Views of health system policymakers on the role of research in health policymaking in Israel

Background: The use of research evidence in health policymaking is an international challenge. Health systems, including that of Israel, are usually characterized by scarce resources and the necessity to make rapid policy decisions. Knowledge transfer and exchange (KTE) has emerged as a paradigm to start bridging the “know-do” gap. The purpose of this study was to explore the views of health system policymakers and senior executives involved in the policy development process in Israel regarding the role of health systems and policy research (HSPR) in health policymaking, the barriers and facilitators to the use of evidence in the policymaking process, and suggestions for improving the use of HSPR in the policymaking process. Methods: A survey and an interview were verbally administered in a single face-to-face meeting with health system policymakers and senior executives involved in the policy development process in Israel. The data collection period was from July to October 2014. The potential participants included members of Knesset, officials from Israel’s Ministry of Health, Ministry of Finance, health services organizations, and other stakeholder organizations (i.e., National Insurance Institute). The close-ended questions were based on previous surveys that had been conducted in this field. Interviews were tape recorded and transcribed. Descriptive statistics were conducted for close ended survey-questions and thematic analysis was conducted for open-ended interview questions. Results: There were 32 participants in this study. Participants felt that the use of HSPR helps raise awareness on policy issues, yet the actual use of HSPR was hindered for many reasons. Facilitators do exist to support the use of HSPR in the policymaking process, such as a strong foundation of relationships between researchers and policymakers. However, many barriers exist such as the lack of relevance and timeliness of much of the currently available research to support decision-making and the paucity of funding to support research use. Suggestions to improve the use of HSPR focused on improving dissemination of research findings and ensuring that the research was more relevant and timely. Conclusions: This research demonstrated that health systems policymakers in Israel perceive having strong relationships and collaborations with researchers however there is room for improvement, e.g. partnering in research projects to ensure relevance and use. Furthermore, health system policymakers seem to be interested in receiving relevant research in a more useable format and are open to using research in decision making

Two Biexciton Types Coexisting in Coupled Quantum Dot Molecules

Coupled colloidal quantum dot molecules (CQDMs) are an emerging class of nanomaterials, manifesting two coupled emission centers and thus introducing additional degrees of freedom for designing quantum-dot-based technologies. The properties of multiply excited states in these CQDMs are crucial to their performance as quantum light emitters, but they cannot be fully resolved by existing spectroscopic techniques. Here we study the characteristics of biexcitonic species, which represent a rich landscape of different configurations essentially categorized as either segregated or localized biexciton states. To this end, we introduce an extension of Heralded Spectroscopy to resolve the different biexciton species in the prototypical CdSe/CdS CQDM system. By comparing CQDMs with single quantum dots and with nonfused quantum dot pairs, we uncover the coexistence and interplay of two distinct biexciton species: A fast-decaying, strongly interacting biexciton species, analogous to biexcitons in single quantum dots, and a long-lived, weakly interacting species corresponding to two nearly independent excitons. The two biexciton types are consistent with numerical simulations, assigning the strongly interacting species to two excitons localized at one side of the quantum dot molecule and the weakly interacting species to excitons segregated to the two quantum dot molecule sides. This deeper understanding of multiply excited states in coupled quantum dot molecules can support the rational design of tunable single- or multiple-photon quantum emitters.U.B. and D.O. acknowledge the support of the Israel Science Foundation (ISF) and the Directorate for Defense Research and Development (DDR&D), grant No. 3415/21. J.I.C. and J.P. acknowledge support from UJI project B-2021-06. E.S., A.L., Y.E.P., and Y.O. acknowledge support from the Hebrew University Center for Nanoscience and Nanotechnology

Does the majority always know best? Young children's flexible trust in majority opinion

Copying the majority is generally an adaptive social learning strategy but the majority does not always know best. Previous work has demonstrated young children's selective uptake of information from a consensus over a lone dissenter. The current study examined children's flexibility in following the majority: do they overextend their reliance on this heuristic to situations where the dissenting individual has privileged knowledge and should be trusted instead? Four- to six- year-olds (N = 103) heard conflicting claims about the identity of hidden drawings from a majority and a dissenter in two between-subject conditions: in one, the dissenter had privileged knowledge over the majority (he drew the pictures); in the other he did not (they were drawn by an absent third party). Overall, children were less likely to trust the majority in the Privileged Dissenter condition. Moreover, 5- and 6- year-olds made majority-based inferences when the dissenter had no privileged knowledge but systematically endorsed the dissenter when he drew the pictures. The current findings suggest that by 5 years, children are able to make an epistemic-based judgment to decide whether or not to follow the majority rather than automatically following the most common view

