Monopoly power of the medical school market and high incomes of U.S. physicians

We expect the incomes of physicians to remain high in the next decades. Using the latest published physician income data (2015) we calculated the weighted median income of U.S. physicians and the net present value (NPV) of an investment in physician education. We estimated the NPV assuming that the physicians training began in 2007 and their practice would commence in 2015. We estimated the NPV of the lifetime earnings of a physician based on the median income of all physicians in the sample to be between $7.1 and$7.3 million. This finding of high NPV’s is consistent with almost all earlier studies of this kind. Physicians continue to experience relatively high incomes and very slow increases in the number of new graduates. We expect an excess demand for positions in medical colleges to continue. Our findings with respect to the incomes of non-primary physicians (surgeons, radiologist and cardiologists), indicate will continue to be much higher than those of primary physicians. There are strong evidence suggesting this is because of blockages in physician residency openings in these non-primary fields of medicine.peer-reviewe

Modelling lubricated revolute joints in multibody mechanical systems

This work deals with the modelling of lubricated revolute joints in multibody mechanical systems. In most machines and mechanisms, the joints are designed to operate with some lubricant fluid. The high pressures generated in the lubricant fluid act to keep the journal and the bearing apart. Moreover, the thin film formed by lubricant reduces friction and wear, provides load capacity and adds damping to dissipate undesirable mechanical vibrations. In the dynamic analysis of journal–bearings, the hydrodynamic forces, which include both squeeze and wedge effects, produced by the lubricant fluid oppose the journal motion. These forces are obtained by integrating the pressure distribution evaluated with the aid of Reynolds’ equation written for the dynamic regime. The hydrodynamic forces are nonlinear functions of journal centre position and velocity relative to the bearing centre. In a simple way, the hydrodynamic forces built up by the lubricant fluid are evaluated from the state of variable of the system and included into the equations of motion of the mechanical system. Results for an elementary slider–crank mechanism, in which a lubricated revolute joint connects the connecting rod and slider, are used to discuss the assumptions and procedures adopted.Fundação para a Ciência e a Tecnologia (FCT

High prevalence of scrapie in a dairy goat herd: tissue distribution of disease-associated PrP and effect of PRNP genotype and age

Following a severe outbreak of clinical scrapie in 2006–2007, a large dairy goat herd was culled and 200 animals were selected for post-mortem examinations in order to ascertain the prevalence of infection, the effect of age, breed and PRNP genotype on the susceptibility to scrapie, the tissue distribution of diseaseassociated PrP (PrP$^{\rm d}$), and the comparative efficiency of different diagnostic methods. As determined by immunohistochemical (IHC) examinations with Bar224 PrP antibody, the prevalence of preclinical infection was very high (72/200; 36.0%), with most infected animals being positive for PrP$^{\rm d}$ in lymphoreticular system (LRS) tissues (68/72; 94.4%) compared to those that were positive in brain samples (38/72; 52.8%). The retropharyngeal lymph node and the palatine tonsil showed the highest frequency of PrP$^{\rm d}$ accumulation (87.3% and 84.5%, respectively), while the recto-anal mucosa-associated lymphoid tissue (RAMALT) was positive in only 30 (41.7%) of the infected goats. However, the efficiency of rectal and palatine tonsil biopsies taken shortly before necropsy was similar. The probability of brain and RAMALT being positive directly correlated with the spread of PrP$^{\rm d}$ within the LRS. The prevalence of infection was influenced by PRNP genetics at codon 142 and by the age of the goats: methionine carriers older than 60 months showed a much lower prevalence of infection (12/78; 15.4%) than those younger than 60 months (20/42; 47.6%); these last showed prevalence values similar to isoleucine homozygotes of any age (40/80; 50.0%). Two of seven goats with definite signs of scrapie were negative for PrP$^{\rm d}$ in brain but positive in LRS tissues, and one goat showed biochemical and IHC features of PrP$^{\rm d}$ different from all other infected goats. The results of this study have implications for surveillance and control policies for scrapie in goats

Nano-magnetic droplets and implications to orbital ordering in La1-xSrxCoO3

Inelastic cold neutron scattering on LaCoO3 provided evidence for a distinct low energy excitation at 0.6 meV coincident with the thermally induced magnetic transition. Coexisting strong ferromagnetic (FM) and weaker antiferromagnetic (AFM) correlations that are dynamic follow the activation to the excited state, identified as the intermediate S=1 spin triplet. This is indicative of dynamical orbital ordering favoring the observed magnetic interactions. With hole doping as in La1-xSrxCoO3, the FM correlations between Co spins become static and isotropically distributed due to the formation of FM droplets. The correlation length and condensation temperature of these droplets increase rapidly with metallicity due to the double exchange mechanism.Comment: To appear in Phys. Rev. Let

CD4+ lymphocyte adenosine triphosphate determination in sepsis: a cohort study

INTRODUCTION: Patients suffering from sepsis are currently classified on a clinical basis (i.e., sepsis, severe sepsis, septic shock); however, this clinical classification may not accurately reflect the overall immune status of an individual patient. Our objective was to describe a cohort of patients with sepsis in terms of their measured immune status. METHODS: Fifty-two patients with sepsis (n = 13), severe sepsis (n = 21), or septic shock (n = 18) were studied. The immune status was determined by measuring the CD4+ lymphocyte adenosine triphosphate (ATP) content after mitogen stimulation in whole blood. RESULTS: The measured CD4+ lymphocyte ATP content at the time of ICU admission did not differ among the various groups defined by the sepsis classification system (sepsis = 454 ± 79 ng/ml; severe sepsis = 359 ± 54 ng/ml; septic shock = 371 ± 53 ng/ml; P = 0.44). Furthermore, survivors of sepsis had a significantly higher CD4+ lymphocyte ATP content at the time of ICU admission than did nonsurvivors of sepsis (431 ± 41 ng/mL vs. 266 ± 53 ng/mL, respectively; P = 0.04). CONCLUSIONS: The sepsis classification system that is currently used is not representative of the individual immune status as determined by measuring the CD4+ lymphocyte ATP content. Moreover, a lower CD4+ ATP content at the time of ICU admission is associated with a worse clinical outcome in those suffering from sepsis

