Overbilling and Informed Financial Consent — A Contractual Solution

U.S. hospitals and physicians regularly charge uninsured patients and patients receiving care outside their health-plan networks far more what most health insurers pay and far more than their actual costs. Such practices have triggered over 100 lawsuits and prompted calls for pricing transparency in Congress and price regulation in several states. This Perspective argues that the theory of implied contracts, a foundation in most first-year courses in contract law, offers a useful legal and ethical mechanism for handling these troubling problems in health care billing

Predicting Changes of Body Weight, Body Fat, Energy Expenditure and Metabolic Fuel Selection in C57BL/6 Mice

The mouse is an important model organism for investigating the molecular mechanisms of body weight regulation, but a quantitative understanding of mouse energy metabolism remains lacking. Therefore, we created a mathematical model of mouse energy metabolism to predict dynamic changes of body weight, body fat, energy expenditure, and metabolic fuel selection. Based on the principle of energy balance, we constructed ordinary differential equations representing the dynamics of body fat mass (FM) and fat-free mass (FFM) as a function of dietary intake and energy expenditure (EE). The EE model included the cost of tissue deposition, physical activity, diet-induced thermogenesis, and the influence of FM and FFM on metabolic rate. The model was calibrated using previously published data and validated by comparing its predictions to measurements in five groups of male C57/BL6 mice (N = 30) provided ad libitum access to either chow or high fat diets for varying time periods. The mathematical model accurately predicted the observed body weight and FM changes. Physical activity was predicted to decrease immediately upon switching from the chow to the high fat diet and the model coefficients relating EE to FM and FFM agreed with previous independent estimates. Metabolic fuel selection was predicted to depend on a complex interplay between diet composition, the degree of energy imbalance, and body composition. This is the first validated mathematical model of mouse energy metabolism and it provides a quantitative framework for investigating energy balance relationships in mouse models of obesity and diabetes

Do low-carbohydrate diets increase energy expenditure?

Peer reviewedPublisher PD

Comment on "Local accumulation times for source, diffusion, and degradation models in two and three dimensions" [J. Chem. Phys. 138, 104121 (2013)]

In a recent paper, Gordon, Muratov, and Shvartsman studied a partial differential equation (PDE) model describing radially symmetric diffusion and degradation in two and three dimensions. They paid particular attention to the local accumulation time (LAT), also known in the literature as the mean action time, which is a spatially dependent timescale that can be used to provide an estimate of the time required for the transient solution to effectively reach steady state. They presented exact results for three-dimensional applications and gave approximate results for the two-dimensional analogue. Here we make two generalizations of Gordon, Muratov, and Shvartsman’s work: (i) we present an exact expression for the LAT in any dimension and (ii) we present an exact expression for the variance of the distribution. The variance provides useful information regarding the spread about the mean that is not captured by the LAT. We conclude by describing further extensions of the model that were not considered by Gordon,Muratov, and Shvartsman. We have found that exact expressions for the LAT can also be derived for these important extensions..

Preface : causes of obesity, theories, conjectures and evidence

Peer reviewedPublisher PD

The Progressive Increase of Food Waste in America and Its Environmental Impact

Food waste contributes to excess consumption of freshwater and fossil fuels which, along with methane and CO2 emissions from decomposing food, impacts global climate change. Here, we calculate the energy content of nationwide food waste from the difference between the US food supply and the food consumed by the population. The latter was estimated using a validated mathematical model of metabolism relating body weight to the amount of food eaten. We found that US per capita food waste has progressively increased by ∼50% since 1974 reaching more than 1400 kcal per person per day or 150 trillion kcal per year. Food waste now accounts for more than one quarter of the total freshwater consumption and ∼300 million barrels of oil per year

Global forms and local forces : PhD enrollments and graduations in Australia, Canada, the Czech Republic, the United Kingdom, and the United States

 This chapter presents and discusses data from five different nations—Australia, Canada, the Czech Republic, the United Kingdom, and the United States—on doctoral candidates and graduates. These data are from governmental and institutional sources for the years 1998–2004, a sample that enables changes across a five-year span to be identified. They span important basic characteristics, such as gender, age, discipline, and study load (that is, full-time or part-time study). Therefore, readers can see national as well as international trends and differences in such characteristics and can match these to equivalent and/or contemporary data in their own nations. The five countries considered here are among those whose data were discussed at the 2007 CIRGE research synthesis meeting in Australia. Although these countries are not universally representative of doctoral education, their practices do offer a vivid sense of how vastly the enterprise of doctoral education differs in its scope and dimensions around the worl

Listening and Negotiation II

This paper is based on a panel held in June, 2017 in Columbus, Ohio, jointly sponsored by the Women in Engineering Division and by the Minorities in Engineering Division. It is focused on negotiation, with an emphasis on providing practical strategies that are relevant in an academic setting. The panel featured academic leaders at multiple levels, including professor, chair and dean, from diverse engineering institutions, ranging from teaching-centric to heavily research-focused. Panelists discussed strategies for negotiation, with an emphasis on an approach that meets the interests of both parties to the extent possible. The panel was administrated with an opening lightning-round in which each panelist provided one strategy for negotiation; this was followed by a role-play of a negotiation, followed with questions and input from the audience. This paper, associated with the panel, provides several examples of negotiation that were presented in the panel discussion

Time to revisit the passive overconsumption hypothesis?:Humans show sensitivity to calories in energy-rich meals

BACKGROUND: A possible driver of obesity is insensitivity (passive overconsumption) to food energy density (ED, kcal/g); however, it is unclear whether this insensitivity applies to all meals. OBJECTIVES: We assessed the influence of ED on energy intake (kcal) across a broad and continuous range of EDs comprised of noncovertly manipulated, real-world meals. We also allowed for the possibility that the association between energy intake and ED is nonlinear. METHODS: We completed a secondary analysis of 1519 meals which occurred in a controlled environment as part of a study conducted by Hall and colleagues to assess the effects of food ultra-processing on energy intake. To establish the generalizability of the findings, the analyses were repeated in 32,162 meals collected from free-living humans using data from the UK National Diet and Nutrition Survey (NDNS). Segmented regressions were performed to establish ED “breakpoints” at which the association between consumed meal ED and mean centered meal caloric intake (kcal) changed. RESULTS: Significant breakpoints were found in both the Hall et al. data set (1.41 kcal/g) and the NDNS data set (1.75 and 2.94 kcal/g). Centered meal caloric intake did not increase linearly with consumed meal ED, and this pattern was captured by a 2-component (“volume” and “calorie content” [biologically derived from the sensing of fat, carbohydrate, and protein]) model of physical meal size (g), in which volume is the dominant signal with lower energy-dense foods and calorie content is the dominant signal with higher energy-dense foods. CONCLUSIONS: These analyses reveal that, on some level, humans are sensitive to the energy content of meals and adjust meal size to minimize the acute aversive effects of overconsumption. Future research should consider the relative importance of volume and calorie-content signals, and how individual differences impact everyday dietary behavior and energy balance

Restricted feedback control of one-dimensional maps

Dynamical control of biological systems is often restricted by the practical constraint of unidirectional parameter perturbations. We show that such a restriction introduces surprising complexity to the stability of one-dimensional map systems and can actually improve controllability. We present experimental cardiac control results that support these analyses. Finally, we develop new control algorithms that exploit the structure of the restricted-control stability zones to automatically adapt the control feedback parameter and thereby achieve improved robustness to noise and drifting system parameters.Comment: 29 pages, 9 embedded figure