Measuring grain size fractions of bidisperse granular materials using X-ray radiography

The mechanical properties of granular materials such as sand, snow and rice are inherently tied to the size of the constituent particles. When a system is composed of particles of various sizes, it is common for these particles to segregate by size when disturbed. There is therefore a need to measure the particle size distribution within granular media as it evolves over time. However, there are very few experimental techniques available which can measure the particle sizes in situ without disturbing the medium. Here we present a technique to determine the volume fractions of the grain sizes in bidisperse granular materials with the aid of dynamic X-ray radiography. As a result of the penetration of the X-rays into the medium, radiography minimises the effect of walls and boundaries on experimental measurements, which typically dominate optical measurements. The technique proposed here is based on using Fourier transforms of X-ray radiographs to extract local measurements evolving over time that can be related to the particle size distribution. For the case of bidisperse granular media, with two distinct particle sizes, we show that this technique can measure the relative concentration of the two species, which we determine via a heuristic calibration parameter. We validate this technique by comparing discrete element simulations of mixtures of known concentration with experimental measurements derived from X-ray radiography of glass beads. In the future, this technique could be used to measure the grain size distribution in systems of bidisperse dense granular media where the concentration of particles is not known a priori. Additionally, the technique can be used to analyse granular segregation as it evolves dynamically

Forme des ressauts granulaires en canal incliné: implications possibles pour le dimensionnement des digues paravalanches

