Variation in Rheumatoid Hand and Wrist Surgery among Medicare Beneficiaries: A Population-based Cohort Study

Objective. To examine the rate and variation in rheumatoid arthritis (RA)-related hand and wrist surgery among Medicare (elderly) beneficiaries in the United States, and to identify the patient and provider factors that influence surgical rates. Methods. Using the 2006–2010 100% Medicare claims data of beneficiaries with RA diagnosis, we examined rates of rheumatoid hand and wrist arthroplasty, arthrodesis, and hand tendon reconstruction in the United States. We used multivariate logistic regression models to examine variation in receipt of surgery by patient and regional characteristics (density of providers, intensity of use of biologic disease-modifying antirheumatic drugs). Results. Between 2006 and 2010, the annual rate of RA-related hand and wrist arthroplasty or arthrodesis was 23.1 per 10,000 patients, and the annual rate of hand tendon reconstruction was 4.2 per 10,000 patients. The rates of surgery varied 9-fold across hospital referral regions in the United States. Younger patient age, female sex, white race, higher socioeconomic status (SES), and rural residence were associated with a higher likelihood of undergoing arthroplasty and arthrodesis. We observed a significant decline in rate of arthroplasty and arthrodesis with increasing density of rheumatologists. Tendon reconstruction was not influenced by provider factors, but was correlated with age, race, SES, and rural status of the patients. Conclusion. Surgical reconstruction of rheumatoid hand deformities varies widely across the United States, driven by both regional availability of subspecialty care in rheumatology and individual patient factors

Optimal decision-making in mammals : insights from a robot study of rodent texture discrimination

Texture perception is studied here in a physical model of the rat whisker system consisting of a robot equipped with a biomimetic vibrissal sensor. Investigations of whisker motion in rodents have led to several explanations for texture discrimination, such as resonance or stick-slips. Meanwhile, electrophysiological studies of decision-making in monkeys have suggested a neural mechanism of evidence accumulation to threshold for competing percepts, described by a probabilistic model of Bayesian sequential analysis. For our robot whisker data, we find that variable reaction-time decision-making with sequential analysis performs better than the fixed response-time maximum-likelihood estimation. These probabilistic classifiers also use whatever available features of the whisker signals aid the discrimination, giving improved performance over a single-feature strategy, such as matching the peak power spectra of whisker vibrations. These results cast new light on how the various proposals for texture discrimination in rodents depend on the whisker contact mechanics and suggest the possibility of a common account of decision-making across mammalian species

An observational treatment study of metacognition in anxious-depression

Prior studies have found metacognitive biases are linked to a transdiagnostic dimension of anxious-depression, manifesting as reduced confidence in performance. However, previous work has been cross-sectional and so it is unclear if under-confidence is a trait-like marker of anxious-depression vulnerability, or if it resolves when anxious-depression improves. Data were collected as part of a large-scale transdiagnostic, four-week observational study of individuals initiating internet-based cognitive behavioural therapy (iCBT) or antidepressant medication. Self-reported clinical questionnaires and perceptual task performance were gathered to assess anxious-depression and metacognitive bias at baseline and 4-week follow-up. Primary analyses were conducted for individuals who received iCBT (n=649), with comparisons between smaller samples that received antidepressant medication (n=82) and a control group receiving no intervention (n=88). Prior to receiving treatment, anxious-depression severity was associated with under-confidence in performance in the iCBT arm, replicating previous work. From baseline to follow-up, levels of anxious-depression were significantly reduced, and this was accompanied by a significant increase in metacognitive confidence in the iCBT arm (β=0.17, SE=0.02, p<0.001). These changes were correlated (r(647)=-0.12, p=0.002); those with the greatest reductions in anxious-depression levels had the largest increase in confidence. While the three-way interaction effect of group and time on confidence was not significant (F(2, 1632)=0.60, p=0.550), confidence increased in the antidepressant group (β=0.31, SE = 0.08, p<0.001), but not among controls (β=0.11, SE = 0.07, p=0.103). Metacognitive biases in anxious-depression are state-dependent; when symptoms improve with treatment, so does confidence in performance. Our results suggest this is not specific to the type of intervention

