Large variations in the prices of urologic procedures at academic medical centers 1 year after implementation of the Price Transparency Final Rule

IMPORTANCE: Patients with urologic diseases often experience financial toxicity, defined as high levels of financial burden and concern, after receiving care. The Price Transparency Final Rule, which requires hospitals to disclose both the commercial and cash prices for at least 300 services, was implemented to facilitate price shopping, decrease price dispersion, and lower health care costs. OBJECTIVE: To evaluate compliance with the Price Transparency Final Rule and to quantify variations in the price of urologic procedures among academic hospitals and by insurance class. DESIGN, SETTING, AND PARTICIPANTS: This was a cross-sectional study that determined the prices of 5 common urologic procedures among academic medical centers and by insurance class. Prices were obtained from the Turquoise Health Database on March 24, 2022. Academic hospitals were identified from the Association of American Medical Colleges website. The 5 most common urologic procedures were cystourethroscopy, prostate biopsy, laparoscopic radical prostatectomy, transurethral resection of the prostate, and ureteroscopy with laser lithotripsy. Using the corresponding Current Procedural Terminology codes, the Turquoise Health Database was queried to identify the cash price, Medicare price, Medicaid price, and commercial insurance price for these procedures. EXPOSURES: The Price Transparency Final Rule, which went into effect January 1, 2021. MAIN OUTCOMES AND MEASURES: Variability in procedure price among academic medical centers and by insurance class (Medicare, Medicaid, commercial, and cash price). RESULTS: Of 153 hospitals, only 20 (13%) listed a commercial price for all 5 procedures. The commercial price was reported most often for cystourethroscopy (86 hospitals [56%]) and least often for laparoscopic radical prostatectomy (45 hospitals [29%]). The cash price was lower than the Medicare, Medicaid, and commercial price at 24 hospitals (16%). Prices varied substantially across hospitals for all 5 procedures. There were significant variations in the prices of cystoscopy (χ23 = 85.9; P = .001), prostate biopsy (χ23 = 64.6; P = .001), prostatectomy (χ23 = 24.4; P = .001), transurethral resection of the prostate (χ23 = 51.3; P = .001), and ureteroscopy with laser lithotripsy (χ23 = 63.0; P = .001) by insurance type. CONCLUSIONS AND RELEVANCE: These findings suggest that, more than 1 year after the implementation of the Price Transparency Final Rule, there are still large variations in the prices of urologic procedures among academic hospitals and by insurance class. Currently, in certain situations, health care costs could be reduced if patients paid out of pocket. The Centers for Medicare & Medicaid Services may improve price transparency by better enforcing penalties for noncompliance, increasing penalties, and ensuring that hospitals report prices in a way that is easy for patients to access and understand

Peacock bass mortality associated with catch-and-release sport fishing in the Negro River, Amazonas State, Brazil

Sport fishing for peacock bass Cichla spp. in the Brazilian Amazon has increased in popularity and attracts anglers who generate significant economic benefits in rural regions. The sustainability of this fishery is partly dependent on the survival of fish caught through catch-and-release fishing. The objective of this work was to investigate, hooking mortality of Cichla spp., including speckled peacock bass (C. temensis Humbolt), butterfly peacock bass (C. orinocensis Humbolt), and popoca peacock bass (C. monoculus Agassiz) in the basin of the Negro River, the largest tributary of the Amazon River. Fish were caught at two different sites using artificial lures, transported to pens anchored in the river and monitored for 72 hours. A total of 162 individual peacock bass were captured and hooking mortality (mean % ± 95% confidence intervals) was calculated. Mean mortality was 3.5% (± 5.0), 2.3% (± 3.5) and 5.2% (± 10.2) for speckled peacock bass, butterfly peacock bass, and popoca peacock bass, respectively. Lengths of captured fish ranged from 26 to 79 cm (standard length), however, only fish under 42 cm died. This research suggests that catch-and-release sport fishing of peacock bass does not result in substantial mortality in the Negro River basin.A pesca esportiva de tucunarés Cichla spp., na Amazônia brasileira, aumentou em popularidade nos últimos anos e tem atraído pescadores esportivos que geram benefícios econômicos para essa região. Entretanto, a sustentabilidade dessa pescaria depende em parte da sobrevivência dos peixes capturados por meio da prática do pesque e solte. O objetivo deste trabalho foi avaliar a mortalidade de Cichla spp., incluindo o tucunaré paca (C. temensis Humbolt), o borboleta (C. orinocensis Humbolt) e o popoca (C. monoculus Agassiz) em dois locais na bacia do rio Negro, o maior tributário do rio Amazonas. Os peixes foram capturados por variados tipos de iscas artificiais e posteriormente monitorados em viveiros construídos no próprio rio por 72 horas. Um total de 162 tucunarés foi capturado, e as mortalidades (% ± intervalo de confiança 95%) foram calculadas. A mortalidade foi 3,5% (± 5,0), 2,3% (± 3,2) e 5,2% (±10,2) para o paca, o borboleta e o popoca, respectivamente. O comprimento padrão dos peixes capturados variou de 26 a 79 cm, mas apenas os peixes menores até 42 cm morreram. A pesquisa sugere que a pesca esportiva não causou substancial mortalidade na população de Cichla spp. na bacia do rio Negro

A Simple Model for Predicting Survival of Angler-Caught and Released Largemouth Bass

