Physician Consolidation and the Spread of Accountable Care Organizations

Accountable Care Organizations (ACOs) are groups of physicians and hospitals that jointly contract to care for a patient population. ACO contracts incentivize coordination of care across providers. This can lead to greater consolidation of physician practices, which can in turn generate higher costs and lower quality. Given this, the study asks, as ACOs enter health care markets, do physician practices grow larger

Social Movement Success as a Political Process: The Case of the 2012 Quebec Student Protests

University tuition fees in Quebec remain among the lowest in North America, despite recent government attempts to raise them. What explains the success of the 2012 Quebec student protests? This paper, drawing upon scholarship on social movement success, argues that the unfolding of political events in 2012 demonstrates the counter-intuitive manner in which a state can come to reflect a social movement's objectives. The Quebec student movement succeeded not by garnering public support or directly influencing policy decisions, but by allying itself with an opposition party that won an election in spite of its association with the movement. The student movement was not backed by popular opinion, and its success resulted from aligning itself with a party that was able to withstand the detrimental effects of this relationship

Why do Adolescents Seek Online Mental Health Information?

Many adolescents avoid seeking psychological help despite the increasing prevalence of mental disorders. The current study investigated whether distress and stigma exhibit differential relationships to decisions to seek online mental health information among a sample of predominantly racial/ethnic minority U.S. adolescents. In this investigation, 174 adolescents (Age: M = 15.90, SD = 0.85, Range = 14−19) completed assessments of help-seeking stigma, psychological distress, and a question asking if they would like to view a website with mental health information. Distress was a statistically significant predictor of decisions to seek online mental health information, but stigma was not. Severely distressed boys were more likely to seek online information than severely distressed girls. Evidence-based online resources may be particularly effective ways to support distressed adolescents

Excitability in autonomous Boolean networks

We demonstrate theoretically and experimentally that excitable systems can be built with autonomous Boolean networks. Their experimental implementation is realized with asynchronous logic gates on a reconfigurabe chip. When these excitable systems are assembled into time-delay networks, their dynamics display nanosecond time-scale spike synchronization patterns that are controllable in period and phase.Comment: 6 pages, 5 figures, accepted in Europhysics Letters (epljournal.edpsciences.org

A Closer Look at Self-Esteem, Perceived Social Support, and Coping Strategy: A Prospective Study of Depressive Symptomatology Across the Transition to College

The first year of college is a significant life transition, which is often characterized by stress and may contribute to the development or exacerbation of depressive symptoms. Due to the considerable negative outcomes that are associated with depressive symptoms across the lifespan, it is important to understand the mechanisms and pathways through which depressive symptoms arise. This prospective study examines the mediating and moderating roles of perceived social support and disengagement coping on the association between self-esteem and depressive symptomatology in a sample of 1,118 first-year college students. Results of longitudinal cross-lagged path analyses indicate that self-esteem predicts depressive symptomatology via perceived social support and disengagement coping. The association between self-esteem and perceived social support appear to be bidirectional, in that level of self-esteem predicts perceived social support, and vice versa. Furthermore, disengagement coping was found to moderate the effect of self-esteem on depressive symptomatology, in that increased levels of disengagement coping led to greater depressive symptoms within the context of both high and low self-esteem. However, this pattern was not observed at lower levels of disengagement coping, which indicates high levels of disengagement coping as a particular risk factor for depressive symptomatology, diminishing the advantage of high self-esteem

Epidural Hematoma Following Cervical Spine Surgery.

STUDY DESIGN: A multicentered retrospective case series. OBJECTIVE: To determine the incidence and circumstances surrounding the development of a symptomatic postoperative epidural hematoma in the cervical spine. METHODS: Patients who underwent cervical spine surgery between January 1, 2005, and December 31, 2011, at 23 institutions were reviewed, and all patients who developed an epidural hematoma were identified. RESULTS: A total of 16 582 cervical spine surgeries were identified, and 15 patients developed a postoperative epidural hematoma, for a total incidence of 0.090%. Substantial variation between institutions was noted, with 11 sites reporting no epidural hematomas, and 1 site reporting an incidence of 0.76%. All patients initially presented with a neurologic deficit. Nine patients had complete resolution of the neurologic deficit after hematoma evacuation; however 2 of the 3 patients (66%) who had a delay in the diagnosis of the epidural hematoma had residual neurologic deficits compared to only 4 of the 12 patients (33%) who had no delay in the diagnosis or treatment (P = .53). Additionally, the patients who experienced a postoperative epidural hematoma did not experience any significant improvement in health-related quality-of-life metrics as a result of the index procedure at final follow-up evaluation. CONCLUSION: This is the largest series to date to analyze the incidence of an epidural hematoma following cervical spine surgery, and this study suggest that an epidural hematoma occurs in approximately 1 out of 1000 cervical spine surgeries. Prompt diagnosis and treatment may improve the chance of making a complete neurologic recovery, but patients who develop this complication do not show improvements in the health-related quality-of-life measurements

