Hispanic Ethnicity Is Associated With Increased Hospital Charges After Radical Cystectomy in the United States

Objective: To examine the impact of race and ethnicity on financial charges associated with radical cystectomy (RC). Data Sources/Study Setting: The Nationwide Inpatient Sample was used to identify patients who underwent RC for bladder cancer between 1998 and 2010. Study Design: The primary outcome was total hospital charges adjusted for inflation. Multivariate analysis was performed using a generalized linear model on the logarithmically transformed outcome variable (total hospital charges) after adjusting for age, sex, race, Elixhauser comorbidities, surgical approach, year, primary payer, hospital and surgeon annual RC volume, hospital characteristics, and postoperative complications. Principle findings: A total of 14,873 patients were identified. Hispanic and black patients were more likely to be treated by low-volume surgeons and/or institutions (both P=.07). Conclusions: Hispanic ethnicity but not black race predicts higher hospital charges after RC

Developing a strategy for the national coordinated soil moisture monitoring network

Soil moisture is a critical land surface variable, affecting a wide variety of climatological, agricultural, and hydrological processes. Determining the current soil moisture status is possible via a variety of methods, including in situ monitoring, remote sensing, and numerical modeling. Although all of these approaches are rapidly evolving, there is no cohesive strategy or framework to integrate these diverse information sources to develop and disseminate coordinated national soil moisture products that will improve our ability to understand climate variability. The National Coordinated Soil Moisture Monitoring Network initiative has developed a national strategy for network coordination with NOAA’s National Integrated Drought Information System. The strategy is currently in review within NOAA, and work is underway to implement the initial milestones of the strategy. This update reviews the goals and steps being taken to establish this national-scale coordination for soil moisture monitoring in the United States

Feedback control architecture and the bacterial chemotaxis network.

PMCID: PMC3088647This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Bacteria move towards favourable and away from toxic environments by changing their swimming pattern. This response is regulated by the chemotaxis signalling pathway, which has an important feature: it uses feedback to 'reset' (adapt) the bacterial sensing ability, which allows the bacteria to sense a range of background environmental changes. The role of this feedback has been studied extensively in the simple chemotaxis pathway of Escherichia coli. However it has been recently found that the majority of bacteria have multiple chemotaxis homologues of the E. coli proteins, resulting in more complex pathways. In this paper we investigate the configuration and role of feedback in Rhodobacter sphaeroides, a bacterium containing multiple homologues of the chemotaxis proteins found in E. coli. Multiple proteins could produce different possible feedback configurations, each having different chemotactic performance qualities and levels of robustness to variations and uncertainties in biological parameters and to intracellular noise. We develop four models corresponding to different feedback configurations. Using a series of carefully designed experiments we discriminate between these models and invalidate three of them. When these models are examined in terms of robustness to noise and parametric uncertainties, we find that the non-invalidated model is superior to the others. Moreover, it has a 'cascade control' feedback architecture which is used extensively in engineering to improve system performance, including robustness. Given that the majority of bacteria are known to have multiple chemotaxis pathways, in this paper we show that some feedback architectures allow them to have better performance than others. In particular, cascade control may be an important feature in achieving robust functionality in more complex signalling pathways and in improving their performance

Modified-Source Gravity and Cosmological Structure Formation

One way to account for the acceleration of the universe is to modify general relativity, rather than introducing dark energy. Typically, such modifications introduce new degrees of freedom. It is interesting to consider models with no new degrees of freedom, but with a modified dependence on the conventional energy-momentum tensor; the Palatini formulation of $f(R)$ theories is one example. Such theories offer an interesting testing ground for investigations of cosmological modified gravity. In this paper we study the evolution of structure in these ``modified-source gravity'' theories. In the linear regime, density perturbations exhibit scale dependent runaway growth at late times and, in particular, a mode of a given wavenumber goes nonlinear at a higher redshift than in the standard $\Lambda$CDM model. We discuss the implications of this behavior and why there are reasons to expect that the growth will be cut off in the nonlinear regime. Assuming that this holds in a full nonlinear analysis, we briefly describe how upcoming measurements may probe the differences between the modified theory and the standard $\Lambda$CDM model.Comment: 22 pages, 6 figures, uses iopart styl

