Effects of a Commercial Insurance Policy Restriction on Lumbar Fusion in North Carolina and the Implications for National Adoption

Analysis of the State Inpatient Database of North Carolina, 2005–2012, and the Nationwide Inpatient Sample, including all inpatient lumbar fusion admissions from non-federal hospitals

β-Lactam Effects on Mixed Cultures of Common Respiratory Isolates as an Approach to Treatment Effects on Nasopharyngeal Bacterial Population Dynamics

BACKGROUND: Streptococcus pneumoniae, Streptococcus pyogenes and Haemophilus influenzae are bacteria present in the nasopharynx as part of normal flora. The ecological equilibrium in the nasopharynx can be disrupted by the presence of antibiotics. METHODOLOGY/PRINCIPAL FINDINGS: A computerized two-compartment pharmacodynamic model was used to explore beta-lactam effects on the evolution over time of a bacterial load containing common pharyngeal isolates by simulating free serum concentrations obtained with amoxicillin (AMX) 875 mg tid, amoxicillin/clavulanic acid (AMC) 875/125 mg tid and cefditoren (CDN) 400 mg bid regimens over 24 h. Strains and MICs (microg/ml) of AMX, AMC and CDN were: S. pyogenes (0.03, 0.03 and 0.015), S. pneumoniae (2, 2 and 0.25), a beta-lactamase positive H. influenzae (BL(+); >16, 2 and 0.06) and a beta-lactamase positive AMC-resistant H. influenzae (BLPACR, >16, 8 and 0.06). Mixture of identical 1:1:1:1 volumes of each bacterial suspension were prepared yielding an inocula of approximately 4 x 10(6) cfu/ml. Antibiotic concentrations were measured both in bacterial and in bacteria-free antibiotic simulations. beta-lactamase production decreased AMX concentrations and fT(>MIC) against S. pneumoniae (from 43.2% to 17.7%) or S. pyogenes (from 99.9% to 24.9%), and eradication was precluded. The presence of clavulanic acid countered this effect of co-pathogenicity, and S. pyogenes (but not BL(+) and S. pneumoniae) was eradicated. Resistance of CDN to TEM beta-lactamase avoided this co-pathogenicity effect, and CDN eradicated S. pyogenes and H. influenzae strains (fT(>MIC) >58%), and reduced in 94% S. pneumoniae counts (fT(>MIC) approximately 25%). CONCLUSIONS/SIGNIFICANCE: Co-pathogenicity seems to be gradual since clavulanic acid countered this effect for strains very susceptible to AMX as S. pyogenes but not for strains with AMX MIC values in the limit of susceptibility as S. pneumoniae. There is a potential therapeutic advantage for beta-lactamase resistant cephalosporins with high activity against streptococci

SPARTAN: a global network to evaluate and enhance satellite-based estimates of ground-level particulate matter for global health applications

