Miracle-dz/UniFAR-FTUs huggingface dataset:
Tiered Hospital Networks, Health Care Demand, and Prices

Health insurers are increasingly using plan designs that incentivize consumers to shop for health care based on price. I study the effects of one such plan design on demand and equilibrium prices. Tiered hospital networks group hospitals by price ranking and vary consumers’ outof-pocket prices to reflect the price variation faced by the insurer. Proponents argue that tiered networks reduce health care spending by steering consumers toward lower-priced hospitals, and by giving insurers an additional bargaining lever in price negotiations with hospitals. To evaluate these claims, I estimate a structural model of health care demand and insurer-hospital bargaining over prices in the Massachusetts private health insurance market. The model extends the standard Nash bargaining framework to explicitly account for the multiplicity of possible tier outcomes. I find that the effects of tiered networks on demand alone can lead to moderate reductions in hospital spending of 0.7% to 1.8%. The effects on negotiated hospital prices are substantially larger, with an average price decline of 11% across hospitals. I conclude that insurance plan designs with demand-side incentives can have large health care spending reduction effects. JEL codes: I11, I13, L11, L13 The latest version is available here. I am indebted to my advisor, Bob Town, and to my dissertation committee, Mark Pauly, Katja Seim, and Ashley Swanson for their invaluable guidance and support. I also received helpful suggestions from participants in the Wharton health economics and industrial organization workshops, as well as Nora Becker, Shulamite Chiu, Guy David, Sunita Desai, Brian Finkelman, Cinthia Konichi, Adam Leive, Dan Polsky, Preethi Rao, and Amanda Starc. Financial support from the Agency for Healthcare Research and Quality (dissertation grant R36-HS024164), the Social Sciences and Humanities Research Council of Canada, the Leonard Davis Institute of Health Economics Pilot Grant program, and the Ackoff Doctoral Student Fellowship is gratefully acknowledged. This research does not represent the official views of any of these funding agencies. The Wharton School, University of Pennsylvania. Address: Colonial Penn Center 402, 3641 Locust Walk, Philadelphia, PA 19104. Email: elprager@wharton.upenn. edu. 1 Applicant upload/2015-11-20/academicjobsonline.org
Experimental investigation of ventilated cavities.

Experimental Investigation of Ventilated Cavities Richard James Kinnear Submitted to the Department of Naval Architecture and Marine Engineering on 17 May 1968 in partial fulfillment of the requirements for the Master of Science degree in Mechanical Engineering and the Professional Degree, •• Naval Engineer . A wedge with a 3.5 inch chord and a half-angle of 4.1 degrees is tested in the MIT Propeller Tunnel. No pulsations were observed on the cavity. Thus, the attempt to verify the theory that pulsations are possible in an infinite medium (without a free surface) is inconclusive. Although there exist a variance in the cavitation number between theory and experiment, the data plotted show that the general shape of the curve for a 4.1 degree wedge is correct. The primary discrepancy is in the pressure recording methods. Visual observations become difficult when ventilated cavities are generated in the test section. It takes only about 5 to 10 seconds for the air introduced into the cavity to recirculate through the tunnel. Thesis Supervisor: Patrick Leehey Title: Professor of Naval Architecture
Quantitative Contrast‐enhanced Ultrasonographic Assessment of Naturally Occurring Pancreatitis in Dogs

Background Quantitative contrast‐enhanced ultrasonography (CEUS) can detect pancreatic perfusion changes in experimentally induced canine pancreatitis. However, its usefulness in detecting perfusion changes in naturally occurring pancreatitis is unclear. Hypothesis/Objectives To determine the feasibility of using CEUS to detect pancreatic and duodenal perfusion changes in naturally occurring canine pancreatitis. Animals Twenty‐three client‐owned dogs with pancreatitis, 12 healthy control dogs. Methods Dogs diagnosed with pancreatitis were prospectively included. CEUS of the pancreas and duodenum were performed. Time‐intensity curves were created from regions of interest in the pancreas and duodenum. Five perfusion parameters were obtained for statistical analyses: time to initial up‐slope, peak time (Tp), time to wash‐out (TTW), peak intensity (PI), and area under the curve (AUC). Results For the pancreas, Tp of the pancreatitis group was prolonged when compared to controls (62 ± 11 seconds versus 39 ± 13 seconds; P < .001). TTW also was prolonged but not significantly (268 ± 69 seconds versus 228 ± 47 seconds; P = .47). PI and AUC were increased when compared to controls (95 ± 15 versus 78 ± 13 MPV; P = .009 and 14,900 ± 3,400 versus 11,000 ± 2,800 MPV*s; P = .013, respectively). For the duodenum, PI and AUC were significantly increased in the pancreatitis group when compared to controls. Conclusions and Clinical Importance Contrast‐enhanced ultrasonography can detect pancreatic perfusion changes in naturally occurring canine pancreatitis characterized by delayed peak with prolonged hyperechoic enhancement of the pancreas on CEUS. Additionally, duodenal perfusion changes secondary to pancreatitis were observed.
Role of MMP 2 and MMP 9 in TRPV 4-induced lung injury

