bluuebunny/crossref_metadata_2025 huggingface dataset:
Social wireless sensor network toward device-to-device interactive Internet of Things services
Authors: Kim Sunme , Yim Yongbin , Oh Seungmin , Kim Sang-Ha
Published: September 2016

As wireless sensor networks have been typically designed for monitoring of environments or habitats, all sensed data flow down toward fixed sinks. With the proliferation of Internet of Things, a variety of services require that data should be delivered not to the fixed sinks but directly to operator-specified devices, such as actuators and inside sensor fields. Then, the data will directly trigger interactive and immediate actions at the devices for the services. We call this kind of service as a device-to-device interactive Internet of Things service. However, the wireless sensor networks with fixed architecture could not support the device-to-device interactive services. The services might have the sociality based on the service-specific organic relationships between sensor and device, or between devices according to the purpose of the service. Social wireless sensor network is the architecture and mechanism to define the organic relationships of sensing data and the flow of data per service dynamically and flexibly over wireless sensor networks. In this article, we propose the social wireless sensor network architecture, functions, and challenges to provide the sociality of the services over wireless sensor networks.
A scalable neighbor-based routing protocol for mobile ad hoc networks
Authors: Ejmaa Ali Mohamed E , Subramaniam Shamala , Zukarnain Zuriati Ahmad , Hanapi Zurina Mohd
Published: September 2016

Broadcasting is an essential and effective mechanism used to disseminate data on several types of networks such as mobile ad hoc network. Such method is adopted by a considerable number of routing protocols, in particular, in the route discovery stage since the broadcasting is easy to implement and certainly provides an ideal connectivity among nodes. However, the broadcasting increases the routing overhead, packet delay, which negativity affects the throughput due to the excessive use of the redundant Route REQuest message. In addition, the network is susceptible to so-called broadcast storm problem. Therefore, developing a new routing protocol, which is able to relieve the unnecessary Route REQuest messages while boosting the performance of the network, is required. In this article, a novel routing protocol for mobile ad hoc network, called scalable neighbor-based mobile routing, is proposed. The broadcasting in this protocol is governed by the inverse relation between the number of neighbors and the probability of the rebroadcasted Route REQuest messages. Extensive simulation experiments are carried out to evaluate the performance of the proposed protocol and to compare the state-of-the-art protocols, namely, neighbor coverage-based probabilistic rebroadcast, with the latest version of ad hoc on-demand distance vector protocol. Simulation results show that scalable neighbor-based mobile routing outperforms both protocols, the neighbor coverage-based probabilistic rebroadcast and the ad hoc on-demand distance vector, in terms of routing overhead, medium access control collision, end-to-end delay, packet delivery ratio, and energy consumption.
Evolutionary stable participation game of smartphones in crowdsourced sensing
Authors: Weng Zhengqiu , Chen Qinghua , Sun Yao
Published: September 2016

It is crucial to stimulate active participation of smartphone workers in crowdsourced sensing systems. This is due to the fact that it takes a smartphone worker considerable cost in terms of dedicated smartphone resources, human intervention, and possible privacy breach. Many incentive mechanisms have been proposed. However, existing incentive mechanisms suffer a serious common problem: they all assume full rationality of smartphone worker. Such fully rational smartphone workers are often too idealized! A smartphone worker may not be able to get the complete information and hence fails to compute the optimal strategy. In the real world, however, smartphone workers are usually bounded rational. Being bounded rational, a smartphone worker would not change the current strategy until its utility becomes too low. In this article, we propose an evolutionary stable participation game framework for crowdsourced sensing systems with smartphone workers of bounded rationality. Based on the evolutionary dynamics, we design and implement an evolutionary stable participation mechanism. It is proved that the system converges to an evolutionary equilibrium, which is globally asymptotically stable and robust to any degree of perturbations of the workers. Extensive simulation results show that the evolutionary participation mechanism leads the system to an evolutionary equilibrium quickly.
Core–periphery models for graphs based on their δ-hyperbolicity: An example using biological networks
Authors: Alrasheed Hend , Dragan Feodor F
Published: September 2016

Hyperbolicity is a global property of graphs that measures how close their structures are to trees in terms of their distances. It embeds multiple properties that facilitate solving several problems that found to be hard in the general graph form. In this paper, we investigate the hyperbolicity of graphs not only by considering Gromov’s notion of δ-hyperbolicity but also by analyzing its relationship to other graph’s parameters. This new perspective allows us to classify graphs with respect to their hyperbolicity and to show that many biological networks are hyperbolic. Then we introduce the eccentricity-based bending property which we exploit to identify the core vertices of a graph by proposing two models: the maximum-peak model and the minimum cover set model. In this extended version of the paper, we include some new theorems, as well as proofs of the theorems proposed in the conference paper. Also, we present the algorithms we used for each of the proposed core identification models, and we provide more analysis, explanations, and examples.
When the High School Coach Is a Bully
Authors: Wilson Kelley Miller
Published: September 2016

Though it is known that a minority of bully coaches exist, statistics regarding the actual prevalence of bully coaches in high schools are not well researched. School nurses may be placed in a consultative role with student athletes and their family members. Resource availability and suggestions for a plan of action are important for the school nurse. Support and encouragement for student athletes is critical for the development of positive mental health for young adults; therefore, families, peers, school personnel, and school nurses must all work together to produce positive sports experiences for high school age students.
Why Do We Pin? New Gratifications Explain Unique Activities in Pinterest
Authors: Wang Ruoxu , Yang Fan , Zheng Saijing , Sundar S. Shyam
Published: September 2016

