Disparities In Cancer Care And Costs At The End Of Life: Evidence From England's National Health Service

In universal health care systems such as the English National Health Service, equality of access is a core principle, and health care is free at the point of delivery. However, even within a universal system, disparities in care and costs exist along a socioeconomic gradient. Little is known about socioeconomic disparities at the end of life and how they affect health care costs. This study examines disparities in end-of-life treatment costs for cancer patients in England. Analyzing data on over 250,000 colorectal, breast, prostate, and lung cancer patients from multiple national databases, we found evidence illustrating that disparities are driven largely by the greater use of emergency inpatient care among patients of lower socioeconomic status. Even within a system with free health care, differences in the use of care create disparities in cancer costs. While further studies of these barriers is required, our research suggests that disparities may be reduced through better management of needs through the use of less expensive and more effective health care settings and treatments

Clinical predictors of antipsychotic use in children and adolescents with autism spectrum disorders: a historical open cohort study using electronic health records.

JOURNAL ARTICLEThe final publication is available at Springer via http://dx.doi.org/ 10.1007/s00787-015-0780-7Children with autism spectrum disorders (ASD) are more likely to receive antipsychotics than any other psychopharmacological medication, yet the psychiatric disorders and symptoms associated with treatment are unclear. We aimed to determine the predictors of antipsychotic use in children with ASD receiving psychiatric care. The sample consisted of 3482 children aged 3-17 with an ICD-10 diagnosis of ASD referred to mental health services between 2008 and 2013. Antipsychotic use outcome, comorbid diagnoses, and other clinical covariates, including challenging behaviours were extracted from anonymised patient records. Of the 3482 children (79 % male) with ASD, 348 (10 %) received antipsychotic medication. The fully adjusted model indicated that comorbid diagnoses including hyperkinetic (OR 1.44, 95 %CI 1.01-2.06), psychotic (5.71, 3.3-10.6), depressive (2.36, 1.37-4.09), obsessive-compulsive (2.31, 1.16-4.61) and tic disorders (2.76, 1.09-6.95) were associated with antipsychotic use. In addition, clinician-rated levels of aggression, self-injurious behaviours, reduced adaptive function, and overall parental concern for their child's presenting symptoms were significant risk factors for later antipsychotic use. In ASD, a number of comorbid psychiatric disorders are independent predictors for antipsychotic treatment, even after adjustment for familial, socio-demographic and individual factors. As current trial evidence excludes children with comorbidity, more pragmatic randomised controlled trials with long-term drug monitoring are needed.NIHRBiomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King’s College LondonGuy’s and St. Thomas’ CharityMaudsley CharityMR

Shigley Hauler

By requiring students to meet demanding functional specifications using limited resources, the competitive Shigley Hauler project offers undergraduate students practical "hands-on" experience in the design, fabrication, and testing of mechanical systems. The project imparts a thorough experiential understanding of the key principles that govern the selection and integration of basic machinery components - gears, shafts, bearings, DC motors, etc. - into a robust and efficient working system. The Shigley Hauler project has been successfully incorporated into the mechanical engineering curriculum at UC Davis for more than a decade, and its pedagogical and motivational value is corroborated by student feedback. The project is run within a 10-week timeframe, and entails only modest costs for the instructor and student teams

Denitrification and nitrous oxide emissions from riparian forests soils exposed to prolonged nitrogen runoff

Compared to upland forests, riparian forest soils have greater potential to remove nitrate (NO3) from agricultural run-off through denitrification. It is unclear, however, whether prolonged exposure of riparian soils to nitrogen (N) loading will affect the rate of denitrification and its end products. This research assesses the rate of denitrification and nitrous oxide (N2O) emissions from riparian forest soils exposed to prolonged nutrient run-off from plant nurseries and compares these to similar forest soils not exposed to nutrient run-off. Nursery run-off also contains high levels of phosphate (PO4). Since there are conflicting reports on the impact of PO4 on the activity of denitrifying microbes, the impact of PO4 on such activity was also investigated. Bulk and intact soil cores were collected from N-exposed and non-exposed forests to determine denitrification and N2O emission rates, whereas denitrification potential was determined using soil slurries. Compared to the non-amended treatment, denitrification rate increased 2.7- and 3.4-fold when soil cores collected from both N-exposed and non-exposed sites were amended with 30 and 60 μg NO3-N g-1 soil, respectively. Net N2O emissions were 1.5 and 1.7 times higher from the N-exposed sites compared to the non-exposed sites at 30 and 60 μg NO3-N g-1 soil amendment rates, respectively. Similarly, denitrification potential increased 17 times in response to addition of 15 μg NO3-N g-1 in soil slurries. The addition of PO4 (5 μg PO4–P g-1) to soil slurries and intact cores did not affect denitrification rates. These observations suggest that prolonged N loading did not affect the denitrification potential of the riparian forest soils; however, it did result in higher N2O emissions compared to emission rates from non-exposed forests