Villalta PC, Rocic P, Townsley MI. Role of MMP2 and MMP9 in TRPV4-induced lung injury. Am J Physiol Lung Cell Mol Physiol 307: L652–L659, 2014. First published August 22, 2014; doi:10.1152/ajplung.00113. 2014. —Ca entry through transient receptor potential vanilloid 4 (TRPV4) results in swelling, blebbing, and detachment of the epithelium and capillary endothelium in the intact lung. Subsequently, increased permeability of the septal barrier and alveolar flooding ensue. In this study, we tested the hypothesis that TRPV4 activation provides a Ca source necessary for proteolytic disruption of cell-cell or cell-matrix adhesion by matrix metalloproteinases (MMPs) 2 and 9, thus increasing septal barrier permeability. In our study, C57BL/6 or TRPV4 / mouse lungs were perfused with varying doses of the TRPV4 agonist GSK-1016790A (Sigma) and then prepared for Western blot. Lung injury, assessed by increases in lung wet-to-dry weight ratios and total protein levels in the bronchoalveolar lavage fluid, was increased in a dose-dependent fashion in TRPV4 / but not TRPV4 / lungs. In concert with lung injury, we detected increased active MMP2 and MMP9 isoforms, suggesting that TRPV4 can provide the Ca source necessary for increased MMP2/9 activation. Furthermore, tissue inhibitor of metalloproteinases (TIMP) 2 levels in the TRPV4-injured lungs were decreased, suggesting that TRPV4 activation increases the availability of these active MMPs. We then determined whether MMP2 and MMP9 mediate TRPV4-induced lung injury. Pharmacological blockade (SB-3CT, 1 M; Sigma) of MMP2 and MMP9 resulted in protection against TRPV4-induced lung injury. We conclude that TRPV4 activation and the subsequent Ca transient initiates a rapid cascade of events leading to release and activation of the gelatinase MMPs, which then contribute to lung injury.
Complex interactions in Parkinson's disease: A two‐phased approach

The identification of pathogenic mutations in the three genes α‐synuclein, parkin, and ubiquitin carboxy‐terminal hydrolase L1 (UCHL1) has elucidated the ubiquitin proteasome system (UPS) and its potential role as a causal pathway in Parkinson's disease (PD). In addition, polymorphisms of these three genes have been shown to be independently associated with PD. In a sample of 298 unrelated PD cases and 185 controls, we applied a two‐phased approach of recursive partitioning and logistic regression analyses to explore complex interactions. For women only, we observed an epistatic interaction of UCHL1 and α‐synuclein genotypes with significant effects on PD risk (odds ratio = 2.42; P = 0.003). Our findings are consistent with the hypothesis that PD is a multigenic disorder of the UPS. © 2003 Movement Disorder Society
Population games, stable games, and passivity

Stable games [1] have the attractive property of admitting global convergence to equilibria under many learning dynamics. We show that stable games can be formulated as passive input-output systems. This observation enables us to identify passivity of a learning dynamic as a sufficient condition for global convergence in stable games. Notably, dynamics satisfying our condition need not exhibit positive correlation between the payoffs and their directions of motion. Our condition is satisfied by the dynamics known to exhibit global convergence in stable games. We give a decision-theoretic interpretation for passive learning dynamics that mirrors the interpretation of stable games as strategic environments exhibiting self-defeating externalities. Lastly, we exploit the flexibility of the passivity condition to study the impact of applying various forecasting heuristics to the payoffs used in the learning process.
Three-Dimensional Architecture of Presynaptic Terminal Cytomatrix

