434 research outputs found
Overregulation of Health Care: Musings on Disruptive Innovation Theory
Disruptive innovation theory provides one lens through which to describe how regulations may stifle innovation and increase costs. Basing their discussion on this theory, Curtis and Schulman consider some of the effects that regulatory controls may have on innovation in the health sector
A novel tissue inhibitor of metalloproteinases-3 mutation reveals a common molecular phenotype in sorsby's fundus dystrophy
Sorsby’s fundus dystrophy (SFD) is a dominantly inherited
degenerative disease of the retina that leads to
loss of vision in middle age. It has been shown to be
caused by mutations in the gene for tissue inhibitor of
metalloproteinases-3 (TIMP-3). Five different mutations
have previously been identified, all introducing an extra
cysteine residue into exon 5 (which forms part of the
C-terminal domain) of the TIMP-3 molecule; however,
the significance of these mutations to the disease phenotype
was unknown. In this report, we describe the
expression of several of these mutated genes, together
with a previously unreported novel TIMP-3 mutation
from a family with SFD that results in truncation of
most of the C-terminal domain of the molecule. Despite
these differences, all of these molecules are expressed
and exhibit characteristics of the normal protein, including
inhibition of metalloproteinases and binding to
the extracellular matrix. However, unlike wild-type
TIMP-3, they all form dimers. These observations, together
with the recent finding that expression of TIMP-3
is increased, rather than decreased, in eyes from patients
with SFD, provides compelling evidence that
dimerized TIMP-3 plays an active role in the disease
process by accumulating in the eye. Increased expression
of TIMP-3 is also observed in other degenerative
retinal diseases, including the more severe forms of agerelated
macular degeneration, the most common cause
of blindness in the elderly in developed countries. We
hypothesize that overexpression of TIMP-3 may prove to
be a critical step in the progression of a variety of degenerative
retinopathies
Echo Features of Posteromedial Papillary Muscle Rupture without Papillary Muscle Prolapse into the Left Atrium
A 67-year-old male presented to the hospital emergency department with a 3-day history of decreased exercise tolerance, fatigue and exertional chest tightness. These symptoms began after an initial episode of prolonged chest pain associated with diaphoresis and dyspnea.. The admission electrocardiogram (EKG) and cardiac "markers" were consistent with a recent inferolateral myocardial infarction (MI). There was no history of cardiovascular disease. Risk factors were that of a family history of heart disease, long-standing tobacco use and elevated lipids. The patient was on no medications. Bedside echocardiography (TTE) revealed left ventricular (LV) basal inferior-inferolateral aneurysmal formation with mild mitral regurgitation (MR). Significant aortic sclerosis was noted (movie clip S1). Because of continued exertional chest pain up through admission, diagnostic angiography was performed. The coronary tree was codominant, with only disease in the circumflex system noted. A large obtuse marginal (OM) branch of the circumflex artery was occluded and could not be opened percutaneously. Left ventriculography was consistent with findings by TTE, with inferobasal dyskinesis noted. The following morning, the patient developed sudden dyspnea, hypotension and pulmonary edema. Cardiac auscultation revealed only a soft systolic murmur, heard at the left sternal border and also apex. The EKG was unchanged, except that Mobitz Type I AV block developed. The patient required endotracheal intubation with mechanical ventilation, along with inotropic support. Address for correspondence and reprint requests: Edmund Kenneth Kerut, M.D., Heart Clinic of Louisiana, 1111 Medical Center Blvd, Suite N613, Marrero, LA 70072. Fax: 504-349-6621; E-mail: [email protected] A second bedside TTE was performed. Twodimensional imaging revealed new prolapse of the posterior mitral valve leaflet, "erratic" reverberations within the LV cavity, and evidence of severe MR by Doppler interrogation Based on the clinical scenario and suggestive findings by TTE, transesophageal echocardiography (TEE) was performed. Findings confirmed rupture of the posteromedial (PM) papillary muscle An intraaortic balloon pump (IABP) was placed and the patient taken to the operating room, where the PM papillary muscle was found to be ruptured In the setting of myocardial infarction, papillary muscle rupture is rather an uncommon event, occurring in 1% to 3% of patients with acute MI
Two-Photon Doppler cooling of alkaline-earth-metal and ytterbium atoms
A new possibility of laser cooling of alkaline-earth-metal and Ytterbium
atoms using a two-photon transition is analyzed. We consider a -
transition, with excitation in near resonance with the
level. This greatly increases the two-photon transition rate, allowing an
effective transfer of momentum. The experimental implementation of this
technique is discussed and we show that for Calcium, for example, two-photon
cooling can be used to achieve a Doppler limit of 123 microKelvin. The
efficiency of this cooling scheme and the main loss mechanisms are analyzed.Comment: 7 pages, 5 figure
Patient-Powered Research Networks of the Autoimmune Research Collaborative: Rationale, Capacity, and Future Directions
