Epidemiological and Economic Trends in Inpatient and Outpatient Thyroidectomy in the United States, 1996–2006

Background: Traditionally, thyroid surgery has been an inpatient procedure due to the risk of several well-documented complications. Recent research suggests that for selected patients, outpatient thyroid surgery is safe and feasible, with the additional potential benefit of cost savings. In recognition of these observations, we hypothesized that there would be an increase in U.S. outpatient thyroidectomies with a concurrent decline in inpatient thyroidectomies over time. Methods: Comparative cross-sectional analyses of the National Survey of Ambulatory Surgery (NSAS) and Nationwide Inpatient Sample (NIS) databases from 1996 and 2006 were performed. All cases of thyroid surgery were extracted, as well as data on age, sex, and insurance status. Diagnoses and surgical cases were identified using International Classification of Diseases, Ninth Revision (ICD-9) diagnostic and treatment codes. Hospital charges were acquired from the NIS 1996 and 2006 and NSAS 2006 releases, using imputed data where necessary. After survey weights were applied, patient characteristics, diagnoses, and procedures were compared for inpatient versus outpatient procedures. Results: The total number of thyroidectomies increased 39%, from 66,864 to 92,931 cases per year during the study timeframe. Outpatient procedures increased by 61%, while inpatient procedures increased by 30%. The proportion of privately insured inpatients declined slightly from 63.8% to 60.1%, while those covered by Medicare increased from 22.8% to 25.8%. In contrast, the proportion of privately insured outpatients declined sharply from 76.8% to 39.9%, while those covered by Medicare rose from 17.2% to 45.7%. These trends coincided with a small increase in the mean inpatient age from 50.2 to 52.3 years and a larger increase in the mean outpatient age from 50.7 to 58.1 years. Inflation-adjusted per-capita charges for inpatient thyroidectomies more than doubled from $9,934 in 1996 to$22,537 in 2006, while aggregate national inpatient charges tripled from $464 million to$1.37 billion. By comparison, per-capita charges for outpatient thyroidectomy totaled $7,222 in 2006. Conclusions: From 1996 to 2006, there has been a concurrent modest increase in inpatient and pronounced increase in outpatient thyroidectomies in the United States, with a consequential demographic shift and economic impact.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140257/1/thy.2012.0218.pd

Transcriptional Response of Selenopolypeptide Genes and Selenocysteine Biosynthesis Machinery Genes in Escherichia coli during Selenite Reduction

This work was supported by a United States Department of Agriculture-Cooperative State Research, Education, and Extension Service grant (no. 2009-35318-05032), a Biotechnology Research grant (no. 2007-BRG-1223) from the North Carolina Biotechnology Center, and a startup fund from the Golden LEAF Foundation to the Biomanufacturing Research Institute and Technology Enterprise (BRITE).Bacteria can reduce toxic selenite into less toxic, elemental selenium (Se0), but the mechanism on how bacterial cells reduce selenite at molecular level is still not clear. We used Escherichia coli strain K12, a common bacterial strain, as a model to study its growth response to sodium selenite (Na2SeO3) treatment and then used quantitative real-time PCR (qRT-PCR) to quantify transcript levels of three E. coli selenopolypeptide genes and a set of machinery genes for selenocysteine (SeCys) biosynthesis and incorporation into polypeptides, whose involvements in the selenite reduction are largely unknown. We determined that 5 mM Na2SeO3 treatment inhibited growth by ∼50% while 0.001 to 0.01 mM treatments stimulated cell growth by ∼30%. Under 50% inhibitory or 30% stimulatory Na2SeO3 concentration, selenopolypeptide genes (fdnG, fdoG, and fdhF) whose products require SeCys but not SeCys biosynthesis machinery genes were found to be induced ≥2-fold. In addition, one sulfur (S) metabolic gene iscS and two previously reported selenite-responsive genes sodA and gutS were also induced ≥2-fold under 50% inhibitory concentration. Our findings provide insight about the detoxification of selenite in E. coli via induction of these genes involved in the selenite reduction process.Publisher PDFPeer reviewe

