End-stage Renal Disease and Economic Incentives: The International Study of Health Care Organization and Financing

End-stage renal disease (ESRD), or kidney failure, is a debilitating, costly, and increasingly common medical condition. Little is known about how different financing approaches affect ESRD outcomes and delivery of care. This paper presents results from a comparative review of 12 countries with alternative models of incentives and benefits, collected under the International Study of Health Care Organization and Financing, a substudy within the Dialysis Outcomes and Practice Patterns Study. Variation in spending per ESRD patient is relatively small and is correlated with overall per capita health care spending. Between-country variations in spending are reduced using an input price parity index constructed for this study. Remaining differences in costs and outcomes do not seem strongly linked to differences in incentives embedded in national programs.

The Konkoly Blazhko Survey: Is light-curve modulation a common property of RRab stars?

A systematic survey to establish the true incidence rate of the Blazhko modulation among short-period, fundamental-mode, Galactic field RR Lyrae stars has been accomplished. The Konkoly Blazhko Survey (KBS) was initiated in 2004. Since then more than 750 nights of observation have been devoted to this project. A sample of 30 RRab stars was extensively observed, and light-curve modulation was detected in 14 cases. The 47% occurrence rate of the modulation is much larger than any previous estimate. The significant increase of the detected incidence rate is mostly due to the discovery of small-amplitude modulation. Half of the Blazhko variables in our sample show modulation with so small amplitude that definitely have been missed in the previous surveys. We have found that the modulation can be very unstable in some cases, e.g. RY Com showed regular modulation only during one part of the observations while during two seasons it had stable light curve with abrupt, small changes in the pulsation amplitude. This type of light-curve variability is also hard to detect in other Survey's data. The larger frequency of the light-curve modulation of RRab stars makes it even more important to find the still lacking explanation of the Blazhko phenomenon. The validity of the [Fe/H](P,phi_{31}) relation using the mean light curves of Blazhko variables is checked in our sample. We have found that the formula gives accurate result for small-modulation-amplitude Blazhko stars, and this is also the case for large-modulation-amplitude stars if the light curve has complete phase coverage. However, if the data of large-modulation-amplitude Blazhko stars are not extended enough (e.g. < 500 data points from < 15 nights), the formula may give false result due to the distorted shape of the mean light curve used.Comment: Accepted for publication in MNRAS, 14 pages, 7 Figure

Bilateral nephrectomy for adult polycystic kidney disease does not affect the graft function of transplant patients and does not result in sensitisation

Background. Native nephrectomy in Adult Polycystic Kidney Disease (ADPKD) patients is a major operation with controversy related to timing and indications. We present our single centre experience in transplanted patients and future candidates for transplantation. Methods. Retrospective analysis from an anonymised database of bilateral nephrectomies for ADPKD patients. Results were reported as median, range, and percentage. Differences between groups were tested using ANOVA and t-test. Surgery was performed between January 2012 and July 2018. Results. Thirty-three patients underwent bilateral native nephrectomy for APKD. 18 had a functioning kidney transplant (transplant group, 55%) while 15 patients were on dialysis (dialysis group, 45%) at the time of surgery; 8 patients of the latter group (24% of the whole cohort) were eventually transplanted. 53% were males, with median age of 55 years (27-71). Indications to surgery were the following: space (symptoms related to the size of the native kidneys or need to create space for transplantation) (59%), recurrent cyst infection (36%), haematuria (15%), pain (24%), and weight loss associated with cystic alteration on imaging (3%). In the transplant group, postoperative kidney function was not affected; haemoglobin serum levels significantly dropped in the whole cohort: 121 (82-150) g/L, versus 108 (58-154) g/L (p<0.001), with 14 patients being transfused perioperatively. Elevation of anti-HLA antibodies was noted in one female patient on dialysis, with no change in DSA levels and no rejection after transplant for all 26 transplanted patients. Median postoperative length of hospital stay was 9 days (6-71). One patient died (3%) after six months. Median follow-up for the whole cohort was 282 days (13-1834). Histopathological examination revealed incidental renal neoplasms in five cases (15%): 1 pT1a papillary renal cell carcinoma and 4 papillary adenomas. Conclusions. Native nephrectomy for ADPKD could be safely performed in case of refractory symptoms, suspect of cancer or to create space for transplantation. It does not affect graft function or DSA status of transplanted patients or the prospect of transplantation of those on the waiting list

