You Had Me At Hello: The Effects Of Disruptions To The Patient-Physician Relationship

Despite substantial focus on continuity of care, recent policy has led to significant patient churn. There is little research, however, on the effects of these discontinuities on physician behavior and patient outcomes, and whether physicians behave differently when anticipating a discontinuity. In this paper, I develop a theory of provider behavior. In theory, a provider must choose whether to spend her time treating an ailment or seeking information to diagnose. The optimal trade-off between seeking information and treating varies with the complexity of the patient, but also varies if there is a stock of information from previous encounters. I test this theory using 10 years of panel data from the Military Health System. In this setting, primary care physicians are pulled from their practices and deployed overseas. Using a stacked difference in differences strategy, I separately identify changes in use of care in an anticipatory period after a provider has been informed of the deployment, and in a post period after the provider has left. I find significant changes in both periods, with specialist visits increasing 15- 30 percent (4-8 percentage points) and emergency department visits increasing 15-18 percent (1.7-2 percentage points)

REGIONAL COMPETITIVE POSITION OF PORK INDUSTRY

In the recent past U.S. pork industry experienced geographical shifts in its production and processing. Some geographical areas have competitive advantages over the areas in raising pigs. Costs of raising pigs vary by type and size of operations, and other location specific factors. We used enterprise budgeting approach to estimate the profitability of representative feeder to finishing operations in different geographical regions in U.S. We obtained data from the United States Department of Agriculture databases, costs and returns survey and various university sources. The cost differences were not due to the unit prices of inputs but were largely driven by the differences in their efficiencies. Overhead costs varies by locations and size of operation. Pork feeding operations of all sizes operate at a loss if we account for all the cash expenses and opportunity costs given the prices of all inputs and output. However, producers got positive profits over the variable costs. The Eastern Corn belt regions' pork producers reap the highest operating profit ($1,861 per 100 hogs) followed by the Western Corn Belt region and the West region ($1,661). The results of production systems analyses as outlined here suggest that smaller firms have limited ability to compete with larger firms on the basis of cost of production. The key to keeping hog business competitive is higher production efficiency. Feed, labor, and building and equipment efficiencies were potential means of cutting production costs. Smaller producers who do not attain strong efficiencies in production are at a disadvantage relative to larger producers.Livestock Production/Industries,

The statistical properties of RCTs and a proposal for shrinkage

We abstract the concept of a randomized controlled trial as a triple (β,b,s) , where β is the primary efficacy parameter, b the estimate, and s the standard error ( s>0 ). If the parameter β is either a difference of means, a log odds ratio or a log hazard ratio, then it is reasonable to assume that b is unbiased and normally distributed. This then allows us to estimate the joint distribution of the z-value z=b/s and the signal-to-noise ratio SNR=β/s from a sample of pairs (bi,si) . We have collected 23 551 such pairs from the Cochrane database. We note that there are many statistical quantities that depend on (β,b,s) only through the pair (z,SNR) . We start by determining the estimated distribution of the achieved power. In particular, we estimate the median achieved power to be only 13%. We also consider the exaggeration ratio which is the factor by which the magnitude of β is overestimated. We find that if the estimate is just significant at the 5% level, we would expect it to overestimate the true effect by a factor of 1.7. This exaggeration is sometimes referred to as the winner's curse and it is undoubtedly to a considerable extent responsible for disappointing replication results. For this reason, we believe it is important to shrink the unbiased estimator, and we propose a method for doing so. We show that our shrinkage estimator successfully addresses the exaggeration. As an example, we re-analyze the ANDROMEDA-SHOCK trial. Keywords: Cochrane review; achieved power; exaggeration; randomized controlled trial; type M error

On the Transit Potential of the Planet Orbiting iota Draconis

Most of the known transiting exoplanets are in short-period orbits, largely due to the bias inherent in detecting planets through the transit technique. However, the eccentricity distribution of the known radial velocity planets results in many of those planets having a non-negligible transit probability. One such case is the massive planet orbiting the giant star iota Draconis, a situation where both the orientation of the planet's eccentric orbit and the size of the host star inflate the transit probability to a much higher value than for a typical hot Jupiter. Here we present a revised fit of the radial velocity data with new measurements and a photometric analysis of the stellar variability. We provide a revised transit probability, an improved transit ephemeris, and discuss the prospects for observing a transit of this planet from both the ground and space.Comment: 6 pages, 7 figures, accepted for publication in ApJ. Radial velocities will be made available in the on-line version and through the NASA Star and Exoplanet Database (NStED). Minor corrections from ApJ proof have been applie