Dynamic Covalent Synthesis of Crystalline Porous Graphitic Frameworks

Porous graphitic framework (PGF) is a two-dimensional (2D) material that has emerging energy applications. An archetype contains stacked 2D layers, the structure of which features a fully annulated aromatic skeleton with embedded heteroatoms and periodic pores. Due to the lack of a rational approach in establishing in-plane order under mild synthetic conditions, the structural integrity of PGF has remained elusive and ultimately limited its material performance. Here, we report the discovery of the unusual dynamic character of the C=N bonds in the aromatic pyrazine ring system under basic aqueous conditions, which enables the successful synthesis of a crystalline porous nitrogenous graphitic framework with remarkable in-plane order, as evidenced by powder X-ray diffraction studies and direct visualization using high-resolution transmission electron microscopy. The crystalline framework displays superior performance as a cathode material for lithium-ion batteries, outperforming the amorphous counterparts in terms of capacity and cycle stability. Insertion of well-defined, evenly spaced nanoscale pores into the two-dimensional (2D) layers of graphene invokes exciting properties due to the modulation of its electronic band gaps and surface functionalities. A bottom-up synthesis approach to such porous graphitic frameworks (PGFs) is appealing but also remains a great challenge. The current methods of building covalent organic frameworks rely on a small collection of thermodynamically reversible reactions. Such reactions are, however, inadequate in generating a fully annulated aromatic skeleton in PGFs. With the discovery of dynamic pyrazine formation, we succeeded in applying this linking chemistry to obtain a crystalline PGF material, which has displayed high electrical conductivity and remarkable performance as a cathode material for lithium-ion batteries. We envision that the demonstrated success will open the door to a wide array of fully annulated 2D porous frameworks, which hold immense potential for clean energy applications. We report the unusual dynamic characteristics of the C=N bonds in the pyrazine ring promoted under basic aqueous conditions, which enables the successful synthesis of two-dimensional porous graphitic frameworks (PGFs) featuring fully annulated aromatic skeletons and periodic pores. The PGF displayed high electrical conductivity and remarkable performance as a cathode material for lithium-ion batteries, far outperforming the amorphous counterparts in terms of capacity and cycle stability

Association between hospital case volume and the use of bronchoscopy and esophagoscopy during head and neck cancer diagnostic evaluation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102212/1/cncr28379.pd

From d-wave to s-wave pairing in the iron-pnictide superconductor (Ba,K)Fe2As2

The nature of the pairing state in iron-based superconductors is the subject of much debate. Here we argue that in one material, the stoichiometric iron pnictide KFe2As2, there is overwhelming evidence for a d-wave pairing state, characterized by symmetry-imposed vertical line nodes in the superconducting gap. This evidence is reviewed, with a focus on thermal conductivity and the strong impact of impurity scattering on the critical temperature Tc. We then compare KFe2As2 to Ba0.6K0.4Fe2As2, obtained by Ba substitution, where the pairing symmetry is s-wave and the Tc is ten times higher. The transition from d-wave to s-wave within the same crystal structure provides a rare opportunity to investigate the connection between band structure and pairing mechanism. We also compare KFe2As2 to the nodal iron-based superconductor LaFePO, for which the pairing symmetry is probably not d-wave, but more likely s-wave with accidental line nodes

Prospective Head and Neck Cancer Research: A Four‐Decade Bibliometric Perspective

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/139977/1/onco0584.pd

Numerical Renormalization Group Approach to a Quantum Dot Coupled to Normal and Superconducting Leads

We study transport through a quantum dot coupled to normal and superconducting leads using the numerical renormalization group method. We show that the low-energy properties of the system are described by the local Fermi liquid theory despite of the superconducting correlations penetrated into the dot due to a proximity effect. We calculate the linear conductance due to the Andreev reflection in the presence of the Coulomb interaction. It is demonstrated that the maximum structure appearing in the conductance clearly characterizes a crossover between two distinct spin-singlet ground states, i.e. the superconducting singlet state and the Kondo singlet state. It is further elucidated that the gate-voltage dependence of the conductance shows different behavior in the superconducting singlet region from that in the Kondo singlet region.Comment: 10 pages, 6 figures; a typo in eq. (B.5) corrected, which does not affect any other results of the pape

Incretin treatment and risk of pancreatitis in patients with type 2 diabetes mellitus : systematic review and meta-analysis of randomised and non-randomised studies

