Changing the Ties That Bind? The Emerging Roles and Identities of General Practitioners and Managers in the New Clinical Commissioning Groups in the English NHS

The English National Health Service (NHS) is undergoing significant reorganization following the 2012 Health and Social Care Act. Key to these changes is the shift of responsibility for commissioning services from Primary Care Trusts (PCTs) to general practitioners (GPs) working together in Clinical Commissioning Groups (CCGs). This article is based on an empirical study that examined the development of emerging CCGs in eight case studies across England between September 2011 and June 2012. The findings are based on interviews with GPs and managers, observations of meetings, and reading of related documents. Scott’s notion that institutions are constituted by three pillars—the regulative, normative, and cognitive–cultural—is explored here. This approach helps to understand the changing roles and identities of doctors and managers implicated by the present reforms. This article notes the far reaching changes in the regulative pillar and questions how these changes will affect the normative and cultural–cognitive pillars

Job Creation, Job Destruction, and International Competition

The authors present a picture of how the effects of international trade on employment in U.S. manufacturing industries vary widely. They explore the labor-market dynamics and adjustment costs associated with international factors, particularly the way fluctuations in exchange rates, overseas economic activity, and the altering of trade restrictions contribute to churning-the simultaneous job creation among some firms and job destruction among others.https://research.upjohn.org/up_press/1049/thumbnail.jp

Vertical integration and firm boundaries : the evidence

Since Ronald H. Coase's (1937) seminal paper, a rich set of theories has been developed that deal with firm boundaries in vertical or input–output structures. In the last twenty-five years, empirical evidence that can shed light on those theories also has been accumulating. We review the findings of empirical studies that have addressed two main interrelated questions: First, what types of transactions are best brought within the firm and, second, what are the consequences of vertical integration decisions for economic outcomes such as prices, quantities, investment, and profits. Throughout, we highlight areas of potential cross-fertilization and promising areas for future work

From SICs and MUBs to Eddington

This is a survey of some very old knowledge about Mutually Unbiased Bases (MUB) and Symmetric Informationally Complete POVMs (SIC). In prime dimensions the former are closely tied to an elliptic normal curve symmetric under the Heisenberg group, while the latter are believed to be orbits under the Heisenberg group in all dimensions. In dimensions 3 and 4 the SICs are understandable in terms of elliptic curves, but a general statement escapes us. The geometry of the SICs in 3 and 4 dimensions is discussed in some detail.Comment: 12 pages; from the Festschrift for Tony Sudber

Lava geochemistry as a probe into crustal formation at the East Pacific Rise

Author Posting. © The Oceanography Society, 2012. This article is posted here by permission of The Oceanography Society for personal use, not for redistribution. The definitive version was published in Oceanography 25, no. 1 (2012): 89–93, doi:10.5670/oceanog.2012.06.Basalt lavas comprise the greatest volume of volcanic rocks on Earth, and most of them erupt along the world's mid-ocean ridges (MORs). These MOR basalts (MORBs) are generally thought to be relatively homogeneous in composition over large segments of the global ridge system (e.g., Klein, 2005). However, detailed sampling of two different regions on the northern East Pacific Rise (EPR) and extensive analysis of the samples show that fine-scale mapping and sampling of the ridge axis can reveal significant variations in lava chemistry on both small spatial and short temporal scales. The two most intensely sampled sites within the EPR Integrated Study Site (ISS) lie on and off axis between 9°17'N and 10°N, and from a wide region centered around 9°N where two segments of the EPR overlap (see Fornari et al., 2012, Figure 3, in this issue). The chemical composition of erupted lavas, similar to the genotype of an organism, can be used by igneous petrologists to trace the evolution of magmas from the mantle to the seafloor. The extensive and detailed geochemical studies at the EPR highlight how a thorough understanding of the variability in lava compositions on small spatial scales (i.e., between lava flows) and large spatial scales (i.e., from segment center to segment end and including discontinuities in the ridge crest) can be used in combination with seafloor photography, lava morphology, and bathymetry to provide insights into the magmatic system that drives volcanism and influences hydrothermal chemistry and biology at a fast-spreading MOR.Grants that supported EPR ISS field and laboratory studies for our research programs include: MRP: OCE-0138088, OCE-0819469, OCE-825265, OCE-638406, OCE-527077, OCE-535532; DJF: OCE-9819261, OCE-0525863, OCE-0838923, OCE-0096468, OCE-0732366, and OCE-0112737

Tissue Effects in a Randomized Controlled Trial of Short-term Finasteride in Early Prostate Cancer.

