Universal Health Care Coverage in Massachusetts: A Follow-up on the Effects on Neurosurgical Practice

Background: It has been four years since the introduction of universal health care coverage in Massachusetts. Our initial assessment performed from 2007-2008 demonstrated largely positive results. Objectives: We performed a follow-up study to assess the long term financial impact of universal health care on hospital charges associated with neurosurgical operative cases at our institution. Methods: The billing records from July 1, 2009 – June 30, 2010 were compared to those from 2007 and 2008. Records were analyzed for length of stay, case mix, patient age, hospital charge, reimbursement, and procedure. Results: Case volume increased by 31% and mean acuity increased from 2.3 to 3.1 (p \u3c 0.005). Hospital stays lengthened by 1 day (p \u3c 0.005). Payor mix changed over this time with Commonwealth Care and Medicaid comprising 2.9% and 12.4%, respectively, of neurosurgical inpatients; neither had significantly different acuity or lengths of stay. Despite an increase in case volume by 31% and significantly increased acuity in 2010, revenue increased 14% over early reform data. When volume was normalized, extrapolations of pre-reform and early reform coverage on current financials demonstrated that the change in payor mix alone had decreased revenue by 30% and 24%, respectively. When modifying 2010 financials by considering 2007 reimbursement rates and 2007 payor mix, these changes together resulted in a revenue reduction of 36%. Conclusions: Taken together, our data suggests that revenue associated with hospital charges for neurosurgical inpatients has decreased significantly since health care reform went into effect

Conservative formulations of general relativistic kinetic theory

Experience with core-collapse supernova simulations shows that accurate accounting of total particle number and 4-momentum can be a challenge for computational radiative transfer. This accurate accounting would be facilitated by the use of particle number and 4-momentum transport equations that allow transparent conversion between volume and surface integrals in both configuration and momentum space. Such conservative formulations of general relativistic kinetic theory in multiple spatial dimensions are presented in this paper, and their relevance to core-collapse supernova simulations is described.Comment: 48 page

DBS-implanted Parkinson\u27s Disease Patients Show Better Olfaction Than Those Treated Medically

Dysosmia in PD (Parkinson’s Disease) may result from changes in the olfactory apparatus or in structures involved in olfactory perception. Previous work1,2 has suggested that deep brain stimulation (DBS) pa-tients have improved odor discrimination in stimulation-on/medication-off state in comparison to their own scores in a stimulation-off/medication-off state. What remains unclear is whether it is the ON state itself or an effect of stimulation that leads to improved olfaction. In this study we evaluate dysosmia in two PD cohorts in the ON state, those treated with medication alone and those treated with medication and DBS. A prospective study geared at improving predictive value of olfactory testing with a battery of psychological tests enrolled 45 PD patients and 44 controls. Of the PD patients, 9 had bilateral STN (subthalamic nucleus) DBS and 36 were medically treated. Subset analysis of PD patients with and without DBS placement revealed no difference in apathy or depression. DBS patients had better olfaction on UPSIT (Univ of Pennsylvania Smell Identification Test) (p This study provides further data that DBS patients have improved ol-faction. It also provides preliminary evidence that DBS with medica-tion improves dysosmia to a greater extent than medication alone. This may result from indirect stimulation of olfactory processing cen-ters or changes in olfactory circuitry metabolism

The immunogenicity of a viral cytotoxic T cell epitope is controlled by its MHC-bound conformation