Objective To investigate the risk of pancreatitis associated with the use of incretin-based treatments in patients with type 2 diabetes mellitus. Design Systematic review and meta-analysis. Data sources Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov. Eligibility criteria Randomised and non-randomised controlled clinical trials, prospective or retrospective cohort studies, and case-control studies of treatment with glucagon-like peptide-1 (GLP-1) receptor agonists or dipeptidyl peptidase-4 (DPP-4) inhibitors in adults with type 2 diabetes mellitus compared with placebo, lifestyle modification, or active anti-diabetic drugs. Data collection and analysis Pairs of trained reviewers independently screened for eligible studies, assessed risk of bias, and extracted data. A modified Cochrane tool for randomised controlled trials and a modified version of the Newcastle-Ottawa scale for observational studies were used to assess bias. We pooled data from randomised controlled trials using Peto odds ratios, and conducted four prespecified subgroup analyses and a post hoc subgroup analysis. Because of variation in outcome measures and forms of data, we describe the results of observational studies without a pooled analysis. Results 60 studies (n=353 639), consisting of 55 randomised controlled trials (n=33 350) and five observational studies (three retrospective cohort studies, and two case-control studies; n=320 289) were included. Pooled estimates of 55 randomised controlled trials (at low or moderate risk of bias involving 37 pancreatitis events, raw event rate 0.11%) did not suggest an increased risk of pancreatitis with incretins versus control (odds ratio 1.11, 95% confidence interval 0.57 to 2.17). Estimates by type of incretin suggested similar results (1.05 (0.37 to 2.94) for GLP-1 agonists v control; 1.06 (0.46 to 2.45) for DPP-4 inhibitors v control). Analyses according to the type of control, mode, duration of treatment, and individual incretin agents suggested no differential effect by subgroups, and sensitivity analyses by alternative statistical modelling and effect measures did not show important differences in effect estimates. Three retrospective cohort studies (moderate to high risk of bias, involving 1466 pancreatitis events, raw event rate 0.47%) also did not suggest an increased risk of pancreatitis associated with either exenatide (adjusted odds ratios 0.93 (0.63 to 1.36) in one study and 0.9 (0.6 to 1.5) in another) or sitagliptin (adjusted hazard ratio 1.0, 0.7 to 1.3); a case-control study at moderate risk of bias (1003 cases, 4012 controls) also suggested no significant association (adjusted odds ratio 0.98, 0.69 to 1.38). Another case-control study (1269 cases, 1269 controls) at moderate risk of bias, however, suggested that the use of either exenatide or sitagliptin was associated with significantly increased odds of acute pancreatitis (use within two years v no use, adjusted odds ratio 2.07, 1.36 to 3.13). Conclusions The available evidence suggests that the incidence of pancreatitis among patients using incretins is low and that the drugs do not increase the risk of pancreatitis. Current evidence, however, is not definitive, and more carefully designed and conducted observational studies are warranted to definitively establish the extent, if any, of increased risk

Stellar Populations and Mass-Loss in M15: A Spitzer Detection of Dust in the Intra-Cluster Medium

We present Spitzer Space Telescope IRAC and MIPS observations of the galactic globular cluster M15 (NGC 7078), one of the most metal-poor clusters with a [Fe/H] = -2.4. Our Spitzer images reveal a population of dusty red giants near the cluster center, a previously detected planetary nebula (PN) designated K648, and a possible detection of the intra-cluster medium (ICM) arising from mass loss episodes from the evolved stellar population. Our analysis suggests 9 (+/-2) x 10^-4 solar masses of dust is present in the core of M15, and this material has accumulated over a period of approximately 10^6 years, a timescale ten times shorter than the last galactic plane crossing event. We also present Spitzer IRS follow up observations of K648, including the detection of the [NeII] 12.81 micron line, and discuss abundances derived from infrared fine structure lines.Comment: Accepted for publication in AJ. 20 pages, 10 figures, 6 tables. Full resolution versions of figures 1, 5, 7, and 8 are available in a PDF version of this manuscript at http://ir.astro.umn.edu/~mboyer/ms_060906.pd

Degradation Science: Mesoscopic Evolution and Temporal Analytics of Photovoltaic Energy Materials

Based on recent advances in nanoscience, data science and the availability of massive real-world datastreams, the mesoscopic evolution of mesoscopic energy materials can now be more fully studied. The temporal evolution is vastly complex in time and length scales and is fundamentally challenging to scientific understanding of degradation mechanisms and pathways responsible for energy materials evolution over lifetime. We propose a paradigm shift towards mesoscopic evolution modeling, based on physical and statistical models, that would integrate laboratory studies and real-world massive datastreams into a stress/mechanism/response framework with predictive capabilities. These epidemiological studies encompass the variability in properties that affect performance of material ensembles. Mesoscopic evolution modeling is shown to encompass the heterogeneity of these materials and systems, and enables the discrimination of the fast dynamics of their functional use and the slow and/or rare events of their degradation. We delineate paths forward for degradation science