In vivo testing of gold nanoparticles using the Caenorhabditis elegans model organism

Gold nanoparticles (AuNPs) are present in many man-made products and cosmetics, and are also used by the food and medical industries. Tight regulations regarding the use of mammalian animals for product testing can hamper the study of the specific interactions between engineered nanoparticles and biological systems. Invertebrate models, such as the nematode Caenorhabditis elegans (C. elegans), can offer alternative approaches during the early phases of nanoparticle discovery. Here, we thoroughly evaluated the biodistribution of 11-nm and 150-nm citrate-capped AuNPs in the model organism C. elegans at multiple scales, moving from micrometric to nanometric resolution and from the organismal to cellular level. We confirmed that the nanoparticles were not able to cross the intestinal and dermal barriers. We investigated the effect of AuNPs on the survival and reproductive performance of C. elegans, and correlated these effects with the uptake of AuNPs in terms of their number, surface area, and metal mass. In general, exposure to 11-nm AuNPs resulted in a higher toxicity than the larger 150-nm AuNPs. NP aggregation inside C. elegans was determined using absorbance microspectroscopy, which allowed the plasmonic properties of AuNPs to be correlated with their confinement inside the intestinal lumen, where anatomical traits, acidic pH and the presence of biomolecules play an essential role on NP aggregation. Finally, quantitative PCR of selected molecular markers indicated that exposure to AuNPs did not significantly affect endocytosis and intestinal barrier integrity. Statement of significance This work highlights how the simple, yet information-rich, animal model C. elegans is ideally suited for preliminary screening of nanoparticles or chemicals mitigating most of the difficulties associated with mammalian animal models, namely the ethical issues, the high cost, and time constraints. This is of particular relevance to the cosmetic, food, and pharmaceutical industries, which all have to justify the use of animals, especially during the discovery, development and initial screening phases. This work provides a detailed and thorough analysis of 11-nm and 150-nm AuNPs at multiple levels of organization (the whole organism, organs, tissues, cells and molecules).Peer ReviewedPostprint (author's final draft

TopBP1 interacts with BLM to maintain genome stability but is dispensable for preventing BLM degradation.

The Bloom syndrome helicase BLM and topoisomerase-IIβ-binding protein 1 (TopBP1) are key regulators of genome stability. It was recently proposed that BLM phosphorylation on Ser338 mediates its interaction with TopBP1, to protect BLM from ubiquitylation and degradation (Wang et al., 2013). Here, we show that the BLM-TopBP1 interaction does not involve Ser338 but instead requires BLM phosphorylation on Ser304. Furthermore, we establish that disrupting this interaction does not markedly affect BLM stability. However, BLM-TopBP1 binding is important for maintaining genome integrity, because in its absence cells display increased sister chromatid exchanges, replication origin firing and chromosomal aberrations. Therefore, the BLM-TopBP1 interaction maintains genome stability not by controlling BLM protein levels, but via another as-yet undetermined mechanism. Finally, we identify critical residues that mediate interactions between TopBP1 and MDC1, and between BLM and TOP3A/RMI1/RMI2. Taken together, our findings provide molecular insights into a key tumor suppressor and genome stability network.293FT cells, E1A antibody, and hr703 virus were gifts from Roger Grand, and DT40 cells and human LCLs were gifts from Julian Sale and Ian Hickson, respectively. We thank Nathan Ellis, Thanos Halazonetis, Frank Hänel, and Minoru Takata for plasmids; Grant Stewart and Yi Wang for antibodies; and Gabriel Balmus, Josep Forment, Abderrahmane Kaidi, Christine Schmidt, and Jon Travers for critical reading of the manuscript. This work was funded by a Worldwide Cancer Research International Fellowship and a WIMM/Medical Research Council Senior Non-Clinical Fellowship (MRCG0902418) to W.N., and by Polish Ministry of Science and Higher Education fellowship and Polish National Science Center grant number N303 571539 to J.N. The Jackson lab is funded by Cancer Research UK (CRUK) program grant C6/A11224, the European Research Council, and the European Community Seventh Framework Programme grant agreement number HEALTH-F2-2010-259893 (DDResponse). Core infrastructure funding is provided by CRUK (C6946/A14492) and the Wellcome Trust (WT092096). S.P.J. receives his salary from the University of Cambridge, supplemented by CRUK.This is the final version of the article. It first appeared from Cell Press via http://dx.doi.org/10.1016/j.molcel.2015.02.01