Tracing jet emission at the base of a high-mass YSO. First AMBER/VLTI observations of the Brγemission in IRAS 13481-6124

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.To probe the circumstellar environment of IRAS 13481-6124, a 20 M_sun high-mass young stellar object (HMYSO) with a parsec-scale jet and accretion disc, we investigate the origin of its Br\gamma-emission line through NIR interferometry. We present the first AMBER/VLTI observations of the Br\gamma-emitting region in an HMYSO at R~1500. Our AMBER/VLTI observations reveal a spatially and spectrally resolved Br\gamma-line in emission with a strong P Cygni profile, indicating outflowing matter with a terminal velocity of ~500 km/s. Visibilities, differential phases, and closure phases are detected in our observations within the spectral line and in the adjacent continuum. Both total visibilities (continuum plus line emitting region) and pure-line visibilities indicate that the Br\gamma-emitting region is more compact (2-4 mas in diameter or ~6-13 au at 3.2 kpc) than the continuum-emitting region (~5.4 mas or ~17 au). The absorption feature is also spatially resolved at the longest baselines (81 and 85 m) and has a visibility that is slightly smaller than the continuum-emitting region. The differential phases at the four longest baselines display an \u2018S\u2019-shaped structure across the line, peaking in the blue- and red-shifted high-velocity components. The calibrated photocentre shifts are aligned with the known jet axis, i.e they are probably tracing an ionised jet. The high-velocity components (v_r~100-500 km/s) are located far from the source, whereas the low-velocity components (0-100 km/s) are observed to be closer, indicating a strong acceleration of the gas flow in the inner 10 au. Finally, a non-zero closure phase along the continuum is detected. By comparing our observations with the synthetic images of the continuum around 2.16 um, we confirm that this feature originates from the asymmetric brightness distribution of the continuum owing to the inclination of the inner disc.A.C.G., R.G.L., and T.P.R. were supported by Science Foundation Ireland, grant 13/ERC/I2907. A.K. and S.K. acknowledge support from a STFC Ernest Rutherford fellowship and grant (ST/J004030/1, ST/K003445/1), and Marie-Sklodowska Curie CIG grant (Ref. 618910). A.S. was supported by the Deutsche Forschungsgemeinschaft (DFG) Priority Program 1573. This research has also made use of NASA’s Astrophysics Data System Bibliographic Services and the SIMBAD database operated at the CDS, Strasbourg, France

Enhanced Motor Function by Training in Spinal Cord Contused Rats Following Radiation Therapy

Weight-bearing stepping, without supraspinal re-connectivity, can be attained by treadmill training in an animal whose spinal cord has been completely transected at the lower thoracic level. Repair of damaged tissue and of supraspinal connectivity/circuitry following spinal cord injury in rat can be achieved by specific cell elimination with radiation therapy of the lesion site delivered within a critical time window, 2-3 weeks postinjury. Here we examined the effects of training in the repaired spinal cord following clinical radiation therapy. Studies were performed in a severe rat spinal cord contusion injury model, one similar to fracture/crush injuries in humans; the injury was at the lower thoracic level and the training was a combined hindlimb standing and stepping protocol. Radiotherapy, in a similar manner to that reported previously, resulted in a significant level of tissue repair/preservation at the lesion site. Training in the irradiated group, as determined by limb kinematics tests, resulted in functional improvements that were significant for standing and stepping capacity, and yielded a significant direct correlation between standing and stepping performance. In contrast, the training in the unirradiated group resulted in no apparent beneficial effects, and yielded an inverse correlation between standing and stepping performance, e.g., subject with good standing showed poor stepping capacity. Further, without any training, a differential functional change was observed in the irradiated group; standing capacity was significantly inhibited while stepping showed a slight trend of improvement compared with the unirradiated group. These data suggest that following repair by radiation therapy the spinal circuitries which control posture and locomotor were modified, and that the beneficial functional modulation of these circuitries is use dependent. Further, for restoring beneficial motor function following radiotherapy, training seems to be crucial

