Knowledge of Practicing Physicians about Their Legal Obligations When Caring for Patients with Disability

doi: 10.1377/hlthaff.2018.05060 HEALTH AFFAIRS 38, NO. 4 (2019): 545–55

A Trapped Field of 17.6 T in Melt-Processed, Bulk Gd-Ba-Cu-O Reinforced with Shrink-Fit Steel

The ability of large grain, REBa$_{2}$Cu$_{3}$O$_{7-\delta}$ [(RE)BCO; RE = rare earth] bulk superconductors to trap magnetic field is determined by their critical current. With high trapped fields, however, bulk samples are subject to a relatively large Lorentz force, and their performance is limited primarily by their tensile strength. Consequently, sample reinforcement is the key to performance improvement in these technologically important materials. In this work, we report a trapped field of 17.6 T, the largest reported to date, in a stack of two, silver-doped GdBCO superconducting bulk samples, each of diameter 25 mm, fabricated by top-seeded melt growth (TSMG) and reinforced with shrink-fit stainless steel. This sample preparation technique has the advantage of being relatively straightforward and inexpensive to implement and offers the prospect of easy access to portable, high magnetic fields without any requirement for a sustaining current source.Comment: Updated submission to reflect licence change to CC-BY. This is the "author accepted manuscript" and is identical in content to the published versio

Confidence intervals for ranks of age-adjusted rates across states or counties

Health indices provide information to the general public on the health condition of the community. They can also be used to inform the government’s policy making, to evaluate the effect of a current policy or healthcare program, or for program planning and priority setting. It is a common practice that the health indices across different geographic units are ranked and the ranks are reported as fixed values. We argue that the ranks should be viewed as random and hence should be accompanied by an indication of precision (i.e., the confidence intervals). A technical difficulty in doing so is how to account for the dependence among the ranks in the construction of confidence intervals. In this paper, we propose a novel Monte Carlo method for constructing the individual and simultaneous confidence intervals of ranks for age-adjusted rates. The proposed method uses as input age-specific counts (of cases of disease or deaths) and their associated populations. We have further extended it to the case in which only the age-adjusted rates and confidence intervals are available. Finally, we demonstrate the proposed method to analyze US age-adjusted cancer incidence rates and mortality rates for cancer and other diseases by states and counties within a state using a website that will be publicly available. The results show that for rare or relatively rare disease (especially at the county level), ranks are essentially meaningless because of their large variability, while for more common disease in larger geographic units, ranks can be effectively utilized

Association of Medical Students' Reports of Interactions with the Pharmaceutical and Medical Device Industries and Medical School Policies and Characteristics: A Cross-Sectional Study

Background: Professional societies use metrics to evaluate medical schools' policies regarding interactions of students and faculty with the pharmaceutical and medical device industries. We compared these metrics and determined which US medical schools' industry interaction policies were associated with student behaviors. Methods and Findings: Using survey responses from a national sample of 1,610 US medical students, we compared their reported industry interactions with their schools' American Medical Student Association (AMSA) PharmFree Scorecard and average Institute on Medicine as a Profession (IMAP) Conflicts of Interest Policy Database score. We used hierarchical logistic regression models to determine the association between policies and students' gift acceptance, interactions with marketing representatives, and perceived adequacy of faculty–industry separation. We adjusted for year in training, medical school size, and level of US National Institutes of Health (NIH) funding. We used LASSO regression models to identify specific policies associated with the outcomes. We found that IMAP and AMSA scores had similar median values (1.75 [interquartile range 1.50–2.00] versus 1.77 [1.50–2.18], adjusted to compare scores on the same scale). Scores on AMSA and IMAP shared policy dimensions were not closely correlated (gift policies, r = 0.28, 95% CI 0.11–0.44; marketing representative access policies, r = 0.51, 95% CI 0.36–0.63). Students from schools with the most stringent industry interaction policies were less likely to report receiving gifts (AMSA score, odds ratio [OR]: 0.37, 95% CI 0.19–0.72; IMAP score, OR 0.45, 95% CI 0.19–1.04) and less likely to interact with marketing representatives (AMSA score, OR 0.33, 95% CI 0.15–0.69; IMAP score, OR 0.37, 95% CI 0.14–0.95) than students from schools with the lowest ranked policy scores. The association became nonsignificant when fully adjusted for NIH funding level, whereas adjusting for year of education, size of school, and publicly versus privately funded school did not alter the association. Policies limiting gifts, meals, and speaking bureaus were associated with students reporting having not received gifts and having not interacted with marketing representatives. Policy dimensions reflecting the regulation of industry involvement in educational activities (e.g., continuing medical education, travel compensation, and scholarships) were associated with perceived separation between faculty and industry. The study is limited by potential for recall bias and the cross-sectional nature of the survey, as school curricula and industry interaction policies may have changed since the time of the survey administration and study analysis. Conclusions: As medical schools review policies regulating medical students' industry interactions, limitations on receipt of gifts and meals and participation of faculty in speaking bureaus should be emphasized, and policy makers should pay greater attention to less research-intensive institutions. Please see later in the article for the Editors' Summar