Augmented visual feedback of movement performance to enhance walking recovery after stroke : study protocol for a pilot randomised controlled trial

Increasing evidence suggests that use of augmented visual feedback could be a useful approach to stroke rehabilitation. In current clinical practice, visual feedback of movement performance is often limited to the use of mirrors or video. However, neither approach is optimal since cognitive and self-image issues can distract or distress patients and their movement can be obscured by clothing or limited viewpoints. Three-dimensional motion capture has the potential to provide accurate kinematic data required for objective assessment and feedback in the clinical environment. However, such data are currently presented in numerical or graphical format, which is often impractical in a clinical setting. Our hypothesis is that presenting this kinematic data using bespoke visualisation software, which is tailored for gait rehabilitation after stroke, will provide a means whereby feedback of movement performance can be communicated in a more meaningful way to patients. This will result in increased patient understanding of their rehabilitation and will enable progress to be tracked in a more accessible way. The hypothesis will be assessed using an exploratory (phase II) randomised controlled trial. Stroke survivors eligible for this trial will be in the subacute stage of stroke and have impaired walking ability (Functional Ambulation Classification of 1 or more). Participants (n = 45) will be randomised into three groups to compare the use of the visualisation software during overground physical therapy gait training against an intensity-matched and attention-matched placebo group and a usual care control group. The primary outcome measure will be walking speed. Secondary measures will be Functional Ambulation Category, Timed Up and Go, Rivermead Visual Gait Assessment, Stroke Impact Scale-16 and spatiotemporal parameters associated with walking. Additional qualitative measures will be used to assess the participant's experience of the visual feedback provided in the study. Results from the trial will explore whether the early provision of visual feedback of biomechanical movement performance during gait rehabilitation demonstrates improved mobility outcomes after stroke and increased patient understanding of their rehabilitation

Comparison of MRI- and TRUS-Informed Prostate Biopsy for Prostate Cancer Diagnosis in Biopsy-Naive Men: A Systematic Review and Meta-Analysis.

PURPOSE: Multiparametric magnetic resonance imaging (mpMRI) with informed targeted biopsies (TGBX) has changed the paradigm of prostate cancer (PCa) diagnosis. Randomized studies have demonstrated a diagnostic benefit of Clinically significant (CS) for TGBX compared to standard systematic biopsies (SBX). We aimed to evaluate whether mpMRI-informed TGBX has superior diagnosis rates of any-, CS-, high-grade (HG)-, and clinically insignificant (CI)-PCa compared to SBX in biopsy-naive men. METHODS: Data was searched in Medline, Embase, Web of Science, and Evidence-based medicine reviews-Cochrane Database of systematic reviews from database inception until 2019. Studies were selected by two authors independently, with disagreements resolved by consensus with a third author. Overall 1951 unique references were identified, and 100 manuscripts underwent full-text review. Data were pooled using random-effects models. The meta-analysis is reported according to the PRISMA statement. The study protocol is registered with PROSPERO (CRD42019128468). RESULTS: Overall 29 studies (13,845 patients) were analyzed. Compared to SBX, use of mpMRI-informed TGBX was associated with a 15% higher rate of any PCa diagnosis (95% CI 10-20%, p\u3c0.00001). This relationship was not affected by the study methodology (p=0.11). Diagnosis of CS and HG PCa were more common in the mpMRI-informed TGBX group (risk difference of 11%, 95% CI 0-20%, p=0.05, and 2%, 95% CI 1-4%; p=0.005, respectively) while there was no difference in diagnosis of CI PCa (risk difference of 0, 95% CI -3-3%, p=0.96). Notably, the exclusion of SBX in the mpMRI-informed TGBX arm significantly modified the association between a mpMRI strategy and lower rates of CI PCa diagnosis (p=0.01) without affecting the diagnosis rates of CS- or HG-PCa. CONCLUSIONS: In comparison to SBX, a mpMRI-informed TGBX strategy results in a significantly higher diagnosis rate of any-, CS-, and HG-PCa. Excluding SBX from mpMRI-informed TGBX was associated with decreased rates of CI-PCa diagnosis without affecting diagnosis of CS- or HG-PCa

