4,047 research outputs found
Tax research techniques
https://egrove.olemiss.edu/aicpa_guides/1570/thumbnail.jp
Tax research techniques
https://egrove.olemiss.edu/aicpa_guides/2730/thumbnail.jp
Tax research techniques
https://egrove.olemiss.edu/aicpa_guides/1370/thumbnail.jp
Tax research techniques
https://egrove.olemiss.edu/aicpa_guides/1569/thumbnail.jp
A cost effectiveness study of integrated care in health services delivery: a diabetes program in Australia
BACKGROUND: Type 2 diabetes is rapidly growing as a proportion of the disease burden in Australia as
elsewhere. This study addresses the cost effectiveness of an integrated approach to assisting general
practitioners (GPs) with diabetes management. This approach uses a centralized database of clinical data
of an Australian Division of General Practice (a network of GPs) to co-ordinate care according to national
guidelines.
METHODS: Long term outcomes for patients in the program were derived using clinical parameters after
5 years of program participation, and the United Kingdom Prospective Diabetes Study (UKPDS)
Outcomes Model, to project outcomes for 40 years from the time of diagnosis and from 5 years postdiagnosis.
Cost information was obtained from a range of sources. While program costs are directly
available, and costs of complications can be estimated from the UKPDS model, other costs are estimated
by comparing costs in the Division with average costs across the state or the nation. The outcome and
cost measures are used derive incremental cost-effectiveness ratios.
RESULTS: The clinical data show that the program is effective in the short term, with improvement or no
statistical difference in most clinical measures over 5 years. Average HbA1c levels increased by less than
expected over the 5 year period. While the program is estimated to generate treatment cost savings,
overall net costs are positive. However, the program led to projected improvements in expected life years
and Quality Adjusted Life Expectancy (QALE), with incremental cost effectiveness ratios of A9,730 per year of QALE gained.
CONCLUSIONS: The combination of an established model of diabetes progression and generally available
data has provided an opportunity to establish robust methods of testing the cost effectiveness of a
program for which a formal control group was not available. Based on this methodology, integrated health
care delivery provided by a network of GPs improved health outcomes of type 2 diabetics with acceptable
cost effectiveness, which suggests that similar outcomes may be obtained elsewhere
Metabolic changes associated with adaptive resistance to daptomycin in Streptococcus mitis-oralis
Background: Viridans group streptococci of the Streptococcus mitis-oralis subgroup are important endovascular pathogens. They can rapidly develop high-level and durable non-susceptibility to daptomycin both in vitro and in vivo upon exposure to daptomycin. Two consistent genetic adaptations associated with this phenotype (i.e., mutations in cdsA and pgsA) lead to the depletion of the phospholipids, phosphatidylglycerol and cardiolipin, from the bacterial membrane. Such alterations in phospholipid biosynthesis will modify carbon flow and change the bacterial metabolic status. To determine the metabolic differences between daptomycin-susceptible and non- susceptible bacteria, the physiology and metabolomes of S. mitis-oralis strains 351 (daptomycin-susceptible) and 351-D10 (daptomycin non-susceptible) were analyzed. S. mitis-oralis strain 351-D10 was made daptomycin non- susceptible through serial passage in the presence of daptomycin.
Background: Viridans group streptococci of the Streptococcus mitis-oralis subgroup are important endovascular pathogens. They can rapidly develop high-level and durable non-susceptibility to daptomycin both in vitro and in vivo upon exposure to daptomycin. Two consistent genetic adaptations associated with this phenotype (i.e., mutations in cdsA and pgsA) lead to the depletion of the phospholipids, phosphatidylglycerol and cardiolipin, from the bacterial membrane. Such alterations in phospholipid biosynthesis will modify carbon flow and change the bacterial metabolic status. To determine the metabolic differences between daptomycin-susceptible and non- susceptible bacteria, the physiology and metabolomes of S. mitis-oralis strains 351 (daptomycin-susceptible) and 351-D10 (daptomycin non-susceptible) were analyzed. S. mitis-oralis strain 351-D10 was made daptomycin non- susceptible through serial passage in the presence of daptomycin.
