An Examination Of Medical Technology Disadoption And Its Relation To Technology Adoption And Physician Organization

Medical technology disadoption, a topic which has not previously been studied in great detail by health economists, is of great importance in a health care system where technology is understood to be a major driver of expenditure growth and the adoption of new technologies is consistently promoted by cultural norms and financial incentives. The disadoption of technologies with sub-optimal efficacy or safety is a key to improving the quality and value of care, and thus there is obvious utility to learning more about factors that influence technology disadoption. This dissertation establishes a novel theoretical framework to characterize the disadoption process along multiple dimensions, and then develops a simple mathematical model to describe physician disadoption behavior. Disadoption is examined empirically by analyzing the use of coronary drug-eluting stents (DES) in 2006-07(following their rapid adoption in 2003-04) using New York and Florida hospital discharge data, national practice organization data, and physician characteristic data. Preceding DES adoption behavior and physician group size are the primary factors studied for association with DES disadoption behavior. Empirical analyses indicate that faster DES adoption may be weakly associated with later DES disadoption, which may be consistent with physician risk aversion or product loyalty playing roles in disadoption decisions. Also, analyses suggest that there may be a week negative relationship between group size and timing of DES disadoption, suggesting that physicians in larger groups may begin the disadoption process later. These empirical results, which are subjected to instrumental variable analysis and extensive robustness checks, generally lack statistical significance, which highlights the current level of uncertainty surrounding disadoption behavior, including the observation that it does not appear to be empirically either similar or related to adoption behavior. Thus, this work both promotes and guides future research on medical disadoption and its determinants

Enhanced Protective Efficacy of a Chimeric Form of the Schistosomiasis Vaccine Antigen Sm-TSP-2

The large extracellular loop of the Schistosoma mansoni tetraspanin, Sm-TSP-2, when fused to a thioredoxin partner and formulated with Freund's adjuvants, has been shown to be an efficacious vaccine against murine schistosomiasis. Moreover, Sm-TSP-2 is uniquely recognised by IgG1 and IgG3 from putatively resistant individuals resident in S. mansoni endemic areas in Brazil. In the present study, we expressed Sm-TSP-2 at high yield and in soluble form in E. coli without the need for a solubility enhancing fusion partner. We also expressed in E. coli a chimera called Sm-TSP-2/5B, which consisted of Sm-TSP-2 fused to the immunogenic 5B region of the hookworm aspartic protease and vaccine antigen, Na-APR-1. Sm-TSP-2 formulated with alum/CpG showed significant reductions in adult worm and liver egg burdens in two separate murine schistosomiasis challenge studies. Sm-TSP-2/5B afforded significantly greater protection than Sm-TSP-2 alone when both antigens were formulated with alum/CpG. The enhanced protection obtained with the chimeric fusion protein was associated with increased production of anti-Sm-TSP-2 antibodies and IL-4, IL-10 and IFN-γ from spleen cells of vaccinated animals. Sera from 666 individuals from Brazil who were infected with S. mansoni were screened for potentially deleterious IgE responses to Sm-TSP-2. Anti-Sm-TSP-2 IgE to this protein was not detected (also shown previously for Na-APR-1), suggesting that the chimeric antigen Sm-TSP-2/5B could be used to safely and effectively vaccinate people in areas where schistosomes and hookworms are endemic

Systems-Level Modeling of Cancer-Fibroblast Interaction

Cancer cells interact with surrounding stromal fibroblasts during tumorigenesis, but the complex molecular rules that govern these interactions remain poorly understood thus hindering the development of therapeutic strategies to target cancer stroma. We have taken a mathematical approach to begin defining these rules by performing the first large-scale quantitative analysis of fibroblast effects on cancer cell proliferation across more than four hundred heterotypic cell line pairings. Systems-level modeling of this complex dataset using singular value decomposition revealed that normal tissue fibroblasts variably express at least two functionally distinct activities, one which reflects transcriptional programs associated with activated mesenchymal cells, that act either coordinately or at cross-purposes to modulate cancer cell proliferation. These findings suggest that quantitative approaches may prove useful for identifying organizational principles that govern complex heterotypic cell-cell interactions in cancer and other contexts

Environmental impacts of the deep-water oil and gas industry: a review to guide management strategies

The industrialization of the deep sea is expanding worldwide. Increasing oil and gas exploration activities in the absence of sufficient baseline data in deep-sea ecosystems has made environmental management challenging. Here, we review the types of activities that are associated with global offshore oil and gas development in water depths over 200 m, the typical impacts of these activities, some of the more extreme impacts of accidental oil and gas releases, and the current state of management in the major regions of offshore industrial activity including 18 exclusive economic zones. Direct impacts of infrastructure installation, including sediment resuspension and burial by seafloor anchors and pipelines, are typically restricted to a radius of ~100 m on from the installation on the seafloor. Discharges of water-based and low-toxicity oil-based drilling muds and produced water can extend over 2 km, while the ecological impacts at the population and community levels on the seafloor are most commonly on the order of 200–300 m from their source. These impacts may persist in the deep sea for many years and likely longer for its more fragile ecosystems, such as cold-water corals. This synthesis of information provides the basis for a series of recommendations for the management of offshore oil and gas development. An effective management strategy, aimed at minimizing risk of significant environmental harm, will typically encompass regulations of the activity itself (e.g., discharge practices, materials used), combined with spatial (e.g., avoidance rules and marine protected areas), and temporal measures (e.g., restricted activities during peak reproductive periods). Spatial management measures that encompass representatives of all of the regional deep-sea community types is important in this context. Implementation of these management strategies should consider minimum buffer zones to displace industrial activity beyond the range of typical impacts: at least 2 km from any discharge points and surface infrastructure and 200 m from seafloor infrastructure with no expected discharges. Although managing natural resources is, arguably, more challenging in deep-water environments, inclusion of these proven conservation tools contributes to robust environmental management strategies for oil and gas extraction in the deep sea.Copyright © 2016 Cordes, Jones, Schlacher, Amon, Bernardino, Brooke, Carney, DeLeo, Dunlop, Escobar-Briones, Gates, Génio, Gobin, Henry, Herrera, Hoyt, Joye, Kark, Mestre, Metaxas, Pfeifer, Sink, Sweetman and Witte. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms

