The current health care reform bills seek to expand the role of wellness incentives, but these provisions cannot be given an ethical free pass. Harald Schmidt and colleagues believe that some changes must be made to reconcile incentive use with ethical norms.
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December 30, 2009 (DOI: 10.1056/NEJMp0911552)
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Abortion Politics and Health Insurance Reform
The centrality of abortion in U.S. politics makes it likely that abortion funding will play a major role in determining whether there is any health care reform law at all. George Annas describes the Stupak amendment and the current state of the law on federal funding for abortion.
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Published Online December 2, 2009 (DOI: 10.1056/NEJMp0911513)
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Australia’s Winter with the 2009 Pandemic Influenza A (H1N1) Virus
Dr. James Bishop and colleagues write that key lessons from Australia’s experience with the spread of H1N1 suggest that important elements of a response were a national coordination of efforts and the use and modification of a national pandemic plan framework.
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Published Online November 25, 2009 (DOI: 10.1056/NEJMp0910445)
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The Emotional Epidemiology of H1N1 Influenza Vaccination
Dr. Danielle Ofri describes the fascinating and frustrating shift in public sentiment over the course of the H1N1 epidemic.
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Published Online November 25, 2009 (DOI: 10.1056/NEJMp0911047)
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Industry Influence on Comparative-Effectiveness Research Funded through Health Care Reform
The Senate Finance Committee’s health care reform bill would mandate industry involvement in the oversight of comparative-effectiveness research. Drs. Harry Selker and Alastair Wood make a case for the independence of the scientific process.
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Published Online November 18, 2009 (DOI: 10.1056/NEJMp0910747)
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Responses to 2009 H1N1 Vaccine in Children 3 to 17 Years of Age
These preliminary data support the use of one 15-µg dose of 2009 H1N1 vaccine without adjuvant in children between the ages of 9 and 17 years. However, in children 3 to 8 years of age, only the 7.5-µg dose of 2009 H1N1 vaccine with adjuvant met both the immunogenicity criteria after one dose.
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December 30, 2009 (DOI: 10.1056/NEJMc0909988)
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