Infrared Emission from Supernova Remnants: Formation and Destruction of Dust

We review the observations of dust emission in supernova rem- nants (SNRs) and supernovae (SNe). Theoretical calculations suggest that SNe, particularly core-collapse, should make significant quantities of dust, perhaps as much as a solar mass. Observations of extragalactic SNe have yet to find anywhere near this amount, but this may be the result of observa- tional limitations. SN 1987A, in the process of transitioning from a SN to an SNR, does show signs of a significant amount of dust forming in its ejecta, but whether this dust will survive the passage of the reverse shock to be injected into the ISM is unknown. IR observations of SNRs have not turned up significant quantities of dust, and the dust that is observed is generally swept-up by the forward shock, rather than created in the ejecta. Because the shock waves also destroy dust in the ISM, we explore the question of whether SNe might be net destroyers, rather than net creators of dust in the universe.Comment: Published in the Springer Handbook of Supernova

Validation of the SCID-hu Thy/Liv mouse model with four classes of licensed antiretrovirals.

BackgroundThe SCID-hu Thy/Liv mouse model of HIV-1 infection is a useful platform for the preclinical evaluation of antiviral efficacy in vivo. We performed this study to validate the model with representatives of all four classes of licensed antiretrovirals.Methodology/principal findingsEndpoint analyses for quantification of Thy/Liv implant viral load included ELISA for cell-associated p24, branched DNA assay for HIV-1 RNA, and detection of infected thymocytes by intracellular staining for Gag-p24. Antiviral protection from HIV-1-mediated thymocyte depletion was assessed by multicolor flow cytometric analysis of thymocyte subpopulations based on surface expression of CD3, CD4, and CD8. These mice can be productively infected with molecular clones of HIV-1 (e.g., the X4 clone NL4-3) as well as with primary R5 and R5X4 isolates. To determine whether results in this model are concordant with those found in humans, we performed direct comparisons of two drugs in the same class, each of which has known potency and dosing levels in humans. Here we show that second-generation antiretrovirals were, as expected, more potent than their first-generation predecessors: emtricitabine was more potent than lamivudine, efavirenz was more potent than nevirapine, and atazanavir was more potent than indinavir. After interspecies pharmacodynamic scaling, the dose ranges found to inhibit viral replication in the SCID-hu Thy/Liv mouse were similar to those used in humans. Moreover, HIV-1 replication in these mice was genetically stable; treatment of the mice with lamivudine did not result in the M184V substitution in reverse transcriptase, and the multidrug-resistant NY index case HIV-1 retained its drug-resistance substitutions.ConclusionGiven the fidelity of such comparisons, we conclude that this highly reproducible mouse model is likely to predict clinical antiviral efficacy in humans

A four-dimensional {\Lambda}CDM-type cosmological model induced from higher dimensions using a kinematical constraint

A class of cosmological solutions of higher dimensional Einstein field equations with the energy-momentum tensor of a homogeneous, isotropic fluid as the source are considered with an anisotropic metric that includes the direct sum of a 3-dimensional (physical, flat) external space metric and an n-dimensional (compact, flat) internal space metric. A simple kinematical constraint is postulated that correlates the expansion rates of the external and internal spaces in terms of a real parameter {\lambda}. A specific solution for which both the external and internal spaces expand at different rates is given analytically for n=3. Assuming that the internal dimensions were at Planck length scales when the external space starts with a Big Bang (t=0), they expand only 1.49 times and stay at Planck length scales even in the present age of the universe (13.7 Gyr). The effective four dimensional universe would exhibit a behavior consistent with our current understanding of the observed universe. It would start in a stiff fluid dominated phase and evolve through radiation dominated and pressureless matter dominated phases, eventually going into a de Sitter phase at late times.Comment: 12 pages, 8 figures; matches the version published in General Relativity and Gravitatio