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This paper discusses the current literature on the evaluation of brownfield redevelopment programs and compares that literature to the data that are currently available to the public through the EPA databases, ACRES and CIMC. We examine data from the City of Rochester, New York, which has had a long history of participation in the Brownfield Assistance Program (BAP) and has a history of collecting and maintaining data as required by the EPA. We compare the data that the city and EPA are required to collect to the data that the current literature suggests are necessary for a detailed assessment. This comparison reveals the difficulty in determining the success of the program. The purpose of this paper is to provide a better understanding of the data collection required by the EPA and to identify potential gaps in that data in determining the relative success of the BAP. We find that the current data requirements are insufficient if one of the goals is to assess the potential benefits of the BAP for a large number of sites. [ABSTRACT FROM AUTHOR]

Background: Measuring allele-specific RNA expression provides valuable insights into cis-acting genetic and epigenetic regulation of gene expression. Widespread adoption of high-throughput sequencing technologies for studying RNA expression (RNA-Seq) permits measurement of allelic RNA expression imbalance (AEI) at heterozygous single nucleotide polymorphisms (SNPs) across the entire transcriptome, and this approach has become especially popular with the emergence of large databases, such as GTEx. However, the existing binomial-type methods used to model allelic expression from RNA-seq assume a strong negative correlation between reference and variant allele reads, which may not be reasonable biologically. Results: Here we propose a new strategy for AEI analysis using RNA-seq data. Under the null hypothesis of no AEI, a group of SNPs (possibly across multiple genes) is considered comparable if their respective total sums of the allelic reads are of similar magnitude. Within each group of "comparable" SNPs, we identify SNPs with AEI signal by fitting a mixture of folded Skellam distributions to the absolute values of read differences. By applying this methodology to RNA-Seq data from human autopsy brain tissues, we identified numerous instances of moderate to strong imbalanced allelic RNA expression at heterozygous SNPs. Findings with SLC1A3 mRNA exhibiting known expression differences are discussed as examples. Conclusion: The folded Skellam mixture model searches for SNPs with significant difference between reference and variant allele reads (adjusted for different library sizes), using information from a group of "comparable" SNPs across multiple genes. This model is particularly suitable for performing AEI analysis on genes with few heterozygous SNPs available from RNA-seq, and it can fit over-dispersed read counts without specifying the direction of the correlation between reference and variant alleles. [ABSTRACT FROM AUTHOR]

The serotonin 2 A receptor gene ( HTR2A) harbors two functional single nucleotide polymorphisms ( SNPs) that are frequent in populations of African and European descent; rs6311, which affects mRNA expression, and rs6314, which changes the amino acid sequence of the encoded protein and affects the signaling properties of the receptor. Multiple clinical associations support a role for these SNPs in cognitive and neuropsychiatric phenotypes, although studies in autism spectrum disorder ( ASD) remain equivocal. Here, we tested transmission disequilibrium of rs6311 and rs6314 in a cohort of 158 ASD trios (simplex and multiplex), observing significant under-transmission of the minor ' A' allele of rs6311 to offspring with ASD (permuted P = 0.0004). Consistent with our previous findings in the dorsolateral prefrontal cortex of unaffected individuals, rs6311/A decreases expression of HTR2A mRNA with an extended 5′ untranslated region ( UTR) in the frontopolar cortex in brain samples from 54 ASD patients and controls. Interpreting the clinical results in the context of our mRNA expression analysis, we speculate that any risk associated with rs6311 is conferred by greater expression of the long 5′ UTR mRNA isoform. The current study corroborates earlier associations between rs6311 and ASD in a family study, supporting the hypothesis that rs6311 plays a modulatory role in ASD risk. Autism Res 2014, 7: 459-467. © 2014 International Society for Autism Research, Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background: Prefrontal behavior and activity in humans are heritable. Studies in animals demonstrate an interaction between dopamine D2 receptors and nicotinic acetylcholine receptors on prefrontal behavior but evidence in humans is weak. Therefore, we hypothesize that genetic variation regulating dopamine D2 and nicotinic acetylcholine receptor signaling impact prefrontal cortex activity and related cognition. To test this hypothesis in humans, we explored the interaction between functional genetic variants in the D2 receptor gene (DRD2, rs1076560) and in the nicotinic receptor α5 gene (CHRNA5, rs16969968) on both dorsolateral prefrontal cortex mediated behavior and physiology during working memory and on prefrontal gray matter volume. Methods: A large sample of healthy subjects was compared for genotypic differences for DRD2 rs1076560 (G>T) and CHNRA5 rs16969968 (G>A) on prefrontal phenotypes, including cognitive performance at the N-Back task, prefrontal physiology with BOLD fMRI during performance of the 2-Back working memory task, and prefrontal morphometry with structural MRI. Results: We found that DRD2 rs1076560 and CHNRA5 rs16969968 interact to modulate cognitive function, prefrontal physiology during working memory, and prefrontal gray matter volume. More specifically, CHRNA5-AA/DRD2-GT subjects had greater behavioral performance, more efficient prefrontal cortex activity at 2Back working memory task, and greater prefrontal gray matter volume than the other genotype groups. Conclusions: The present data extend previous studies in animals and enhance our understanding of dopamine and acetylcholine signaling in the human prefrontal cortex, demonstrating interactions elicited by working memory that are modulated by genetic variants in DRD2 and CHRNA5. [ABSTRACT FROM AUTHOR]

