The Impact of Managed Care Payer Contracts on the Subspecialty Medical Provider: Policy Implications that Impact on the Care of Disabled Children

This Note explores the impact of current managed care contractual practices on the subspecialty provider\u27s ability to deliver health care to chronically ill and disabled children. In doing so, it delves into the historical events giving rise to the development of health care reform. It then reviews various physician agreements with several managed care organizations ( MCOs ) to demonstrate how contract conditions affect compensation for pediatric neurosurgical services. This Note then details the impact of managed care on the management of the chronic health problems of such children and proposes alternative solutions for affordable health care delivery systems for poor, medically fragile groups with complex health problems

Choirs in Concert

Enjoy a performance by Women\u27s Choir, Men\u27s Chorale, and Chamber Singers, led by Alison Mann, Reid Masters, and Leslie Blackwell.https://digitalcommons.kennesaw.edu/musicprograms/2409/thumbnail.jp

Biological reference points for Atlantic surfclam (Spisula solidissima) in warming seas

Atlantic surfclam (Spisula solidissima) are a large, commercially important shellfish in the United States faced with several important management challenges. Compared to many harvested fish and shellfish, their life history is relatively unknown. They are undergoing contraction in the southern and inshore parts of their range, as well as expansion into deeper water. Atlantic surfclam are thermally sensitive, and the changes in their distribution track changes in maximum bottom temperature. Sessile species cannot emigrate and are limited to recruitment and mortality as mechanisms for redistribution in response to changing climate. Management of Atlantic surf clam should account for these challenges. We describe a simulation designed to calculate biological reference points that will work well for Atlantic surfclam relative to biological and fishery goals, over a range of life history parameters, assessment uncertainties, and increases in temperature. Simulations of the trade-off between somatic growth and mortality under increased temperature led to target fishing mortality rates higher than the status quo, but also to increased variability in yield. Results suggest that increasing temperature may adversely affect the Atlantic surfclam industry, which prefers stable catches to short term increases in yield, due to market limitations. The results of this analysis are specific to Atlantic surfclam, but the methods described here could be used to enhance management for other harvested species facing similar challenges

Temporal activity patterns of predators and prey across broad geographic scales

Predators and prey are locked in an evolutionary arms race that shapes their behavior and life history. Predators target prey vulnerabilities to maximize hunting success, while prey trade-off foraging against predation avoidance. Though studies have demonstrated how predation risk can alter how prey allocate daily foraging effort, little work has considered the implications of this temporal component of behavior from a predator’s perspective, or assessed its influence on broad-scale predator–prey interactions. We develop a method to compare daily activity patterns of avian predators and prey using data from 2 large citizen science datasets collected on different continents. Our analyses reveal evidence for convergent daily hunting strategies across avian predators, with distinct differences according to prey type. By comparing predator data with correspondent data from songbirds, our study suggests that predators (Accipiters) specialized to hunt songbirds match the activity patterns of their prey species. These results indicate predators have evolved common temporal hunting strategies to exploit temporal patterns in prey behavior

Pathologies in Asymptotically Lifshitz Spacetimes

There has been significant interest in the last several years in studying possible gravitational duals, known as Lifshitz spacetimes, to anisotropically scaling field theories by adding matter to distort the asymptotics of an AdS spacetime. We point out that putative ground state for the most heavily studied example of such a spacetime, that with a flat spatial section, suffers from a naked singularity and further point out this singularity is not resolvable by any known stringy effect. We review the reasons one might worry that asymptotically Lifshitz spacetimes are unstable and employ the initial data problem to study the stability of such systems. Rather surprisingly this question, and even the initial value problem itself, for these spacetimes turns out to generically not be well-posed. A generic normalizable state will evolve in such a way to violate Lifshitz asymptotics in finite time. Conversely, enforcing the desired asymptotics at all times puts strong restrictions not just on the metric and fields in the asymptotic region but in the deep interior as well. Generically, even perturbations of the matter field of compact support are not compatible with the desired asymptotics.Comment: 36 pages, 1 figure, v2: Enhanced discussion of singularity, including relationship to Gubser's conjecture and singularity in RG flow solution, plus minor clarification

Ceria Entrapped Palladium Novel Composites for Hydrogen Oxidation Reaction in Alkaline Medium