Higher expression of the strawberry xyloglucan endotransglucosylase/hydrolase genes FvXTH9 and FvXTH6 accelerates fruit ripening

Fruit softening in Fragaria (strawberry) is proposed to be associated with the modification of cell wall components such as xyloglucan by the action of cell wall‐modifying enzymes. This study focuses on the in vitro and in vivo characterization of two recombinant xyloglucan endotransglucosylase/hydrolases (XTHs) from Fragaria vesca, FvXTH9 and FvXTH6. Mining of the publicly available F. vesca genome sequence yielded 28 putative XTH genes. FvXTH9 showed the highest expression level of all FvXTHs in a fruit transcriptome data set and was selected with the closely related FvXTH6 for further analysis. To investigate their role in fruit ripening in more detail, the coding sequences of FvXTH9 and FvXTH6 were cloned into the vector pYES2 and expressed in Saccharomyces cerevisiae. FvXTH9 and FvXTH6 displayed xyloglucan endotransglucosylase (XET) activity towards various acceptor substrates using xyloglucan as the donor substrate. Interestingly, FvXTH9 showed activity of mixed‐linkage glucan:xyloglucan endotransglucosylase (MXE) and cellulose:xyloglucan endotransglucosylase (CXE). The optimum pH of both FvXTH9 and FvXTH6 was 6.5. The prediction of subcellular localization suggested localization to the secretory pathway, which was confirmed by localization studies in Nicotiana tabacum. Overexpression showed that Fragaria × ananassa fruits infiltrated with FvXTH9 and FvXTH6 ripened faster and showed decreased firmness compared with the empty vector control pBI121. Thus FvXTH9 and also FvXTH6 might promote strawberry fruit ripening by the modification of cell wall components

Bioavailability of cerium oxide nanoparticles to Raphanus sativus L. in two soils.

Cerium oxide nanoparticles (CeO2 NP) are a common component of many commercial products. Due to the general concerns over the potential toxicity of engineered nanoparticles (ENPs), the phytotoxicity and in planta accumulation of CeO2 NPs have been broadly investigated. However, most previous studies were conducted in hydroponic systems and with grain crops. For a few studies performed with soil grown plants, the impact of soil properties on the fate and transport of CeO2 NPs was generally ignored even though numerous previous studies indicate that soil properties play a critical role in the fate and transport of environmental pollutants. The objectives of this study were to evaluate the soil fractionation and bioavailability of CeO2 NPs to Raphanus sativus L (radish) in two soil types. Our results showed that the silty loam contained slightly higher exchangeable fraction (F1) of cerium element than did loamy sand soil, but significantly lower reducible (F2) and oxidizable (F3) fractions as CeO2 NPs concentration increased. CeO2 NPs associated with silicate minerals or the residue fraction (F4) dominated in both soils. The cerium concentration in radish storage root showed linear correlation with the sum of the first three fractions (r(2) = 0.98 and 0.78 for loamy sand and silty loam respectively). However, the cerium content in radish shoots only exhibited strong correlations with F1 (r(2) = 0.97 and 0.89 for loamy sand and silty loam respectively). Overall, the results demonstrated that soil properties are important factors governing the distribution of CeO2 NPs in soil and subsequent bioavailability to plants

Method and device for maximizing memory system bandwidth by accessing data in a dynamically determined order

A data processing system is disclosed which comprises a data processor and memory control device for controlling the access of information from the memory. The memory control device includes temporary storage and decision ability for determining what order to execute the memory accesses. The compiler detects the requirements of the data processor and selects the data to stream to the memory control device which determines a memory access order. The order in which to access said information is selected based on the location of information stored in the memory. The information is repeatedly accessed from memory and stored in the temporary storage until all streamed information is accessed. The information is stored until required by the data processor. The selection of the order in which to access information maximizes bandwidth and decreases the retrieval time