Pinterest is now the fourth most popular social network site after Facebook, Twitter, and LinkedIn in the United States, offering its own suite of functions. This study investigated why individuals use specific features of Pinterest such as pinning, creating, liking, following, commenting, inviting, sharing, checking, searching, and browsing different categories. An online survey ( N = 113) revealed that a brand new set of gratifications (specific to digital media) predicted a large number of user behaviors in Pinterest. The results showcased the predictive value of affordance-based gratifications in shaping specific user behaviors on social-media.
Organizational Structure as a Determinant of Job Burnout
Authors: Bilal Atif , Ahmed Hafiz Mushtaq
Published: September 2016

This exploratory study determined the impact of organizational structure, particularly participation in decision making, instrumental communication, formalization, integration, and promotional opportunity, on burnout among Pakistani pediatric nurses. Data were collected from pediatric nurses working for Punjab’s largest state-run hospital. The findings revealed that participation in decision making, instrumental communication, and promotional opportunity prevented burnout. Formalization contributed to burnout but integration was not related to burnout. Quite interestingly, except for supervisory status, most control variables for this study were not significantly related to emotional burnout. Hence, the hypothesis that organizational structure is a determinant of job burnout was accepted.
Material properties of Islamic paper
Authors: Mahgoub Hend , Bardon Tiphaine , Lichtblau Dirk , Fearn Tom , Strlič Matija
Published: September 2016

In contrast to scientific research focussing on European paper, there is a significant gap in our knowledge of Islamic papermaking. This research surveys the evidence of techniques and materials typically used in Islamic papermaking, to deduce what might be considered as the most significant characteristics. A substantial collection of 228 Islamic papers (~18th–20th century) was characterized using chemical analytical methods: surface profilometry, gloss measurements, specular vs. diffuse reflectance ratio at 457 nm, scanning electron microscopy and infrared spectroscopy for identification of polishing, iodine test for identification of starch, Raspail test for identification of rosin, and fibre furnish analysis. Morphological analysis was performed to examine the presence of watermarks and sieve patterns. In addition, acidity and degree of polymerization of cellulose in paper were determined to explore the average material state of paper in the collection. Near infrared spectroscopic data of the collection were correlated to chemical properties with the aid of multivariate data analysis methods. Four different models were developed focusing on two main characteristics of Islamic paper: two for identification of polishing and starch, and two quantitative models to determine the acidity and degree of polymerization of cellulose in paper. While no single defining characteristic of Islamic paper was identified, 88 % of all papers in the studied collection either contain starch or are polished, or both. ~2 % of papers contain rosin. The majority of papers are neutral to mildly acidic, which is in contrast to their extensive degradation: ~69 % have DP < 1000. Polishing and starch appear to be associated with current values of pH and DP. The developed non-destructive characterization methodology could be applied to Islamic collections in libraries and archives to expand the database with the material properties of papers of known age and provenance and thus better understand geographic and temporal distributions of papermaking practices in Islamic countries.
Complete genome sequence of Halomonas sp. R5-57
Authors: Williamson Adele , De Santi Concetta , Altermark Bjørn , Karlsen Christian , Hjerde Erik
Published: September 2016

The marine Arctic isolate Halomonas sp. R5-57 was sequenced as part of a bioprospecting project which aims to discover novel enzymes and organisms from low-temperature environments, with potential uses in biotechnological applications. Phenotypically, Halomonas sp. R5-57 exhibits high salt tolerance over a wide range of temperatures and has extra-cellular hydrolytic activities with several substrates, indicating it secretes enzymes which may function in high salinity conditions. Genome sequencing identified the genes involved in the biosynthesis of the osmoprotectant ectoine, which has applications in food processing and pharmacy, as well as those involved in production of polyhydroxyalkanoates, which can serve as precursors to bioplastics. The percentage identity of these biosynthetic genes from Halomonas sp. R5-57 and current production strains varies between 99 % for some to 69 % for others, thus it is plausible that R5-57 may have a different production capacity to currently used strains, or that in the case of PHAs, the properties of the final product may vary. Here we present the finished genome sequence (LN813019) of Halomonas sp. R5-57 which will facilitate exploitation of this bacterium; either as a whole-cell production host, or by recombinant expression of its individual enzymes.
Interferon regulatory factor 4 (IRF4) controls myeloid-derived suppressor cell (MDSC) differentiation and function
Authors: Nam Sorim , Kang Kyeongah , Cha Jae Seon , Kim Jung Woo , Lee Hee Gu , Kim Yonghwan , Yang Young , Lee Myeong-Sok , Lim Jong-Seok
Published: September 2016

