Hypothesizing a Small Opioid MDL Settlement: An Argument for Local Public Health Action and Lessons from Big Tobacco

In response to the opioid epidemic, counties and cities across the United States waged In re: National Prescription Opiate Litigation, better known as the opioid MDL, against manufacturers and distributors of opioids. The county and city plaintiffs appear to have taken their litigation strategy straight from Big Tobacco playbook of the 1990s. This is to the great disdain of state attorneys general, who fronted Big Tobacco litigation with state-sponsored parens patriae litigation. The state attorneys general vehemently assert that the MDL claims are the province of state governments rather than local governments. However, the attorney general-led Big Tobacco litigation of the 1990s left much to be desired. While the states were able to procure a $206 billion tobacco Master Settlement Agreement in 1998, a seemingly enormous win for tobacco victims, the state attorneys general allocated a devastatingly low amount of the proceeds to the intended purposes of smoking cessation programs and public health initiatives. Just like Big Tobacco litigation, a global opioid settlement purported to resolve the MDL claims seems inevitable—and states are eager to undermine local efforts in reaching a settlement. This Note argues that state attorneys general should not be permitted to overthrow settlement negotiations in the county-and-city-led opioid MDL, positioning that counties and cities are better suited than states to implement evidence-based public health initiates in their own communities. Spending shortfalls of the Master Settlement Agreement demonstrate precisely why allocating settlement money to the states guarantees little to no spending accountability. This Note further identifies three reasons why, despite many similarities in the litigation tactics between tobacco and opioids, a global opioid settlement agreement will be far smaller than the$206 billion tobacco Master Settlement Agreement of 1998. Therefore, a smaller settlement would be best utilized by apportioning settlement proceeds directly to the local governments, which are the most impacted by the opioid epidemic

The price, quality and distribution of mortgage payment protection insurance: a hedonic pricing approach

Mortgage payment protection insurance (hereafter MPPI) provides varying combinations of accident, sickness and unemployment insurance and is used to protect the mortgage payments of policyholders in the event of a fall in income. Despite alleviating housing market failures, this service has been heavily criticised for providing poor value for money and being associated with unhelpful sales techniques especially when sold jointly with a mortgage in the UK. Consequently, the Competition Commission (2009) ruled that after February 2011 MPPI should not be sold jointly with mortgage lending within seven days of the credit transaction. We examine whether this prohibition was justified and if the form of distribution, either jointly with the mortgage or independently influences the premium levels. This assessment uses a hedonic pricing approach with details and premiums of MPPI policies in 2010 and 2012. Despite the success in reducing MPPI premium levels, we conclude that the Competition Commission judgement has raised concerns as to mortgagee protection

Design and Implementation of MPICH2 over InfiniBand with RDMA Support

For several years, MPI has been the de facto standard for writing parallel applications. One of the most popular MPI implementations is MPICH. Its successor, MPICH2, features a completely new design that provides more performance and flexibility. To ensure portability, it has a hierarchical structure based on which porting can be done at different levels. In this paper, we present our experiences designing and implementing MPICH2 over InfiniBand. Because of its high performance and open standard, InfiniBand is gaining popularity in the area of high-performance computing. Our study focuses on optimizing the performance of MPI-1 functions in MPICH2. One of our objectives is to exploit Remote Direct Memory Access (RDMA) in Infiniband to achieve high performance. We have based our design on the RDMA Channel interface provided by MPICH2, which encapsulates architecture-dependent communication functionalities into a very small set of functions. Starting with a basic design, we apply different optimizations and also propose a zero-copy-based design. We characterize the impact of our optimizations and designs using microbenchmarks. We have also performed an application-level evaluation using the NAS Parallel Benchmarks. Our optimized MPICH2 implementation achieves 7.6 $\mu$s latency and 857 MB/s bandwidth, which are close to the raw performance of the underlying InfiniBand layer. Our study shows that the RDMA Channel interface in MPICH2 provides a simple, yet powerful, abstraction that enables implementations with high performance by exploiting RDMA operations in InfiniBand. To the best of our knowledge, this is the first high-performance design and implementation of MPICH2 on InfiniBand using RDMA support.Comment: 12 pages, 17 figure

SYSTEMS-2: a randomised phase II study of radiotherapy dose escalation for pain control in malignant pleural mesothelioma

SYSTEMS-2 is a randomised study of radiotherapy dose escalation for pain control in 112 patients with malignant pleural mesothelioma (MPM). Standard palliative (20Gy/5#) or dose escalated treatment (36Gy/6#) will be delivered using advanced radiotherapy techniques and pain responses will be compared at week 5. Data will guide optimal palliative radiotherapy in MPM

