Non-continuous fundamental groups of continuous loops

Let (Y,T) be a topological space, let y0 ? Y, and let C(Y,y0) denote the set of continuous loops in Y at y0. It has long been known that using continuous functions as relating functions on C(Y,y0) produces an equivalence relation on C(Y,y0), and that there is a natural binary operation on the resulting equivalence classes which makes the equivalence classes a group - called the fundamental group of Y at y0, denoted by TT1(Y,y0). In this thesis another type of relating functions, the class of which we call an admitting homotopy relation, is defined and it is shown that these functions also produce a group, which we call the N-fundamental group of Y with respect to y0, denoted by N(Y,y0). It is shown that this group satisfies the usual properties of the fundamental group, and that given a topological space (Y, T) and y0 ? Y, there is an epimorphism from TT1 (Y,y0) onto N(Y,y0)

Neural Activity In The Amygdala Of Young Rats Evoked By One Or More Seizures

Generalized seizures involving clonic convulsions of the entire body are often a feature of epilepsy and result from abnormal neural firing spreading throughout the forebrain. The amygdala is often required to relay abnormal neuronal excitatory activity to the forebrain. In a model of acquired reflex epilepsy, rats are made susceptible to generalized sound-induced or audiogenic seizures (AGS) and exhibit generalized clonic convulsions. AGS-induced activation in the amygdala was examined using the immediate early gene (IEG) c-fos as a neural marker. Rats were divided into three seizure induction conditions: AGS 1, 6, or 12 inductions and corresponding control groups. Brain tissue was stained for the c-fos protein or cell bodies. Comparison between seizure and control groups and within the AGS group revealed a significant increase in LA neuron activation between 1 and 6 seizures but no additional activation with 12 AGS. No changes in neuronal activation of BLA dependent on number of AGS were observed. Repeated AGS affects LA neurons more than BLA neurons in this model of acquired reflex epilepsy with activation of LA neurons stabilizing after a number of seizures. The results from this model of an acquired seizure disorder are comparable to models of inherited epilepsy

A Vulnerability Assessment Of Extreme Drought And Unprecedented Wildfire In The Southern Appalachian Mountains

In 2016, an extreme drought occurred in the southeastern United States. Dry conditions resulted in unprecedented wildfires throughout the southern Appalachian Mountains, specifically in western North Carolina. Western North Carolina is an important source of water for nearby metropolitan locations. In the future, climate change is expected to increase temperatures, alter precipitation, and stress water resources in the region, which could lead to more frequent drought and wildfire. The recent drought and wildfire events offer an opportunity to assess vulnerability and prepare for resilience. The study explores the spatiotemporal characteristics of the recent wildfires by identifying wildfires that contributed to diminished air quality across the state. The study then explores wildfire vulnerability by identifying communities with the greatest socioeconomic vulnerability to wildfires and locations with the greatest physical vulnerability to wildfires. The result is a future wildfire vulnerability index for western North Carolina. The results indicate that quality of life was significantly impacted by the recent drought and wildfire events and the greatest wildfire vulnerability occurs in the southwestern portion of the state with a gradual decrease heading eastward. The individual socioeconomic and physical characteristics of locations must be considered when determining emergency management practices relating to drought and wildfire

An Assessment Of Wildfire Vulnerability In Western North Carolina, USA Following The 2016 Wildfires