Myeloid-derived suppressor cells (MDSCs) are immature cells that do not differentiate into mature myeloid cells. Two major populations of PMN-MDSCs (Ly6GhighLy6ClowGr1highCD11b+) and MO-MDSCs (Ly6G−Ly6ChighGr-1intCD11b+) have an immune suppressive function. Interferon regulatory factor 4 (IRF4) has a role in the negative regulation of TLR signaling and is associated with lymphoid cell development. However, the roles of IRF4 in myeloid cell differentiation are unclear. In this study, we found that IRF4 expression was remarkably suppressed during the development of MDSCs in the tumor microenvironment. Both the mRNA and protein levels of IRF4 in MDSCs were gradually reduced, depending on the development of tumors in the 4T1 model. siRNA-mediated knockdown of IRF4 in bone marrow cells promoted the differentiation of PMN-MDSCs. Similarly, IRF4 inhibition in bone marrow cells using simvastatin, which has been known to inhibit IRF4 expression, increased PMN-MDSC numbers. In contrast, IRF4 overexpression in bone marrow cells inhibited the total numbers of MDSCs, especially PMN-MDSCs. Notably, treatment with IL-4, an upstream regulator of IRF4, induced IRF4 expression in the bone marrow cells, and consequently, IL-4–induced IRF4 expression resulted in a decrease in PMN-MDSC numbers. Finally, we confirmed that IRF4 expression in MDSCs can modulate their activity to inhibit T cell proliferation through IL-10 production and ROS generation, and myeloid-specific deletion of IRF4 leads to the increase of MDSC differentiation. Our present findings indicate that IRF4 reduction induced by tumor formation can increase the number of MDSCs, and increases in the IRF4 expression in MDSCs may infringe on the immune-suppressive function of MDSCs.
Selenoprotein K regulation of palmitoylation and calpain cleavage of ASAP2 is required for efficient FcγR-mediated phagocytosis
Authors: Norton Robert L , Fredericks Gregory J , Huang Zhi , Fay Jeffrey D , Hoffmann FuKun W , Hoffmann Peter R
Published: September 2016

Effective activation of macrophages through phagocytic Fcγ receptors (FcγR) has been shown to require selenoprotein K (Selk). We set out to determine whether the FcγR-mediated uptake process itself also requires Selk and potential underlying mechanisms. Macrophages from Selk knockout (KO) mice were less efficient compared with wild-type (WT) controls in engulfing IgG-coated fluorescent beads. Using LC-MS/MS to screen for Selk-binding partners involved in FcγR-mediated phagocytosis, we identified Arf-GAP with SH3 domain, ANK repeat, and PH domain-containing protein 2 (ASAP2). Coimmunoprecipitation assays confirmed interactions between Selk and ASAP2. Selk was required for ASAP2 to be cleaved by calpain-2 within the Bin/Amphiphysin/Rvs (BAR) domain of ASAP2. BAR domains promote membrane association, which was consistent with our data showing that Selk deficiency led to retention of ASAP2 within the phagocytic cup. Because Selk was recently identified as a cofactor for the palmitoylation of certain proteins, we investigated whether ASAP2 was palmitoylated and whether this was related to its cleavage by calpain-2. Acyl/biotin exchange assays and MALDI-TOF analysis showed that cysteine-86 in ASAP2 was palmitoylated in WT, but to a much lesser extent in KO, mouse macrophages. Inhibitors of either palmitoylation or calpain-2 cleavage and rescue experiments with different versions of Selk demonstrated that Selk-dependent palmitoylation of ASAP2 leads to cleavage by calpain-2 within the BAR domain, which releases this protein from the maturing phagocytic cup. Overall, these findings identify ASAP2 as a new target of Selk-dependent palmitoylation and reveal a new mechanism regulating the efficiency of FcγR-mediated phagocytosis.
NK cells regulate CXCR2+ neutrophil recruitment during acute lung injury
Authors: Hoegl Sandra , Ehrentraut Heidi , Brodsky Kelley S , Victorino Francisco , Golden-Mason Lucy , Eltzschig Holger K , McNamee Eóin N
Published: September 2016

A critical step in the pathogenesis of acute lung injury (ALI) is excessive recruitment of polymorphonuclear neutrophils (PMNs) into the lungs, causing significant collateral tissue damage. Defining the molecular and cellular steps that control neutrophil infiltration and activation during ALI is therefore of important therapeutic relevance. Based on previous findings implicating the transcription factor Tbet in mucosal Th1-inflammation, we hypothesized a detrimental role for Tbet during ALI. In line with our hypothesis, initial studies of endotoxin-induced lung injury revealed a marked protection of Tbet−/− mice, including attenuated neutrophilia compared to WT counterparts. Surprisingly, subsequent studies identified natural killer (NK) cells as the major source of pulmonary Tbet during ALI. In addition, a chemokine screen suggested that mature Tbet+ NK-cells are critical for the production of pulmonary CXCL1 and -2, thereby contributing to pulmonary PMN recruitment. Indeed, both NK-cell Ab depletion and adoptive transfer studies provide evidence for NK cells in the orchestration of neutrophil recruitment during endotoxin-induced ALI. Taken together, these findings identify a novel role for Tbet+ NK-cells in initiating the early events of noninfectious pulmonary inflammation.
Health-Related Quality-of-Life Results From the Open-Label, Randomized, Phase III ASPIRE Trial Evaluating Carfilzomib, Lenalidomide, and Dexamethasone Versus Lenalidomide and Dexamethasone in Patients With Relapsed Multiple Myeloma
Authors: Stewart A. Keith , Dimopoulos Meletios A. , Masszi Tamás , Špička Ivan , Oriol Albert , Hájek Roman , Rosiñol Laura , Siegel David S. , Niesvizky Ruben , Jakubowiak Andrzej J. , San-Miguel Jesus F. , Ludwig Heinz , Buchanan Jacqui , Cocks Kim , Yang Xinqun , Xing Biao , Zojwalla Naseem , Tonda Margaret , Moreau Philippe , Palumbo Antonio
Published: September 2016

Purpose

To determine the effects of carfilzomib, lenalidomide, and dexamethasone (KRd) versus lenalidomide and dexamethasone (Rd) on health-related quality of life (HR-QoL) in the Carfilzomib, Lenalidomide, and Dexamethasone Versus Lenalidomide and Dexamethasone for the Treatment of Patients With Relapsed Multiple Myeloma (ASPIRE) trial.