The integration of research on neuroimaging and pharmacogenetics holds promise for improving treatment for neuropsychiatric conditions. Neuroimaging may provide a more sensitive early measure of treatment response in genetically defined patient groups, and could facilitate development of novel therapies based on an improved understanding of pathogenic mechanisms underlying pharmacogenetic associations. This review summarizes progress in efforts to incorporate neuroimaging into genetics and treatment research on major psychiatric disorders, such as schizophrenia, major depressive disorder, bipolar disorder, attention-deficit/hyperactivity disorder, and addiction. Methodological challenges include: performing genetic analyses in small study populations used in imaging studies; inclusion of patients with psychiatric comorbidities; and the extensive variability across studies in neuroimaging protocols, neurobehavioral task probes, and analytic strategies. Moreover, few studies use pharmacogenetic designs that permit testing of genotype × drug effects. As a result of these limitations, few findings have been fully replicated. Future studies that pre-screen participants for genetic variants selected a priori based on drug metabolism and targets have the greatest potential to advance the science and practice of psychiatric treatment. [ABSTRACT FROM AUTHOR]

The dopamine receptor D2 (encoded by DRD2) is implicated in susceptibility to mental disorders and cocaine abuse, but mechanisms responsible for this relationship remain uncertain. DRD2 mRNA exists in two main splice isoforms with distinct functions: D2 long (D2L) and D2 short (D2S, lacking exon 6), expressed mainly postsynaptically and presynaptically, respectively. Two intronic single-nucleotide polymorphisms (SNPs rs2283265 (intron 5) and rs1076560 (intron 6)) in high linkage disequilibrium (LD) with each other have been reported to alter D2S/D2L splicing and several behavioral traits in human subjects, such as memory processing. To assess the role of DRD2 variants in cocaine abuse, we measured levels of D2S and D2L mRNA in human brain autopsy tissues (prefrontal cortex and putamen) obtained from cocaine abusers and controls, and genotyped a panel of DRD2 SNPs (119 abusers and 95 controls). Robust effects of rs2283265 and rs1076560 on reducing formation of D2S relative to D2L were confirmed. The minor alleles of rs2283265/rs1076560 were considerably more frequent in Caucasians (18%) compared with African Americans (7%). Also, in Caucasians, rs2283265/rs1076560 minor alleles were significantly overrepresented in cocaine abusers compared with controls (rs2283265: 25 to 9%, respectively; p=0.001; OR=3.4 (1.7-7.1)). Several SNPs previously implicated in diverse clinical association studies are in high LD with rs2283265/rs1076560 and could have served as surrogate markers. Our results confirm the role of rs2283265/rs1076560 in D2 alternative splicing and support a strong role in susceptibility to cocaine abuse. [ABSTRACT FROM AUTHOR]

