Some Phonetic Structures of Koasati

This paper presents results of the first quantitative phonetic study of Koasati, a Muskogean language spoken in Louisiana and Texas. We examine vowel quality, length contrasts in vowels and consonants, the limited system of lexical tone contrasts in nouns, and the grammatical system of tone in verbs. We also study the realization of several word-final consonant clusters (fn, tl, lw, etc.) that are absent in related languages and that are typologically unusual due to their sonority reversals. Finally, we examine the cognates in related languages of the tones we document in Koasati nouns and verbs

Milk whey protein concentration and mRNA associated with β-lactoglobulin phenotype

Two common genetic variants of β-lactoglobulin (β-lg), A and B, exist as co- dominant alleles in dairy cattle (Aschaffenburg, 1968). Numerous studies have shown that cows homozygous for β-lg A have more β-lg and less α-lactalbumin (α-la) and casein in their milk than cows expressing only the B variant of β-lg (Ng-Kwai-Hang et al. 1987; Graml et al. 1989; Hill, 1993; Hill et al. 1995, 1997). These differences have a significant impact on the processing characteristics of the milk. For instance, the moisture-adjusted yield of Cheddar cheese is up to 10% higher using milk from cows of the β-lg BB phenotype compared with milk from cows expressing only the A variant (Hill et al. 1997). All these studies, however, describe compositional differences associated with β-lg phenotype in established lactation only. No information is available on the first few weeks of lactation, when there are marked changes in the concentrations of β-lg and α-la (Pérez et al. 1990)

NCAM: a surface marker for human small cell lung cancer cells

Immunocytochemical and immunochemical techniques were used to study the expression of the neural cell adhesion molecule (NCAM) by human lung cancer cell lines. Intense surface staining for NCAM was found at light and electron microscopic levels on small cell lung cancer cells. The NCAM polypeptide of Mr 140000 (NCAM 140) was detected by immunoblotting in all of 7 small cell lung cancer cell lines examined and in one out of two of the closely related large cell cancer cell lines: it was not detected in cell lines obtained from one patient with a mesothelioma, in two cases of adenocarcinoma, nor in two cases of squamous cell cancer. In contrast, neuron-specific enolase was found by immunoblotting in all the lung cancer cell lines tested and synaptophysin in all but the adenocarcinoma cell lines. These antigens were localized intracellularly. The specific expression of NCAM 140 by human small and large cell lung carcinomas suggests its potential as a diagnostic marker

The experiences of individuals in the gig economy

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Blockchains, Property Rights and Health Technology Assessment in the Pharmaceutical and Device(s) Industries

Ongoing concerns with the security of health information, both from the perspective of the individual patient as well as health systems has led to increased attention being given to the potential role of blockchain technology in the secure storage of health information through encryption, the integration of diverse health record systems and the vesting of property and access rights to health data in the patient. While the security offered by blockchain technology has long been recognized in the finance sector with the emergence of a range of cryptocurrencies as a medium of exchange and store of value, demonstrating the value of blockchain technology in health management and health technology assessment has yet to be achieved. In this commentary, a number of questions are raised as to the potential value offered by blockchain technology as a complement to existing electronic medical record systems. Chief among these are: (i) the allocation of property rights as a necessary precondition for blockchain uptake; (ii) access and incentives for active as opposed to passive blockchain membership; (iii) monetization of blockchain access; (iv) capturing data from within the blockchain and the possibility of value added data; (v) the potential for blockchain platforms in formulary evaluations; (vi) the blockchain as a managed market for health data; and (vii) the role of intermediation in blockchain management.   Article Type: Commentar

Blockchains, Formulary Evaluations and Health Technology Assessment

Blockchains have the potential, if appropriately implemented and managed, of contributing to a fundamental change in the application of techniques of health technology assessment in formulary decision making. Rather than continuing to rely on claims made by manufacturers that are non-evaluable, the introduction of blockchains as adjunct to the electronic medical record, meet an unmet medical need in enabling a platform for the real time assessment of claims. Rather than focusing the case for their product on lifetime cost-per-QALY models, which have no chance of ever being validated, the blockchain platform offers a low cost opportunity for claims evaluation. Manufacturers would be required to abandon the construction of imaginary cost-per-QALY worlds to support claims for pricing and formulary trier position, in favor of claims that can be evaluated and reported back to formulary committees in a short yet meaningful time horizon. Manufacturers would present a claims assessment protocol as part of the formulary submission package. If agreed with the formulary committee, the protocol would be implemented and managed through the patient blockchain membership. Claims would be monitored and evaluated in real time with a final report to the formulary committee in a matter of months. Lifetime imaginary claims for cost-per-QALY, set alongside willingness-to-pay thresholds, would be a thing of the past. Pricing decisions and formulary placement would reflect a robust evidence base and not just extrapolations from pivotal clinical trials.   Article Type: Commentar