THE LATIN SCHOOL AND THE EMERGENCE OF A STATE UNIVERSITY IN NEBRASKA: A HISTORY OF PREPARATORY EDUCATION AT THE UNIVERSITY OF NEBRASKA, 1871-1897.

Abstract not availabl

Spatio-temporal transmission and environmental determinants of Schistosomiasis Japonica in Anhui Province, China.

BACKGROUND:Schistosomiasis japonica still remains of public health and economic significance in China, especially in the lake and marshland areas along the Yangtze River Basin, where the control of transmission has proven difficult. In the study, we investigated spatio-temporal variations of S. japonicum infection risk in Anhui Province and assessed the associations of the disease with key environmental factors with the aim of understanding the mechanism of the disease and seeking clues to effective and sustainable schistosomiasis control. METHODOLOGY/PRINCIPAL FINDINGS:Infection data of schistosomiasis from annual conventional surveys were obtained at the village level in Anhui Province, China, from 2000 to 2010 and used in combination with environmental data. The spatio-temporal kriging model was used to assess how these environmental factors affected the spatio-temporal pattern of schistosomiasis risk. Our results suggested that seasonal variation of the normalized difference vegetation index (NDVI), seasonal variation of land surface temperature at daytime (LSTD), and distance to the Yangtze River were negatively significantly associated with risk of schistosomiasis. Predictive maps showed that schistosomiasis prevalence remained at a low level and schistosomiasis risk mainly evolved along the Yangtze River. Schistosomiasis risk also followed a focal spatial pattern, fluctuating temporally with a peak (the largest spatial extent) in 2005 and then contracting gradually but with a scattered distribution until 2010. CONCLUSION:The fitted spatio-temporal kriging model can capture variations of schistosomiasis risk over space and time. Combined with techniques of geographic information system (GIS) and remote sensing (RS), this approach facilitates and enriches risk modeling of schistosomiasis, which in turn helps to identify prior areas for effective and sustainable control of schistosomiasis in Anhui Province and perhaps elsewhere in China

Sandwich mapping of schistosomiasis risk in Anhui Province, China

Schistosomiasis mapping using data obtained from parasitological surveys is frequently used in planning and evaluation of disease control strategies. The available geostatistical approaches are, however, subject to the assumption of stationarity, a stochastic process whose joint probability distribution does not change when shifted in time. As this is impractical for large areas, we introduce here the sandwich method, the basic idea of which is to divide the study area (with its attributes) into homogeneous subareas and estimate the values for the reporting units using spatial stratified sampling. The sandwich method was applied to map the county-level prevalence of schistosomiasis japonica in Anhui Province, China based on parasitological data collected from sample villages and land use data. We first mapped the county-level prevalence using the sandwich method, then compared our findings with block Kriging. The sandwich estimates ranged from 0.17 to 0.21% with a lower level of uncertainty, while the Kriging estimates varied from 0 to 0.97% with a higher level of uncertainty, indicating that the former is more smoothed and stable compared to latter. Aside from various forms of reporting units, the sandwich method has the particular merit of simple model assumption coupled with full utilization of sample data. It performs well when a disease presents stratified heterogeneity over space

Microdistribution of Faunal Assemblages at Deep-Sea Hydrothermal Vents in the Southern Ocean

Chemosynthetic primary production by microbes supports abundant faunal assemblages at deep-sea hydrothermal vents, with zonation of invertebrate species typically occurring along physico-chemical gradients. Recently discovered vent fields on the East Scotia Ridge (ESR) in the Southern Ocean represent a new province of vent biogeography, but the spatial dynamics of their distinct fauna have yet to be elucidated. This study determines patterns of faunal zonation, species associations, and relationships between faunal microdistribution and hydrothermal activity in a vent field at a depth of 2,400 m on the ESR. Remotely operated vehicle (ROV) dives obtained high-definition imagery of three chimney structures with varying levels of hydrothermal activity, and a mosaic image of >250 m2 of seafloor co-registered with temperature measurements. Analysis of faunal microdistribution within the mosaiced seafloor reveals a consistent pattern of faunal zonation with increasing distance from vent sources and peak temperatures. Assemblages closest to vent sources are visibly dominated by a new species of anomuran crab, Kiwa n. sp. (abundance >700 individuals m?2), followed by a peltospiroid gastropod (>1,500 individuals m?2), eolepadid barnacle (>1,500 individuals m?2), and carnivorous actinostolid anemone (>30 individuals m?2). Peripheral fauna are not dominated by a single taxon, but include predatory and scavenger taxa such as stichasterid seastars, pycnogonids and octopus. Variation in faunal microdistribution on chimneys with differing levels of activity suggests a possible successional sequence for vent fauna in this new biogeographic province. An increase in ?34S values of primary consumers with distance from vent sources, and variation in their ?13C values also indicate possible zonation of nutritional modes of the vent fauna. By using ROV videography to obtain a high-resolution representation of a vent environment over a greater extent than previous studies, these results provide a baseline for determining temporal change and investigations of processes structuring faunal assemblages at Southern Ocean vents