Methods

Patients with relapsed multiple myeloma were randomly assigned to receive KRd or Rd. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 and myeloma-specific module were administered at baseline; day 1 of cycles 3, 6, 12, and 18; and after treatment. The Global Health Status/Quality of Life (GHS/QoL) scale and seven subscales (fatigue, nausea and vomiting, pain, physical functioning, role functioning, disease symptoms, and adverse effects of treatment) were compared between groups using a mixed model for repeated measures. The percentages of responders with ≥ 5- or 15-point GHS/QoL improvement at each cycle were compared between groups.

Results

Baseline questionnaire compliance was excellent (94.1% of randomly assigned patients). KRd patients had higher GHS/QoL scores versus Rd patients over 18 treatment cycles (two-sided P < .001). The minimal important difference was met at cycle 12 (5.6 points) and approached at cycle 18 (4.8 points). There was no difference between groups for the other prespecified subscales from ASPIRE. A higher proportion of KRd patients met the GHS/QoL responder definition (≥ 5-point improvement) with statistical differences at cycle 12 (KRd v Rd patients, 25.5% v 17.4%, respectively) and 18 (KRd v Rd patients, 24.2% v 12.9%, respectively).

Conclusion

KRd improves GHS/QoL without negatively affecting patient-reported symptoms when compared with Rd. These data further support the benefit of KRd in patients with relapsed multiple myeloma.
Clinical Effects of Driver Somatic Mutations on the Outcomes of Patients With Myelodysplastic Syndromes Treated With Allogeneic Hematopoietic Stem-Cell Transplantation
Authors: Della Porta Matteo G. , Gallì Anna , Bacigalupo Andrea , Zibellini Silvia , Bernardi Massimo , Rizzo Ettore , Allione Bernardino , van Lint Maria Teresa , Pioltelli Pietro , Marenco Paola , Bosi Alberto , Voso Maria Teresa , Sica Simona , Cuzzola Mariella , Angelucci Emanuele , Rossi Marianna , Ubezio Marta , Malovini Alberto , Limongelli Ivan , Ferretti Virginia V. , Spinelli Orietta , Tresoldi Cristina , Pozzi Sarah , Luchetti Silvia , Pezzetti Laura , Catricalà Silvia , Milanesi Chiara , Riva Alberto , Bruno Benedetto , Ciceri Fabio , Bonifazi Francesca , Bellazzi Riccardo , Papaemmanuil Elli , Santoro Armando , Alessandrino Emilio P. , Rambaldi Alessandro , Cazzola Mario
Published: September 2016

Purpose

The genetic basis of myelodysplastic syndromes (MDS) is heterogeneous, and various combinations of somatic mutations are associated with different clinical phenotypes and outcomes. Whether the genetic basis of MDS influences the outcome of allogeneic hematopoietic stem-cell transplantation (HSCT) is unclear.

Patients and Methods

We studied 401 patients with MDS or acute myeloid leukemia (AML) evolving from MDS (MDS/AML). We used massively parallel sequencing to examine tumor samples collected before HSCT for somatic mutations in 34 recurrently mutated genes in myeloid neoplasms. We then analyzed the impact of mutations on the outcome of HSCT.

Results

Overall, 87% of patients carried one or more oncogenic mutations. Somatic mutations of ASXL1, RUNX1, and TP53 were independent predictors of relapse and overall survival after HSCT in both patients with MDS and patients with MDS/AML (P values ranging from .003 to .035). In patients with MDS/AML, gene ontology (ie, secondary-type AML carrying mutations in genes of RNA splicing machinery, TP53-mutated AML, or de novo AML) was an independent predictor of posttransplantation outcome (P = .013). The impact of ASXL1, RUNX1, and TP53 mutations on posttransplantation survival was independent of the revised International Prognostic Scoring System (IPSS-R). Combining somatic mutations and IPSS-R risk improved the ability to stratify patients by capturing more prognostic information at an individual level. Accounting for various combinations of IPSS-R risk and somatic mutations, the 5-year probability of survival after HSCT ranged from 0% to 73%.

Conclusion

Somatic mutation in ASXL1, RUNX1, or TP53 is independently associated with unfavorable outcomes and shorter survival after allogeneic HSCT for patients with MDS and MDS/AML. Accounting for these genetic lesions may improve the prognostication precision in clinical practice and in designing clinical trials.
Cautionary Note on Using Cross-Validation for Molecular Classification
Authors: Qin Li-Xuan , Huang Huei-Chung , Begg Colin B.
Published: September 2016

Purpose

Reproducibility of scientific experimentation has become a major concern because of the perception that many published biomedical studies cannot be replicated. In this article, we draw attention to the connection between inflated overoptimistic findings and the use of cross-validation for error estimation in molecular classification studies. We show that, in the absence of careful design to prevent artifacts caused by systematic differences in the processing of specimens, established tools such as cross-validation can lead to a spurious estimate of the error rate in the overoptimistic direction, regardless of the use of data normalization as an effort to remove these artifacts.