Quand un écoulement granulaire à surface libre en régime supercritique rencontre un mur normal à la direction de l'écoulement, il peut se former une discontinuité en hauteur et en vitesse, dit ressaut granulaire par analogie aux ressauts hydrauliques, se propageant vers l'amont. Pour cela, il faut que la hauteur de l'obstacle soit supérieure à une hauteur critique conduisant à la formation du ressaut qui marque la transition entre le régime supercritique et le régime subcritique. En dessous de cette hauteur critique, l'écoulement reste supercritique et déborde sans formation de ressaut. Au-dessus de la hauteur critique, si le ressaut formé est de hauteur inférieure à la hauteur critique alors le ressaut se propage vers l'amont sans débordement de l'obstacle. Si le ressaut est de hauteur supérieure à la hauteur critique du mur alors ce dernier est débordé par l'écoulement. Ces processus, associés à la hauteur critique de l'obstacle pour qu'il y ait formation d'un ressaut d'une part et à la hauteur du ressaut formé d'autre part, constituent aujourd'hui les bases des recommandations Européennes en matière de dimensionnement des digues paravalanches d'arrêt visant à stopper entièrement l'écoulement d'avalanche ainsi que des digues de déviation [1]. Les valeurs de hauteur critique de l'obstacle et de hauteur du ressaut sont calculées à partir des équations traditionnelles des ressauts hydrauliques et sont essentiellement fonction du nombre de Froude de l'écoulement incident. Plusieurs études (voir par exemple [2,3,4]) ont démontré que ces équations classiques de l'hydraulique offraient de bonnes prédictions pour les ressauts, normaux ou obliques, formés dans les écoulements granulaires, ces derniers étant de bons modèles pour les écoulements de neige. Cependant la plupart des expériences de laboratoire sont restées jusqu'à présent limitées à des pentes fortes où l'inertie est dominante (nombre de Froude de l'ordre de 5-15), ce qui reste des valeurs élevées par rapport aux valeurs du nombre de Froude généralement plus faibles (de l'ordre de l'unité ou de quelques unités) dans la zone d'arrêt des avalanches. Des questions viennent alors à l'esprit : que se passe-t-il aux faibles valeurs du nombre de Froude pour lesquelles les forces d'inertie dans le ressaut ne sont pas dominantes ? Quel sont les effets des fortes de gravité et de frottement dans le ressaut ? Les équations classiques de l'hydraulique sont-elles toujours valides ? Afin de progresser sur ces questions, nous avons étudié en détail les ressauts stationnaires formés dans les écoulements granulaires en pente. Nous avons développé un nouveau dispositif expérimental qui permet de générer des ressauts granulaires stationnaires. Une vanne placée à la sortie d'un canal incliné à fond lisse permet d'obstruer en partie les écoulements granulaires permanents formés dans le canal et de générer des ressauts se propageant vers l'amont. En ajustant le débit de sortie au débit entrant, il est possible de rendre le ressaut stationnaire dans une large gamme de pente et débit. Des mesures basées sur des techniques d'imagerie (détection de surface libre, analyse de diagrammes spatio-temporels obtenus à la base de l'écoulement, aux parois et à la surface libre à l'aide d'une caméra rapide) couplées à des mesures de débit massique nous ont permis de mesurer en détail la dynamique des écoulements incidents (hauteur, vitesse, masse volumique) et la forme des ressauts pour chaque type d'écoulement. Nous avons pu établir un diagramme de phase qui permet de mettre en évidence une riche variété de ressauts granulaires. A haut débit, les écoulements sont denses et la forme des ressauts granulaires varie largement avec la pente. Au-delà d'une certaine pente, les écoulements sont légèrement non uniformes (uniformément accélérés) et les ressauts sont très raides avec une zone de recirculation au pied du ressaut. Pour une large gamme de pente, les écoulements sont uniformes, la zone de recirculation dans le ressaut disparait et les ressauts sont de plus en plus diffus quand la pente diminue. A une pente critique égale à l'angle de frottement typique du matériau, il est impossible de former un ressaut. Cette première série de tests à haut débit met en évidence une transition entre ressauts raides avec recirculation et ressauts diffus. Les ressauts diffus ont des hauteurs plus grandes que la hauteur prédite par l'hydraulique alors que la hauteur des ressauts raides avec recirculation est bien prédite par l'hydraulique classique. Nous montrons qu'une équation de ressaut avec prise en compte du poids du ressaut dans la direction de l'écoulement diminué de la force de frottement dans le ressaut (comme initialement proposé par [5] et récemment revisité par [6]) permet d'expliquer l'écart observé entre l'hydraulique classique et les ressauts granulaires diffus, dits ressauts frictionnels, à bas nombre de Froude typiquement en dessous de 4 dans nos tests. A faible débit, les écoulements incidents sont plus dilués et génèrent des ressauts dits compressibles pour lesquels il existe, en plus de la discontinuité en hauteur et en vitesse, une variation non négligeable de la masse volumique à travers le ressaut. Nous proposons une équation qui prend en compte cette variation de masse volumique. Cette équation est ainsi capable de prédire la diminution de la hauteur des ressauts quand les écoulements incidents sont de plus en plus dilués du fait de la diminution du débit entrant (à pente constante). Notre étude expérimentale de laboratoire couplée à des solutions analytiques a permis de mettre en évidence (i) une première transition entre ressauts granulaires raides avec recirculation et ressauts granulaires diffus frictionnels et (ii) une seconde transition entre ressauts granulaires incompressibles et compressibles. Les effets des termes source dans l'équation de ressaut (poids, force de frottement) à faible nombre de Froude et de la variation de masse volumique pour les écoulements dilués mis en évidence pour les ressauts stationnaires sont susceptibles de se manifester aussi dans les ressauts instationnaires. Cela peut remettre en question les recommandations Européennes existantes en matière de dimensionnement des digues paravalanches, notamment quand le nombre de Froude est faible (typiquement inférieur à 4 dans nos tests). Notre étude montre que les ressauts frictionnels diffus ont une hauteur plus grande que la hauteur prédite par l'équation de l'hydraulique alors que les ressauts compressibles ont une hauteur plus faible. Si le dernier résultat va dans le sens de la sécurité, le premier résultat est lui plus problématique quant au dimensionnement actuel des digues et au risque de débordement en aval des digues. En effet, nos résultats suggèrent que la hauteur des ressauts, donc la hauteur de digue nécessaire, peut être sous-estimée dans les régimes d'écoulement à bas nombre de Froude si l'équation de l'hydraulique (sans les termes source) est utilisée

Multiplexed characterization of rationally designed promoter architectures deconstructs combinatorial logic for IPTG-inducible systems