BackgroundIn the Prostate Cancer Prevention Trial, finasteride selectively suppressed low-grade prostate cancer and significantly reduced the incidence of prostate cancer in men treated with finasteride compared with placebo. However, an apparent increase in high-grade disease was also observed among men randomized to finasteride. We aimed to determine why and hypothesized that there is a grade-dependent response to finasteride.MethodsFrom 2007 to 2012, we randomized dynamically by intranet-accessible software 183 men with localized prostate cancer to receive 5mg finasteride or placebo daily in a double-blind study during the 4-6weeks preceding prostatectomy. As the primary end point, the expression of a predefined molecular signature (ERβ, UBE2C, SRD5A2, and VEGF) differentiating high- and low-grade tumors in Gleason grade (GG) 3 areas of finasteride-exposed tumors from those in GG3 areas of placebo-exposed tumors, adjusted for Gleason score (GS) at prostatectomy, was compared. We also determined androgen receptor (AR) levels, Ki-67, and cleaved caspase 3 to evaluate the effects of finasteride on the expression of its downstream target, cell proliferation, and apoptosis, respectively. The expression of these markers was also compared across grades between and within treatment groups. Logistic regression was used to assess the expression of markers.FindingsWe found that the predetermined molecular signature did not distinguish GG3 from GG4 areas in the placebo group. However, AR expression was significantly lower in the GG4 areas of the finasteride group than in those of the placebo group. Within the finasteride group, AR expression was also lower in GG4 than in GG3 areas, but not significantly. Expression of cleaved caspase 3 was significantly increased in both GG3 and GG4 areas in the finasteride group compared to the placebo group, although it was lower in GG4 than in GG3 areas in both groups.InterpretationWe showed that finasteride's effect on apoptosis and AR expression is tumor grade dependent after short-term intervention. This may explain finasteride's selective suppression of low-grade tumors observed in the PCPT

Activating WASP mutations associated with X-linked neutropenia result in enhanced actin polymerization, altered cytoskeletal responses, and genomic instability in lymphocytes

X-linked neutropenia (XLN) is caused by activating mutations in the Wiskott-Aldrich syndrome protein (WASP) that result in aberrant autoinhibition. Although patients with XLN appear to have only defects in myeloid lineages, we hypothesized that activating mutations of WASP are likely to affect the immune system more broadly. We generated mouse models to assess the role of activating WASP mutations associated with XLN (XLN-WASP) in lymphocytes. XLN-WASP is expressed stably in B and T cells and induces a marked increase in polymerized actin. XLN-WASP–expressing B and T cells migrate toward chemokines but fail to adhere normally. In marked contrast to WASP-deficient cells, XLN-WASP–expressing T cells proliferate normally in response to cell-surface receptor activation. However, XLN-WASP–expressing B cells fail to proliferate and secrete lower amounts of antibodies. Moreover, XLN-WASP expression in lymphocytes results in modestly increased apoptosis associated with increased genomic instability. These data indicate that there are unique requirements for the presence and activation status of WASP in B and T cells and that WASP-activating mutations interfere with lymphocyte cell survival and genomic stability

Characteristic Energy of the Coulomb Interactions and the Pileup of States

Tunneling data on $\mathrm{La_{1.28}Sr_{1.72}Mn_2O_7}$ crystals confirm Coulomb interaction effects through the $\sqrt{\mathrm{E}}$ dependence of the density of states. Importantly, the data and analysis at high energy, E, show a pileup of states: most of the states removed from near the Fermi level are found between ~40 and 130 meV, from which we infer the possibility of universal behavior. The agreement of our tunneling data with recent photoemission results further confirms our analysis.Comment: 4 pages, 4 figures, submitted to PR

Ernst Freund as Precursor of the Rational Study of Corporate Law

Gindis, David, Ernst Freund as Precursor of the Rational Study of Corporate Law (October 27, 2017). Journal of Institutional Economics, Forthcoming. Available at SSRN: https://ssrn.com/abstract=2905547, doi: https://dx.doi.org/10.2139/ssrn.2905547The rise of large business corporations in the late 19th century compelled many American observers to admit that the nature of the corporation had yet to be understood. Published in this context, Ernst Freund's little-known The Legal Nature of Corporations (1897) was an original attempt to come to terms with a new legal and economic reality. But it can also be described, to paraphrase Oliver Wendell Holmes, as the earliest example of the rational study of corporate law. The paper shows that Freund had the intuitions of an institutional economist, and engaged in what today would be called comparative institutional analysis. Remarkably, his argument that the corporate form secures property against insider defection and against outsiders anticipated recent work on entity shielding and capital lock-in, and can be read as an early contribution to what today would be called the theory of the firm.Peer reviewe