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December 30, 2010  Vol. 363 No. 27

Audio Summary of this Issue

Perspective
2577-2579
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The performance of scheduled elective surgery is one practice area that may be amenable to policies — beginning with informed consent — aimed at improving patient safety by reducing the adverse effects of physicians' sleep deprivation.

2579-2582

Improving care coordination under health care reform will require the development of accountable care organizations (ACOs). A crucial question is whether hospitals or physicians will control ACOs — and capture the largest share of any savings they achieve.

2583-2585
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An accountable care organization (ACO) model that does not attend to the way patients seek care may fail to achieve its cost-saving and quality goals and may give rise to a backlash. Policymakers should focus on creating incentives to build patients' loyalty to an ACO.

Original Articles
2587-2599

In this study, 2499 HIV-seronegative men or transgender women who were at high risk for HIV acquisition were enrolled in a trial of daily emtricitabine plus tenofovir versus placebo. Those receiving the antiretroviral medication had a 44% reduction in HIV incidence.

2600-2610

Survival in chronic granulomatous disease is related to the level of NADPH oxidase activity, which correlates with the altered site on the mutated gene. Assessed NADPH oxidase activity is a more powerful prognostic factor than reported clinical features of the disease.

2611-2620

In this trial, an intervention involving a medically supervised nurse providing guideline-based management, as compared with usual care, resulted in improved medical outcomes in patients who had depression and diabetes, coronary heart disease, or both.

2621-2627

Two deer hunters presented with a violaceous nodule on a finger several weeks after field-dressing white-tailed deer. Electron microscopy revealed ovoid virions suggestive of parapoxvirus. DNA sequence analysis indicated that the causative agent was a unique parapoxvirus.

2628-2637

In a man with a BUB1B mutation, multiple gastrointestinal polyps and gastric and colonic aneuploid neoplasms developed. Abnormalities affecting the spindle-assembly checkpoint, which ensures that each daughter cell of a cell division contains the correct number of chromosomes, may contribute to common types of cancer.

Review Article
2638-2650

This review discusses the clinical and neurophysiological features of general anesthesia and their relationships to sleep and coma, focusing on the neural mechanisms of unconsciousness induced by selected intravenous anesthetic drugs.

Images in Clinical Medicine
2651
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An 88-year-old man who reported he did not smoke and who had a long-standing history of diabetes mellitus, hypertension, and hypercholesterolemia was admitted to the hospital with a 4-month history of painful and progressive ischemic gangrene of the right ...

e40
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A 20-year-old woman was evaluated at the hospital 2 hours after ingesting 5 g of diphenhydramine in a suicide attempt. She had a generalized seizure en route to the hospital and several more in the emergency department. Electrocardiography revealed sinus ...

Case Records of the Massachusetts General Hospital
2652-2661
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A 68-year-old woman was transferred to this hospital because of substernal chest pain. An ECG showed evidence of MI. Coronary angiography was performed, with stenting of an occluded coronary artery. On the fourth hospital day, hypotension, bradycardia, and cardiac arrest occurred, and the patient died.

Editorials
2663-2665

Despite the growing global access to life-extending antiretroviral drugs for the more than 33 million persons living with human immunodeficiency virus (HIV) infection, approximately 7000 new infections occur daily. This alarming number speaks to the ...

2665-2666

Genomic instability is a common occurrence in solid tumors, and it has long been conjectured that this process plays a causal role in cancer. The field of human molecular genetics has provided a means to test this hypothesis, fueled in part by the ...

Clinical Implications of Basic Research
2667-2669

Rosiglitazone and other thiazolidinediones are thought to sensitize adipose and other tissues to insulin by activating a molecule called PPARγ. A recent study suggests that the therapeutic effect of rosiglitazone is mediated by its prevention of the phosphorylation of PPARγ.

Correspondence
2670-2671

To the Editor: In their article on exacerbation in patients with chronic obstructive pulmonary disease (COPD), Hurst et al. (Sept. 16 issue)1 report that the rate of occurrence appears to reflect a susceptibility phenotype. I believe that stimulation of ...

2672

To the Editor: In the case review of a 62-year-old woman with idiopathic urgency urinary incontinence, Nygaard (Sept. 16 issue)1 suggests treatment with an anticholinergic medication after a trial of lifestyle and behavioral therapies. She further ...

2672-2673

To the Editor: The Perspective article by Nurok et al. in this issue of the Journal 1 is a timely one that clearly articulates the surgical profession's concerns about the effects of sleep deprivation on performance. The American College of Surgeons (ACS)...

Corrections
2673

Medicaid Expansion — The Soft Underbelly of Health Care Reform? Perspective, N Engl J Med 2010;363:2085-2087. In the figure legend (page 2086), the last sentence should have read, “The red line shows the regression equation: Enrollment=0.66−0.46×Newly ...

2673

Hereditary Angioedema — Therapies Old and New Editorial, N Engl J Med 2010;363:581-583. In the fourth paragraph, beginning “The initial formulations . . .” (page 581), the fourth sentence should have read, “The recent International Multicentre Prospective ...

2674

Maternal Vitamin A Supplementation and Lung Function in Offspring Original Article, N Engl J Med 2010;362:1784-1794. In the “Characteristics of the Study Population” subsection of Results (page 1787), the first sentence of the final paragraph should have ...