The Effect of Financial Incentives on Patient Decisions to Undergo Low‐value Head Computed Tomography Scans

BackgroundExcessive diagnostic testing and defensive medicine contribute to billions of dollars in avoidable costs in the United States annually. Our objective was to determine the influence of financial incentives, accompanied with information regarding test risk and benefit, on patient preference for diagnostic testing.MethodsWe conducted a cross‐sectional survey of patients at the University of Michigan emergency department (ED). Each participant was presented with a hypothetical scenario involving an ED visit following minor traumatic brain injury. Participants were given information regarding potential benefit (detecting brain hemorrhage) and risk (developing cancer) of head computed tomography scan, as well as an incentive of $0 or$100 to forego testing. We used 0.1 and 1% for test benefit and risk, and values for risk, benefit, and financial incentive varied across participants. Our primary outcome was patient preference to undergo testing. We also collected demographic and numeracy information. We then used logistic regression to estimate odds ratios (ORs), which were adjusted for multiple potential confounders. Our sample size was designed to find at least 300 events (preference for testing) to allow for inclusion of up to 30 covariates in fully adjusted models. We had 85% to 90% power to detect a 10% absolute difference in testing rate across groups, assuming a 95% significance level.ResultsWe surveyed 913 patients. Increasing test benefit from 0.1% to 1% significantly increased test acceptance (adjusted OR [AOR] = 1.6, 95% confidence interval [CI] = 1.2 to 2.1) and increasing test risk from 0.1% to 1% significantly decreased test acceptance (AOR = 0.70, 95% CI = 0.52 to 0.93). Finally, a $100 incentive to forego low‐value testing significantly reduced test acceptance (AOR = 0.6; 95% CI = 0.4 to 0.8).ConclusionsProviding financial incentives to forego testing significantly decreased patient preference for testing, even when accounting for test benefit and risk. This work is preliminary and hypothetical and requires confirmation in larger patient cohorts facing these actual decisions.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151851/1/acem13823_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151851/2/acem13823-sup-0001-DataSupplementS1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151851/3/acem13823.pd

From counting to construction of BPS states in N=4 SYM

We describe a universal element in the group algebra of symmetric groups, whose characters provides the counting of quarter and eighth BPS states at weak coupling in N=4 SYM, refined according to representations of the global symmetry group. A related projector acting on the Hilbert space of the free theory is used to construct the matrix of two-point functions of the states annihilated by the one-loop dilatation operator, at finite N or in the large N limit. The matrix is given simply in terms of Clebsch-Gordan coefficients of symmetric groups and dimensions of U(N) representations. It is expected, by non-renormalization theorems, to contain observables at strong coupling. Using the stringy exclusion principle, we interpret a class of its eigenvalues and eigenvectors in terms of giant gravitons. We also give a formula for the action of the one-loop dilatation operator on the orthogonal basis of the free theory, which is manifestly covariant under the global symmetry.Comment: 41 pages + Appendices, 4 figures; v2 - refs and acknowledgments adde

Gauge invariant perturbation theory and non-critical string models of Yang-Mills theories

We carry out a gauge invariant analysis of certain perturbations of $D-2$-branes solutions of low energy string theories. We get generically a system of second order coupled differential equations, and show that only in very particular cases it is possible to reduce it to just one differential equation. Later, we apply it to a multi-parameter, generically singular family of constant dilaton solutions of non-critical string theories in $D$ dimensions, a generalization of that recently found in arXiv:0709.0471[hep-th]. According to arguments coming from the holographic gauge theory-gravity correspondence, and at least in some region of the parameters space, we obtain glue-ball spectra of Yang-Mills theories in diverse dimensions, putting special emphasis in the scalar metric perturbations not considered previously in the literature in the non critical setup. We compare our numerical results to those studied previously and to lattice results, finding qualitative and in some cases, tuning properly the parameters, quantitative agreement. These results seem to show some kind of universality of the models, as well as an irrelevance of the singular character of the solutions. We also develop the analysis for the T-dual, non trivial dilaton family of solutions, showing perfect agreement between them.Comment: A new reference added

Modeling recursive RNA interference.