CHRNA5, encoding the nicotinic α5 subunit, is implicated in multiple disorders, including nicotine addiction and lung cancer. Previous studies demonstrate significant associations between promoter polymorphisms and CHRNA5 mRNA expression, but the responsible sequence variants remain uncertain. To search for cis-regulatory variants, we measured allele-specific mRNA expression of CHRNA5 in human prefrontal cortex autopsy tissues and scanned the CHRNA5 locus for regulatory variants. A cluster of six frequent single-nucleotide polymorphisms (rs1979905, rs1979906, rs1979907, rs880395, rs905740, and rs7164030), in complete linkage disequilibrium (LD), fully account for a >2.5-fold allelic expression difference and a fourfold increase in overall CHRNA5 mRNA expression. This proposed enhancer region resides more than 13 kilobases upstream of the CHRNA5 transcription start site. The same upstream variants failed to affect CHRNA5 mRNA expression in peripheral blood lymphocytes, indicating tissue-specific gene regulation. Other promoter polymorphisms were also correlated with overall CHRNA5 mRNA expression in the brain, but were inconsistent with allelic mRNA expression ratios, a robust and proximate measure of cis-regulatory variants. The enhancer region and the nonsynonymous polymorphism rs16969968 generate three main haplotypes that alter the risk of developing nicotine dependence. Ethnic differences in LD across the CHRNA5 locus require consideration of upstream enhancer variants when testing clinical associations. [ABSTRACT FROM AUTHOR]

Background & Aims: Recently an association was shown between the single nucleotide polymorphism (SNP), rs11209026, within the interleukin-23 receptor (IL23R) locus and Crohn’s disease (CD) as a consequence of a genome-wide association study of this disease in adults. We examined the effects of this and other previously reported SNPs at this locus with respect to CD in children. Methods: By using data from our ongoing genome-wide association study in our cohort of 142 pediatric CD patients and 281 matched controls, we investigated the association of the previously reported SNPs at the IL23R locus with the childhood form of this disease. Results: By using the Fisher exact test, the minor allele frequency of rs11209026 in the patients was 1.75%, whereas it was 6.61% in the controls, yielding a protective odds ratio (OR) of 0.25 (95% confidence interval, 0.10–0.65; 1-sided P = 9.2 × 10−4). Furthermore, of all the SNPs previously reported, rs11209026 was associated the most strongly. A subsequent family based association test (which is more resistant to population stratification) with 65 sets of trios derived from our initial patient cohort yielded significant association with rs11209026 in a transmission disequilibrium test (1-sided P = .0017). In contrast, no association was detected to the caspase-recruitment domain 15 gene for the inflammatory bowel disease phenotype. Conclusions: The OR of the IL23R variant in our pediatric study is highly comparable with that reported previously in a non-Jewish adult inflammatory bowel disease case-control cohort (OR, 0.26). As such, variants in the IL23R gene confer a similar magnitude of risk of CD to children as for their adult counterparts. [Copyright &y& Elsevier]

Acquired pendular nystagmus (APN) complicates multiple sclerosis and other neurological disorders, causes visual impairment, and frequently resists treatment. Vision could be improved by a visual aid that gates or shifts the seen world in lockstep with the APN. Since the pathological oscillations are embedded in normal eye movements, such a device must track the nystagmus selectively. We evaluated the ability of an adaptive filter to perform this tracking and improve acuity when coupled to either of two devices-a shutter that permitted brief glimpses of the world synchronized with the nystagmus, or simulated image-shifting optics. In 10 normal subjects whose decimal acuity averaged 1.46 ± 0.20, acuity fell to 0.36 ± 0.08 under viewing conditions simulating APN. The synchronized shutter restored acuity to 0.60 ± 0.12, while image-stabilization raised it to 1.17 ± 0.13. Adaptive filters provide a practical means by which to track nystagmus. The most effective visual aid would couple such filters to image-stabilizing optics. [ABSTRACT FROM AUTHOR]

Acquired pendular nystagmus (APN) complicates multiple sclerosis and other neurological disorders, causes visual impairment, and is often refractory to available treatments. Vision could be improved by an optical aid that shifts the seen world in lockstep with the APN. An essential component of such a device is the image-shifting mechanism, which must be light, accurate, suitable for battery operation, and capable of image shifting at the frequencies and amplitudes seen in APN. We determined that a three-lens image-shifting mechanism used in commercial image-stabilizing lenses has the potential to satisfy all these requirements. In combination with software designed to track nystagmus, the optical mechanism proved capable of improving visual acuity in 12 normal subjects experiencing simulated two-dimensional nystagmus. Acuity was restored to within an average of 0.12 logMAR (range 0.0-0.22) of the subjects' values without the simulated nystagmus. These results support the feasibility of an assistive device for patients with APN. [ABSTRACT FROM AUTHOR]

A letter to the editor which offers information about the association of the T300A non-synonymous variant of the ATG16L1 gene with susceptibility to pediatric Crohn's disease is presented.