Effect of development of antibodies to hla and cytomegalovirus mismatch on lung transplantation survival and development of bronchiolitis obliterans syndrome

AbstractObjective: A retrospective analysis was performed to examine the role of HLA antibodies and cytomegalovirus mismatch on the development of bronchiolitis obliterans syndrome and survival after lung transplantation. Methods: Of 339 consecutive lung transplantations performed over a 102-month interval, 301 patients survived at least 3 months. There was a minimum follow-up period of 13 months. Bronchiolitis obliterans syndrome was defined as a decline in forced expiratory volume in 1 second less than 80% of posttransplantation baseline and/or histologic presence of obliterative bronchiolitis and was defined as occurring “early” if documented within 3 years of transplantation. Variables analyzed included preoperative donor and recipient cytomegalovirus status and the development of antibodies to human leukocyte antigens after transplantation. Microcytotoxicity was used to determine the presence of antibodies to human leukocyte antigens. Variables were subjected to Kaplan-Meier analysis to determine their impact on freedom from bronchiolitis obliterans syndrome and survival. Results: The development of antibodies to human leukocyte antigens after transplantation correlated significantly with bronchiolitis obliterans syndrome (P = .02). The development of antibodies to human leukocyte antigens did not affect survival (P = .33) unless they were detected within 2 years of transplantation (P = .04). There was greater frequency of early bronchiolitis obliterans syndrome in cytomegalovirus seronegative patients who received allografts from seropositive donors compared with all other combinations (P = .02). There was also a trend toward worse survival of cytomegalovirus seronegative patients who received allografts from seropositive donors (P = .13). Conclusion: These data suggest that bronchiolitis obliterans syndrome is the result of an immune-mediated process in which HLA antibodies and cytomegalovirus may play a significant role. (J Thorac Cardiovasc Surg 1998;116:812-20

Are agri‐environment schemes successful in delivering conservation grazing management on saltmarsh?

1.Grasslands occur around the globe and, in temperate regions, their natural management by fire, drought and wild herbivores has largely been replaced by grazing with domestic livestock. Successful management for agriculture is not always suitable for conservation and can have a detrimental effect on biodiversity. Conservation grazing of saltmarshes, delivered through agri‐environment schemes, may provide a solution to counteract biodiversity loss by providing farmers with financial incentives to graze these internationally important coastal wetlands more sensitively. 2.To assess whether conservation grazing is being achieved, and whether agri‐environment schemes are effective in delivering this management, we conducted a national survey on English saltmarshes, scoring the management on each site as optimal, suboptimal or detrimental in terms of suitability for achieving conservation aims for five aspects of grazing: presence, stock type, intensity, timing and habitat impact. 3.Although most saltmarshes suitable for grazing in England were grazed, conservation grazing was not being achieved. Sites under agri‐environment management for longer did score higher and approached optimal levels in terms of grazing intensity in one region, but sites with agri‐environment agreements were no more likely to be grazed at optimal conservation levels than sites without them overall, indicating that agri‐environment schemes, in their current form, are an ineffective delivery mechanism for conservation grazing on saltmarsh. 4.The low specificity of agri‐environment prescription wording may contribute to this failure, with prescriptions either being vague or specifying suboptimal or detrimental management objectives, particularly for grazing intensity, timing and stock type. These objectives are often set too high or too low, during unsuitable periods, or using stock types inappropriate for achieving conservation aims. 5.Synthesis and applications. Our national survey indicates that agri‐environment schemes are not currently delivering conservation grazing on English saltmarshes. Agri‐environment schemes are the only mechanism through which such grazing can be implemented on a national scale, so improving their effectiveness is a priority. Policymakers, researchers and managers need to work together to ensure better translation of conservation guidelines into schemes, increasing the specificity of management prescriptions and improving understanding of the need for management measures. A more detailed and reliable system of auditing to ensure that management activities are taking place would be beneficial, or alternatively moving to a results‐based scheme where payments are made on desirable outcomes rather than on evidence of management

Correlation between bulk thermodynamic measurements and the low temperature resistance plateau in SmB6

Topological insulators are materials characterized by dissipationless, spin-polarized surface states resulting from non-trivial band topologies. Recent theoretical models and experiments suggest that SmB6 is the first topological Kondo insulator, in which the topologically non-trivial band structure results from electron-electron interactions via Kondo hybridization. Here, we report that the surface conductivity of SmB6 increases systematically with bulk carbon content. Further, addition of carbon is linked to an increase in n-type carriers, larger low temperature electronic contributions to the specific heat with a characteristic temperature scale of T* = 17 K, and a broadening of the crossover to the insulating state. Additionally, X-ray absorption spectroscopy shows a change in Sm valence at the surface. Our results highlight the importance of phonon dynamics in producing a Kondo insulating state and demonstrate a correlation between the bulk thermodynamic state and low temperature resistance of SmB6