Methods

We demonstrated this important yet overlooked complication of cross-validation using a unique pair of data sets on the same set of tumor samples. One data set was collected with uniform handling to prevent handling effects; the other was collected without uniform handling and exhibited handling effects. The paired data sets were used to estimate the biologic effects of the samples and the handling effects of the arrays in the latter data set, which were then used to simulate data using virtual rehybridization following various array-to-sample assignment schemes.

Results

Our study showed that (1) cross-validation tended to underestimate the error rate when the data possessed confounding handling effects; (2) depending on the relative amount of handling effects, normalization may further worsen the underestimation of the error rate; and (3) balanced assignment of arrays to comparison groups allowed cross-validation to provide an unbiased error estimate.

Conclusion

Our study demonstrates the benefits of balanced array assignment for reproducible molecular classification and calls for caution on the routine use of data normalization and cross-validation in such analysis.
Timing Is Everything: What Is the Optimal Duration After Chemoradiation for Surgery for Rectal Cancer?
Authors: Goodman Karyn A.
Published: September 2016

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology , to patients seen in their own clinical practice.

A 47-year-old woman was referred for management of a newly diagnosed rectal cancer. She presented with a 2-month history of rectal bleeding and change in bowel habits. She underwent a colonoscopy that demonstrated a 5-cm fungating, friable, and partially obstructing mass in the distal rectum, approximately 5 cm from the anal verge. The tumor was palpable on digital rectal examination on the anterior wall of rectum. The biopsy demonstrated a moderately differentiated invasive adenocarcinoma, microsatellite stable. A staging work-up, including a computed tomography scan of the chest, abdomen, and pelvis, demonstrated rectal wall thickening in the midrectum and small lymph nodes in the left perirectal fat. There was a nonspecific 3-mm right lower lobe pulmonary nodule. Rectal magnetic resonance imaging demonstrated a 3-cm mass arising from mid-distal rectum with minimal extension beyond muscularis propria into the mesorectal fat, but without invasion of mesorectal fascia ( Fig 1 ). There were at least three small mesorectal lymph nodes present; the largest rounded node measured up to 5 mm, and no additional pelvic lymphadenopathy was identified. Her carcinoembryonic antigen was 1.1, and all other laboratory studies were within normal limits. She was seen in the Colorectal Multidisciplinary Conference for a discussion of her treatment options.
Public Reporting of Hospital-Level Cancer Surgical Volumes in California: An Opportunity to Inform Decision Making and Improve Quality
Authors: Clarke Christina A. , Asch Steven M. , Baker Laurence , Bilimoria Karl , Dudley R. Adams , Fong Niya , Holliday-Hanson Merry L. , Hopkins David S.P. , Imholz Elizabeth M. , Malin Jennifer , Moy Lisa , O’Sullivan Maryann , Parker Joseph P. , Saigal Christopher S. , Spurlock Bruce , Teleki Stephanie , Zingmond David , Lang Lance
Published: September 2016

Purpose:

Most patients, providers, and payers make decisions about cancer hospitals without any objective data regarding quality or outcomes. We developed two online resources allowing users to search and compare timely data regarding hospital cancer surgery volumes.

Methods:

Hospital cancer surgery volumes for all California hospitals were calculated using ICD-9 coded hospital discharge summary data. Cancer surgeries included (bladder, brain, breast, colon, esophagus, liver, lung, pancreas, prostate, rectum, and stomach) were selected on the basis of a rigorous literature review to confirm sufficient evidence of a positive association between volume and mortality. The literature could not identify threshold numbers of surgeries associated with better or worse outcomes. A multidisciplinary working group oversaw the project and ensured sound methodology.

Results:

In California in 2014, about 60% of surgeries were performed at top-quintile–volume hospitals, but the per-hospital median numbers of surgeries for esophageal, pancreatic, stomach, liver, or bladder cancer surgeries were four or fewer. At least 670 patients received cancer surgery at hospitals that performed only one or two surgeries for a particular cancer type; 72% of those patients lived within 50 miles of a top-quintile–volume hospital.

Conclusion:

There is clear potential for more readily available information about hospital volumes to help patient, providers, and payers choose cancer surgery hospitals. Our successful public reporting of hospital volumes in California represents an important first step toward making publicly available even more provider-specific data regarding cancer care quality, costs, and outcomes, so those data can inform decision-making and encourage quality improvement.
Increase in Cancer Center Staff Effort Related to Electronic Patient Portal Use
Authors: Laccetti Andrew L. , Chen Beibei , Cai Jennifer , Gates Samantha , Xie Yang , Lee Simon J. Craddock , Gerber David E.
Published: September 2016

Purpose:

Electronic portals provide patients with real-time access to personal health records. Use of this technology by individuals with cancer is particularly intensive. We therefore examined patterns of use of electronic portals by clinic staff at a National Cancer Institute–designated comprehensive cancer center.

Methods:

We identified and characterized cancer center providers and clinic staff who performed electronic activities related to MyChart, the institution’s personal health records portal, from 2009 to 2014. Total MyChart actions and messages received were quantified and characterized according to type, timing, and staff category.