Background: Despite recent advancements in migraine treatment, some patients continue to endure significant disease burden. Due to the controlled nature of randomized trials in migraine prevention, many real-world patients with comorbidities or prior exposure to certain therapies are excluded. Capturing evidence of the effectiveness of treatment in real-world clinical settings can further shape treatment paradigms. The objective of this study was to develop a comprehensive understanding of both patients' and physicians' real-world experiences with eptinezumab for chronic migraine (CM)., Methods: REVIEW (Real-world EVidence and Insights into Experiences With eptinezumab) is an observational, multi-site (n = 4), US-based study designed to evaluate real-world experiences of patients treated with eptinezumab and their treating physicians. Patients were ≥ 18 years of age, with a diagnosis of CM, who had completed ≥ 2 consecutive eptinezumab infusion cycles (≥ 6 months of exposure). The study included a retrospective chart review, a patient survey, and a semi-structured physician interview that assessed patient and/or physician satisfaction with elements of daily living / well-being, migraine symptomology, and perspectives of the eptinezumab infusion experience., Results: Of the 94 patients enrolled, 83% (78/94) were female, the mean age was 49.2 years, and the mean time since migraine diagnosis was 15.4 years. Before eptinezumab treatment, patients experienced a mean of 8 self-reported "good" days/month, which increased to 18 after treatment. Most patients took, on average, ≥ 10 days/month of prescription and/or over-the-counter medication (81% [75/93] and 66% [61/93], respectively) to treat migraine attacks before eptinezumab treatment, which dropped to 26% (24/93) and 23% (21/93) following eptinezumab treatment. Prior to receiving eptinezumab, 62% (58/93) of patients indicated being at least slightly concerned about infusions; after eptinezumab infusion, this dropped to 14% (13/93). These patient survey findings were consistent with physician responses., Conclusion: This real-world evidence study demonstrated high overall satisfaction with the effectiveness of eptinezumab treatment for CM among most patients and their physicians., (© 2024. The Author(s).)

Background: Given the high prevalence of symptoms of major depressive disorder (MDD) in medical students, identifying factors that impact the development of such symptoms is important. Previous data suggest that medical students can experience symptoms of MDD after medical school exams. It is not known if medical students experience more symptoms of MDD directly before or after exams. The aim of the current study is to determine the prevalence of symptoms of MDD in first- and second-year medical students directly before and after high-stakes medical school examinations., Methods: Two anonymous surveys were sent via REDCap to first- and second-year medical students at the University of New England College of Osteopathic Medicine. A pre-exam survey on the day of the exam asking about the past three days' MDD symptoms, and a post-exam survey sent three days after the exam asking about MDD symptoms experienced after the exam was sent out to a total of 391 students with a response rate of 23%., Results: First- and second-year medical students regardless of gender experienced symptoms of MDD at higher rates before exams than afterwards. Female students experienced symptoms of MDD (as defined by the DSM-5) including sadness, sleep disturbances, and feelings of guilt or worthlessness at a greater rate compared to males before exams. After exams, females were more likely to experience sleep disturbances and decreased energy. Second-year male students were the least likely to experience symptoms of MDD., Conclusion: First- and second-year medical students can experience symptoms of MDD surrounding exams. This study highlights the emotional burden that students may carry near exams. It underscores the importance of further research on this topic to evaluate the effect exams have on the mental health of medical students during their training., Competing Interests: The authors declare no conflicts of interest in the research, authorship, or publication of this manuscript., (© 2023 Arabatzis et al.)

Introduction: From 1999 to 2020, the suicide rate in Virginia increased from 13.1 to 15.9 per 100,000 persons aged 10 years and older. Few studies have examined spatial patterns of suicide geographies smaller than the county level., Methods: We analyzed data from suicide decedents aged ≥10 years from 2010 through 2015 in the Virginia Violent Death Reporting System. We identified spatial clusters of high suicide rates using spatially adaptive filtering with standardized mortality ratio (SMR) significantly higher than the state SMR (p < 0.001). We compared demographic characteristics, method of injury, and suicide circumstances of decedents within each cluster to decedents outside any cluster., Results: We identified 13 high-risk suicide clusters (SMR between 1.7 and 2.0). Suicide decedents in the clusters were more likely to be older (40+ years), non-Hispanic white, widowed/divorced/separated, and less likely to have certain precipitating suicide circumstances than decedents outside the clusters. Suicide by firearm was more common in four clusters, and suicide by poisoning was more common in two clusters compared to the rest of the state., Conclusions: There are important differences between geographic clusters of suicide in Virginia. These results suggest that place-specific risk factors for suicide may be relevant for targeted suicide prevention.