Ground-based observations have insufficient spatial coverage to assess long-term human exposure to fine particulate matter (PM2.5) at the global scale. Satellite remote sensing offers a promising approach to provide information on both short-and long-term exposure to PM2.5 at local-to-global scales, but there are limitations and outstanding questions about the accuracy and precision with which ground-level aerosol mass concentrations can be inferred from satellite remote sensing alone. A key source of uncertainty is the global distribution of the relationship between annual average PM2.5 and discontinuous satellite observations of columnar aerosol optical depth (AOD). We have initiated a global network of ground-level monitoring stations designed to evaluate and enhance satellite remote sensing estimates for application in health-effects research and risk assessment. This Surface PARTiculate mAtter Network (SPARTAN) includes a global federation of ground-level monitors of hourly PM2.5 situated primarily in highly populated regions and collocated with existing ground-based sun photometers that measure AOD. The instruments, a three-wavelength nephelometer and impaction filter sampler for both PM2.5 and PM10, are highly autonomous. Hourly PM2.5 concentrations are inferred from the combination of weighed filters and nephelometer data. Data from existing networks were used to develop and evaluate network sampling characteristics. SPARTAN filters are analyzed for mass, black carbon, water-soluble ions, and metals. These measurements provide, in a variety of regions around the world, the key data required to evaluate and enhance satellite-based PM2.5 estimates used for assessing the health effects of aerosols. Mean PM2.5 concentrations across sites vary by more than 1 order of magnitude. Our initial measurements indicate that the ratio of AOD to ground-level PM2.5 is driven temporally and spatially by the vertical profile in aerosol scattering. Spatially this ratio is also strongly influenced by the mass scattering efficiency.Fil: Snider, G.. Dalhousie University Halifax; CanadáFil: Weagle, C. L.. Dalhousie University Halifax; CanadáFil: Martin, R. V.. Dalhousie University Halifax; Canadá. University of Cambridge; Reino UnidoFil: van Donkelaar, A.. Dalhousie University Halifax; CanadáFil: Conrad, K.. Dalhousie University Halifax; CanadáFil: Cunningham, D.. Dalhousie University Halifax; CanadáFil: Gordon, C.. Dalhousie University Halifax; CanadáFil: Zwicker, M.. Dalhousie University Halifax; CanadáFil: Akoshile, C.. University of Ilorin; NigeriaFil: Artaxo, P.. Governo Do Estado de Sao Paulo; BrasilFil: Anh, N. X.. Vietnam Academy of Science and Technology. Institute of Geophysics; VietnamFil: Brook, J.. University of Toronto; CanadáFil: Dong, J.. Tsinghua University; ChinaFil: Garland, R. M.. North-West University; SudáfricaFil: Greenwald, R.. Rollins School of Public Health; Estados UnidosFil: Griffith, D.. Council for Scientific and Industrial Research; SudáfricaFil: He, K.. Tsinghua University; ChinaFil: Holben, B. N.. NASA Goddard Space Flight Center; Estados UnidosFil: Kahn, R.. NASA Goddard Space Flight Center; Estados UnidosFil: Koren, I.. Weizmann Institute Of Science Israel; IsraelFil: Lagrosas, N.. Manila Observatory, Ateneo de Manila University campus; FilipinasFil: Lestari, P.. Institut Teknologi Bandung; IndonesiaFil: Ma, Z.. Rollins School of Public Health; Estados UnidosFil: Vanderlei Martins, J.. University of Maryland; Estados UnidosFil: Quel, Eduardo Jaime. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Rudich, Y.. Weizmann Institute Of Science Israel; IsraelFil: Salam, A.. University Of Dhaka; BangladeshFil: Tripathi, S. N.. Indian Institute Of Technology, Kanpur; IndiaFil: Yu, C.. Rollins School of Public Health; Estados UnidosFil: Zhang, Q.. Tsinghua University; ChinaFil: Zhang, Y.. Tsinghua University; ChinaFil: Brauer, M.. University of British Columbia; CanadáFil: Cohen, A.. Health Effects Institute; Estados UnidosFil: Gibson, M. D.. Dalhousie University Halifax; CanadáFil: Liu, Y.. Rollins School of Public Health; Estados Unido

Gas Accretion and Galactic Chemical Evolution: Theory and Observations

This chapter reviews how galactic inflows influence galaxy metallicity. The goal is to discuss predictions from theoretical models, but particular emphasis is placed on the insights that result from using models to interpret observations. Even as the classical G-dwarf problem endures in the latest round of observational confirmation, a rich and tantalizing new phenomenology of relationships between $M_*$, $Z$, SFR, and gas fraction is emerging both in observations and in theoretical models. A consensus interpretation is emerging in which star-forming galaxies do most of their growing in a quiescent way that balances gas inflows and gas processing, and metal dilution with enrichment. Models that explicitly invoke this idea via equilibrium conditions can be used to infer inflow rates from observations, while models that do not assume equilibrium growth tend to recover it self-consistently. Mergers are an overall subdominant mechanism for delivering fresh gas to galaxies, but they trigger radial flows of previously-accreted gas that flatten radial gas-phase metallicity gradients and temporarily suppress central metallicities. Radial gradients are generically expected to be steep at early times and then flattened by mergers and enriched inflows of recycled gas at late times. However, further theoretical work is required in order to understand how to interpret observations. Likewise, more observational work is needed in order to understand how metallicity gradients evolve to high redshifts.Comment: Invited review to appear in Gas Accretion onto Galaxies, Astrophysics and Space Science Library, eds. A. J. Fox & R. Dav\'e, to be published by Springer. 29 pages, 2 figure

High-E_T dijet photoproduction at HERA

The cross section for high-E_T dijet production in photoproduction has been measured with the ZEUS detector at HERA using an integrated luminosity of 81.8 pb-1. The events were required to have a virtuality of the incoming photon, Q^2, of less than 1 GeV^2 and a photon-proton centre-of-mass energy in the range 142 < W < 293 GeV. Events were selected if at least two jets satisfied the transverse-energy requirements of E_T(jet1) > 20 GeV and E_T(jet2) > 15 GeV and pseudorapidity requirements of -1 < eta(jet1,2) < 3, with at least one of the jets satisfying -1 < eta(jet) < 2.5. The measurements show sensitivity to the parton distributions in the photon and proton and effects beyond next-to-leading order in QCD. Hence these data can be used to constrain further the parton densities in the proton and photon.Comment: 36 pages, 13 figures, 20 tables, including minor revisions from referees. Accepted by Phys. Rev.