In 2016, an intense drought occurred in the southeastern U.S. Dry conditions resulted in unprecedented wildfires throughout southern Appalachia, especially in western North Carolina (WNC). Future climate change is expected to increase temperatures, alter precipitation, and stress water resources in the region, which could lead to more frequent wildfires. The increasing threat of destructive wildfires combined with a growing wildland-urban interface indicate a need for a comprehensive assessment of wildfire vulnerability in WNC, while recent wildfires offer an opportunity to evaluate assessment accuracy. The study identifies locations vulnerable to wildfire in WNC based on wildfires from 1985-2016. By combining tract-level socioeconomic and physical data in a geographic information system, specific locations of vulnerability were identified and validated using wildfires in 2016. The study contributes to vulnerability research by embracing novel techniques through validation. The vulnerability index indicates that social vulnerability varies greatly, while physical and overall wildfire vulnerability is greatest in rural, mountainous portions of the region, which are less equipped for mitigation. The impacts of future wildfires will vary across the region, so targeted responses are needed. The vulnerability index provides transparency to vulnerable communities and enables policymakers to identify opportunities to prepare for resilience by targeting vulnerability hotspots

Heterogeneity and the effect of mental health parity mandates on the labor market

Health insurance benefit mandates are believed to have adverse effects on the labor market, but efforts to document such effects for mental health parity mandates have had limited success. I show that one reason for this failure is that the association between parity mandates and labor market outcomes vary with mental distress. Accounting for this heterogeneity, I find adverse labor market effects for non-distressed individuals, but favorable effects for moderately distressed individuals and individuals with a moderately distressed family member. On net, I conclude that the mandates are welfare increasing for moderately distressed workers and their families, but may be welfare decreasing for non-distressed individuals

Texas Senate Bill 8 significantly reduced travel to abortion clinics in Texas

The Dobbs v. Jackson decision by the United States Supreme Court has rescinded theconstitutional guarantee of abortion across the United States. As a result, at least 13 states havebanned abortion access with unknown effects. Using “Texas” SB8 law that similarly restrictedabortions in Texas, we provide insight into how individuals respond to these restrictionsusing aggregated and anonymized human mobility data. We find that “Texas” SB 8 lawreduced mobility near abortion clinics in Texas by people who live in Texas and those who liveoutside the state. We also find that mobility from Texas to abortion clinics in other statesincreased, with notable increases in Missouri and Arkansas, two states that subsequently enactedpost-Dobbs bans. These results highlight the importance of out-of-state abortion services forwomen living in highly restrictive states

Constraints on Formulary Design Under the Affordable Care Act

I study the effect of prescription drug essential health benefits (EHB) requirements from the Affordable Care Act on prescription drug formularies of health insurance marketplace plans. The EHB regulates the number of drugs covered but leaves other dimensions (cost sharing and utilization management) of the formulary unregulated. Using data on almost all formularies in the country, I demonstrate that requiring insurers to cover one additional drug adds 0.22 drugs (3.3%) to the average formulary, mostly owing to firms increasing the number of drugs covered to comply with the EHB requirement. The EHB requirement also increases the probability that a drug is subject to utilization management and is assigned to a higher (more costly) formulary tier. My results suggest that newly covered drugs are 22.3 percentage points more likely to be subject to utilization management, compared to 36.7% for the average covered drug. Using formularies for Medicare Advantage plans, which are subject to uniform, nationwide benefit design standards, and the formulary status of newly approved drugs that do not satisfy the EHB requirement, I reject the hypotheses that consumer demand or effects on plan entry can explain my results

Predictors of venous thromboembolism in patients with advanced common solid cancers

There is uncertainty about risk heterogeneity for venous thromboembolism (VTE) in older patientswith advanced cancer and whether patients can be stratified according to VTE risk. We performeda retrospective cohort study of the linked Medicare-Surveillance, Epidemiology, and End Resultscancer registry in older patients with advanced cancer of lung, breast, colon, prostate, or pancreasdiagnosed between 1995–1999. We used survival analysis with demographics, comorbidities, andtumor characteristics/treatment as independent variables. Outcome was VTE diagnosed at leastone month after cancer diagnosis. VTE rate was highest in the first year (3.4%). Compared toprostate cancer (1.4 VTEs/100 person-years), there was marked variability in VTE risk (hazardratio (HR) for male-colon cancer 3.73 (95% CI 2.1–6.62), female-colon cancer HR 6.6 (3.83–11.38), up to female-pancreas cancer HR 21.57 (12.21–38.09). Stage IV cancer and chemotherapyresulted in higher risk (HRs 1.75 (1.44–2.12) and 1.31 (1.0–1.57), resp.). Stratifying the cohort bycancer type and stage using recursive partitioning analysis yielded five groups of VTE rates(nonlocalized prostate cancer 1.4 VTEs/100 person-years, to nonlocalized pancreatic cancer17.4 VTEs/100 patient-years). In a high-risk population with advanced cancer, substantialvariability in VTE risk exists, with notable differences according to cancer type and stage