Presynaptic terminals are specialized for mediating rapid fusion of synaptic vesicles (SVs) after calcium influx. The regulated trafficking of SVs likely results from a highly organized cytomatrix. How this cytomatrix links SVs, maintains them near the active zones (AZs) of release, and organizes docked SVs at the release sites is not fully understood. To analyze the three-dimensional (3D) architecture of the presynaptic cytomatrix, electron tomography of presynaptic terminals contacting spines was performed in the stratum radiatum of the rat hippocampal CA1 area. To preserve the cytomatrix, hippocampal slices were immobilized using high-pressure freezing, followed by cryosubstitution and embedding. SVs are surrounded by a dense network of filaments. A given vesicle is connected to ∼1.5 neighboring ones. SVs at the periphery of this network are also linked to the plasma membrane, by longer filaments. More of these filaments are found at the AZ. At the AZ, docked SVs are grouped around presynaptic densities. Filaments with adjacent SVs emerge from these densities. Immunogold localizations revealed that synapsin is located in the presynaptic bouton, whereas Bassoon and CAST (ERC2) are at focal points next to the AZ. In synapsin triple knock-out mice, the number of SVs is reduced by 63%, but the size of the boutons is reduced by only 18%, and the mean distance of SVs to the AZ is unchanged. This 3D analysis reveals the morphological constraints exerted by the presynaptic molecular scaffold. SVs are tightly interconnected in the axonal bouton, and this network is preferentially connected to the AZ.
Impact of immunosuppressant therapy on new-onset diabetes in liver transplant recipients

This nationwide, population-based study aimed to clarify the effects of immunosuppressive regimens on new-onset diabetes after liver transplantation (NODALT). The National Health Insurance database of Taiwan was explored for patients who received liver transplantation without pre-transplant diabetes from 1998 to 2012. Information regarding clinical conditions and immunosuppressant utilization among these patients was analyzed statistically. Of the 2,140 patients included in our study, 189 (8.8%) developed NODALT. The pre-transplant risk factors for NODALT were identified as old age, male sex, hepatitis C, alcoholic hepatitis, and immunosuppressant use of tacrolimus (TAC). All patients used corticosteroids as a baseline immunosuppressant. The immunosuppressant regimen of cyclosporine (CsA)+TAC+mycophenolate mofetil (MMF) contributed most to NODALT (adjusted hazard ratio 7.596) in comparison with the regimens of TAC+MMF and CsA+MMF; this regimen also contributed significantly to higher post-transplant bacteremia, urinary tract infection, pneumonia, renal failure, and mortality rate. In conclusion, our analysis confirmed TAC-based immunosuppression contributes to higher NODALT incidence than CsA-based regimen, and TAC-CsA conversion due to any causes might lead to worse clinical outcomes. Clinicians should make better risk stratifications before prescribing immunosuppressants for liver transplant recipients.
Matrix metalloproteinase 9 is involved in airway inflammation in cough variant asthma

Previous studies have revealed the role of matrix metalloproteinase 9 (MMP9) in asthma and chronic obstructive pulmonary disease (COPD). However, its role in airway inflammation in cough variant asthma (CVA) remains unknown. In the present study, variations in the levels of MMP9 and interleukin (IL)-5 in the induced sputum of patients with CVA prior to and following therapy with inhaled corticosteroid and long-acting β2-agonist (ICS/LABA), were detected. The levels of IL-5 and percentage of eosinophils (EOS) in the induced sputum from patients with CVA were significantly higher than those in the control group of healthy individuals. The levels of MMP9 in the induced sputum from patients with CVA were also significantly higher than those in the control group. Following treatment with ICS/LABA for 6–9 months, the levels of MMP9 and IL-5, as well as the percentage of EOS, in the induced sputum from patients with CVA had significantly decreased. Thus, MMP9 may be an important biomarker in the airway inflammation of CVA.
Dorsal and Ventral Hippocampus Differentiate in Functional Pathways and Differentially Associate with Neurological Disease-Related Genes during Postnatal Development