Objective: To compare the harvestable donor septal cartilage among patients. Background: Trends in donor septal cartilage anatomy are not well quantified in the literature. Methods: Harvestable septal cartilage area and length (preserving a 1-cm L-strut) were measured on fine-cut maxillofacial computed tomography (CT) for 200 patients in four self-described racial/ethnic groups: African American, Asian American, European American, and Latin American. Height, sex, and age were recorded. Demographic variables were modeled by multivariate logistic regression to determine characteristics predictive of harvestable septal cartilage. Results: Older age, shorter height, African American or Asian American self-described race, and female sex were independently associated with smaller harvestable area and shorter length (all p  < 0.05). On multivariate regression, Asian American [odds ratio (OR) 5.23, p  = 0.005] and African American (OR 3.75, p  = 0.015) patients were more likely than Latin American or European Americans patients have a smaller harvestable area. Age (OR 1.02, p  = 0.043) and height (OR 0.94, p  = 0.029) were also correlated with smaller cartilage area and length, respectively. Conclusions: CT scan and demographic characteristics predicted donor septal cartilage availability.

Background: As evidence-based medicine has taken hold across medical specialties, the level of evidence within the facial plastic surgery literature has risen, but remains weak in comparison. There has not yet been a systematic, critical appraisal of the relative strength of evidence among subsets of the practice of facial plastic surgery., Methods: The current study is a systematic review, designed to evaluate the level of evidence observed in the facial plastic surgery literature. Five journals were queried using facial plastic surgery terms for four selected years over a 10-year period. Following screening, articles were assigned to a category regarding subject matter, assessed for the presence of various methodological traits, and evaluated for overall level of evidence. Comparisons were made in regard to level of evidence across the breadth of facial plastic surgery subject matter., Results: A total of 826 articles were included for final review. Studies on operative facial rejuvenation and rhinoplasty had significantly fewer authors on average than studies on cancer reconstruction or craniofacial topics. Craniofacial studies demonstrated higher levels of evidence relative to all other categories, with the exception of facial paralysis and facial trauma studies, from which there was no significant difference. In general, reconstructive studies had significantly more authors and higher levels of evidence than did articles with an aesthetic focus., Conclusion: Level of evidence in facial plastic surgery remains relatively weak overall. Reconstructive and particularly craniofacial studies demonstrate higher mean level of evidence, relative to other subsets of facial plastic surgery., Level of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Background: The aesthetics of social media have become increasingly important to cosmetic surgery patients in recent years; however, aesthetic treatments have not kept pace with the desires of modern patients. The current study investigates the most common angles employed by various user cohorts when posting a selfie on social media platforms and proposes that aesthetic surgeons consider utilizing a selfie angle alongside standard pre- and postoperative photographic views., Methods: Full face photographs published on the social media platform Instagram™ with the tag #selfie were divided into three cohorts: female models/influencers, amateur females, and amateur males. Each cohort contained 100 photographs. The photographs were analyzed using cloud-based facial analysis software for facial pan, roll, and tilt relative to the camera., Results: One hundred photographs from each cohort were analyzed and demonstrated that amateur females (AF) take photographs from higher angles than amateur males (AM) or model females (MF). Roll-off-midline was significantly greater for AF and MF as compared to AM. The MF group had significantly a greater pan-off-midline as compared to AF and AM, while AF had significantly a greater pan-off-midline than AM., Conclusions: Common photography practices employed within selfie photographs utilize angles not captured in standard perioperative photographs. This study supports the implementation of a selfie photograph into the standard set of pre- and postoperative photographs taken by aesthetic surgeons to evaluate the effects of interventions in the context of selfie photography. The angle employed can vary depending upon the demographic profile of the patient., Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Importance: Forehead feminization cranioplasty (FFC) is an important component of gender-affirming surgery and has become increasingly popular in recent years. Little objective evidence exists for the procedure's safety and clinical impact via patient-reported outcome measures (PROMs)., Objective: To determine what complications are observed following FFC, the relative frequency of complications by surgical technique, and what impact the procedure has on patient's quality of life., Data Sources: Database searches were performed in PubMed/MEDLINE, Scopus, CINAHL, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, and PsycINFO. The search terms included variations of forehead setback/FFC. Both controlled vocabularies (i.e., MeSH and CINAHL's Suggested Subject Terms) and keywords in the title or abstract fields were searched., Study Selection: Two independent reviewers screened the titles and abstracts of all articles. Two independent surgeon reviewers evaluated the full text of all included articles, and relevant data points were extracted., Main Outcomes and Measures: Complications and complication rate observed following FFC. Additional outcome measures were the approach utilized, concurrent procedures performed, and the use and findings of a PROM., Results: Ten articles describing FFC were included, encompassing 673 patients. The overall pooled complication rate was 1.3%. PROMs were used in half of studies, with no standardization among studies., Conclusions and Relevance: Complications following FFC are rare and infrequently require reoperation. Further studies into standardized and validated PROMs in facial feminization patients are warranted., Level of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Skin cancer is a common indication for reconstructive surgery of the ear. The unique anatomy of the external ear makes the restoration of form and function challenging for the reconstructive surgeon. This article reviews the relevant anatomy of the ear, defines the goals of reconstruction, outlines the assessment of defects based on location, and describes specific surgical techniques useful in auricular reconstruction., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Neck rejuvenation attempts to correct the unattractive features that result from the process of facial aging. The aesthetic goals of surgery include creating a well-defined jaw contour, optimal cervicomental angle, smooth-appearing skin, and a healthy redistribution of soft tissue volume. Unique patient characteristics create inherent challenges that may limit the degree to which improvement can be made. Psychological expectations and motivations influence patient satisfaction and must be understood through careful evaluation and counseling. This article describes common difficult situations encountered during neck rejuvenation and discusses unresolved problems. Several clinical examples along with specific surgical solutions are included., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objectives: To assess clinician attitudes and experiences in Health eHearts, a quality recognition and financial incentive program using health information technology., Study Design: Survey of physicians., Methods: A survey was administered to 140 lead clinicians at each participating practice. Survey domains included clinicians' experiences and attitudes toward the selected clinical quality measures focused on cardiovascular care, use of electronic health records (EHRs), technical assistance visits, quality measurement reports, and incentive payments. Responses were compared across groups of practices receiving financial incentives with those in the control (no financial rewards)., Results: Survey response rate was 74%. The majority of respondents reported receiving and reviewing the quality reports (89%), agreed with the prioritization of measures (89%), and understood the information given in the quality reports (95%). Over half of the respondents had a quality improvement visit (56%), with incentive clinicians more likely to have had a visit compared with the control group (68% vs 43%, P = .01). The incentive group respondents (92%) were more likely to report using clinical decision support system alerts than control group respondents (82%, P = .11)., Conclusions: Clinicians in both incentive and control groups reported positive experiences with the program. No differences were detected between groups regarding agreement with selected clinical measures or their relevance to the patient population. However, clinicians in the incentive group were more likely to review quarterly performance reports and access quality improvement visits. Incentives may be used to further engage clinicians operating in small independently owned practices to participate in quality improvement activities.