Results:

Two hundred eighty-nine employees were included in our analysis: 85 nurses (29%), 79 ancillary staff (27%), 49 clerical/managerial staff (17%), 47 physicians (16%), and 29 advanced practice providers (10%). These individuals performed 740,613 MyChart actions and received 117,799 messages. Seventy-seven percent of actions were performed by nurses, 11% by ancillary staff, 6% by advanced practice providers, 5% by physicians, and 1% by clerical/managerial staff. From 2011 to 2014, staff MyChart activity increased approximately 10-fold. On average, 6.3 staff MyChart actions were performed per patient-initiated message. In 2014, nurses performed an average of 3,838 MyChart actions and received an average of 589 messages, compared with 591 actions and 87 messages in 2011 ( P < .001). Sixteen percent of all actions occurred outside clinic hours.

Conclusion:

Cancer center employee effort related to an electronic patient portal has increased markedly over time, particularly among nursing staff. Because further uptake of this technology is expected, it is critical to consider potential effects on clinical resources, employee and patient satisfaction, and patient safety.
No Exit: Identifying Avoidable Terminal Oncology Intensive Care Unit Hospitalizations
Authors: Daly Bobby , Hantel Andrew , Wroblewski Kristen , Balachandran Jay S. , Chow Selina , DeBoer Rebecca , Fleming Gini F. , Hahn Olwen M. , Kline Justin , Liu Hongtao , Patel Bhakti K. , Verma Anshu , Witt Leah J. , Fukui Mayumi , Kumar Aditi , Howell Michael D. , Polite Blase N.
Published: September 2016

Purpose:

Terminal oncology intensive care unit (ICU) hospitalizations are associated with high costs and inferior quality of care. This study identifies and characterizes potentially avoidable terminal admissions of oncology patients to ICUs.

Methods:

This was a retrospective case series of patients cared for in an academic medical center’s ambulatory oncology practice who died in an ICU during July 1, 2012 to June 30, 2013. An oncologist, intensivist, and hospitalist reviewed each patient’s electronic health record from 3 months preceding terminal hospitalization until death. The primary outcome was the proportion of terminal ICU hospitalizations identified as potentially avoidable by two or more reviewers. Univariate and multivariate analysis were performed to identify characteristics associated with avoidable terminal ICU hospitalizations.

Results:

Seventy-two patients met inclusion criteria. The majority had solid tumor malignancies (71%), poor performance status (51%), and multiple encounters with the health care system. Despite high-intensity health care utilization, only 25% had documented advance directives. During a 4-day median ICU length of stay, 81% were intubated and 39% had cardiopulmonary resuscitation. Forty-seven percent of these hospitalizations were identified as potentially avoidable. Avoidable hospitalizations were associated with factors including: worse performance status before admission (median 2 v 1; P = .01), worse Charlson comorbidity score (median 8.5 v 7.0, P = .04), reason for hospitalization (P = .006), and number of prior hospitalizations (median 2 v 1; P = .05).

Conclusion:

Given the high frequency of avoidable terminal ICU hospitalizations, health care leaders should develop strategies to prospectively identify patients at high risk and formulate interventions to improve end-of-life care.
Delivery of Quality Oncology Care in a Large, Urban Practice: A Primer
Authors: Holcombe Randall F. , Evangelista Michelle , Cartwright Frances
Published: September 2016

A comprehensive quality improvement program is critically important for participation in value-based reimbursement models. Seven essential characteristics must be addressed in the development of a cancer-focused quality program. These include leadership, environment, engagement, ethos, metrics, accountability, and sustainability (Q=LE3MAS). This article describes how to address each essential characteristic and provides examples from the experience at Mount Sinai Hospital, a large, urban, academic hospital/health system in New York City.
Mechanisms Underlying the Pathogenesis of Isolated Impaired Glucose Tolerance in Humans
Authors: Varghese Ron T. , Dalla Man Chiara , Sharma Anu , Viegas Ivan , Barosa Cristina , Marques Catia , Shah Meera , Miles John M. , Rizza Robert A. , Jones John G. , Cobelli Claudio , Vella Adrian
Published: September 2016

Context:

Prediabetes is a heterogeneous disorder classified on the basis of fasting glucose concentrations and 2-hour glucose tolerance.

Objective:

We sought to determine the relative contributions of insulin secretion and action to the pathogenesis of isolated impaired glucose tolerance (IGT).

Design:

The study consisted of an oral glucose tolerance test and a euglycemic clamp performed in two cohorts matched for anthropometric characteristics and fasting glucose but discordant for glucose tolerance.

Setting:

An inpatient clinical research unit at an academic medical center.

Patients or Other Participants:

Twenty-five subjects who had normal fasting glucose (NFG) and normal glucose tolerance (NGT) and 19 NFG/IGT subjects participated in this study.

Intervention(s):

Subjects underwent a seven-sample oral glucose tolerance test and a 4-hour euglycemic, hyperinsulinemic clamp on separate occasions. Glucose turnover during the clamp was measured using tracers, and endogenous hormone secretion was inhibited by somatostatin.

Main Outcome Measures:

We sought to determine whether hepatic glucose metabolism, specifically the contribution of gluconeogenesis to endogenous glucose production, differed between subjects with NFG/NGT and those with NFG/IGT.

Results:

Endogenous glucose production did not differ between groups before or during the clamp. Insulin-stimulated glucose disappearance was lower in NFG/IGT (24.6 ± 2.2 vs 35.0 ± 3.6 μmol/kg/min; P = .03). The disposition index was decreased in NFG/IGT (681 ± 102 vs 2231 ± 413 × 10−14 dL/kg/min2 per pmol/L; P < .001).