We conducted a controlled experiment in the laboratory to assess the influence of anatomical hooking location and water temperature on survival of angler-caught and released largemouth bass Micropterus salmoides. Survival was 98% (58 of 59 fish) among fish that were hand-hooked within the oral cavity (including the gills), whereas survival was 66% (33 of 50 fish) among fish that were hand-hooked in the esophagus. Survival of hooked fish was not significantly influenced by water temperature (7–27 °C) or the hooking location × water temperature interaction. We combined our results with prior research to develop a predictive model of largemouth bass survival, which was 98.3% (SD=1.87%) for fish hooked in the oral cavity and 55.0% (SD=9.70%) for fish hooked in the esophagus. The model is valid for water temperatures ranging from 7 °C to 27 °C and allows one to estimate, with known precision, the survival of angler-caught and released largemouth bass without the need for controlled studies or for holding fish in pens or cages to assess delayed mortality

Enthalpic Signature of Methonium Desolvation Revealed in a Synthetic Host–Guest System Based on Cucurbit[7]uril

Methonium (N⁺Me₃) is an organic cation widely distributed in biological systems. As an organic cation, the binding of methonium to protein receptors requires the removal of a positive charge from water. The appearance of methonium in biological transmitters and receptors seems at odds with the large unfavorable desolvation free energy reported for tetramethylammonium (TMA⁺), a frequently utilized surrogate of methonium. Here, we report an experimental system that facilitates incremental internalization of methonium within the molecular cavity of cucurbit[7]­uril (CB[7]). Using a combination of experimental and computational studies, we show that the transfer of methonium from bulk water (partially solvated methonium state) to the CB[7] cavity (mostly desolvated methonium state) is accompanied by a remarkably small desolvation enthalpy of just 0.5 ± 0.3 kcal·mol^–1, a value significantly less endothermic than those values suggested from gas-phase model studies. Our results are in accord with neutron scattering measurements that suggest methonium produces only a minimal perturbation in the bulk water structure, which highlights the limitations of gas-phase models. More surprisingly, the incremental withdrawal of the methonium surface from water produces a nonmonotonic response in desolvation enthalpy. A partially desolvated state exists, in which a portion of the methonium group remains exposed to solvent. This structure incurs an increased enthalpic penalty of ∼3 kcal·mol^–1 compared to other solvation states. We attribute this observation to the pre-encapsulation dewetting of the methonium surface. Together, our results offer a rationale for the wide distribution of methonium in a biological context and suggest limitations to computational estimates of binding affinities based on simple parametrization of solvent-accessible surface area

Enthalpic Signature of Methonium Desolvation Revealed in a Synthetic Host–Guest System Based on Cucurbit[7]uril

Methonium (N⁺Me₃) is an organic cation widely distributed in biological systems. As an organic cation, the binding of methonium to protein receptors requires the removal of a positive charge from water. The appearance of methonium in biological transmitters and receptors seems at odds with the large unfavorable desolvation free energy reported for tetramethylammonium (TMA⁺), a frequently utilized surrogate of methonium. Here, we report an experimental system that facilitates incremental internalization of methonium within the molecular cavity of cucurbit[7]­uril (CB[7]). Using a combination of experimental and computational studies, we show that the transfer of methonium from bulk water (partially solvated methonium state) to the CB[7] cavity (mostly desolvated methonium state) is accompanied by a remarkably small desolvation enthalpy of just 0.5 ± 0.3 kcal·mol^–1, a value significantly less endothermic than those values suggested from gas-phase model studies. Our results are in accord with neutron scattering measurements that suggest methonium produces only a minimal perturbation in the bulk water structure, which highlights the limitations of gas-phase models. More surprisingly, the incremental withdrawal of the methonium surface from water produces a nonmonotonic response in desolvation enthalpy. A partially desolvated state exists, in which a portion of the methonium group remains exposed to solvent. This structure incurs an increased enthalpic penalty of ∼3 kcal·mol^–1 compared to other solvation states. We attribute this observation to the pre-encapsulation dewetting of the methonium surface. Together, our results offer a rationale for the wide distribution of methonium in a biological context and suggest limitations to computational estimates of binding affinities based on simple parametrization of solvent-accessible surface area

Kyoto protocol cooperation: does government corruption facilitate environmental lobbying?

Does environmental lobbying affect the probability of environmental treaty ratification? Does the level of government corruption play a role for the success of such lobbying? In this paper, we propose that a more corruptible government may be more responsive to the demands of the environmental lobby. We use several stratified hazard models and panel data from 170 countries on the timing of Kyoto Protocol ratification to test this hypothesis. We find that increased environmental lobby group activity raises the probability of ratification, and the effect rises with the degree of corruption

Class Size in the Early Years: Is Smaller Really Better?

Other things being equal, theory would suggest that students in smaller classes at school should do better in terms of attainment; convincing experimental evidence for this also exists in the US. However, a relationship between small classes and better outcomes has not generally been evident in individual-level studies, possibly because of endogeneity arising from low-attaining or otherwise 'difficult' students being put into smaller classes than their higher-achieving counterparts. The present paper uses data from the National Child Development Study to estimate the effects of class size. Ordinary least-squares estimates indicate that small classes are not related to attainment; however, instrumental variables estimates, with class size instrumented by the interaction between school size and school type, show a significant and sizeable association between smaller classes and higher attainment in reading in the early years of school. This effect is common to different groups of students, and for some groups (girls, and those from larger families), this association is also found to persist through to age 11