Instrumental variable methods to assess quality of care the marginal effects of process-of-care on blood pressure change and treatment costs

Background: Hypertension is poorly controlled. Team-based care and changes in the process of care have been proposed to address these quality problems. However, assessing care processes is difficult because they are often confounded even in randomized behavioral studies by unmeasured confounders based on discretion of health care providers. Objective: To evaluate the effects of process measures including number of counseling sessions about lifestyle modification and number of antihypertensive medications on blood pressure change and payer-perspective treatment costs. Methods: Data were obtained from two prospective, cluster randomized controlled clinical trials (Trial A and B) implementing physician-pharmacist collaborative interventions compared with usual care over six months in community-based medical offices in the Midwest. Multivariate linear regression models with both instrumental variable methods and as-treated methods were utilized. Instruments were indicators for trial and study arms. Models of blood pressure change and costs included both process measures, demographic variables, and clinical variables. Results: The analysis included 496 subjects. As-treated methods showed no significant associations between process and outcomes. The instruments used in the study were insufficient to simultaneously identify distinct process effects. However, the post-hoc instrumental variable models including one process measure at a time while controlling for the other process demonstrated significant associations between the processes and outcomes with estimates considerably larger than as-treated estimates. Conclusions: Instrumental variable methods with combined randomized behavioral studies may be useful to evaluate the effects of different care processes. However, substantial distinct process variation across studies is needed to fully capitalize on this approach. Instrumental variable methods focusing on individual processes provided larger and stronger outcome relationships than those found using as-treated methods which are subject to confounding

Mapping of the Epstein-Barr virus and C3dg binding sites to a common domain on complement receptor type 2.

Complement receptor type 2 (CR2;CD21), a member of the superfamily of proteins containing short consensus repeats (SCRs), is the B cell receptor for both the gp350/220 envelope protein of Epstein-Barr virus (EBV), and for the C3dg protein of complement. By analysis of CR2 deletion mutants and chimeras formed with CR1 (CD35) we determined that of the 15 SCRs in CR2, the NH2-terminal two SCRs are necessary and sufficient to bind both gp350/220 and C3dg with affinities equivalent to those of the wild-type receptor. The epitope for OKB-7, a mAb that blocks binding of both EBV and C3dg and shares with these ligands B cell-activating capabilities, also requires both SCR-1 and SCR-2, whereas mAbs lacking these functions bind to other SCRs. Thus, EBV, a polyclonal activator of B cells, has selected a site that is proximate or identical to the natural ligand binding site in CR2, perhaps reflecting the relative immutability of that site as well as its signal transducing function

New observations on Saturnella saturnus (Steinecke) Fott: the first British record of a little-known enigmatic ‘green’ alga

Saturnella saturnus was discovered in March 2014 in open-water pools on blanket peatland at the Moor House - Upper Teesdale National Nature Reserve, straddling Cumbria and County Durham in NE England. This is the first record for the British Isles of a little-known alga known previously only from a few peat bog areas, mainly in mainland Europe. The literature is reviewed and new observations presented on its morphology and reproduction based on LM examination of living cells. New observations on the chloroplast structure and cytoplasmic inclusions (especially oil droplets) are discussed in relation to the findings of earlier studies. Doubt attaches as whether it is a chlorophyte or a xanthophyte and the identity of small spherical inclusions that have been frequently interpreted as autospores. It occurs in Upper Teesdale in pools that are that are small, relatively newly formed and mostly well-oxygenated. Also discussed is its relationship to Trochiscia, another coloniser of peatland pools. Photographic images are presented for the first time and comments made on its ecology in the context of blanket bog conservation projects and apparent rarity

Direct Conversion of Hydrazones to Amines using Transaminases

Transaminase enzymes (TAms) have been widely used for the amination of aldehydes and ketones, often resulting in optically pure products. In this work, transaminases were directly reacted with hydrazones in a novel approach to form amine products. Several substrates were investigated, including those with furan and phenyl moieties. It was determined that the amine yields increased when an additional electrophile was added to the reaction mixture, suggesting that they can sequester the hydrazine released in the reaction. Pyridoxal 5’-phosphate (PLP), a cofactor for transaminases, and polyethylene glycol (PEG)-aldehydes were both found to increase the yield of amine formed. Notably, the amination of (S)-(−)-1-amino-2-(methoxymethyl)pyrrolidine (SAMP) hydrazones gave promising results as a method to form chiral β-substituted amines in good yield

Separability of Black Holes in String Theory

We analyze the origin of separability for rotating black holes in string theory, considering both massless and massive geodesic equations as well as the corresponding wave equations. We construct a conformal Killing-Stackel tensor for a general class of black holes with four independent charges, then identify two-charge configurations where enhancement to an exact Killing-Stackel tensor is possible. We show that further enhancement to a conserved Killing-Yano tensor is possible only for the special case of Kerr-Newman black holes. We construct natural null congruences for all these black holes and use the results to show that only the Kerr-Newman black holes are algebraically special in the sense of Petrov. Modifying the asymptotic behavior by the subtraction procedure that induces an exact SL(2)^2 also preserves only the conformal Killing-Stackel tensor. Similarly, we find that a rotating Kaluza-Klein black hole possesses a conformal Killing-Stackel tensor but has no further enhancements.Comment: 27 page

Particle dynamics near extreme Kerr throat and supersymmetry

The extreme Kerr throat solution is believed to be non-supersymmetric. However, its isometry group SO(2,1) x U(1) matches precisely the bosonic subgroup of N=2 superconformal group in one dimension. In this paper we construct N=2 supersymmetric extension of a massive particle moving near the horizon of the extreme Kerr black hole. Bosonic conserved charges are related to Killing vectors in a conventional way. Geometric interpretation of supersymmetry charges remains a challenge.Comment: V2: 10 pages; discussion in sect. 4 and 5 extended, acknowledgements and references adde