Success factors in merging teaching hospitals.

Merger has served as a major strategy for the leaders of academic medical centers (i.e., teaching hospitals) who are pursuing health system development for their institutions. Applying hindsight to their personal experience, the authors explore common themes in several mergers that have survived the test of time. Although many elements influence merger outcomes, experience suggests several of unique importance. These include effective leadership in the areas of creating trust, managing uncertainty, ensuring medical staff stability, and bridging cultural divides across the organizations. While a quantitative business case should support any merger, the authors' experiences underscore the importance of successfully assessing and managing organizational and individual dynamics when bringing together major teaching hospitals.

A personal perspective on the early, early history of in vivo (DNA-based) gene therapy.

Our first efforts in the laboratory to explore the concept of in vivo gene therapy began in late 1984. Our first peer-reviewed paper demonstrating success in vitro was published in January 1988, and our first demonstration of proof-of-principle in vivo in an experimental animal was published in August 1989. At this stage, as a strong supporter of the future of gene and cell therapy, I felt I could make a more important contribution as a scientific leader than as a bench scientist. Accordingly, in late 1989, I moved to the University of Pennsylvania in a senior leadership position where I was able, among other accomplishments, to establish the Institute for Human Gene Therapy in 1992 and the Department of Molecular and Cellular Engineering in 1993. Dr. Jim Wilson was recruited in 1993 to head these two academic units as Director and Chairman, respectively. The burgeoning growth and accelerating successes in the field of gene and cell therapy worldwide, the important contributions to the field by a large number of faculty at the University of Pennsylvania, and my role early in this history have been richly rewarding. A brief summary of this early, early history is provided below.

Spatial and phylogenetic analysis of vesicular stomatitis virus over-wintering in the United States.

From 2004 through 2006, 751 vesicular stomatitis (VS) outbreaks caused by vesicular stomatitis virus serotype New Jersey (VSNJV) were reported in nine states of the southwestern United States. The normal model of the spatial scan statistic and phylogenetic techniques were used to assess whether the spatial and genetic relations among VSNJV outbreaks were consistent with the hypothesis that VSNJV over-wintered in specific regions of the southwestern United States infected in 2004 and 2005, respectively. Use of the spatial scan statistic led to the identification of two clusters of outbreaks for which the Euclidean distance to the nearest outbreak reported in the previous or following year, whichever was shorter, was significantly (P<0.01) shorter than the epidemic's (2004-2006) mean. Clusters were centered at Colorado and Wyoming and included 375 and 21 outbreaks, respectively. Results were supported by the phylogenetic analysis of 49 VSV samples collected from 2004 through 2006 in the United States and 10 VSV samples originated from Mexico. These findings, which were displayed using a publicly accessible web-based system referred to as the FMD BioPortal, were consistent with over-wintering of specific sub-lineages of VSNJV in a limited geographical region of the United States affected by a VS epidemic in 2005 and 2006.

ASCI: reflections on the first 100 years and a proposal for the next.

Congratulations to the ASCI and its membership on the first 100 years. From their first organizational meeting on the Boardwalk in Atlantic City in June 1907, our predecessors recognized the need for an organization for the clinician who had a strong interest in true experimental medicine. These nine Young Turks formed the Society, had their first meeting at the Willard Hotel in Washington, DC, in 1909, and went on to become some of the leaders of American medicine in the first half of the 20th century. The establishment of the JCI in 1924 further enhanced the high standards of the ASCI and its membership. Surely thousands of us have benefited from the foundation of the ASCI and the JCI, as have, I would submit, millions of patients as well.

Molecular epidemiology of vesicular stomatitis New Jersey virus from the 2004-2005 US outbreak indicates a common origin with Mexican strains.

Vesicular stomatitis (VS) outbreaks of unknown origin occur at 8-10-year intervals in the south-western USA with the most recent outbreak beginning in 2004. A previous study has suggested that strains causing US outbreaks are closely related to strains causing outbreaks in Mexico [Rodriguez (2002) Virus Res 85, 211-219]. This study determined the phylogenetic relationships among 116 vesicular stomatitis New Jersey virus (VSNJV) strains obtained from the 2004 outbreak and from endemic areas in Mexico. All 69 US viruses showed little sequence divergence (

A new JCI conflict-of-interest policy.

As stewards of the JCI, we are responsible for instituting and sustaining the highest possible standards for integrity. To this end, we have established a very specific set of guidelines for handling potential conflicts of interest - not only for authors and referees, but also for ourselves.