Hospital Community Benefits After the ACA: Building on State Experience

Analyzes hospitals' requirements to conduct community health needs assessments, financial assistance and billing and collection policies, and community benefit reporting and oversight strategies. Notes implications for federal and state law and practice

Revisiting the middle molecule hypothesis of uremic toxicity: A systematic review of beta 2 microglobulin population kinetics and large scale modeling of hemodialysis trials in silico

Background Beta-2 Microglobulin (β2M) is a prototypical "middle molecule" uremic toxin that has been associated with a higher risk of death in hemodialysis patients. A quantitative description of the relative importance of factors determining β2M concentrations among patients with impaired kidney function is currently lacking. Methods Herein we undertook a systematic review of existing studies reporting patient level data concerning generation, elimination and distribution of β2M in order to develop a population model of β2M kinetics. We used this model and previously determined relationships between predialysis β2M concentration and survival, to simulate the population distribution of predialysis β2M and the associated relative risk (RR) of death in patients receiving conventional thrice-weekly hemodialysis with low flux (LF) and high flux (HF) dialyzers, short (SD) and long daily (LD) HF hemodialysis sessions and on-line hemodiafiltration at different levels of residual renal function (RRF). Results We identified 9 studies of 106 individuals and 156 evaluations of or more compartmental kinetic parameters of β2M. These studies used a variety of experimental methods to determine β2M kinetics ranging from isotopic dilution to profiling of intra/inter dialytic concentration changes. Most of the patients (74/106) were on dialysis with minimal RRF, thus facilitating the estimation of non-renal elimination kinetics of β2M. In large scale (N = 10000) simulations of individuals drawn from the population of β2M kinetic parameters, we found that, higher dialytic removal materially affects β2M exposures only when RRF (renal clearance of β2M) was below 2 ml/min. In patients initiating conventional HF hemodialysis, total loss of RRF was predicted to be associated with a RR of death of more than 20%. Hemodiafiltration and daily dialysis may decrease the high risk of death of anuric patients by 10% relative to conventional, thrice weekly HF dialysis. Only daily long sessions of hemodialysis consistently reduced mortality risk between 7-19% across the range of β2M generation rate. Conclusions Preservation of RRF should be considered one of the therapeutic goals of hemodialysis practice. Randomized controlled trials of novel dialysis modalities may require large sample sizes to detect an effect on clinical outcomes even if they enroll anuric patients. The developed population model for β2M may allow personalization of hemodialysis prescription and/ or facilitate the design of such studies by identifying patients with higher β2M generation rate

The near-critical planar FK-Ising model

We study the near-critical FK-Ising model. First, a determination of the correlation length defined via crossing probabilities is provided. Second, a phenomenon about the near-critical behavior of FK-Ising is highlighted, which is completely missing from the case of standard percolation: in any monotone coupling of FK configurations $\omega_p$ (e.g., in the one introduced in [Gri95]), as one raises $p$ near $p_c$, the new edges arrive in a self-organized way, so that the correlation length is not governed anymore by the number of pivotal edges at criticality.Comment: 34 pages, 8 figures. This is a streamlined version; the previous one contains more explanations and additional material on exceptional times in FK models with general $q$. Furthermore, the statement and proof of Theorem 1.2 have slightly change

Response to Cult of the "I"

Purpose: The purpose of this paper is to respond to an earlier article in the Journal of Documentation: The Cult of the “I”. / Design/methodology/approach: The method is a form of critical response. / Findings: Numerous problems regarding the The Cult of the “I” article are discussed. / Originality/value: This paper puts forward views about the iSchools Movement

