William Hobbs

We analyzed the prevalence, inheritance, progression, and functional implications of spinal deformity in Marfan syndrome using four different groups of patients. We studied 113 patients who had Marfan syndrome, eighty-two of whom were skeletally immature, in order to characterize the alignment and function of the spine. The patients were selected from a clinic that provides total care with no bias toward the presence of orthopaedic conditions. Scoliosis was identified in fifty-two of the eighty-two patients, and the prevalences for the sexes were equal. The thoracic portion of the curve was convex to the right in all but two patients. The mean kyphosis was greater than that in the general population. Five distinct sagittal profiles were identified on the basis of whether the thoracic kyphosis was within, greater than, or less than normal limits and whether the transition between the kyphosis and lordosis occurred at or caudad to the normal level or whether the curves were reversed. Spondylolisthesis was present in five patients (6 per cent), with a mean slip of 30 per cent. Fourteen pedigrees were studied in depth. There was no familial pattern of the scoliosis. A separate group of fifty-six patients with scoliosis, for whom serial follow-up radiographs were available, was studied for progression. Patients who had a curve of more than 30 degrees had mild progression, and those who had a curve of more than 50 degrees had marked progression (mean, 3 +/- 4 degrees per year). Pain and function of the back were studied in thirty patients who were thirty-five to forty-five years old; these patients were found to be more impaired than matched controls. The presence of scoliosis was associated with pain in the region of the curve in these patients.

Abstract This paper analyses Chinese sub-national governments’ implementation strategies to meet national energy efficiency targets in the 11th Five-Year Plan (2006–2010). Previous research has focused on the ways governance practices and decision-making structures shape implementation outcomes, yet very little attention has been given to what strategies local leaders actually employ to bridge national priorities with local interests. To illustrate how local leaders work politically, this paper highlights specific implementation methods officials use to strengthen formal incentives and create effective informal incentives to comply with energy efficiency mandates. The analysis is drawn from 53 interviews conducted in June and July of 2010 in Shanxi, a major coal-producing and energy-intensive province. Findings suggest that local government leaders conform to national directives by “bundling” the energy efficiency policy with policies of more pressing local importance or by “bundling” their energy efficiency objectives with the interests of groups with significant political influence. Ultimately, sub-national government officials frame policies in ways that give them legitimacy at the local level.

Conventional wisdom assumes that increased censorship will strictly decrease access to information. We delineate circumstances when increases in censorship expand access to information for a substantial subset of the population. When governments suddenly impose censorship on previously uncensored information, citizens accustomed to acquiring this information will be incentivized to learn methods of censorship evasion. These evasion tools provide continued access to the newly blocked information—and also extend users’ ability to access information that has long been censored. We illustrate this phenomenon using millions of individual-level actions of social media users in China before and after the block of Instagram. We show that the block inspired millions of Chinese users to acquire virtual private networks, and that these users subsequently joined censored websites like Twitter and Facebook. Despite initially being apolitical, these new users began browsing blocked political pages on Wikipedia, following Chinese political activists on Twitter, and discussing highly politicized topics such as opposition protests in Hong Kong.

The authors reviewed reported cases of antibiotic-induced manic episodes by means of a MEDLINE and PsychLit search for reports of antibiotic-induced mania. Unpublished reports were requested from the World Health Organization (WHO) and the Food and Drug Administration (FDA). Twenty-one reports of antimicrobial-induced mania were found in the literature. There were 6 cases implicating clarithromycin, 13 implicating isoniazid, and 1 case each implicating erythromycin and amoxicillin. The WHO reported 82 cases. Of these, clarithromycin was implicated in 23 (27.6%) cases, ciprofloxacin in 12 (14.4%) cases, and ofloxacin in 10 (12%) cases. Cotrimoxazole, metronidazole, and erythromycin were involved in 15 reported manic episodes. Cases reported by the FDA showed clarithromycin and ciprofloxacin to be the most frequently associated with the development of mania. Statistical analysis of the data would not have demonstrated a significant statistical correlative risk and was therefore not undertaken. Patients have an increased risk of developing mania while being treated with antimicrobials. Although this is not a statistically significant risk, physicians must be aware of the effect and reversibility. Further research clearly is required to determine the incidence of antimicrobial-induced mania, the relative risk factors of developing an antimicrobial-induced manic episode among various demographic populations, and the incidence of patients who continue to have persistent affective disorders once the initial episode, which occurs while the patient is taking antibiotics, subsides. The authors elected to name this syndrome "antibiomania."

Social interactions increasingly take place online. Friendships and other offline social ties have been repeatedly associated with human longevity, but online interactions might have different properties. Here, we reference 12 million social media profiles against California Department of Public Health vital records and use longitudinal statistical models to assess whether social media use is associated with longer life. The results show that receiving requests to connect as friends online is associated with reduced mortality but initiating friendships is not. Additionally, online behaviors that indicate face-to-face social activity (like posting photos) are associated with reduced mortality, but online-only behaviors (like sending messages) have a nonlinear relationship, where moderate use is associated with the lowest mortality. These results suggest that online social integration is linked to lower risk for a wide variety of critical health problems. Although this is an associational study, it may be an important step in understanding how, on a global scale, online social networks might be adapted to improve modern populations' social and physical health.