Thousands of potentially antigenic peptides are encoded by an infecting pathogen; however, only a small proportion induce measurable CD8+ T cell responses. To investigate the factors that control peptide immunogenicity, we have examined the cytotoxic T lymphocyte (CTL) response to a previously undefined epitope (77APQPAPENAY86) from the BZLF1 protein of Epstein-Barr virus (EBV). This peptide binds well to two human histocompatibility leukocyte antigen (HLA) allotypes, HLA-B*3501 and HLA-B*3508, which differ by a single amino acid at position 156 (156Leucine vs. 156Arginine, respectively). Surprisingly, only individuals expressing HLA-B*3508 show evidence of a CTL response to the 77APQPAPENAY86 epitope even though EBV-infected cells expressing HLA-B*3501 process and present similar amounts of peptide for CTL recognition, suggesting that factors other than peptide presentation levels are influencing immunogenicity. Functional and structural analysis revealed marked conformational differences in the peptide, when bound to each HLA-B35 allotype, that are dictated by the polymorphic HLA residue 156 and that directly affected T cell receptor recognition. These data indicate that the immunogenicity of an antigenic peptide is influenced not only by how well the peptide binds to major histocompatibility complex (MHC) molecules but also by its bound conformation. It also illustrates a novel mechanism through which MHC polymorphism can further diversify the immune response to infecting pathogens

Turbulent Magnetic Field Amplification from Spiral SASI Modes: Implications for Core-Collapse Supernovae and Proto-Neutron Star Magnetization

We extend our investigation of magnetic field evolution in three-dimensional flows driven by the stationary accretion shock instability (SASI) with a suite of higher-resolution idealized models of the post-bounce core-collapse supernova environment. Our magnetohydrodynamic simulations vary in initial magnetic field strength, rotation rate, and grid resolution. Vigorous SASI-driven turbulence inside the shock amplifies magnetic fields exponentially; but while the amplified fields reduce the kinetic energy of small-scale flows, they do not seem to affect the global shock dynamics. The growth rate and final magnitude of the magnetic energy are very sensitive to grid resolution, and both are underestimated by the simulations. Nevertheless our simulations suggest that neutron star magnetic fields exceeding $10^{14}$ G can result from dynamics driven by the SASI, \emph{even for non-rotating progenitors}.Comment: 28 pages, 17 figures, accepted for publication in the Ap

The HIKCUPS trial: a multi-site randomized controlled trial of a combined physical activity skill-development and dietary modification program in overweight and obese children

BACKGROUND: Childhood obesity is one of the most pressing health issues of our time. Key health organizations have recommended research be conducted on the effectiveness of well-designed interventions to combat childhood obesity that can be translated into a variety of settings. This paper describes the design and methods used in the Hunter Illawarra Kids Challenge Using Parent Support (HIKCUPS) trial, an ongoing multi-site randomized controlled trial, in overweight/obese children comparing the efficacy of three interventions: 1) a parent-centered dietary modification program; 2) a child-centered physical activity skill-development program; and 3) a program combining both 1 and 2 above. METHODS/DESIGN: Each intervention consists of three components: i) 10-weekly face-to-face group sessions; ii) a weekly homework component, completed between each face-to-face session and iii) three telephone calls at monthly intervals following completion of the 10-week program. Details of the programs' methodological aspects of recruitment, randomization and statistical analyses are described here a priori. DISCUSSION: Importantly this paper describes how HIKCUPS addresses some of the short falls in the current literature pertaining to the efficacy of child obesity interventions. The HIKCUPS trial is funded by the National Medical Research Council, Australia

A Self-Consistent Approach to Neutral-Current Processes in Supernova Cores

The problem of neutral-current processes (neutrino scattering, pair emission, pair absorption, axion emission, \etc) in a nuclear medium can be separated into an expression representing the phase space of the weakly interacting probe, and a set of dynamic structure functions of the medium. For a non-relativistic medium we reduce the description to two structure functions S_A(\o) and S_V(\o) of the energy transfer, representing the axial-vector and vector interactions. $S_V$ is well determined by the single-nucleon approximation while $S_A$ may be dominated by multiply interacting nucleons. Unless the shape of S_A(\o) changes dramatically at high densities, scattering processes always dominate over pair processes for neutrino transport or the emission of right-handed states. Because the emission of right-handed neutrinos and axions is controlled by the same medium response functions, a consistent constraint on their properties from consideration of supernova cooling should use the same structure functions for both neutrino transport and exotic cooling mechanisms.Comment: 33 pages, Te