Bond percolation on isoradial graphs: criticality and universality

In an investigation of percolation on isoradial graphs, we prove the criticality of canonical bond percolation on isoradial embeddings of planar graphs, thus extending celebrated earlier results for homogeneous and inhomogeneous square, triangular, and other lattices. This is achieved via the star-triangle transformation, by transporting the box-crossing property across the family of isoradial graphs. As a consequence, we obtain the universality of these models at the critical point, in the sense that the one-arm and 2j-alternating-arm critical exponents (and therefore also the connectivity and volume exponents) are constant across the family of such percolation processes. The isoradial graphs in question are those that satisfy certain weak conditions on their embedding and on their track system. This class of graphs includes, for example, isoradial embeddings of periodic graphs, and graphs derived from rhombic Penrose tilings.Comment: In v2: extended title, and small changes in the tex

Exercise-induced alterations in phospholipid hydrolysis, airway surfactant, and eicosanoids and their role in airway hyperresponsiveness in asthma

The mechanisms responsible for driving endogenous airway hyperresponsiveness (AHR) in the form of exercise-induced bronchoconstriction (EIB) are not fully understood. We examined alterations in airway phospholipid hydrolysis, surfactant degradation, and lipid mediator release in relation to AHR severity and changes induced by exercise challenge. Paired induced sputum

Surface roughness over the northern half of the Greenland Ice Sheet from airborne laser altimetry

This is the published version, also available here: http://dx.doi.org/10.1029/2008JF001067.Surface roughness, defined as the standard deviation of small-scale elevation fluctuations from the linear trend over 0.5 km, can be estimated from high-resolution airborne laser altimetry. Here we present results for the northern half of the Greenland Ice Sheet using laser data collected in May 1995. Roughness is smallest in the central region straddling the ice divide, increases in amplitude toward the coast, and appears to be correlated with slope of the ice surface. For most of the study region surface roughness is 8 cm or less (<2.5 cm water equivalent). In smaller regions associated with fast flow, larger values are found. Comparison of the size of small-scale topographic disturbances with the spatial noise estimated from five closely spaced ice cores drilled in northwest Greenland shows good agreement. Similar correspondence was found earlier using nine ice cores from the Summit region. These results indicate that the airborne laser altimeter provides an efficient platform for characterizing the statistical nature of the snow surface over large areas of the polar ice sheets

Novel Glial Cells Missing-2 (GCM2) variants in parathyroid disorders

Objective: The aim of this study was to analyze variants of the gene glial cells missing-2 (GCM2), encoding a parathyroid cell-specific transcription factor, in familial hypoparathyroidism and in familial isolated hyperparathyroidism (FIHP) without and with parathyroid carcinoma. Design: We characterized 2 families with hypoparathyroidism and 19 with FIHP in which we examined the mechanism of action of GCM2 variants. Methods: Leukocyte DNA of hypoparathyroid individuals was Sanger sequenced for CASR, PTH, GNA11 and GCM2 mutations. DNA of hyperparathyroid individuals underwent MEN1, CDKN1B, CDC73, CASR, RET and GCM2 sequencing. The actions of identified GCM2 variants were evaluated by in vitro functional analyses. Results: A novel homozygous p.R67C GCM2 mutation which failed to stimulate transcriptional activity in a luciferase assay was identified in affected members of two hypoparathyroid families. Oligonucleotide pull-down assay and in silico structural modeling indicated that this mutant had lost the ability to bind the consensus GCM recognition sequence of DNA. Two novel (p.I383M and p.T386S) and one previously reported (p.Y394S) heterozygous GCM2 variants that lie within a C-terminal conserved inhibitory domain were identified in three affected individuals of the hyperparathyroid families. One family member, heterozygous for p.I138M, had parathyroid carcinoma (PC), and a heterozygous p.V382M variant was found in another patient affected by sporadic PC. These variants exerted significantly enhanced in vitro transcriptional activity, including increased stimulation of the PTH promoter. Conclusions: We provide evidence that two novel GCM2 R67C inactivating mutations with an inability to bind DNA are causative of hypoparathyroidism. Additionally, we provide evidence that two novel GCM2 variants increased transactivation of the PTH promoter in vitro and are associated with FIHP. Furthermore, our studies suggest that activating GCM2 variants may contribute to facilitating more aggressive parathyroid disease