Local Guarantees in Graph Cuts and Clustering

Correlation Clustering is an elegant model that captures fundamental graph cut problems such as Min $s-t$ Cut, Multiway Cut, and Multicut, extensively studied in combinatorial optimization. Here, we are given a graph with edges labeled $+$ or $-$ and the goal is to produce a clustering that agrees with the labels as much as possible: $+$ edges within clusters and $-$ edges across clusters. The classical approach towards Correlation Clustering (and other graph cut problems) is to optimize a global objective. We depart from this and study local objectives: minimizing the maximum number of disagreements for edges incident on a single node, and the analogous max min agreements objective. This naturally gives rise to a family of basic min-max graph cut problems. A prototypical representative is Min Max $s-t$ Cut: find an $s-t$ cut minimizing the largest number of cut edges incident on any node. We present the following results: $(1)$ an $O(\sqrt{n})$-approximation for the problem of minimizing the maximum total weight of disagreement edges incident on any node (thus providing the first known approximation for the above family of min-max graph cut problems), $(2)$ a remarkably simple $7$-approximation for minimizing local disagreements in complete graphs (improving upon the previous best known approximation of $48$), and $(3)$ a $1/(2+\varepsilon)$-approximation for maximizing the minimum total weight of agreement edges incident on any node, hence improving upon the $1/(4+\varepsilon)$-approximation that follows from the study of approximate pure Nash equilibria in cut and party affiliation games

An unusual case of cardiac dysfunction after left ventricular reconstruction

This report describes an unusual cause of low cardiac output after coronary artery bypass grafting and left ventricular remodeling. It details left ventricular remodeling techniques and discusses the most recent advances and outcomes. As well, significant attention is paid to the issues surrounding failure to separate from cardiopulmonary bypass

Fast approximation of centrality and distances in hyperbolic graphs

We show that the eccentricities (and thus the centrality indices) of all vertices of a $\delta$-hyperbolic graph $G=(V,E)$ can be computed in linear time with an additive one-sided error of at most $c\delta$, i.e., after a linear time preprocessing, for every vertex $v$ of $G$ one can compute in $O(1)$ time an estimate $\hat{e}(v)$ of its eccentricity $ecc_G(v)$ such that $ecc_G(v)\leq \hat{e}(v)\leq ecc_G(v)+ c\delta$ for a small constant $c$. We prove that every $\delta$-hyperbolic graph $G$ has a shortest path tree, constructible in linear time, such that for every vertex $v$ of $G$, $ecc_G(v)\leq ecc_T(v)\leq ecc_G(v)+ c\delta$. These results are based on an interesting monotonicity property of the eccentricity function of hyperbolic graphs: the closer a vertex is to the center of $G$, the smaller its eccentricity is. We also show that the distance matrix of $G$ with an additive one-sided error of at most $c'\delta$ can be computed in $O(|V|^2\log^2|V|)$ time, where $c'< c$ is a small constant. Recent empirical studies show that many real-world graphs (including Internet application networks, web networks, collaboration networks, social networks, biological networks, and others) have small hyperbolicity. So, we analyze the performance of our algorithms for approximating centrality and distance matrix on a number of real-world networks. Our experimental results show that the obtained estimates are even better than the theoretical bounds.Comment: arXiv admin note: text overlap with arXiv:1506.01799 by other author

Compressible flow structures interaction with a two-dimensional ejector: a cold-flow study

An experimental study has been conducted to examine the interaction of compressible flow structures such as shocks and vortices with a two-dimensional ejector geometry using a shock-tube facility. Three diaphragm pressure ratios ofP4 =P1 = 4, 8, and 12 have been employed, whereP4 is the driver gas pressure andP1 is the pressure within the driven compartment of the shock tube. These lead to incident shock Mach numbers of Ms = 1:34, 1.54, and 1.66, respectively. The length of the driver section of the shock tube was 700 mm. Air was used for both the driver and driven gases. High-speed shadowgraphy was employed to visualize the induced flowfield. Pressure measurements were taken at different locations along the test section to study theflow quantitatively. The induced flow is unsteady and dependent on the degree of compressibility of the initial shock wave generated by the rupture of the diaphragm