Auditor Judgment Confidence: Direct Evidence for the Process View

Although there has been considerable research on audit judgment processes and structures, one area that has received little attention is auditor judgment confidence. Determining the nature of confidence attainment has direct implications for audit practice, particularly regarding the timing of evidence evaluation leading to final judgments. The present study extends the early work of Pincus (1991) and is the first to provide direct evidence in support of the process view of audit judgment confidence

Atrial cellular electrophysiological changes in patients with ventricular dysfunction may predispose to AF

<b>Background:</b> Left ventricular systolic dysfunction (LVSD) is a risk factor for atrial fibrillation (AF), but the atrial cellular electrophysiological mechanisms in humans are unclear. Objective This study sought to investigate whether LVSD in patients who are in sinus rhythm (SR) is associated with atrial cellular electrophysiological changes that could predispose to AF. <b>Methods:</b> Right atrial myocytes were obtained from 214 consenting patients in SR who were undergoing cardiac surgery. Action potentials or ion currents were measured using the whole-cell-patch clamp technique. <b>Results:</b> The presence of moderate or severe LVSD was associated with a shortened atrial cellular effective refractory period (ERP) (209 ± 8 ms; 52 cells, 18 patients vs 233 ± 7 ms; 134 cells, 49 patients; P <0.05); confirmed by multiple linear regression analysis. The left ventricular ejection fraction (LVEF) was markedly lower in patients with moderate or severe LVSD (36% ± 4%, n = 15) than in those without LVSD (62% ± 2%, n = 31; P <0.05). In cells from patients with LVEF ≤ 45%, the ERP and action potential duration at 90% repolarization were shorter than in those from patients with LVEF > 45%, by 24% and 18%, respectively. The LVEF and ERP were positively correlated (r = 0.65, P <0.05). The L-type calcium ion current, inward rectifier potassium ion current, and sustained outward ion current were unaffected by LVSD. The transient outward potassium ion current was decreased by 34%, with a positive shift in its activation voltage, and no change in its decay kinetics. <b>Conclusion:</b> LVSD in patients in SR is independently associated with a shortening of the atrial cellular ERP, which may be expected to contribute to a predisposition to AF

A portable instrument for measuring macular pigment with central fixation

urpose: To evaluate the reliability and validity of a portable instrument for measuring macular pigment optical density. Methods: The instrument is small, uses light emitting diodes as light sources and the principles of heterochromatic flicker photometry of comparing foveal and extra-foveal minimum flicker matches. It uses central fixation for the extra-foveal matches, which subjects found easier than eccentric fixation. Subjects with healthy eyes used the instrument to measure their pigment density in a number of eye clinics. Results: The mean pigment density in 124 eyes in 124 individuals was 0.41 +/- 0.16 (mean +/- sd), there was no significant change with age but the density was less in females, those with light irides, smokers, subjects on diets low in precursor carotenoids and in those exposed to several hours of daylight every day or who used sun beds. Conclusions: The portable instrument gave valid and reliable data that confirmed published values for macular pigment. It was convenient to use in the clinic and has potential as a screening tool

Introduced and Native Congeners Use Different Resource Allocation Strategies to Maintain Performance During Infection

Hosts can manage parasitic infections using an array of tactics, which are likely to vary contingent on coevolutionary history between the host and the parasite. Here we asked whether coping ability of congeners that differ in host-parasite coevolutionary history differed in response to experimental infections with a coccidian parasite. House sparrows (Passer domesticus) and gray-headed sparrows (Passer griseus) are sympatric and ecologically similar, but house sparrows are recent colonizers of Kenya, the site of our comparison, whereas gray-headed sparrows are native. We evaluated three variables as barometers of infection coping ability: vertical flight, pectoral muscle size, and fat score. We also measured routing of a dose of 13C-labeled leucine, an essential amino acid, among tissues to compare resource allocation strategies in response to infection. We found that burden effects on performance were minimal in both species, but house sparrows maintained considerably higher burdens than gray-headed sparrows regardless of exposure. House sparrows also had more exogeneous leucine tracer in all tissues after 24 h, demonstrating a difference in the way the two species allocate or distribute resources. We argue that house sparrows may be maintaining larger resource reserves to mitigate costs associated with exposure and infection. Additionally, in response to increased parasite exposure, gray-headed sparrows had less leucine tracer in their spleens and more in their gonads, whereas house sparrows did not change allocation, perhaps indicating a trade-off that is not experienced by the introduced species

Evaluation of a Medicaid Lock-in Program

Background: "Lock-in" programs (LIPs) identify beneficiaries demonstrating potential overutilization of opioids, and other controlled substances, and restrict their access to these medications. LIPs are expanding to address the opioid crisis and could be an effective tool for connecting people to opioid use disorder treatment. We examined the immediate and sustained effects of a Medicaid LIP on overdose risk and use of medication-assisted treatment (MAT) for opioid use disorder. Methods: We analyzed North Carolina Medicaid claims from July 2009 through June 2013. We estimated daily risk differences and ratios of MAT use and overdose during lock-in and following release from the program, compared with periods before program enrollment. Results: The daily probability of MAT use during lock-in and following release was greater, when compared with a period just before LIP enrollment [daily risk ratios: 1.50, 95% confidence interval (CI): 1.18-1.91; 2.27, 95% CI: 1.07-4.80; respectively]. Beneficiaries' average overdose risk while enrolled in the program and following release was similar to their risk just before enrollment (daily risk ratios: 1.01, 95% CI: 0.79-1.28; 1.12, 95% CI: 0.82-1.54; respectively). Discussion: North Carolina's Medicaid LIP was associated with increased use of MAT during enrollment, and this increase was sustained in the year following release from the program. However, we did not observe parallel reductions in overdose risk during lock-in and following release. Identifying facilitators of MAT access and use among this population, as well as potential barriers to overdose reduction are important next steps to ensuring effective LIP design