Ultracool Field Brown Dwarf Candidates Selected at 4.5 microns

We have identified a sample of cool field brown dwarf candidates using IRAC data from the Spitzer Deep, Wide-Field Survey (SDWFS). The candidates were selected from 400,000 SDWFS sources with [4.5] <= 18.5 mag and required to have [3.6]-[4.5] >= 1.5 and [4.5] - [8.0] <= 2.0 on the Vega system. The first color requirement selects objects redder than all but a handful of presently known brown dwarfs with spectral classes later than T7, while the second eliminates 14 probable reddened AGN. Optical detection of 4 of the remaining 18 sources implies they are likely also AGN, leaving 14 brown dwarf candidates. For two of the brightest candidates (SDWFS J143524.44+335334.6 and SDWFS J143222.82+323746.5), the spectral energy distributions including near-infrared detections suggest a spectral class of ~ T8. The proper motion is < 0.25 "/yr, consistent with expectations for a luminosity inferred distance of >70 pc. The reddest brown dwarf candidate (SDWFS J143356.62+351849.2) has [3.6] - [4.5]=2.24 and H - [4.5] > 5.7, redder than any published brown dwarf in these colors, and may be the first example of the elusive Y-dwarf spectral class. Models from Burrows et al. (2003) predict larger numbers of cool brown dwarfs should be found for a Chabrier (2003) mass function. Suppressing the model [4.5] flux by a factor of two, as indicated by previous work, brings the Burrows models and observations into reasonable agreement. The recently launched Wide-field Infrared Survey Explorer (WISE) will probe a volume ~40x larger and should find hundreds of brown dwarfs cooler than T7.Comment: 13 pages, 6 figures, accepted for publication in the June 2010 issue of The Astronomical Journa

Quantitative approaches in climate change ecology

Contemporary impacts of anthropogenic climate change on ecosystems are increasingly being recognized. Documenting the extent of these impacts requires quantitative tools for analyses of ecological observations to distinguish climate impacts in noisy data and to understand interactions between climate variability and other drivers of change. To assist the development of reliable statistical approaches, we review the marine climate change literature and provide suggestions for quantitative approaches in climate change ecology. We compiled 267 peer-reviewed articles that examined relationships between climate change and marine ecological variables. Of the articles with time series data (n = 186), 75% used statistics to test for a dependency of ecological variables on climate variables. We identified several common weaknesses in statistical approaches, including marginalizing other important non-climate drivers of change, ignoring temporal and spatial autocorrelation, averaging across spatial patterns and not reporting key metrics. We provide a list of issues that need to be addressed to make inferences more defensible, including the consideration of (i) data limitations and the comparability of data sets; (ii) alternative mechanisms for change; (iii) appropriate response variables; (iv) a suitable model for the process under study; (v) temporal autocorrelation; (vi) spatial autocorrelation and patterns; and (vii) the reporting of rates of change. While the focus of our review was marine studies, these suggestions are equally applicable to terrestrial studies. Consideration of these suggestions will help advance global knowledge of climate impacts and understanding of the processes driving ecological change

Allelic polymorphism in the T cell receptor and its impact on immune responses

In comparison to human leukocyte antigen (HLA) polymorphism, the impact of allelic sequence variation within T cell receptor (TCR) loci is much less understood. Particular TCR loci have been associated with autoimmunity, but the molecular basis for this phenomenon is undefined. We examined the T cell response to an HLA-B*3501-restricted epitope (HPVGEADYFEY) from Epstein-Barr virus (EBV), which is frequently dominated by a TRBV9*01 public TCR (TK3). However, the common allelic variant TRBV9*02, which differs by a single amino acid near the CDR2β loop (Gln55→His55), was never used in this response. The structure of the TK3 TCR, its allelic variant, and a nonnaturally occurring mutant (Gln55→Ala55) in complex with HLA-B*3501 revealed that the Gln55→His55 polymorphism affected the charge complementarity at the TCR-peptide-MHC interface, resulting in reduced functional recognition of the cognate and naturally occurring variants of this EBV peptide. Thus, polymorphism in the TCR loci may contribute toward variability in immune responses and the outcome of infection