Sld2 binds to origin single-stranded DNA and stimulates DNA annealing

Sld2 is essential for the initiation of DNA replication, but the mechanism underlying its role in replication is not fully understood. The S-phase cyclin dependent kinase (S-CDK) triggers the association of Sld2 with Dpb11, and a phosphomimetic mutation of Sld2, Sld2T84D, functionally mimics the S-CDK phosphorylated state of Sld2. We report that Sld2T84D binds directly to the single-stranded (ss) DNA of two different origins of replication, and S-CDK phosphorylation of Sld2 stimulates the binding of Sld2 to origin ssDNA. Sld2T84D binds to a thymine-rich ssDNA region of the origin ARS1, and substitution of ARS1 thymines with adenines completely disrupts binding of Sld2T84D. Sld2T84D enhances the ability of origin ssDNA to pulldown Dpb11, and Sld2 binding to origin ssDNA may be important to allow Sld2 and Dpb11 to associate with origin DNA. We also report that Sld2T84D anneals ssDNA of an origin sequence. Dpb11 anneals ssDNA to low levels, and the addition of Sld2T84D with Dpb11 results in higher annealing activity than that of either protein alone. Sld2-stimulated annealing may be important for maintaining genome stability during the initiation of DNA replication

What happens if you single out? An experiment

We present an experiment investigating the effects of singling out an individual on trust and trustworthiness. We find that (a) trustworthiness falls if there is a singled out subject; (b) non-singled out subjects discriminate against the singled out subject when they are not responsible of the distinct status of this person; (c) under a negative frame, the singled out subject returns significantly less; (d) under a positive frame, the singled out subject behaves bimodally, either selecting very low or very high return rates. Overall, singling out induces a negligible effect on trust but is potentially disruptive for trustworthiness

The use of standardized patients for mock oral board exams in neurology: a pilot study

BACKGROUND: Mock oral board exams, fashioned after the live patient hour of the American Board of Psychiatry and Neurology exam, are commonly part of resident assessment during residency training. Exams using real patients selected from clinics or hospitals are not standardized and do not allow comparisons of resident performance across the residency program. We sought to create a standardized patient mock oral board exam that would allow comparison of residents' clinical performance. METHODS: Three cases were created and then used for this mock oral boards exercise utilizing trained standardized patients. Residents from the University of Cincinnati and Indiana University participated in the exam. Residents were scored by attending physician examiners who directly observed the encounter with the standardized patient. The standardized patient also assessed each resident. A post-test survey was administered to ascertain participant's satisfaction with the examination process. RESULTS: Resident scores were grouped within one standard deviation of the mean, with the exception of one resident who was also subjectively felt to "fail" the exam. In exams with two faculty "evaluators", scores were highly correlated. The survey showed satisfaction with the examination process in general. CONCLUSION: Standardized patients can be used for mock oral boards in the live patient format. Our initial experience with this examination process was positive. Further testing is needed to determine if this examination format is more reliable and valid than traditional methods of assessing resident competency

Hetero-site-specific X-ray pump-probe spectroscopy for femtosecond intramolecular dynamics

Citation: Picon, A., Lehmann, C. S., Bostedt, C., Rudenko, A., Marinelli, A., Osipov, T., . . . Southworth, S. H. (2016). Hetero-site-specific X-ray pump-probe spectroscopy for femtosecond intramolecular dynamics. Nature Communications, 7, 6. doi:10.1038/ncomms11652New capabilities at X-ray free-electron laser facilities allow the generation of two-colour femtosecond X-ray pulses, opening the possibility of performing ultrafast studies of X-ray-induced phenomena. Particularly, the experimental realization of hetero-site-specific X-ray-pump/X-ray-probe spectroscopy is of special interest, in which an X-ray pump pulse is absorbed at one site within a molecule and an X-ray probe pulse follows the X-ray-induced dynamics at another site within the same molecule. Here we show experimental evidence of a hetero-site pump-probe signal. By using two-colour 10-fs X-ray pulses, we are able to observe the femtosecond time dependence for the formation of F ions during the fragmentation of XeF2 molecules following X-ray absorption at the Xe site