College openings in the United States increase mobility and COVID-19 incidence

School and college reopening-closure policies are considered one of the most promising nonpharmaceuticalinterventions for mitigating infectious diseases. Nonetheless, the effectiveness ofthese policies is still debated, largely due to the lack of empirical evidence on behavior duringimplementation. We examined U.S. college reopenings’ association with changes in humanmobility within campuses and in COVID-19 incidence in the counties of the campuses over atwenty-week period around college reopenings in the Fall of 2020. We used an integrativeframework, with a difference-in-differences design comparing areas with a college campus, beforeand after reopening, to areas without a campus and a Bayesian approach to estimate the dailyreproductive number (Rt). We found that college reopenings were associated with increasedcampus mobility, and increased COVID-19 incidence by 4.9 cases per 100,000 (95% confidenceinterval [CI]: 2.9–6.9), or a 37% increase relative to the pre-period mean. This reflected ourestimate of increased transmission locally after reopening. A greater increase in county COVID-19 incidence resulted from campuses that drew students from counties with high COVID-19incidence in the weeks before reopening (?2(2) = 8.9, p = 0.012) and those with a greater share ofcollege students, relative to population (?2(2) = 98.83, p < 0.001). Even by Fall of 2022, largeshares of populations remained unvaccinated, increasing the relevance of understanding nonpharmaceuticaldecisions over an extended period of a pandemic. Our study sheds light onmovement and social mixing patterns during the closure-reopening of colleges during a publichealth threat, and offers strategic instruments for benefit-cost analyses of school reopening/closurepolicies

Effect of Prescription Drug Coupons on Statin Utilization and Expenditures: A Retrospective Cohort Study

Importance Drug coupons are widely used, but their effects are not well understood.Objective To quantify the effect of coupons on statin use and expenditures.Design Retrospective cohort analysis of IMS Health LRx LifeLink database.Setting U.S. retail pharmacy transactions.Participants Incident statin users who initiated branded atorvastatin or rosuvastatin between June 2006 and February 2013.Main Outcomes and Measures Monthly statin utilization (pill-days of therapy), switching (filling a different statin), termination (failure to refill statin for 6 mo), and out-of-pocket and total costs.Results Of 1.1 million incident atorvastatin and rosuvastatin users, 2% used a coupon for at least one statin fill. At 1 year, compared with noncoupon users, those who used a statin coupon on their first fill were dispensed an equal number of monthly pill-days (23.7 vs 23.8), were less likely to switch statins (14.4% vs 16.3%), and were less likely to have terminated statin therapy (31.3% vs 39.2%). At 4 years, coupon users were more likely to have switched (45.5% vs 40.8%) and less likely to have terminated statin therapy (50.6% vs 61.1%) compared with noncoupon users. Those who used greater numbers of coupons were substantially less likely to switch and terminate statin therapies. Monthly out-of-pocket costs were lower among coupon than noncoupon users at 1 year ($9.7 vs$15.1), but total monthly costs were qualitatively similar ($115.5 vs$116.9). At 4 years, monthly out-of-pocket costs among coupon users remained lower ($14.3 vs$16.6) compared with noncoupon users. Sensitivity analyses supported the main results.Conclusions Coupons for branded statins are associated with higher utilization and lower rates of discontinuation and short-term switching to other statin products