The impact of statistical adjustment on economic profiles of interventional cardiologists

AbstractOBJECTIVESThe objective of this study was to identify preprocedure patient factors associated with percutaneous intervention costs and to examine the impact of these patient factors on economic profiles of interventional cardiologists.BACKGROUNDThere is increasing demand for information about comparative resource use patterns of interventional cardiologists. Economic provider profiles, however, often fail to account for patient characteristics.METHODSData were obtained from Duke Medical Center cost and clinical information systems for 1,949 procedures performed by 13 providers between July 1, 1997, and December 31, 1998. Patient factors that influenced cost were identified using multiple regression analysis. After assessing interprovider variation in unadjusted cost, mixed linear models were used to examine how much cost variability was associated with the provider when patient characteristics were taken into account.RESULTSTotal hospital costs averaged $15,643 (median,$13,809), $6,515 of which represented catheterization laboratory costs. Disease severity, acuity, comorbid illness and lesion type influenced total costs (R2= 38%), whereas catheterization costs were affected by lesion type and acuity (R2= 32%). Patient characteristics varied significantly among providers. Unadjusted total costs were weakly associated with provider, and this association disappeared after accounting for patient factors. The provider influence on catheterization costs persisted after adjusting for patient characteristics. Furthermore, the pattern of variation changed: the adjusted analysis identified three new outliers, and two providers lost their outlier status. Only one provider was consistently identified as an outlier in the unadjusted and adjusted analyses.CONCLUSIONSEconomic profiles of interventional cardiologists may be misleading if they do not adequately adjust for patient characteristics before procedure

Breast cancer risk variants at 6q25 display different phenotype associations and regulate ESR1, RMND1 and CCDC170.

We analyzed 3,872 common genetic variants across the ESR1 locus (encoding estrogen receptor α) in 118,816 subjects from three international consortia. We found evidence for at least five independent causal variants, each associated with different phenotype sets, including estrogen receptor (ER(+) or ER(-)) and human ERBB2 (HER2(+) or HER2(-)) tumor subtypes, mammographic density and tumor grade. The best candidate causal variants for ER(-) tumors lie in four separate enhancer elements, and their risk alleles reduce expression of ESR1, RMND1 and CCDC170, whereas the risk alleles of the strongest candidates for the remaining independent causal variant disrupt a silencer element and putatively increase ESR1 and RMND1 expression.This is the author accepted manuscript. The final version is available from Nature Publishing Group via http://dx.doi.org/10.1038/ng.352

Apparent polysemy and thematic underspecification

In this paper, I would like to extend the theory of thematic underspecification proposed in Cowper (1989) for the verb have, and applied to manner-of-motion verbs in Cowper (1990). The two main claims of the theory are given in (1).(1) a. The lexical conceptual structure of a single lexical item contains no disjunctions and no optional elements. It may contain variables ranging over conceptual categories such as function, event, state, thing, path, place, etc.b. General rules, referring not to specific lexical items, but rather to the structure and content of conceptual structures, instantiate variables and spell out additional conceptual structure.I will take as a starting point the analysis of motion verbs given in Cowper (1990). Working with Levin and Rappaport's (1989) classification of motion verbs, given in (2), I proposed the lexical representations in (3) and the rules in (4)

Deriving inherent case: passives in German

It is well-known that in languages with overt morphological case, marked, or inherent, case behaves differently from regular, or structural, case with respect to various syntactic phenomena. A standard example comes from the passive construction in German, where lexically marked case, but not structural accusative case, is preserved on the derived subject, as shown in (1) and (2).(1) a. Ich habe ihm geholfenI(NOM) have him(DAT) helped.'I helped him' b. Ihm wurde geholfen He(DAT) was helped. (2) a. Ich liebe ihn 1(NOM) love him(ACC) b. Er wird geliebt He (NOM) is lovedThe assumption made in current GB theory (Chomsky 1986, Belletti 1988) is that inherent case is assigned at D-structure, and is θ-linked. Structural case, on the other hand, is assigned at S-structure, independently of θ-marking. Passives such as (1b) and (2b) are accounted for by assuming that passive morphology absorbs, or discharges, structural accusative case but leaves inherent case intact.In this paper, I will argue that case assignment need not be partitioned in this way. Rather, given the appropriate representation of verbs with lexically marked case, it is possible for the process of case assignment to be treated uniformly. Differences between inherent and structural case follow entirely from the lexical representations of the various verbs

The features of tense in English

This paper proposes lexical entries for the seven inflectional morphemes that can head English tense phrases. Following Johns' (1992) One Form/One Meaning Principle, and Cowper's (1995) Strong Monosemy Principle, a single lexical representation is proposed for each morpheme, and the various interpretations of sentences containing these morphemes follow compositionally, once the roles of other elements in the sentence and in the discourse context are properly understood. The various tense morphemes are shown to fall into the three classes defined by standard (Chomsky 1981) Binding Theory, with temporal anaphors, temporal pronominals and temporal R-expressions all playing a role. Finiteness is shown to be simply a matter of subject case licensing, and pastness is argued to constitute merely a marked form of coindexing, similar to that proposed by Saxon (1984) for disjoint anaphors in Dogrib. Sequence of tense phenomena follow straightforwardly from the binding properties of the present and past tense morphemes