A crucial step towards engineering biological systems is the ability to precisely tune the genetic response to environmental stimuli. In the case of Escherichia coli inducible promoters, our incomplete understanding of the relationship between sequence composition and gene expression hinders our ability to predictably control transcriptional responses. Here, we profile the expression dynamics of 8269 rationally designed, IPTG-inducible promoters that collectively explore the individual and combinatorial effects of RNA polymerase and LacI repressor binding site strengths. We then fit a statistical mechanics model to measured expression that accurately models gene expression and reveals properties of theoretically optimal inducible promoters. Furthermore, we characterize three alternative promoter architectures and show that repositioning binding sites within promoters influences the types of combinatorial effects observed between promoter elements. In total, this approach enables us to deconstruct relationships between inducible promoter elements and discover practical insights for engineering inducible promoters with desirable characteristics

Cor Triatriatum Sinister diagnosed in adult life with three dimensional transesophageal echocardiography

<p>Abstract</p> <p>Background</p> <p>Cor triatriatum is a very rare congenital abnormality, usually symptomatic during childhood, diagnosis in adult age is less common.</p> <p>Case Presentation</p> <p>We report the case of a 40 years old woman referred to our hospital for atrial flutter ablation, transthoracic cardiac bidimensional echocardiography showed an abnormal membrane bisecting the left atrium, the diagnosis of cor triatriatum was fully made via three dimensional transesophageal echocardiography. More interstingly three other cardiac anomalies were associated: ostium secundum atrial septal defect, dilated coronary sinus due probably to persistent left superior vena cava and normally functioning bicuspid aortic valve.</p> <p>Conclusions</p> <p>Cor triatriatum sinister in adult life is important to recognize because it may be easily surgically correctable when hemodynamically significant. Three Dimensional transesophageal echocardiography is a minimally invasive and highly sensitive diagnostic modality.</p

Time preferences and risk aversion: tests on domain differences

The design and evaluation of environmental policy requires the incorporation of time and risk elements as many environmental outcomes extend over long time periods and involve a large degree of uncertainty. Understanding how individuals discount and evaluate risks with respect to environmental outcomes is a prime component in designing effective environmental policy to address issues of environmental sustainability, such as climate change. Our objective in this study is to investigate whether subjects' time preferences and risk aversion across the monetary domain and the environmental domain differ. Crucially, our experimental design is incentivized: in the monetary domain, time preferences and risk aversion are elicited with real monetary payoffs, whereas in the environmental domain, we elicit time preferences and risk aversion using real (bee-friendly) plants. We find that subjects' time preferences are not significantly different across the monetary and environmental domains. In contrast, subjects' risk aversion is significantly different across the two domains. More specifically, subjects (men and women) exhibit a higher degree of risk aversion in the environmental domain relative to the monetary domain. Finally, we corroborate earlier results, which document that women are more risk averse than men in the monetary domain. We show this finding to, also, hold in the environmental domain

Prepubertal unilateral gynecomastia: a report of two cases

Item does not contain fulltextBACKGROUND: Gynecomastia is defined as the presence of excessive breast tissue in males, which can appear unilateral or bilateral. Bilateral gynecomastia is frequently found in the neonatal period, early in puberty, and with increasing age. Prepubertal unilateral gynecomastia in the absence of endocrine abnormalities is extremely rare, with only a few cases in literature. METHODS: We report the cases of two otherwise healthy boys of 8 and 11 years old with unilateral breast masses. No abnormalities were found on ultrasonography and all endocrine parameters were within normal limits. Treatment consisted of peripheral liposuction followed by subcutaneous partial resection of the gland, conducted through an infra-areolar incision. Results : Microscopy of the subcutaneous mastectomy specimen revealed gynecomastia without signs of malignancy. Postoperative course of both patients was uncomplicated, with no signs of recurrence of breast tissue. CONCLUSIONS: Atypical presentations of gynecomastia are often not recognized, with little attention to breast development in prepubertal non-obese children. Since prepubertal gynecomastia could be a sign of possible underlying diseases, a thorough examination and further research is recommended. If there is no causal treatment, surgical resection is the therapy of first choice. Peripheral liposuction and surgical resection of the gland tissue are the mainstay of treatment. In summary, we describe two cases of prepubertal unilateral gynecomastia with a normal endocrine workup. Further research is needed to establish the pathophysiologic mechanisms of prepubertal gynecomastia, since underlying etiology in most cases remains unclear