Recently an association was demonstrated between the single nucleotide polymorphism (SNP), rs10516487, within the B-cell gene BANK1 and systemic lupus erythematosus (SLE) as a consequence of a genome wide association study of this disease in European and Argentinean populations. In a bid for replication, we examined the effects of the R61H non-synonymous variant with respect to SLE in our genotyped American cohorts of European and African ancestry. Utilizing data from our ongoing genome-wide association study in our cohort of 178 Caucasian SLE cases and 1808 Caucasian population-based controls plus 148 African American (AA) SLE cases and 1894 AA population-based controls we investigated the association of the previously described non-synonymous SNP at the BANK1 locus with the disease in the two ethnicities separately. Using a Fisher's exact test, the minor allele frequency (MAF) of rs10516487 in the Caucasian cases was 22.6% while it was 31.2% in Caucasian controls, yielding a protective odds ratio (OR) of 0.64 (95% CI 0.49-0.85; one-sided p = 7.07 × 10(-4)). Furthermore, the MAF of rs10516487 in the AA cases was 18.7% while it was 23.3% in AA controls, yielding a protective OR of 0.75 (95% CI 0.55-1.034; one-sided p = 0.039). The OR of the BANK1 variant in our study cohorts is highly comparable with that reported previously in a South American/European SLE case-control cohort (OR = 0.72). As such, R61H in the BANK1 gene confers a similar magnitude of SLE protection, not only in European Americans, but also in African Americans.