The dorsal and ventral regions of the hippocampus are important in cognitive and emotional processing, respectively. Various approaches have revealed the differential molecular and structural characteristics, and functional roles of the hippocampus. Recent RNA sequencing (RNA-seq) technology has enriched our understanding of the hippocampus by elucidating more detailed information on gene expression patterns. However, no RNA-seq–based study on gene profiles in the developing hippocampus has been reported. Using RNA-seq–based bioinformatic analysis in conjunction with quantitative real-time polymerase chain reaction analysis and a comparison of in situ hybridization data obtained from the Allen Brain Atlas, we provide a thorough analysis of differentially expressed genes in the dorsal and ventral hippocampus at specific developmental ages representing the postnatally maturing hippocampus. Genes associated with particular functional pathways and marker genes for particular neurological diseases were found to be distinctively segregated within either the dorsal or ventral hippocampus at specific or at all developmental ages examined. We also report novel molecular markers enriched in the dorsal or ventral hippocampus. Taken together, this study provides insights into the molecular mechanisms underlying physiological functions linked to the dorsal or ventral hippocampus. The information provided in the study also contributes to a better understanding of brain functions and serves as a resource for future studies on the pathophysiology of dorsal and ventral hippocampal functions.
Enhanced Ventilatory Response to Exercise in Patients With Chronic Heart Failure and Preserved Exercise Tolerance: Marker of Abnormal Cardiorespiratory Reflex Control and Predictor of Poor Prognosis

Background —In patients with chronic heart failure (CHF) and preserved exercise tolerance, the value of cardiopulmonary exercise testing for risk stratification is not known. Elevated slope of ventilatory response to exercise (e/co2) predicts poor prognosis in advanced CHF. Derangement of cardiopulmonary reflexes may trigger exercise hyperpnea. We assessed the relationship between cardiopulmonary reflexes and e/co2 and investigated the prognostic value of e/co2 in CHF patients with preserved exercise tolerance. Methods and Results —Among 344 consecutive CHF patients, we identified 123 with preserved exercise capacity, defined as a peak oxygen consumption (peak o2) ≥18 mL · kg−1 · min−1 (age 56 years; left ventricular ejection fraction 28%; peak o2 23.5 mL · kg−1 · min−1). Hypoxic and hypercapnic chemosensitivity (n=38), heart rate variability (n=34), baroreflex sensitivity (n=20), and ergoreflex activity (n=20) were also assessed. We identified 40 patients (33%) with high e/co2 (ie, >34.0). During follow-up (49±22 months, >3 years in all survivors), 34 patients died (3-year survival 81%). High e/co2 (hazard ratio 4.3, P <0.0001) but not peak o2 (P =0.7) predicted mortality. In patients with high e/co2, 3-year survival was 57%, compared with 93% in patients with normal e/co2 (P <0.0001). Patients with high e/co2 demonstrated impaired reflex control, as evidenced by augmented peripheral (P =0.01) and central (P =0.0006) chemosensitivity, depressed low-frequency component of heart rate variability (P <0.0001) and baroreflex sensitivity (P =0.03), and overactive ergoreceptors (P =0.003) compared with patients with normal e/co2. Conclusions —In CHF patients with preserved exercise capacity, enhanced ventilatory response to exercise is a simple marker of a widespread derangement of cardiovascular reflex control; it predicts poor prognosis, which peak o2 does not.
Comparison of the Distal Gut Microbiota from People and Animals in Africa

The gut microbiota plays a key role in the maintenance of healthy gut function as well as many other aspects of health. High-throughput sequence analyses have revealed the composition of the gut microbiota, showing that there is a core signature to the human gut microbiota, as well as variation in its composition between people. The gut microbiota of animals is also being investigated. We are interested in the relationship between bacterial taxa of the human gut microbiota and those in the gut microbiota of domestic and semi-wild animals. While it is clear that some human gut bacterial pathogens come from animals (showing that human – animal transmission occurs), the extent to which the usually non-pathogenic commensal taxa are shared between humans and animals has not been explored. To investigate this we compared the distal gut microbiota of humans, cattle and semi-captive chimpanzees in communities that are geographically sympatric in Uganda. The gut microbiotas of these three host species could be distinguished by the different proportions of bacterial taxa present. We defined multiple operational taxonomic units (OTUs) by sequence similarity and found evidence that some OTUs were common between human, cattle and chimpanzees, with the largest number of shared OTUs occurring between chimpanzees and humans, as might be expected with their close physiological similarity. These results show the potential for the sharing of usually commensal bacterial taxa between humans and other animals. This suggests that further investigation of this phenomenon is needed to fully understand how it drives the composition of human and animal gut microbiotas.
Seroepidemiological Investigation of Toxocariasis in the Isparta Region of Turkey

