Association between physician characteristics and payments from industry in 2015-2017: observational study.

OBJECTIVE:To investigate the association between physician characteristics and the value of industry payments. DESIGN:Observational study. SETTING AND PARTICIPANTS:Using the 2015-2017 Open Payments reports of industry payments linked to the Physician Compare database, we examined the association between physician characteristics (physician sex, years in practice, medical school attended and specialty) and the industry payment value, adjusting for other physician characteristic and institution fixed effects (effectively comparing physicians practicing at the same institution). MAIN OUTCOME MEASURES:Our primary outcome was the value of total industry payments to physicians including (1) general payments (all forms of payments other than those classified for research purpose, eg, consulting fees, food, beverage), (2) research payments (payments for research endeavours under a written contract or protocol) and (3) ownership interests (eg, stock or stock options, bonds). We also investigated each category of payment separately. RESULTS:Of 544 264 physicians treating Medicare beneficiaries, a total of $5.8 billion in industry payments were made to 365 801 physicians during 2015-2017. The top 5% of physicians, by cumulative payments, accounted for 91% of industry payments. Within the same institution, male physicians, physicians with 21-30 years in practice and physicians who attended top 50 US medical schools (based on the research ranking) received higher industry payments. Across specialties, orthopaedic surgeons, neurosurgeons and endocrinologists received the highest payments. When we investigated individual types of payment, we found that orthopaedic surgeons received the highest general payments; haematologists/oncologists were the most likely to receive research payments and surgeons were the most likely to receive ownership interests compared with other types of physicians. CONCLUSIONS:Industry payments to physicians were highly concentrated among a small number of physicians. Male sex, longer length of time in clinical practice, graduated from a top-ranked US medical school and practicing certain specialties, were independently associated with higher industry payments

Winning the Obesity Battle

Winning the Obesity Battl

Reducing and eliminating health disparities through prevention and public health

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Reducing Disparities by way of a Cancer Disparities Research Training Program

Background: For minority populations, there is a continuing disparity in the burden of death and illness from cancer. Research to address this disparity should be conducted by investigators who can best understand and address the needs of culturally diverse communities. However, minorities are under-represented in health-related research. The goal of this project was to develop and evaluate an approach to motivating and preparing master’s degree students for careers dedicated to cancer disparities research. Method: A Cancer Disparities Research Training Program (CDRTP) was initiated in 2010. The program consists of coursework, practicum experiences, and research opportunities. Assessment of the curriculum is based on monitoring achievement of evaluation indicators and includes a quantitative assessment and qualitative approach. Results: In its first three years, the program graduated 20 trainees, all of whom were minorities (18 African Americans and two Asians). When asked about career goals, two-thirds of the trainees indicated interest in pursuing careers in research on cancer prevention and control. The trainees expressed high satisfaction with the courses, instructor, materials, and curriculum. Although trainees had suggestions about course details, evaluations overall were positive. Across focus groups, three recurrent themes emerged regarding activities to enhance the student experience: having a wider variety of topics, more guest speakers, and field trips. Conclusion: The CDRTP was intended to recruit students – primarily African Americans – into research on prevention and control of cancer disparities. Although final evaluation of the program’s overall outcome will not be available for several years, a preliminary evaluation indicates the program is being successful

Chip-Scale, Sub-Hz Fundamental Sub-kHz Integral Linewidth 780 nm Laser through Self-Injection-Locking a Fabry-P\'erot laser to an Ultra-High Q Integrated Resonator

Today's state of the art precision experiments in quantum, gravimetry, navigation, time keeping, and fundamental science have strict requirements on the level and spectral distribution of laser frequency noise. For example, the laser interaction with atoms and qubits requires ultra-low frequency noise at multiple offset frequencies due to hyperfine atomic transitions, motional sidebands, and fast pulse sequencing. Chip-scale integration of lasers that meet these requirements is essential for reliability, low-cost, and weight. Here, we demonstrate a significant advancement in atomic precision light sources by realizing a chip-scale, low-cost, 780 nm laser for rubidium atom applications with record-low 640 mHz (white noise floor at 0.2 Hz$^2$/Hz) fundamental and 732 Hz integral linewidths and a frequency noise that is multiple orders of magnitude lower than previous hybrid and heterogeneous self-injection locked 780 nm lasers and lower noise than bulk microresonator implementations. The laser is a Fabry-P\'erot laser diode self-injection locked to an ultra-high Q photonic integrated silicon nitride resonator. This performance is enabled by a 145 million resonator Q with a 30 dB extinction ratio, the highest Q at 780 nm, to the best of our knowledge. We analyze the impact of our frequency noise on specific atomic applications including atomic frequency references, Rydberg quantum gates, and cold atom gravimeters. The photonic integrated resonator is fabricated using a CMOS foundry-compatible, wafer-scale process, with demonstrated integration of other components showing promise for a full system-on-a-chip. This performance is scalable to other visible atomic wavelengths, opening the door to a variety of transitions across many atomic species and enabling low-power, compact, ultra-low noise lasers impacting applications including quantum sensing, computing, clocks and more