Come back Marshall, all is forgiven? : Complexity, evolution, mathematics and Marshallian exceptionalism

Marshall was the great synthesiser of neoclassical economics. Yet with his qualified assumption of self-interest, his emphasis on variation in economic evolution and his cautious attitude to the use of mathematics, Marshall differs fundamentally from other leading neoclassical contemporaries. Metaphors inspire more specific analogies and ontological assumptions, and Marshall used the guiding metaphor of Spencerian evolution. But unfortunately, the further development of a Marshallian evolutionary approach was undermined in part by theoretical problems within Spencer's theory. Yet some things can be salvaged from the Marshallian evolutionary vision. They may even be placed in a more viable Darwinian framework.Peer reviewedFinal Accepted Versio

Relationship between protein O -linked glycosylation and insulin-stimulated glucose transport in rat skeletal muscle following calorie restriction or exposure to O -(2-acetamido-2-deoxy-d-glucopyranosylidene)amino- N -phenylcarbamate

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65566/1/j.1365-201X.2004.01403.x.pd

Validation of a commercially available markerless motion-capture system for trunk and lower extremity kinematics during a jump-landing assessment

Context: Field-based, portable motion-capture systems can be used to help identify individuals at greater risk of lower extremity injury. Microsoft Kinect-based markerless motion-capture systems meet these requirements; however, until recently, these systems were generally not automated, required substantial data postprocessing, and were not commercially available. Objective: To validate the kinematic measures of a commercially available markerless motion-capture system. Design: Descriptive laboratory study. Setting: Laboratory. Patients or Other Participants: A total of 20 healthy, physically active university students (10 males, 10 females; age ¼ 20.50 6 2.78 years, height ¼ 170.36 6 9.82 cm, mass ¼ 68.38 6 10.07 kg, body mass index ¼ 23.50 6 2.40 kg/m2). Intervention(s): Participants completed 5 jump-landing trials. Kinematic data were simultaneously recorded using Kinect-based markerless and stereophotogrammetric motion-capture systems. Main Outcome Measure(s): Sagittal- and frontal-plane trunk, hip-joint, and knee-joint angles were identified at initial ground contact of the jump landing (IC), for the maximum joint angle during the landing phase of the initial landing (MAX), and for the joint-angle displacement from IC to MAX (DSP). Outliers were removed, and data were averaged across trials. We used intraclass correlation coefficients (ICCs [2,1]) to assess intersystem reliability and the paired-samples t test to examine mean differences (a < .05). Results: Agreement existed between the systems (ICC range ¼1.52 to 0.96; ICC average ¼ 0.58), with 75.00% (n ¼ 24/ 32) of the measures being validated (P < .05). Agreement was better for sagittal- (ICC average ¼ 0.84) than frontal- (ICC average ¼ 0.35) plane measures. Agreement was best for MAX (ICC average ¼ 0.77) compared with IC (ICC average ¼ 0.56) and DSP (ICC average ¼ 0.41) measures. Pairwise comparisons identified differences for 18.75% (6/32) of the measures. Fewer differences were observed for sagittal- (0.00%; 0/15) than for frontal- (35.29%; 6/17) plane measures. Between-systems differences were equivalent for MAX (18.18%; 2/11), DSP (18.18%; 2/11), and IC (20.00%; 2/10) measures. The markerless system underestimated sagittal-plane measures (86.67%; 13/15) and overestimated frontal-plane measures (76.47%; 13/ 17). No trends were observed for overestimating or underestimating IC, MAX, or DSP measures. Conclusions: Moderate agreement existed between markerless and stereophotogrammetric motion-capture systems. Better agreement existed for larger (eg, sagittal-plane, MAX) than for smaller (eg, frontal-plane, IC) joint angles. The DSP angles had the worst agreement. Markerless motion-capture systems may help clinicians identify individuals at greater risk of lower extremity injury

Health Care Utilization and Comorbidity History of North Carolina Medicaid Beneficiaries in a Controlled Substance "Lock-in" Program

BACKGROUND Medicaid "lock-in" programs (MLIPs) are a widely used strategy for addressing potential misuse of prescription drugs among beneficiary populations. However, little is known about the health care needs and attributes of beneficiaries selected into these programs. Our goal was to understand the characteristics of those eligible, enrolled, and retained in a state MLIP. METHODS Demographics, comorbidities, and health care utilization were extracted from Medicaid claims from June 2009 through June 2013. Beneficiaries enrolled in North Carolina's MLIP were compared to those who were MLIP-eligible, but not enrolled. Among enrolled beneficiaries, those completing the 12-month MLIP were compared to those who exited prior to 12 months. RESULTS Compared to beneficiaries who were eligible for, but not enrolled in the MLIP (N = 11,983), enrolled beneficiaries (N = 5,424) were more likely to have: 1) substance use (23% versus 14%) and mental health disorders, 2) obtained controlled substances from multiple pharmacies, and 3) visited more emergency departments (mean: 8.3 versus 4.2 in the year prior to enrollment). One-third (N = 1,776) of those enrolled in the MLIP exited the program prior to completion. LIMITATIONS Accurate information on unique prescribers visited by beneficiaries was unavailable. Time enrolled in Medicaid differed for beneficiaries, which may have led to underestimation of covariate prevalence. CONCLUSIONS North Carolina's MLIP appears to be successful in identifying subpopulations that may benefit from provision and coordination of services, such as substance abuse and mental health services. However, there are challenges in retaining this population for the entire MLIP duration