Conclusions: S. mitis-oralis metabolism is altered in daptomycin non-susceptible bacteria relative to the daptomycin susceptible parent strain. As demonstrated in Staphylococcus aureus, inhibiting the metabolic changes that facilitate the transition from a daptomycin susceptible state to a non-susceptible one, inhibits daptomycin non- susceptibility. By preventing these metabolic adaptations in S. mitis-oralis, it should be possible to deter the formation of daptomycin non-susceptibility
The meaning of life in a developing universe
The evolution of life on Earth has produced an organism that is beginning to model and understand its own evolution and the possible future evolution of life in the universe. These models and associated evidence show that evolution on Earth has a trajectory. The scale over which living processes are organized cooperatively has increased progressively, as has its evolvability. Recent theoretical advances raise the possibility that this trajectory is itself part of a wider developmental process. According to these theories, the developmental process has been shaped by a larger evolutionary process that involves the reproduction of universes. This evolutionary process has tuned the key parameters of the universe to increase the likelihood that life will emerge and develop to produce outcomes that are successful in the larger process (e.g. a key outcome may be to produce life and intelligence that intentionally reproduces the universe and tunes the parameters of ‘offspring’ universes). Theory suggests that when life emerges on a planet, it moves along this trajectory of its own accord. However, at a particular point evolution will continue to advance only if organisms emerge that decide to advance the evolutionary process intentionally. The organisms must be prepared to make this commitment even though the ultimate nature and destination of the process is uncertain, and may forever remain unknown. Organisms that complete this transition to intentional evolution will drive the further development of life and intelligence in the universe. Humanity’s increasing understanding of the evolution of life in the universe is rapidly bringing it to the threshold of this major evolutionary transition
Uranium(III) coordination chemistry and oxidation in a flexible small-cavity macrocycle
U(III) complexes of the conformationally flexible, small-cavity macrocycle trans-calix[2]benzene[2]pyrrolide (L)2–, [U(L)X] (X = O-2,6-tBu2C6H3, N(SiMe3)2), have been synthesized from [U(L)BH4] and structurally characterized. These complexes show binding of the U(III) center in the bis(arene) pocket of the macrocycle, which flexes to accommodate the increase in the steric bulk of X, resulting in long U–X bonds to the ancillary ligands. Oxidation to the cationic U(IV) complex [U(L)X][B(C6F5)4] (X = BH4) results in ligand rearrangement to bind the smaller, harder cation in the bis(pyrrolide) pocket, in a conformation that has not been previously observed for (L)2–, with X located between the two ligand arene rings
Metal-Insulator Transition and Magnetic Order in the Pyrochlore Oxide Hg2Ru2O7
We report results of NMR experiments on the ruthenium oxide Hg2Ru2O7 with the
pyrochlore structure, which exhibits a metal-insulator transition at TMI = 107
K. In the metallic phase above TMI, the nuclear spin-lattice relaxation rate
1/T1 and the Knight shift at the Hg sites follow the Korringa relation,
indicating the absence of substantial spatial spin correlation. At low
temperatures in the insulating phase, 99,101Ru-NMR signals are observed at zero
magnetic field, providing evidence for a commensurate antiferromagnetic order.
The estimated ordered moment is about 1 muB per Ru, much smaller than 3 muB
expected for the ionic (4d)3plus configuration of Ru5plus. Thus the localized
spin models are not appropriate for the insulating phase of Hg2Ru2O7. We also
discuss possible antiferromagnetic spin structures.Comment: 10 pages, 7 figure
Cancer in the offspring of radiation workers: an investigation of employment timing and a reanalysis using updated dose information
An earlier case-control study found no evidence of paternal preconceptional irradiation (PPI) as a cause of childhood leukaemia and non-Hodgkin's lymphoma (LNHL). Although fathers of children with LNHL were more likely to have been radiation workers, the risk was most marked in those with doses below the level of detection. The timing of paternal employment as a radiation worker has now been examined. The previously reported elevated risk of LNHL in the children of male radiation workers was limited to those whose fathers were still radiation workers at conception or whose employment also continued until diagnosis. Children whose fathers stopped radiation work prior to their conception were found to have no excess risk of LNHL. It was not possible to distinguish between the risks associated with paternal radiation work at conception and at the time of diagnosis. A reanalysis of the original study hypothesis incorporating updated dosimetric information gave similar results to those obtained previously. In particular, the risks of LNHL did not show an association with radiation doses received by the father before conception. It seems likely that the increased risk of LNHL among the children of male radiation workers is associated with an increased exposure to some infective agent consequent on high levels of population mixing
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