Restoring the Heart: A Community Vision for the Neighborhood of Aldenville

The goal of the Master of Regional Planning Studio is to develop a student’s techniques for collecting, analyzing, and synthesizing spatial and non-spatial data and then presenting that collective data in a manner (i.e., report, video, presentation, and charettes) that is understandable to academics, professionals, and the public. Planning Studio allows students to integrate knowledge from coursework and research, and apply such knowledge to resolving representative planning problems. At UMASS Amherst, these problems are found in neighborhood, rural, urban, and/or regional settings. For the Fall 2017 Planning Studio, Chicopee tasked the Masters of Regional Planning Studio to prepare a vision plan that focuses on improving Chicopee’s public engagement and land-use in Aldenville. The vision plan will contain a multi-question survey that will query Chicopee residents on their opinions of Chicopee, overall, and/or the neighborhood of Aldenville. In addition, the vision plan will also include two proposed land-use studies (zoning, land-use, pedestrian access, design, street improvements) for the neighborhood of Aldenville. This project has 6 goals: § Goal 1: Develop an outreach/engagement process that includes community survey materials (in hard-copy and digital formats) for distribution to Aldenville residents and stakeholders. The Planning Studio shall develop these materials understanding the City’s intended re-use of materials in a City-wide comprehensive visioning process. § Goal 2: Experiment with non-traditional modes of community engagement to maximize variety and volume of community response and data collection. § Goal 3: Analyze data collected from the outreach/engagement process to best inform the neighborhood visioning process and final Aldenville Vision Plan. § Goal 4: Develop a comprehensive understanding and graphic representation of major neighborhood destinations within Aldenville from which a more connected neighborhood concept can be developed. § Goal 5: Document, analyze, and discuss neighborhood opportunities and challenges (informed by the Community Outreach/Public Engagement Process) to advance visions for improving connectivity within the neighborhood and broadening the potential for Aldenville to function as a destination for all City residents as well as visitors from outside the City. § Goal 6: Document and prioritize destinations within Aldenville and propose urban design interventions to improve these destinations while using these destinations as anchors in a larger neighborhood network

Physical Properties of the X-ray Luminous SN 1978K in NGC 1313 from Multiwavelength Observations

We update the light curves from the X-ray, optical, and radio bandpasses which we have assembled over the past decade, and present two observations in the ultraviolet using the Hubble Space Telescope Faint Object Spectrograph. The HRI X-ray light curve is constant within the errors over the entire observation period. This behavior is confirmed in the ASCA GIS data obtained in 1993 and 1995. In the ultraviolet, we detected Ly-alpha, the [Ne IV] 2422/2424 A doublet, the Mg II doublet at 2800 A, and a line at ~3190 A we attribute to He I 3187. Only the Mg II and He I lines are detected at SN1978K's position. The optical light curve is formally constant within the errors, although a slight upward trend may be present. The radio light curve continues its steep decline. The longer time span of our radio observations compared to previous studies shows that SN1978K is in the same class of highly X-ray and radio-luminous supernovae as SN1986J and SN1988Z. The [Ne IV] emission is spatially distant from the location of SN1978K and originates in the pre-shocked matter. The Mg II doublet flux ratio implies the quantity of line optical depth times density of ~10^14 cm^-3 for its emission region. The emission site must lie in the shocked gas.Comment: 32 pages, 13 figs; LaTeX with AASTEXv5; paper accepted, scheduled for AJ, Dec 199

Gene expression by marrow stromal cells in a porous collagen-glycosaminoglycan scaffold is affected by pore size and mechanical stimulation.

Marrow stromal cell (MSC) populations, which are a potential source of undifferentiated mesenchymal cells, and culture scaffolds that mimic natural extracellular matrix are attractive options for orthopaedic tissue engineering. A type I collagen-glycosaminoglycan (CG) scaffold that has previously been used clinically for skin regeneration was recently shown to support expression of bone-associated proteins and mineralisation by MSCs cultured in the presence of osteogenic supplements. Here we follow RNA markers of osteogenic differentiation in this scaffold. We demonstrate that transcripts of the late stage markers bone sialoprotein and osteocalcin are present at higher levels in scaffold constructs than in two-dimensional culture, and that considerable gene induction can occur in this scaffold even in the absence of soluble osteogenic supplements. We also find that bone-related gene expression is affected by pore size, mechanical constraint, and uniaxial cyclic strain of the CG scaffold. The data presented here further establish the CG scaffold as a potentially valuable substrate for orthopaedic tissue engineering and for research on the mechanical interactions between cells and their environment, and suggest that a more freely-contracting scaffold with larger pore size may provide an environment more conducive to osteogenesis than constrained scaffolds with smaller pore sizes