3-manifolds which are spacelike slices of flat spacetimes

We continue work initiated in a 1990 preprint of Mess giving a geometric parameterization of the moduli space of classical solutions to Einstein's equations in 2+1 dimensions with cosmological constant 0 or -1 (the case +1 has been worked out in the interim by the present author). In this paper we make a first step toward the 3+1-dimensional case by determining exactly which closed 3-manifolds M^3 arise as spacelike slices of flat spacetimes, and by finding all possible holonomy homomorphisms pi_1(M^3) to ISO(3,1).Comment: 10 page

The Vehicle, Spring 1993

Table of Contents The Shape of Things to Come.Peter F. Essigpage 6 SaxophoneWalt Howardpage 6 Gravity BedSue Songerpage 7 UntitledJennifer Gutowskipage 8 uncertaintyWalt Howardpage 9 Ruth Ann, et. al.Susan Eisenhourpage 9 Failed IndustryScott Langenpage 10 UntitledKaren Wisspage 10 wanted:Walt Howardpage 10 Dida; 1978Diana Matijaspage 11 UntitledJennifer Gutowskipage 12 The Lesson in NovemberSue Songerpage 13 Coal MinerJames P. Tangpage 16 Christmas CrueltySue Songerpage 17 Astral ProjectionSusan Eisenhourpage 18 UntitledBen Hausmannpage 19 Into Zagreb\u27s Evening*Diana Matjaspage 20 UntitledJennifer Gutowskipage 22 The AnniversaryJennifer Moropage 23 NudeDan Trutterpage 24 death for saleWalt Howardpage 24 JudgedKevin St. Angelpage 25 Nature\u27s RefugeeScott Langenpage 25 Arrowhead Hunting at TippecanoeJennifer Moropage 26 UntitledKimberly Foxpage 27 TAINTED LOVESarah C. Patiencepage 28 cemeteryWalt Howardpage 28 Cow GameSusan Eisenhourpage 29 UntitledJennifer Gutowskipage 31 ReflectionsPeter F. Essigpage 32 Destination U.S.A.Dan Trutterpage 33 UntitledMario Letopage 33 Authors\u27 Pagepage 34https://thekeep.eiu.edu/vehicle/1061/thumbnail.jp

The Vehicle, Spring 1993

Table of Contents The Shape of Things to Come.Peter F. Essigpage 6 SaxophoneWalt Howardpage 6 Gravity BedSue Songerpage 7 UntitledJennifer Gutowskipage 8 uncertaintyWalt Howardpage 9 Ruth Ann, et. al.Susan Eisenhourpage 9 Failed IndustryScott Langenpage 10 UntitledKaren Wisspage 10 wanted:Walt Howardpage 10 Dida; 1978Diana Matijaspage 11 UntitledJennifer Gutowskipage 12 The Lesson in NovemberSue Songerpage 13 Coal MinerJames P. Tangpage 16 Christmas CrueltySue Songerpage 17 Astral ProjectionSusan Eisenhourpage 18 UntitledBen Hausmannpage 19 Into Zagreb\u27s Evening*Diana Matjaspage 20 UntitledJennifer Gutowskipage 22 The AnniversaryJennifer Moropage 23 NudeDan Trutterpage 24 death for saleWalt Howardpage 24 JudgedKevin St. Angelpage 25 Nature\u27s RefugeeScott Langenpage 25 Arrowhead Hunting at TippecanoeJennifer Moropage 26 UntitledKimberly Foxpage 27 TAINTED LOVESarah C. Patiencepage 28 cemeteryWalt Howardpage 28 Cow GameSusan Eisenhourpage 29 UntitledJennifer Gutowskipage 31 ReflectionsPeter F. Essigpage 32 Destination U.S.A.Dan Trutterpage 33 UntitledMario Letopage 33 Authors\u27 Pagepage 34https://thekeep.eiu.edu/vehicle/1061/thumbnail.jp

