Empirical Constraints on Turbulence in Protoplanetary Accretion Disks

We present arcsecond-scale Submillimeter Array observations of the CO(3-2) line emission from the disks around the young stars HD 163296 and TW Hya at a spectral resolution of 44 m/s. These observations probe below the ~100 m/s turbulent linewidth inferred from lower-resolution observations, and allow us to place constraints on the turbulent linewidth in the disk atmospheres. We reproduce the observed CO(3-2) emission using two physical models of disk structure: (1) a power-law temperature distribution with a tapered density distribution following a simple functional form for an evolving accretion disk, and (2) the radiative transfer models developed by D'Alessio et al. that can reproduce the dust emission probed by the spectral energy distribution. Both types of models yield a low upper limit on the turbulent linewidth (Doppler b-parameter) in the TW Hya system (<40 m/s), and a tentative (3-sigma) detection of a ~300 m/s turbulent linewidth in the upper layers of the HD 163296 disk. These correspond to roughly <10% and 40% of the sound speed at size scales commensurate with the resolution of the data. The derived linewidths imply a turbulent viscosity coefficient, alpha, of order 0.01 and provide observational support for theoretical predictions of subsonic turbulence in protoplanetary accretion disks.Comment: 18 pages, 9 figures, accepted for publication in Ap

Comparative susceptibility of eastern cottontails and New Zealand white rabbits to classical rabbit haemorrhagic disease virus (RHDV) and RHDV2

Rabbit haemorrhagic disease virus (RHDV) is associated with high morbidity and mortality in the European rabbit (Oryctolagus cuniculus). In 2010, a genetically distinct RHDV named RHDV2 emerged in Europe and spread to many other regions, including North America in 2016. Prior to this study it was unknown if eastern cottontails (ECT(s); Sylvilagus floridanus), one of the most common wild lagomorphs in the United States, were susceptible to RHDV2. In this study, 10 wild-caught ECTs and 10 New Zealand white rabbits (NZWR(s); O. cuniculus) were each inoculated orally with either RHDV (RHDVa/GI.1a; n = 5 per species) or RHDV2 (a recombinant GI.1bP-GI.2; n = 5 per species) and monitored for the development of disease. Three of the five ECTs that were infected with RHDV2 developed disease consistent with RHD and died at 4 and 6 days post-inoculation (DPI). The RHDV major capsid protein/antigen (VP60) was detected in the livers of three ECTs infected with RHDV2, but none was detected in the ECTs infected with RHDV. Additionally, RHD viral RNA was detected in the liver, spleen, intestine and blood of ECTs infected with RHDV2, but not in the ECTs infected with RHDV. RHD viral RNA was detected in urine, oral swabs and rectal swabs in at least two of five ECTs infected with RHDV2. One ECT inoculated with RHDV2 seroconverted and developed a high antibody titre by the end of the experimental period (21 DPI). ECTs inoculated with the classic RHDV did not seroconvert. In comparison, NZWRs inoculated with RHDV2 exhibited high mortality (five of five) at 2 DPI and four of five NZWRs inoculated with RHDV either died or were euthanized at 2 DPI indicating both of these viruses were highly pathogenic to this species. This experiment indicates that ECTs are susceptible to RHDV2 and can shed viral RNA, thereby suggesting this species could be involved in the epidemiology of this virus

Resolving the CO Snow Line in the Disk around HD 163296

We report Submillimeter Array (SMA) observations of CO (J=2--1, 3--2 and 6--5) and its isotopologues (13CO J=2--1, C18O J=2--1 and C17O J=3--2) in the disk around the Herbig Ae star HD 163296 at ~2" (250 AU) resolution, and interpret these data in the framework of a model that constrains the radial and vertical location of the line emission regions. First, we develop a physically self-consistent accretion disk model with an exponentially tapered edge that matches the spectral energy distribution and spatially resolved millimeter dust continuum emission. Then, we refine the vertical structure of the model using wide range of excitation conditions sampled by the CO lines, in particular the rarely observed J=6--5 transition. By fitting 13CO data in this structure, we further constrain the vertical distribution of CO to lie between a lower boundary below which CO freezes out onto dust grains (T ~ 19 K) and an upper boundary above which CO can be photodissociated (the hydrogen column density from the disk surface is ~ 10^{21} cm-2). The freeze-out at 19 K leads to a significant drop in the gas-phase CO column density beyond a radius of ~155 AU, a "CO snow line" that we directly resolve. By fitting the abundances of all CO isotopologues, we derive isotopic ratios of 12C/13C, 16O/18O and 18O/17O that are consistent with quiescent interstellar gas-phase values. This detailed model of the HD 163296 disk demonstrates the potential of a staged, parametric technique for constructing unified gas and dust structure models and constraining the distribution of molecular abundances using resolved multi-transition, multi-isotope observations.Comment: 40 pages, 13 figures, accepted for publication in Ap