An important application of the RNA interference (RNAi) pathway is its use as a small RNA-based regulatory system commonly exploited to suppress expression of target genes to test their function in vivo. In several published experiments, RNAi has been used to inactivate components of the RNAi pathway itself, a procedure termed recursive RNAi in this report. The theoretical basis of recursive RNAi is unclear since the procedure could potentially be self-defeating, and in practice the effectiveness of recursive RNAi in published experiments is highly variable. A mathematical model for recursive RNAi was developed and used to investigate the range of conditions under which the procedure should be effective. The model predicts that the effectiveness of recursive RNAi is strongly dependent on the efficacy of RNAi at knocking down target gene expression. This efficacy is known to vary highly between different cell types, and comparison of the model predictions to published experimental data suggests that variation in RNAi efficacy may be the main cause of discrepancies between published recursive RNAi experiments in different organisms. The model suggests potential ways to optimize the effectiveness of recursive RNAi both for screening of RNAi components as well as for improved temporal control of gene expression in switch off-switch on experiments

Quantitative Modeling of Escherichia coli Chemotactic Motion in Environments Varying in Space and Time

Escherichia coli chemotactic motion in spatiotemporally varying environments is studied by using a computational model based on a coarse-grained description of the intracellular signaling pathway dynamics. We find that the cell's chemotaxis drift velocity vd is a constant in an exponential attractant concentration gradient [L]∝exp(Gx). vd depends linearly on the exponential gradient G before it saturates when G is larger than a critical value GC. We find that GC is determined by the intracellular adaptation rate kR with a simple scaling law: . The linear dependence of vd on G = d(ln[L])/dx directly demonstrates E. coli's ability in sensing the derivative of the logarithmic attractant concentration. The existence of the limiting gradient GC and its scaling with kR are explained by the underlying intracellular adaptation dynamics and the flagellar motor response characteristics. For individual cells, we find that the overall average run length in an exponential gradient is longer than that in a homogeneous environment, which is caused by the constant kinase activity shift (decrease). The forward runs (up the gradient) are longer than the backward runs, as expected; and depending on the exact gradient, the (shorter) backward runs can be comparable to runs in a spatially homogeneous environment, consistent with previous experiments. In (spatial) ligand gradients that also vary in time, the chemotaxis motion is damped as the frequency ω of the time-varying spatial gradient becomes faster than a critical value ωc, which is controlled by the cell's chemotaxis adaptation rate kR. Finally, our model, with no adjustable parameters, agrees quantitatively with the classical capillary assay experiments where the attractant concentration changes both in space and time. Our model can thus be used to study E. coli chemotaxis behavior in arbitrary spatiotemporally varying environments. Further experiments are suggested to test some of the model predictions

Using performance-based regulation to reduce childhood obesity

BackgroundWorldwide, the public health community has recognized the growing problem of childhood obesity. But, unlike tobacco control policy, there is little evidence about what public policies would work to substantially reduce childhood obesity. Public health leaders currently tend to support traditional "command and control" schemes that order private enterprises and governments to stop or start doing specific things that, is it hoped, will yield lower childhood obesity rates. These include measures such as 1) taking sweetened beverages out of schools, 2) posting calorie counts on fast-food menu boards, 3) labeling foods with a "red light" if they contain high levels of fat or sugar, 4) limiting the density of fast food restaurants in any neighborhood, 5) requiring chain restaurants to offer "healthy" alternatives, and 6) eliminating junk food ads on television shows aimed at children. Some advocates propose other regulatory interventions such as 1) influencing the relative prices of healthy and unhealthy foods through taxes and/or subsidies and 2) suing private industry for money damages as a way of blaming childhood obesity on certain practices of the food industry (such as its marketing, product composition, or portion size decisions). The food industry generally seeks to deflect blame for childhood obesity onto others, such as parents and schools

New results for the SQCD Hilbert series

We derive new explicit results for the Hilbert series of N=1 supersymmetric QCD with U(N_c) and SU(N_c) color symmetry. We use two methods which have previously been applied to similar computational problems in the analysis of decay of unstable D-branes: expansions using Schur polynomials, and the log-gas approach related to random matrix theory.Comment: 33 pages, 2 figures; v2: references and comments on the 3rd order phase transition added; v3: refs. correcte