Detection of the pairwise kinematic Sunyaev-Zel'dovich effect with BOSS DR11 and the Atacama Cosmology Telescope

We present a new measurement of the kinematic Sunyaev-Zeldovich effect using data from the Atacama Cosmology Telescope (ACT) and the Baryon Oscillation Spectroscopic Survey (BOSS). Using 600 square degrees of overlapping sky area, we evaluate the mean pairwise baryon momentum associated with the positions of 50,000 bright galaxies in the BOSS DR11 Large Scale Structure catalog. A non-zero signal arises from the large-scale motions of halos containing the sample galaxies. The data fits an analytical signal model well, with the optical depth to microwave photon scattering as a free parameter determining the overall signal amplitude. We estimate the covariance matrix of the mean pairwise momentum as a function of galaxy separation, using microwave sky simulations, jackknife evaluation, and bootstrap estimates. The most conservative simulation-based errors give signal-to-noise estimates between 3.6 and 4.1 for varying galaxy luminosity cuts. We discuss how the other error determinations can lead to higher signal-to-noise values, and consider the impact of several possible systematic errors. Estimates of the optical depth from the average thermal Sunyaev-Zeldovich signal at the sample galaxy positions are broadly consistent with those obtained from the mean pairwise momentum signal.Comment: 15 pages, 8 figures, 2 table

Surfactant replacement therapy for respiratory distress syndrome in preterm infants: United Kingdom national consensus

Our aim was to develop consensus recommendations from United Kingdom (UK) neonatal specialists on the use of surfactant for the management of respiratory distress syndrome RDS in preterm infants. RDS due to surfactant deficiency is common in preterm infants. Signs, including tachypnoea, recessions, and grunting, usually commence shortly after birth, and increase in severity during the first 12–48 h of postnatal life. Significant RDS may require mechanical ventilation (MV) or noninvasive ventilatory support (NIV), both of which have potential to cause lung injury via a number of mechanisms.1 The aim of RDS management is to provide appropriate respiratory support whilst minimising complications and, ultimately, bronchopulmonary dysplasia (BPD). Treatment with exogenous surfactant reduces requirement for positive pressure ventilation, mitigates risk of pulmonary air leak, and improves survival.1 International consensus guidelines on management of RDS have been published;1 however, recent developments in the field of less invasive surfactant administration prompt the need for a UK national consensus on surfactant use in preterm infants with, or at risk of, RDS

Measurement of Angular Distributions and R= sigma_L/sigma_T in Diffractive Electroproduction of rho^0 Mesons

Production and decay angular distributions were extracted from measurements of exclusive electroproduction of the rho^0(770) meson over a range in the virtual photon negative four-momentum squared 0.5< Q^2 <4 GeV^2 and the photon-nucleon invariant mass range 3.8< W <6.5 GeV. The experiment was performed with the HERMES spectrometer, using a longitudinally polarized positron beam and a ^3He gas target internal to the HERA e^{+-} storage ring. The event sample combines rho^0 mesons produced incoherently off individual nucleons and coherently off the nucleus as a whole. The distributions in one production angle and two angles describing the rho^0 -> pi+ pi- decay yielded measurements of eight elements of the spin-density matrix, including one that had not been measured before. The results are consistent with the dominance of helicity-conserving amplitudes and natural parity exchange. The improved precision achieved at 47 GeV, reveals evidence for an energy dependence in the ratio R of the longitudinal to transverse cross sections at constant Q^2.Comment: 15 pages, 15 embedded figures, LaTeX for SVJour(epj) document class Revision: Fig. 15 corrected, recent data added to Figs. 10,12,14,15; minor changes to tex