Patient-Powered Research Networks (PPRNs) are US-based registry infrastructures co-created by advocacy groups, patient research partners, academic investigators, and other healthcare stakeholders. Patient-Powered Research Networks collect information directly from patients to conduct and disseminate the results of patient-centered/powered research that helps patients make more informed decisions about their healthcare. Patient-Powered Research Networks gather and utilize real-world data and patient-reported outcomes to conduct comparative effectiveness, safety, and other research, and leverage the Internet to accomplish this effectively and efficiently. Four PPRNs focused on autoimmune and immune-mediated conditions formed the Autoimmune Research Collaborative: ArthritisPower (rheumatoid arthritis, spondyloarthritis, and other rheumatic and musculoskeletal diseases), IBD Partners (inflammatory bowel disease), iConquerMS (multiple sclerosis), and the Vasculitis PPRN (vasculitis). The Autoimmune Research Collaborative aims to inform the healthcare decision making of patients, care partners, and other stakeholders, such as clinicians, regulators, and payers. Illustrated by practical applications from the Autoimmune Research Collaborative and its constituent PPRNs, this article discusses the shared capacities and challenges of the PPRN model, and the opportunities presented by collaborating across autoimmune conditions to design, conduct, and disseminate patient-centered outcomes research
Engaging Multistakeholder Perspectives to Identify Patient-Centered Research Priorities Regarding Vaccine Uptake Among Adults With Autoimmune Conditions
Objective: The study objective was to prioritize topics for future patient-centered research to increase uptake of common vaccines, such as for pneumococcal pneumonia, influenza, herpes zoster, human papillomavirus, and severe acute respiratory syndrome coronavirus 2, among adults living with autoimmune conditions. Methods: A steering committee (SC) was formed that included clinicians, patients, patient advocates, and researchers associated with rheumatic diseases (psoriatic arthritis, rheumatoid arthritis, vasculitis), inflammatory bowel disease, and multiple sclerosis. Through a scoping review and discussions, SC members identified research topics regarding vaccine uptake and/or hesitancy for prioritization. A larger multistakeholder alliance that included patients and patient advocates, clinicians, researchers, policy makers, regulators, and vaccine manufacturers conducted a modified Delphi exercise online with three rating rounds and one ranking round. Frequency analysis and comparisons across stakeholder groups were conducted. A weighted ranking score was generated for each item in the ranking round for final prioritization. Results: Through the Delphi process, 33 research topics were identified, of which 13 topics were rated as critical by more than 70% of all stakeholders (n = 31). The two highest ranked critical topics per the full stakeholder group were “How well a vaccine works for adults with autoimmune conditions” and “How beliefs about vaccine safety affect vaccine uptake.”. Conclusion: A multistakeholder group identified key topics as critically important priorities for future research to decrease vaccine hesitancy and improve uptake of vaccines for adults with autoimmune conditions
Search for the glueball candidates f0(1500) and fJ(1710) in gamma gamma collisions
Data taken with the ALEPH detector at LEP1 have been used to search for gamma
gamma production of the glueball candidates f0(1500) and fJ(1710) via their
decay to pi+pi-. No signal is observed and upper limits to the product of gamma
gamma width and pi+pi- branching ratio of the f0(1500) and the fJ(1710) have
been measured to be Gamma_(gamma gamma -> f0(1500)). BR(f0(1500)->pi+pi-) <
0.31 keV and Gamma_(gamma gamma -> fJ(1710)). BR(fJ(1710)->pi+pi-) < 0.55 keV
at 95% confidence level.Comment: 10 pages, 3 figure
Search for supersymmetry with a dominant R-parity violating LQDbar couplings in e+e- collisions at centre-of-mass energies of 130GeV to 172 GeV
A search for pair-production of supersymmetric particles under the assumption
that R-parity is violated via a dominant LQDbar coupling has been performed
using the data collected by ALEPH at centre-of-mass energies of 130-172 GeV.
The observed candidate events in the data are in agreement with the Standard
Model expectation. This result is translated into lower limits on the masses of
charginos, neutralinos, sleptons, sneutrinos and squarks. For instance, for
m_0=500 GeV/c^2 and tan(beta)=sqrt(2) charginos with masses smaller than 81
GeV/c^2 and neutralinos with masses smaller than 29 GeV/c^2 are excluded at the
95% confidence level for any generation structure of the LQDbar coupling.Comment: 32 pages, 30 figure
Measurement of the polarisation of W bosons produced with large transverse momentum in pp collisions at sqrt(s) = 7 TeV with the ATLAS experiment
This paper describes an analysis of the angular distribution of W->enu and
W->munu decays, using data from pp collisions at sqrt(s) = 7 TeV recorded with
the ATLAS detector at the LHC in 2010, corresponding to an integrated
luminosity of about 35 pb^-1. Using the decay lepton transverse momentum and
the missing transverse energy, the W decay angular distribution projected onto
the transverse plane is obtained and analysed in terms of helicity fractions
f0, fL and fR over two ranges of W transverse momentum (ptw): 35 < ptw < 50 GeV
and ptw > 50 GeV. Good agreement is found with theoretical predictions. For ptw
> 50 GeV, the values of f0 and fL-fR, averaged over charge and lepton flavour,
are measured to be : f0 = 0.127 +/- 0.030 +/- 0.108 and fL-fR = 0.252 +/- 0.017
+/- 0.030, where the first uncertainties are statistical, and the second
include all systematic effects.Comment: 19 pages plus author list (34 pages total), 9 figures, 11 tables,
revised author list, matches European Journal of Physics C versio
Observation of a new chi_b state in radiative transitions to Upsilon(1S) and Upsilon(2S) at ATLAS
The chi_b(nP) quarkonium states are produced in proton-proton collisions at
the Large Hadron Collider (LHC) at sqrt(s) = 7 TeV and recorded by the ATLAS
detector. Using a data sample corresponding to an integrated luminosity of 4.4
fb^-1, these states are reconstructed through their radiative decays to
Upsilon(1S,2S) with Upsilon->mu+mu-. In addition to the mass peaks
corresponding to the decay modes chi_b(1P,2P)->Upsilon(1S)gamma, a new
structure centered at a mass of 10.530+/-0.005 (stat.)+/-0.009 (syst.) GeV is
also observed, in both the Upsilon(1S)gamma and Upsilon(2S)gamma decay modes.
This is interpreted as the chi_b(3P) system.Comment: 5 pages plus author list (18 pages total), 2 figures, 1 table,
corrected author list, matches final version in Physical Review Letter
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