If You Build it Will They Come? Patients, Providers and Blockchains in Health Technology Assessment

It is an open question as to whether blockchains can become an integral part of health care management in the US. On the one hand, there are the advocates of blockchains who see them as empowering patients to capture property rights to their medical records in a secure, encrypted, and portable form. On the other hand, there are blockchain critics that see the opportunities offered in health care as little different from those offered in other industries, viewing a blockchain structure as one that may reduce administrative and transaction costs, with little thought given to the potential of blockchain platforms to support a range of health technology assessment activities. While previous commentaries have pointed to this potential, the obstacles offered by the absence of clearly defined property rights and the absence of a market for DNA profiles have not been explored. The case put forward here is that any expectation that a blockchain as a ‘one-stop-shop’ for the interrogation of personal health records alone is unlikely to succeed. Apart from property rights effectively blocking this business model the blockchain vendor should consider targeted value added activities. At best, only a subset of records has the possibility of being transferred, with ongoing concerns regarding their quality and scope. This does not mean that the blockchain software model should be rejected. Far from it. The blockchain as a health technology assessment platform has the potential to support added value activities which not only improve the process of care and reduce costs and improve efficiencies, but also provide an ideal framework for property rights assignment. This opens the door to incentives and the monetization of value added health data by patients and providers, capturing rents that are at the moment expropriated by third parties. Critical issues are not only property rights and creation of a market place, but the ability to link and incentivize patients and their providers to support active blockchains to generate value added.   Article Type: Commentar

Genetics of attention-deficit hyperactivity disorder

Attention-Deficit Hyperactivity Disorder (ADHD) has long been recognized as being a highly heritable condition and our understanding of the genetic contributions to ADHD has grown over the past few decades. This chapter will discuss the studies that have examined its heritability and the efforts to identify specific genetic risk-variants at the molecular genetic level. We outline the various techniques that have been used to characterize genetic contributions to ADHD, describing what we have learnt so far, what there is still to learn and the methodologies that can be used to further our knowledge. In doing so we will discuss research into rare and common genetic variants, polygenic risk scores, and gene–environment interplay, while also describing what genetic studies have revealed about the biological processes involved in ADHD and what they have taught us about the overlap between ADHD and other psychiatric and somatic disorders. Finally, we will discuss the strengths and limitations of the current methodologies and clinical implications of genetic research to date

Intellectual disability in children with attention deficit hyperactivity disorder

Objective: To determine whether children with attention deficit hyperactivity disorder (ADHD) and mild intellectual disability (ID) are a clinically distinct ADHD subgroup. Study design: This was a cross-sectional study comparing clinical characteristics (ADHD subtypes, total number of symptoms, and rates of common comorbidities) between children with ADHD and mild ID and those with ADHD and IQ test scores >70, and also between children with ADHD and ID and a general population sample of children with ID alone. The sample comprised a clinical sample of children with ADHD with ID (n = 97) and without ID (n = 874) and a general population sample of children with ID and without ADHD (n = 58). Results: After correcting for multiple statistical tests, no differences were found between the 2 ADHD groups on any measure except the presence of conduct disorder (CD) symptoms and diagnoses. Children with ADHD and ID had higher rates of both (OR, 2.38; 95% CI, 1.71-3.32 and OR, 2.69; 95% CI, 1.69-4.28, respectively). Furthermore, children with ADHD and ID had significantly higher rates of oppositional defiant disorder (OR, 5.54; 95% CI, 2.86-10.75) and CD (OR, 13.66; 95% CI, 3.25-57.42) symptoms and a higher incidence of oppositional defiant disorder diagnoses (OR, 30.99; 95% CI, 6.38-150.39) compared with children with ID without ADHD. Conclusion: Children with ADHD and mild ID appear to be clinically typical of children with ADHD except for more conduct problems. This finding has implications for clinicians treating these children in terms of acknowledging the presence and impact of ADHD symptoms above and beyond ID and dealing with a comorbid CD

Rate of Decline in Nontreponemal Antibody Titers and Seroreversion After Treatment of Early Syphilis

Syphilis management is complex and demonstration of treatment response requires monitoring of nontreponemal antibody titers for a ≥ 4-fold decline and/or seroreversion to nonreactive titers