Fundamental noise dynamics in cascaded-order Brillouin lasers

The dynamics of cascaded-order Brillouin lasers make them ideal for applications such as rotation sensing, highly coherent optical communications, and low-noise microwave signal synthesis. Remark- ably, when implemented at the chip-scale, recent experimental studies have revealed that Brillouin lasers can operate in the fundamental linewidth regime where optomechanical and quantum noise sources dominate. To explore new opportunities for enhanced performance, we formulate a simple model to describe the physics of cascaded Brillouin lasers based on the coupled mode dynamics governed by electrostriction and the fluctuation-dissipation theorem. From this model, we obtain analytical formulas describing the steady state power evolution and accompanying noise properties, including expressions for phase noise, relative intensity noise and power spectra for beat notes of cascaded laser orders. Our analysis reveals that cascading modifies the dynamics of intermediate laser orders, yielding noise properties that differ from single-mode Brillouin lasers. These modifications lead to a Stokes order linewidth dependency on the coupled order dynamics and a broader linewidth than that predicted with previous single order theories. We also derive a simple analytical expression for the higher order beat notes that enables calculation of the Stokes linewidth based on only the relative measured powers between orders instead of absolute parameters, yielding a method to measure cascaded order linewidth as well as a prediction for sub-Hz operation. We validate our results using stochastic numerical simulations of the cascaded laser dynamics.Comment: 18 pages, 9 figure

The Small Scale Anisotropies, the Spectrum and the Sources of Ultra High Energy Cosmic Rays

We calculate the number density and luminosity of the sources of ultra high energy cosmic rays (UHECRs), using the information about the small scale anisotropies and the observed spectra. We find that the number of doublets and triplets observed by AGASA can be best reproduced for a source density of $\sim 10^{-5} Mpc^{-3}$, with large uncertainties. The spectrum of UHECRs implies an energy input of $\sim 6\times 10^{44} erg yr^{-1} Mpc^{-3}$ above $10^{19}$ eV and an injection spectrum $\propto E^{-2.6}$. A flatter injection spectrum, $E^{-2.4}$, can be adopted if the sources have luminosity evolution $\propto (1+z)^4$. The combination of these two pieces of information suggests that the single sources should on average have a cosmic ray luminosity above $10^{19}$ eV of $L_{source}\approx 2\times 10^{42} erg s^{-1}$, weakly dependent upon the injection spectrum. Unfortunately, with the limited statistics of events available at present, there are approximately one-two orders of magnitude uncertainty in the source density provided above. We make predictions on the expected performances of the Auger and EUSO experiments, with particular attention for the expected improvements in our understanding of the nature of the sources of UHECRs. We find that a critical experimental exposure $\Sigma_c$ exists, such that experiments with exposure larger than $\Sigma_c$ can detect at least one event from each source at energies above $10^{20}$ eV. This represents a unique opportunity to directly count and identify the sources of UHECRs.Comment: Submitted to Astropart. Phy

Implementing a pilot leadership course for internal medicine residents: design considerations, participant impressions, and lessons learned

Background: Effective clinical leadership is associated with better patient care. We implemented and evaluated a pilot clinical leadership course for second year internal medicine residents at a large United States Academic Medical Center that is part of a multi-hospital health system. Methods: The course met weekly for two to three hours during July, 2013. Sessions included large group discussions and small group reflection meetings. Topics included leadership styles, emotional intelligence, and leading clinical teams. Course materials were designed internally and featured “business school style” case studies about everyday clinical medicine which explore how leadership skills impact care delivery. Participants evaluated the course’s impact and quality using a post-course survey. Questions were structured in five point likert scale and free text format. Likert scale responses were converted to a 1-5 scale (1 = strongly disagree; 3 = neither agree nor disagree; 5 = strongly agree), and means were compared to the value 3 using one-way T-tests. Responses to free text questions were analyzed using the constant comparative method. Results: All sixteen pilot course participants completed the survey. Participants overwhelmingly agreed that the course provided content and skills relevant to their clinical responsibilities and leadership roles. Most participants also acknowledged that taking the course improved their understanding of their strengths and weaknesses as leaders, different leadership styles, and how to manage interpersonal conflict on clinical teams. 88% also reported that the course increased their interest in pursuing additional leadership training. Conclusions: A clinical leadership course for internal medicine residents designed by colleagues, and utilizing case studies about clinical medicine, resulted in significant self-reported improvements in clinical leadership competencies. Electronic supplementary material The online version of this article (doi:10.1186/s12909-014-0257-2) contains supplementary material, which is available to authorized users