Monomeric Bistability and the Role of Autoloops in Gene Regulation

Genetic toggle switches are widespread in gene regulatory networks (GRN). Bistability, namely the ability to choose among two different stable states, is an essential feature of switching and memory devices. Cells have many regulatory circuits able to provide bistability that endow a cell with efficient and reliable switching between different physiological modes of operation. It is often assumed that negative feedbacks with cooperative binding (i.e. the formation of dimers or multimers) are a prerequisite for bistability. Here we analyze the relation between bistability in GRN under monomeric regulation and the role of autoloops under a deterministic setting. Using a simple geometric argument, we show analytically that bistability can also emerge without multimeric regulation, provided that at least one regulatory autoloop is present

The opto-mechanical design of the GMT-Consortium Large Earth Finder (G-CLEF)

The GMT-Consortium Large Earth Finder (G-CLEF) will be part of the first generation instrumentation suite for the Giant Magellan Telescope (GMT). G-CLEF is a general purpose echelle spectrograph operating in the optical passband with precision radial velocity (PRV) capability. The measurement precision goal of G-CLEF is 10 cm/sec; necessary for the detection of Earth analogues. This goal imposes challenging stability requirements on the optical mounts and spectrograph support structures especially when considering the instrument's operational environment. G-CLEF's accuracy will be influenced by changes in temperature and ambient air pressure, vibration, and micro gravity-vector variations caused by normal telescope motions. For these reasons we have chosen to enclose G-CLEF's spectrograph in a wellinsulated, vibration-isolated vacuum chamber in a gravity invariant location on GMT's azimuth platform. Additional design constraints posed by the GMT telescope include; a limited space envelope, a thermal leakage ceiling, and a maximum weight allowance. Other factors, such as manufacturability, serviceability, available technology, and budget are also significant design drivers. G-CLEF will complete its Critical Design phase in mid-2018. In this paper, we discuss the design of GCLEF's optical mounts and support structures including the choice of a low-CTE carbon-fiber optical bench. We discuss the vacuum chamber and vacuum systems. We discuss the design of G-CLEF's insulated enclosure and thermal control systems which simultaneously maintain the spectrograph at milli-Kelvin level stability and limit thermal leakage into the telescope dome. Also discussed are micro gravity-vector variations caused by normal telescope slewing, their uncorrected influence on image motion, and how they are dealt with in the design. We discuss G-CLEF's front-end assembly and fiber-feed system as well as other interface, integration and servicing challenges presented by the telescope, enclosure, and neighboring instrumentation. This work has been supported by the GMTO Corporation, a non-profit organization operated on behalf of an international consortium of universities and institutions: Arizona State University, Astronomy Australia Ltd, the Australian National University, the Carnegie Institution for Science, Harvard University, the Korea Astronomy and Space Science Institute, the São Paulo Research Foundation, the Smithsonian Institution, the University of Texas at Austin, Texas AM University, the University of Arizona, and the University of Chicago

Nanopore native RNA sequencing of a human poly(A) transcriptome

High-throughput complementary DNA sequencing technologies have advanced our understanding of transcriptome complexity and regulation. However, these methods lose information contained in biological RNA because the copied reads are often short and modifications are not retained. We address these limitations using a native poly(A) RNA sequencing strategy developed by Oxford Nanopore Technologies. Our study generated 9.9 million aligned sequence reads for the human cell line GM12878, using thirty MinION flow cells at six institutions. These native RNA reads had a median length of 771 bases, and a maximum aligned length of over 21,000 bases. Mitochondrial poly(A) reads provided an internal measure of read-length quality. We combined these long nanopore reads with higher accuracy short-reads and annotated GM12878 promoter regions to identify 33,984 plausible RNA isoforms. We describe strategies for assessing 3′ poly(A) tail length, base modifications and transcript haplotypes