A new heterogeneous catalyst for hydrogen oxidation reaction (HOR), metallic palladium within which nanoparticles of ceria are entrapped, CeO2@Pd, is described. Its preparation is based on a new materials methodology of molecular doping of metals. The metallic matrix, which encages the nanoparticles, is prepared in foam architecture, to ensure easy molecular diffusion. Characterization of the structural properties of the CeO2@Pd composite using SEM, STEM, TEM, XRD, EXAFS and nitrogen adsorption reveals its morphological architecture, which leads to improved catalytic activity. In-situ electrochemical and H2 temperature-programmed reduction (H2-TPR) spectra provide direct experimental evidence of the weakening of Pd‒H bond in the CeO2@Pd composites, relative to pure (undoped) Pd catalysts. Gas diffusion electrodes based on the entrapped CeO2@Pd catalysts demonstrated one order of magnitude higher activity than pure Pd analog in the HOR reaction in an alkaline medium

An inflamed necrotic appendix epiploicum with immediate contact to a non-inflamed appendix vermiformis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Epiploic appendagitis is a rare cause of focal abdominal pain which, depending on its localisation, can mimic a variety of abdominal diseases. We describe a patient with an inflamed necrotic appendix epiploicum with immediate contact to a non-inflamed appendix vermiformis mimicking acute appendicitis. Considering the rare localization, this is the first report of this kind in the literature.</p> <p>Case presentation</p> <p>We present the case of a 50-year-old Caucasian man who presented with classic signs of acute appendicitis. On clinical exam, McBurney and Blumberg signs were positive. Additionally he had fever, leucocytosis (12/nl) and a slight increase in C-reactive protein (1 mg/dl). Based on the clinical presentation, the patient was taken to the operating room to perform an appendicectomy. Surprisingly, we found an inflamed necrotic appendix epiploicum, located immediately on a non-inflamed appendix vermiformis, which was ligated and excised.</p> <p>Conclusion</p> <p>This case report demonstrates that epiploic appendagitis can mimic acute appendicitis on clinical exam and should be considered in the broad spectrum of abdominal disease presenting with right lower quadrant pain.</p

Variation in HIV-1 Nef function within and among viral subtypes reveals genetically separable antagonism of SERINC3 and SERINC5

HIV Nef counteracts cellular host restriction factors SERINC3 and SERINC5, but our understanding of how naturally occurring global Nef sequence diversity impacts these activities is limited. Here, we quantify SERINC3 and SERINC5 internalization function for 339 Nef clones, representing the major pandemic HIV-1 group M subtypes A, B, C and D. We describe distinct subtype-associated hierarchies for Nef-mediated internalization of SERINC5, for which subtype B clones display the highest activities on average, and of SERINC3, for which subtype B clones display the lowest activities on average. We further identify Nef polymorphisms that modulate its ability to counteract SERINC proteins, including substitutions in the N-terminal domain that selectively impair SERINC3 internalization. Our findings demonstrate that the SERINC antagonism activities of HIV Nef differ markedly among major viral subtypes and between individual isolates within a subtype, suggesting that variation in these functions may contribute to global differences in viral pathogenesis

Innovation and venture capital exit performance

Venture capital is a potent source of R&D financing which contributes significantly to technological innovation output in the form of patented inventions. Scholars have argued that tighter protection of intellectual property rights reduces expropriation risks and encourages venture capitalists to invest in technology firms. Prior studies have showed that early stage technology investors give much weight to investment selection criteria related to innovation e.g. protection of intellectual property, platform and uniqueness. However, VC investors generally receive little on their investments until a liquidation event occurs – IPO and M&A (trade sale) exits define venture capital performance. A review of the literature indicates that few empirical studies have examined the influence of patented innovation on the exit performance of VC-backed technology firms. This paper seeks to address this specific knowledge gap in venture capital research and practice. It builds on resource-based view (RBV) theory which argues that technological innovation is an important strategic resource of the entrepreneurial firm that can attract VC investment, provide competitive advantage and produce superior performance. This study is based on matched data compiled from VentureXpertTM, DelphionTM and NBER/USPTO databases. The resulting unique and proprietary dataset consists of 1504 U.S. VC-backed exits across 7 technology sectors in the 20 years from 1980-2000, 961 IPOs and 543 M&As. The influence of technological innovation on the exit performance of VC-backed technology firms is examined. As predicted by RBV theory, technology firms engaged in patenting activity were found more likely to be associated with the more profitable IPO exit route, higher VC investment and exit value