Background Toxocariasis is a common disease around the world. Our objective was to determine Toxocara seroprevalence in humans in the city of Isparta, Southwest Turkey, in respect of some determinants such as age, socio-economic level, residence in city center or rural area etc. Methods Five hundred and thirty four individual participants from Isparta center and 85 from Asagi Gokdere village were included in the study. T. cati specific antibodies were analyzed using excretory-secretory (ES)-enzyme-linked immunosorbent assay (ELISA) method. Results T. cati antibodies were detected as positive in 73 (13.6%) of 534 samples which were collected from subjects living in the city center and 24 (28.2%) of 85 samples from Asagi Gokdere village. Toxocara seropositivity was detected among 15.6% of whole study group. The seroprevalence of toxocariasis was significantly higher among subjects from village than in subjects from city center (P=0.001). While gender, high school education, source of the water which is used, family income and geophagia/eating nail behaviors were the features which were detected as being associated with toxocariasis seropositivity (odds ratios=0.5; 6.52; 3.61; 0.43; 0.13 respectively), owning dogs or cats and hand washing were detected as being not associated with toxocariasis seropositivity (P>0.05). Furthermore, Toxocara seropositivity was significantly higher among subjects in 0–10 than >40 year-old group (P=0.02). Conclusion It can be suggested that untreated lost pet population, environmental contamination, and way of life have influence on the epidemiology of toxocariasis.
Designing a Java graphics library for CS 1

In recent years, there has been considerable interest in using Java in introductory computer science courses. The advantages of choosing Java, however, must be balanced against two significant drawbacks: the instability caused by the rapid evolution of the Java toolkits and the complexity of the graphics model for new students. This paper outlines a strategy for teaching Java that eliminates these problems. The first component of that strategy is a set of low-level classes, DBCanvas and XGraphics, which together offer a double-buffered graphics model that is well matched to student intuition. The second component is a set of higher-level classes, principally Collage and Widget, which make it easy to introduce object-oriented techniques at the beginning of CS1. The sources for these classes are available on the Web at the URL http://cse.stanford. edu/java
Day case transurethral prostatectomy in Nigeria.

BACKGROUND Caudal block regional anaesthesia has been used over the years for out-patient procedures, and in transurethral resection of the prostate gland in Nigeria since 1995. In a preliminary study involving 10 selected patients undergoing TURP, spontaneous voiding resumed on the operative day, and their discharge on the same day did not in any way lead to any adverse events. This larger series further confirms the safety of transurethral resection of the prostate gland as a day case procedure. METHOD One hundred and eighty patients with obstructing benign prostatic enlargement on urethral catheter drainage with prostate glands weighing 60g or less on ultrasound assessment, were subjected to transurethral resection of the prostate gland (TURP) as day-cases under caudal block regional anesthesia using 2% xylocaine with 1 in 80,000 adrenaline. Hemostasis was secured until effluent of the irrigation fluid from the bladder was totally free of any visible trace of blood. A catheter was not inserted postoperatively. The patients were discharged on the same day after they had satisfactorily voided. RESULTS These patients resumed spontaneous voiding postoperatively before discharge on the operative day. Their discharge on the same day did not in any way lead to any adverse events. CONCLUSIONS With a better understanding of the anatomy of the innervations and blood supply of the prostate gland, and proper patient selection, this larger series has confirmed that day-case TURP without postoperative catheterization can now be safely added to the list of day case procedures.
Integration of Form across Saccadic Eye Movements

To perceive a stable world, one must somehow be able to relate visual information from successive fixations. Little is known, however, about the nature of the integrative process. By using a task which requires the integration of spatial position information from different fixations, it is demonstrated that visual information from previous fixations is preserved in a world-centered representation which is precise enough to support judgements of geometric shape. It is also shown that successive views are aligned with respect to common visual features, indicating that visual stability may be normally accomplished by a visual matching strategy in combination with cancellation by an eye-position signal.