Regulation of Physician Self-Referral Arrangements: Is Prohibition the Answer Or Has Congress Operated on the Wrong Patient

Rapidly increasing health care costs have created a national crisis. Perceiving physician referral behavior as the principal cause, Congress and several state legislatures have prohibited certain referrals. This Comment analyzes the data that spawned such legislation and critiques prohibition of referrals as a solution to the crisis. The Comment asserts that the prohibition remedy is overly broad and largely ineffective. The author recommends a more farsighted solution, such as the creation of a prepaid physician compensation system. The author argues that such a system would minimize the incentive to make unnecessary referrals while simultaneously reducing the level of health care costs borne by the government

Non-crystallographic reduction of generalized Calogero-Moser models

We apply a recently introduced reduction procedure based on the embedding of non-crystallographic Coxeter groups into crystallographic ones to Calogero–Moser systems. For rational potentials the familiar generalized Calogero Hamiltonian is recovered. For the Hamiltonians of trigonometric, hyperbolic and elliptic types, we obtain novel integrable dynamical systems with a second potential term which is rescaled by the golden ratio. We explicitly show for the simplest of these non-crystallographic models, how the corresponding classical equations of motion can be derived from a Lie algebraic Lax pair based on the larger, crystallographic Coxeter group

A whole-rock data set for the Skaergaard intrusion, East Greenland

We report a compilation of new and published whole-rock major and trace element analyses for 646 samples of the Skaergaard intrusion, East Greenland. The samples were collected in 14 stratigraphic profiles either from accessible and well-exposed surface areas or from drill core, and they cover most regions of the intrusion. This includes the Layered Series, the Upper Border Series, the Marginal Border Series and the Sandwich Horizon. The geochemical data were obtained by a combination of X-ray fluorescence and inductively coupled plasma mass spectrometry. This data set can, for example, be used to constrain processes of igneous differentiation and ore formation.

BVR photometry of the resolved dwarf galaxy Ho IX

We present BVR CCD photometry down to limiting magnitude B=23.5 mag for 232 starlike objects and 11 diffuse objects in a 5.4' x 5.4' field of Ho IX. The galaxy is a gas-rich irregular dwarf galaxy possibly very close to M 81, which makes it especially interesting in the context of the evolution of satellite galaxies and the accretion of dwarf galaxies. Investigations of Ho IX were hampered by relatively large contradictions in the magnitude scale between earlier studies. With our new photometry we resolved these discrepancies. The color magnitude diagram (CMD) of Ho IX is fairly typical of a star-forming dwarf irregular, consistent with earlier results. Distance estimates from our new CMD are consistent with Ho IX being very close to M 81 and therefore being a definite member of the M 81 group, apparently in very close physical proximity to M 81.Comment: 9 pages, 8 figures, uses aa.cls, A&A in pres

General practitioners’ perspectives on campaigns to promote rapid help-seeking behaviour at the onset of rheumatoid arthritis

Objective. To explore general practitioners’ (GPs’ ) perspectives on public health campaigns to encourage people with the early symptoms of rheumatoid arthritis (RA) to seek medical help rapidly. Design. Nineteen GPs participated in four semistructured focus groups. Focus groups were audio-recorded, transcribed verbatim, and analysed using thematic analysis. Results. GPs recognised the need for the early treatment of RA and identified that facilitating appropriate access to care was important. However, not all held the view that a delay in help seeking was a clinically significant issue. Furthermore, many were concerned that the early symptoms of RA were often non-specific, and that current knowledge about the nature of symptoms at disease onset was inadequate to inform the content of a help-seeking campaign. They argued that a campaign might not be able to specifically target those who need to present urgently. Poorly designed campaigns were suggested to have a negative impact on GPs’ workloads, and would “clog up” the referral pathway for genuine cases of RA. Conclusions. GPs were supportive of strategies to improve access to Rheumatological care and increase public awareness of RA symptoms. However, they have identified important issues that need to be considered in developing a public health campaign that forms part of an overall strategy to reduce time to treatment for patients with new onset RA. This study highlights the value of gaining GPs’ perspectives before launching health promotion campaigns

Prioritization in visual search: Visual marking is not dependent on a mnemonic search

Visual marking (VM) refers to our ability to completely exclude old items from search when new stimuli are presented in our visual field. We examined whether this ability reflects an attentional scan of the old items, possibly allowing observers to apply inhibition of return or maintain a memory representation of already seen locations. In four experiments, we compared performance in two search conditions. In the double-search (DS) condition, we required participants to pay attention to a first set of items by having them search for a target within the set. Subsequently, they had to search a second set while the old items remained in the field. In the VM condition, the participants expected the target only to be in the second (new) set. Selection of new items in the DS condition was relatively poor and was always worse than would be expected if only the new stimuli had been searched. In contrast, selection of the new items in the VM condition was good and was equal to what would be expected if there had been an exclusive search of the new stimuli. These results were not altered when differences in Set 1 difficulty, task switching, and response generation were controlled for. We conclude that the mechanism of VM is distinct from mnemonic and/or serial inhibition-of-return processes as involved in search, although we also discuss possible links to more global and flexible inhibition-of-return processes not necessarily related to search

Cardiac mitochondrial function depends on BUD23 mediated ribosome programming.

Efficient mitochondrial function is required in tissues with high energy demand such as the heart, and mitochondrial dysfunction is associated with cardiovascular disease. Expression of mitochondrial proteins is tightly regulated in response to internal and external stimuli. Here we identify a novel mechanism regulating mitochondrial content and function, through BUD23-dependent ribosome generation. BUD23 was required for ribosome maturation, normal 18S/28S stoichiometry and modulated the translation of mitochondrial transcripts in human A549 cells. Deletion of Bud23 in murine cardiomyocytes reduced mitochondrial content and function, leading to severe cardiomyopathy and death. We discovered that BUD23 selectively promotes ribosomal interaction with low GC-content 5'UTRs. Taken together we identify a critical role for BUD23 in bioenergetics gene expression, by promoting efficient translation of mRNA transcripts with low 5'UTR GC content. BUD23 emerges as essential to mouse development, and to postnatal cardiac function

Earlier snowmelt may lead to late season declines in plant productivity and carbon sequestration in Arctic tundra ecosystems

Arctic warming is affecting snow cover and soil hydrology, with consequences for carbon sequestration in tundra ecosystems. The scarcity of observations in the Arctic has limited our understanding of the impact of covarying environmental drivers on the carbon balance of tundra ecosystems. In this study, we address some of these uncertainties through a novel record of 119 site-years of summer data from eddy covariance towers representing dominant tundra vegetation types located on continuous permafrost in the Arctic. Here we found that earlier snowmelt was associated with more tundra net CO2 sequestration and higher gross primary productivity (GPP) only in June and July, but with lower net carbon sequestration and lower GPP in August. Although higher evapotranspiration (ET) can result in soil drying with the progression of the summer, we did not find significantly lower soil moisture with earlier snowmelt, nor evidence that water stress affected GPP in the late growing season. Our results suggest that the expected increased CO2 sequestration arising from Arctic warming and the associated increase in growing season length may not materialize if tundra ecosystems are not able to continue sequestering CO2 later in the season.Peer reviewe