Selective Targeting to Glioma with Nucleic Acid Aptamers

Malignant glioma is characterised by a rapid growth rate and high capacity for invasive infiltration to surrounding brain tissue; hence, diagnosis and treatment is difficult and patient survival is poor. Aptamers contribute a promising and unique technology for the in vitro imaging of live cells and tissues, with a potentially bright future in clinical diagnostics and therapeutics for malignant glioma. The binding selectivity, uptake capacity and binding target of two DNA aptamers, SA43 and SA44, were investigated in glioma cells and patient tissues. The binding assay showed that SA43 and SA44 bound with strong affinity (Kd, 21.56 ± 4.60 nM and Kd, 21.11 ± 3.30 nM respectively) to the target U87MG cells. Quantitative analysis by flow cytometry showed that the aptamers were able to actively internalise in U87MG and 1321N1 glioma cells compared to the non-cancerous and non-glioma cell types. Confocal microscopy confirmed staining in the cytoplasm, and co-localisation studies with endoplasmic reticulum, Golgi apparatus and lysosomal markers suggested internalisation and compartmentalisation within the endomembrane system. Both aptamers selectively bound to Ku 70 and Ku 80 DNA repair proteins as determined by aptoprecipitation (AP) followed by mass spectrometry analysis and confirmation by Western blot. In addition, aptohistochemical (AHC) staining on paraffin embedded, formalin fixed patient tissues revealed that the binding selectivity was significantly higher for SA43 aptamer in glioma tissues (grade I, II, III and IV) compared to the non-cancerous tissues, whereas SA44 did not show selectivity towards glioma tissues. The results indicate that SA43 aptamer can differentiate between glioma and non-cancerous cells and tissues and therefore, shows promise for histological diagnosis of glioma

Scientometric analysis of BIM-based research in construction engineering and management

The purpose of this paper is to summarize the latest research of BIM adoption in construction engineering and management (CEM) and propose research directions for future scholarly work. During the recent decade, building information modeling (BIM) has gained increasing applications and research interest in the construction industry. Although there have been review-based studies that summarized BIM-based research in the overall architecture, engineering and construction (AEC) area, there is limited review that evaluates the current stage of BIM-based research specifically in the CEM sub-area. Design/methodology/approach CEM falls into the scope of AEC. It involves construction-related tasks, activities and processes (e.g. scheduling and cost estimates), issues (e.g. constructability), as well as human factors (e.g. collaboration). This study adopted a holistic literature review approach that incorporates bibliometric search and scientometric analysis. A total of 276 articles related to BIM applied in CEM were selected from Scopus as the literature sample for the scientometric analysis. Findings Some key CEM research areas (e.g. CEM pedagogy, integrated project delivery, lean and off-site construction) were identified and evaluated. Research trends in these areas were identified, and analyses were carried out with regard to how they could be integrated with BIM. For example, BIM, as a data repository for ACE facilities, has substantial potential to be integrated with a variety of other digital technologies, project delivery methods and innovative construction techniques throughout the whole process of CEM. Practical implications As BIM is one of the key technologies and digital platforms to improve the construction productivity and collaboration, it is important for industry practitioners to be updated of the latest movement and progress of the academic research. The industry, academics and governmental authorities should work with joint effort to fill the gap by first recognizing the current needs, limitations and trends of applying BIM in the construction industry. For example, it needs more understanding about how to address technical interoperability issues and how to introduce the integrated design and construction delivery approach for BIM implementation under the UK BIM Level 2/3 framework. This study contributed to the body of knowledge in BIM by proposing a framework leading to research directions including the differences of BIM effects between design-bid-build and other fast-track project delivery methods; the integration of BIM with off-site construction; and BIM pedagogy in CEM. It also addressed the need to investigate the similarities and differences between academia and industry toward perceiving the movement of BIM in construction field work

Multistability of free spontaneously-curved anisotropic strips

Multistable structures are objects with more than one stable conformation, exemplified by the simple switch. Continuum versions are often elastic composite plates or shells, such as the common measuring tape or the slap bracelet, both of which exhibit two stable configurations: rolled and unrolled. Here we consider the energy landscape of a general class of multistable anisotropic strips with spontaneous Gaussian curvature. We show that while strips with non-zero Gaussian curvature can be bistable, strips with positive spontaneous curvature are always bistable, independent of the elastic moduli, strips of spontaneous negative curvature are bistable only in the presence of spontaneous twist and when certain conditions on the relative stiffness of the strip in tension and shear are satisfied. Furthermore, anisotropic strips can become tristable when their bending rigidity is small. Our study complements and extends the theory of multistability in anisotropic shells and suggests new design criteria for these structures.Comment: 20 pages, 10 figure

Blood neurofilament light in remote settings: Alternative protocols to support sample collection in challenging pre-analytical conditions

INTRODUCTION: This study investigated alternative pre‐analytical handling of blood for neurofilament light (NfL) analysis where resources are limited. METHOD: Plasma NfL was measured with single molecule array after alternative blood processing procedures: dried plasma spots (DPS), dried blood spots (DBS), and delayed 48‐hour centrifugation. These were compared to standardized plasma processing (reference standard [RS]). In a discovery cohort (n = 10) and a confirmatory cohort (n = 21), whole blood was obtained from individuals with unknown clinical etiology. In the confirmatory cohort, delayed centrifugation protocol was paired with either 37°C incubation or sample shaking to test the effect of these parameters. RESULTS: Delayed centrifugation (R^{2}= 0.991) and DPS (discovery cohort, R^{2} = 0.954; confirmatory cohort, DPS: R^{2} = 0.961) methods were strongly associated with the RS. Delayed centrifugation with higher temperatures (R^{2} = 0.995) and shaking (R^{2} = 0.975) did not affect this association. DPS (P < 0.001) returned concentrations considerably lower than the RS. DISCUSSION: did not affect this association. DPS (P < 0.001) returned concentrations considerably lower than the RS