Conclusions:

We conclude that innate defects in the regulation of glycogenolysis and gluconeogenesis do not contribute to NFG/IGT. However, insulin-stimulated glucose disposal is impaired, exacerbating defects in β-cell function.
Identification of Multiple Gene Mutations Accounts for a new Genetic Architecture of Primary Ovarian Insufficiency
Authors: Bouilly Justine , Beau Isabelle , Barraud Sara , Bernard Valérie , Azibi Kemal , Fagart Jérôme , Fèvre Anne , Todeschini Anne Laure , Veitia Reiner A. , Beldjord Chérif , Delemer Brigitte , Dodé Catherine , Young Jacques , Binart Nadine
Published: September 2016

Context:

Idiopathic primary ovarian insufficiency (POI) is a major cause of amenorrhea and infertility. POI affects 1% of women before age 40 years, and several genetic causes have been reported. To date, POI has been considered a monogenic disorder.

Objective:

The aim of this study was to identify novel gene variations and to investigate if individuals with POI harbor mutation in multiple loci.

Patients and Methods:

One hundred well-phenotyped POI patients were systematically screened for variants in 19 known POI loci (and potential candidate genes) using next-generation sequencing.

Results:

At least one rare protein-altering gene variant was identified in 19 patients, including missense mutations in new candidate genes, namely SMC1β and REC8 (involved in the cohesin complex) and LHX8, a gene encoding a transcription factor. Novel or recurrent deleterious mutations were also detected in the known POI candidate genes NOBOX, FOXL2, SOHLH1, FIGLA, GDF9, BMP15, and GALT. Seven patients harbor mutations in two loci, and this digenicity seems to influence the age of symptom onset.

Conclusions:

Genetic anomalies in women with POI are more frequent than previously believed. Digenic findings in several cases suggest that POI is not a purely monogenic disorder and points to a role of digenicity. The genotype-phenotype correlations in some kindreds suggest that a synergistic effect of several mutations may underlie the POI phenotype.
The Relationship Between Preoperative Clinical Presentation and Quantitative Magnetic Resonance Imaging Features in Patients With Degenerative Cervical Myelopathy
Authors: Nouri Aria , Tetreault Lindsay , Dalzell Kristian , Zamorano Juan J. , Fehlings Michael G.
Published: September 2016

BACKGROUND: Degenerative cervical myelopathy encompasses a group of conditions resulting in progressive spinal cord injury through static and dynamic compression. Although a constellation of changes can present on magnetic resonance imaging (MRI), the clinical significance of these findings remains a subject of controversy and discussion.

OBJECTIVE: To investigate the relationship between clinical presentation and quantitative MRI features in patients with degenerative cervical myelopathy.

METHODS: A secondary analysis of MRI and clinical data from 114 patients enrolled in a prospective, multicenter study was conducted. MRIs were assessed for maximum spinal cord compression (MSCC), maximum canal compromise (MCC), signal changes, and a signal change ratio (SCR). MRI features were compared between patients with and those without myelopathy symptoms with the use of t tests. Correlations between MRI features and duration of symptoms were assessed with the Spearman ρ.

RESULTS: Numb hands and Hoffmann sign were associated with greater MSCC (P < .05); broad-based, unstable gait, impairment of gait, and Hoffmann sign were associated with greater MCC (P < .05); and numb hands, Hoffmann sign, Babinski sign, lower limb spasticity, hyperreflexia, and T1 hypointensity were associated with greater SCR (P < .05). Patients with a T2 signal hyperintensity had greater MSCC and MCC (P < .001).

CONCLUSION: MSCC was associated with upper limb manifestations, and SCR was associated with upper limb, lower limb, and general neurological deficits. Hoffmann sign occurred more commonly in patients with a greater MSCC, MCC and SCR. The Lhermitte phenomenon presented more commonly in patients with a lower SCR and may be an early indicator of mild spinal cord involvement. Research to validate these findings is required.
The interplay between obesity and cancer: a fly view
Authors: Hirabayashi Susumu
Published: September 2016

Accumulating epidemiological evidence indicates a strong clinical association between obesity and an increased risk of cancer. The global pandemic of obesity indicates a public health trend towards a substantial increase in cancer incidence and mortality. However, the mechanisms that link obesity to cancer remain incompletely understood. The fruit fly Drosophila melanogaster has been increasingly used to model an expanding spectrum of human diseases. Fly models provide a genetically simpler system that is ideal for use as a first step towards dissecting disease interactions. Recently, the combining of fly models of diet-induced obesity with models of cancer has provided a novel model system in which to study the biological mechanisms that underlie the connections between obesity and cancer. In this Review, I summarize recent advances, made using Drosophila, in our understanding of the interplay between diet, obesity, insulin resistance and cancer. I also discuss how the biological mechanisms and therapeutic targets that have been identified in fly studies could be utilized to develop preventative interventions and treatment strategies for obesity-associated cancers.
Belief Elicitation with a Synchronized Lottery Choice Menu That Is Invariant to Risk Attitudes
Authors: Holt Charles A. , Smith Angela M.
Published: September 2016