Systematic review: Effects, design choices, and context of pay-for-performance in health care

<p>Abstract</p> <p>Background</p> <p>Pay-for-performance (P4P) is one of the primary tools used to support healthcare delivery reform. Substantial heterogeneity exists in the development and implementation of P4P in health care and its effects. This paper summarizes evidence, obtained from studies published between January 1990 and July 2009, concerning P4P effects, as well as evidence on the impact of design choices and contextual mediators on these effects. Effect domains include clinical effectiveness, access and equity, coordination and continuity, patient-centeredness, and cost-effectiveness.</p> <p>Methods</p> <p>The systematic review made use of electronic database searching, reference screening, forward citation tracking and expert consultation. The following databases were searched: Cochrane Library, EconLit, Embase, Medline, PsychINFO, and Web of Science. Studies that evaluate P4P effects in primary care or acute hospital care medicine were included. Papers concerning other target groups or settings, having no empirical evaluation design or not complying with the P4P definition were excluded. According to study design nine validated quality appraisal tools and reporting statements were applied. Data were extracted and summarized into evidence tables independently by two reviewers.</p> <p>Results</p> <p>One hundred twenty-eight evaluation studies provide a large body of evidence -to be interpreted with caution- concerning the effects of P4P on clinical effectiveness and equity of care. However, less evidence on the impact on coordination, continuity, patient-centeredness and cost-effectiveness was found. P4P effects can be judged to be encouraging or disappointing, depending on the primary mission of the P4P program: supporting minimal quality standards and/or boosting quality improvement. Moreover, the effects of P4P interventions varied according to design choices and characteristics of the context in which it was introduced.</p> <p>Future P4P programs should (1) select and define P4P targets on the basis of baseline room for improvement, (2) make use of process and (intermediary) outcome indicators as target measures, (3) involve stakeholders and communicate information about the programs thoroughly and directly, (4) implement a uniform P4P design across payers, (5) focus on both quality improvement and achievement, and (6) distribute incentives to the individual and/or team level.</p> <p>Conclusions</p> <p>P4P programs result in the full spectrum of possible effects for specific targets, from absent or negligible to strongly beneficial. Based on the evidence the review has provided further indications on how effect findings are likely to relate to P4P design choices and context. The provided best practice hypotheses should be tested in future research.</p

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Assessing public support for restrictions on transport of invasive wild pigs (Sus scrofa) in the United States

Wild pigs (Sus scrofa) are a non-native invasive species in the United States that cause significant economic loss, transmit disease, and inflict damage upon natural resources, agriculture, livestock, and property. Geographic distribution of wild pigs in the United States has nearly tripled since 1982, with anthropogenic influences playing a significant role in the expansion. In this regard, there is speculation that a driver of the expansion may be human-mediated movement of wild pigs to new areas for the purpose of sport hunting. In response, states have implemented a variety of wild pig control policies, including legal restrictions on their transport. The success of such policies depends, in part, on their level of public support, which in turn may be influenced by individuals’ attitudes concerning wild pigs, their interest in maintaining wild pig populations (e.g., for sport hunting), and their knowledge and awareness of the threats wild pigs pose. Multiple regression was used to analyze data collected from a nationwide survey concerning attitudes toward wild pigs and policies that restrict their transport. Results indicate that a majority of individuals in the United States have negative attitudes toward wild pigs and support policies that restrict their transport and penalize transgressors. Consistent with other invasive species research, findings suggest that as knowledge and awareness of wild pigs increase, so too does support for policies restricting and penalizing transport of wild pigs. Contrary to previous studies, this research also finds that hunters are more likely to support restrictions on wild pig transport than are non-hunters. Overall, these findings suggest that legal restrictions on the transport of wild pigs, even in states with large hunter populations, enjoy broad public support and may help to curb the expansion of wild pig populations