Methods for the guideline-based development of quality indicators--a systematic review

<p>Abstract</p> <p>Background</p> <p>Quality indicators (QIs) are used in many healthcare settings to measure, compare, and improve quality of care. For the efficient development of high-quality QIs, rigorous, approved, and evidence-based development methods are needed. Clinical practice guidelines are a suitable source to derive QIs from, but no gold standard for guideline-based QI development exists. This review aims to identify, describe, and compare methodological approaches to guideline-based QI development.</p> <p>Methods</p> <p>We systematically searched medical literature databases (Medline, EMBASE, and CINAHL) and grey literature. Two researchers selected publications reporting methodological approaches to guideline-based QI development. In order to describe and compare methodological approaches used in these publications, we extracted detailed information on common steps of guideline-based QI development (topic selection, guideline selection, extraction of recommendations, QI selection, practice test, and implementation) to predesigned extraction tables.</p> <p>Results</p> <p>From 8,697 hits in the database search and several grey literature documents, we selected 48 relevant references. The studies were of heterogeneous type and quality. We found no randomized controlled trial or other studies comparing the ability of different methodological approaches to guideline-based development to generate high-quality QIs. The relevant publications featured a wide variety of methodological approaches to guideline-based QI development, especially regarding guideline selection and extraction of recommendations. Only a few studies reported patient involvement.</p> <p>Conclusions</p> <p>Further research is needed to determine which elements of the methodological approaches identified, described, and compared in this review are best suited to constitute a gold standard for guideline-based QI development. For this research, we provide a comprehensive groundwork.</p

Measurement of event shapes in deep inelastic scattering at HERA

Inclusive event-shape variables have been measured in the current region of the Breit frame for neutral current deep inelastic ep scattering using an integrated luminosity of 45.0 pb^-1 collected with the ZEUS detector at HERA. The variables studied included thrust, jet broadening and invariant jet mass. The kinematic range covered was 10 < Q^2 < 20,480 GeV^2 and 6.10^-4 < x < 0.6, where Q^2 is the virtuality of the exchanged boson and x is the Bjorken variable. The Q dependence of the shape variables has been used in conjunction with NLO perturbative calculations and the Dokshitzer-Webber non-perturbative corrections (`power corrections') to investigate the validity of this approach.Comment: 7+25 pages, 6 figure

An NLO QCD analysis of inclusive cross-section and jet-production data from the ZEUS experiment

The ZEUS inclusive differential cross-section data from HERA, for charged and neutral current processes taken with e+ and e- beams, together with differential cross-section data on inclusive jet production in e+ p scattering and dijet production in \gamma p scattering, have been used in a new NLO QCD analysis to extract the parton distribution functions of the proton. The input of jet data constrains the gluon and allows an accurate extraction of \alpha_s(M_Z) at NLO; \alpha_s(M_Z) = 0.1183 \pm 0.0028(exp.) \pm 0.0008(model) An additional uncertainty from the choice of scales is estimated as \pm 0.005. This is the first extraction of \alpha_s(M_Z) from HERA data alone.Comment: 37 pages, 14 figures, to be submitted to EPJC. PDFs available at http://durpdg.dur.ac.uk/hepdata in LHAPDFv

Distribution and Extinction of Ungulates during the Holocene of the Southern Levant

BACKGROUND: The southern Levant (Israel, Palestinian Authority and Jordan) has been continuously and extensively populated by succeeding phases of human cultures for the past 15,000 years. The long human impact on the ancient landscape has had great ecological consequences, and has caused continuous and accelerating damage to the natural environment. The rich zooarchaeological data gathered at the area provide a unique opportunity to reconstruct spatial and temporal changes in wild species distribution, and correlate them with human demographic changes. METHODOLOGY: Zoo-archaeological data (382 animal bone assemblages from 190 archaeological sites) from various time periods, habitats and landscapes were compared. The bone assemblages were sorted into 12 major cultural periods. Distribution maps showing the presence of each ungulate species were established for each period. CONCLUSIONS: The first major ungulate extinction occurred during the local Iron Age (1,200-586 BCE), a period characterized by significant human population growth. During that time the last of the largest wild ungulates, the hartebeest (Alcelaphus buselaphus), aurochs (Bos primigenius) and the hippopotamus (Hippopotamus amphibius) became extinct, followed by a shrinking distribution of forest-dwelling cervids. A second major wave of extinction occurred only in the 19th and 20th centuries CE. Furthermore, a negative relationship was found between the average body mass of ungulate species that became extinct during the Holocene and their extinction date. It is thus very likely that the intensified human activity through habitat destruction and uncontrolled hunting were responsible for the two major waves of ungulate extinction in the southern Levant during the late Holocene