This paper uses a Bayesian information processing task to compare belief elicitation mechanisms including a quadratic scoring rule, a Becker-DeGroot-Marschak pricing procedure, and a two-stage menu of lottery choices that is structured to identify a precise point of probability indifference. The choice menu yields a higher incidence of correct Bayesian responses and lower belief error averages. Unlike the quadratic scoring rule, the binary payoffs for the lottery choice mechanism are synchronized to provide theoretical incentive-compatibility regardless of risk attitudes. In addition, the choice menu structure is more transparent and intuitive than the Becker-DeGroot-Marschak procedure. (JEL C91, D44, D81, D83)
A Theory of Rational Demand for Index Insurance
Authors: Clarke Daniel J.
Published: September 2016

Rational demand for index insurance products is shown to be fundamentally different to that for indemnity insurance products due to the presence of basis risk. In particular, optimal demand is zero for infinitely risk-averse individuals, and is nonmonotonic in risk aversion, wealth, and price. For a given belief, upper bounds are derived for the optimal demand from risk-averse and decreasing absolute risk-averse decision makers. A simple ratio for monitoring basis risk is presented and applied to explain the low level of demand for consumer hedging instruments as a rational response to deadweight costs and basis risk. (JEL D14, D81, G13, G22, Q14)
Investing in Skill and Searching for Coworkers: Endogenous Participation in a Matching Market
Authors: Bidner Chris , Roger Guillaume , Moses Jessica
Published: September 2016

We demonstrate how search frictions have important yet subtle implications for participation in a skilled labor market by studying a model in which agents invest in skill prior to searching for coworkers. Search frictions induce the existence of acceptance-constrained equilibria, whereby matching concerns—as opposed to investment costs—dissuade the marginal agent from investing and participating in the skilled matching market. Such equilibria are robust, relevant, and have comparative static properties that contrast sharply with the intuitive properties arising in a benchmark static setting. We consider an extension with separate matching “marketplaces,” and show that our main results continue to hold. (JEL C78, D83, J24)
Exploitative Innovation
Authors: Heidhues Paul , Kőszegi Botond , Murooka Takeshi
Published: September 2016

We analyze innovation incentives when firms can invest either in increasing the product's value (value-increasing innovation) or in increasing the hidden prices they collect from naive consumers (exploitative innovation). We show that if firms cannot return all profits from hidden prices by lowering transparent prices, innovation incentives are often stronger for exploitative than for value-increasing innovations, and are strong even for non-appropriable innovations. These results help explain why firms in the financial industry (e.g., credit-card issuers) have been willing to make innovations others could easily copy, and why these innovations often seem to have included exploitative features. (JEL D21, G21, L11, L25, O31)
Internal Geography, International Trade, and Regional Specialization
Authors: Coşar A. Kerem , Fajgelbaum Pablo D.
Published: September 2016

We introduce an internal geography to the canonical model of international trade driven by comparative advantages to study the regional effects of external economic integration. The model features a dual-economy structure, in which locations near international gates specialize in export-oriented sectors while more distant locations do not trade with the rest of the world. The theory rationalizes patterns of specialization, employment, and relative incomes observed in developing countries that opened up to trade. We find regional specialization patterns consistent with the model in industry-level data from Chinese prefectures. (JEL F11, O18, P23, P25, P33, R12, R32)
Extended Unemployment Benefits and Early Retirement: Program Complementarity and Program Substitution
Authors: Inderbitzin Lukas , Staubli Stefan , Zweimüller Josef
Published: September 2016

We explore how extended unemployment insurance (UI) benefits for older workers affect early retirement and welfare. We argue that extending UI benefits generates program complementarity (more labor market exits and disability benefit take-up in the future) and program substitution (less disability benefit take-up in the present). Exploiting a policy change in Austria, which extended UI benefits to 4 years, we find program complementarity effects for workers aged 50+ and program substitution effects for workers aged 55+. We apply the Baily-Chetty formula for optimal UI to account for complementarity and substitution, showing that UI benefits for older workers were too generous. (JEL J14, J22, J26, J65)
The Strategic Value of Carbon Tariffs
Authors: Böhringer Christoph , Carbone Jared C. , Rutherford Thomas F.
Published: September 2016

We ask whether the threat of carbon tariffs might lower the cost of reductions in world carbon emissions by inducing unregulated regions to adopt emission controls. We use a numerical model to generate payoffs of a game in which a coalition regulates emissions and chooses whether to employ carbon tariffs against unregulated regions. Unregulated regions respond by abating, retaliating, or ignoring the tariffs. In the Nash equilibrium, the use of tariffs is a credible and effective threat. It induces cooperation from noncoalition regions that lowers the cost of global abatement substantially relative to the case where the coalition acts alone. (JEL D58, F13, F18, H23, Q54, Q58)
The Vulnerability of Minority Homeowners in the Housing Boom and Bust
Authors: Bayer Patrick , Ferreira Fernando , Ross Stephen L.
Published: September 2016

This paper examines mortgage outcomes for a large sample of individual home purchases and refinances linked to credit scores in seven major US markets. Among those with similar credit scores and loan attributes, black and Hispanic homeowners had much higher rates of delinquency and default in the downturn. These estimated differences are especially pronounced for loans originated near the peak of the housing boom. These findings suggest that black and Hispanic homeowners drawn into the market near the peak were especially vulnerable to adverse economic shocks and raise concerns about homeownership as a mechanism for reducing racial disparities in wealth. (JEL D14, J15, R23, R31, R38)