Purpose
To investigate the cost-effectiveness of carotid endarterectomy (CEA) vs.
carotid artery stenting (CAS) in terms of hospital reimbursement.
Methods
A retrospective analysis was conducted of ...hospital reimbursement for patients
undergoing CEA and CAS from 1 January 2008 through 30 September 2010 at a
single tertiary referral institution. Hospital cost and reimbursement were
assessed using patient-specific data gathered by the institution's
cost accounting system. Professional fees were excluded.
Results
Hospital reimbursement data were extracted for a total of 301 cases (169 CEA
and 132 CAS). Mean hospital reimbursement was 16% higher for CAS
($12,000±$7372) vs. CEA
($10,160±$6840, p=0.02). However, because of the
significantly higher cost of materials necessary to perform CAS, the net
revenue for the hospital was 29% greater in patients undergoing CEA
($3487) vs. CAS ($2603). The differences in hospital
reimbursement and net revenue were consistent in asymptomatic
(n=183), symptomatic (n=123), and urgent (n=36)
subgroups. When focusing on cases by diagnosis-related group (DRG) codes vs.
current procedural terminology (CPT) codes, the data shifted. Several
patients were coded as an outpatient procedure (DRG 0): 28 (21%) of
the 132 CAS patients and 7 (4%) of the 169 CEA patients, reducing
their mean reimbursement to $4046 and $2513, respectively. If
these patients were excluded, the mean hospital reimbursement differential
widened between and CEA ($10,515) and CAS ($13,825).
Conclusion
Hospital reimbursement for CAS is significantly higher than that for CEA.
While both procedures created net positive income for the hospital, CEA was
associated with a 29% higher net revenue due to the 40% cost
premium of CAS when looking at all carotid procedures. However, proper DRG
coding of CAS cases would have likely resulted in similar net revenue.
Asymptomatic patients had the lowest cost and highest net revenue of all the
subgroups. Per capita, significantly more healthcare resources were expended
with CAS when compared to CEA. Given the lack of improved clinical outcome
in most cases, CAS cannot be considered cost-effective for most
patients.
Disruption of normal ciliary function results in a range of diseases collectively referred to as ciliopathies. Here we report a child with a phenotype that overlapped with Joubert, ...oral-facial-digital, and Pallister-Hall syndromes including brain, limb, and craniofacial anomalies. We performed exome-sequence analysis on a proband and both parents, filtered for putative causative variants, and Sanger-verified variants of interest. Identified variants in
were functionally analyzed in a
system to determine their effect on ciliary function. Two variants in
were identified through exome-sequence analysis, Chr16:g.3558407T>G, c.338T>G, p.(Met113Arg) and Chr16:g.3570011C>T, c.688C>T, p.(Arg230Ter). These variants were rare in the Exome Aggregation Consortium (ExAC) data set of 65,000 individuals (one and two occurrences, respectively). Transfection of mutant
constructs into
embryos showed reduced protein levels p.(Arg230Ter) and reduced intraflagellar transport p.(Met113Arg). The genetic data show that these variants are present in an affected child, are rare in the population, and result in reduced, but not absent, intraflagellar transport. We conclude that biallelic mutations in
resulted in this novel ciliopathy syndrome in the proband.
With white blood cell count emerging as an important risk factor for chronic inflammatory diseases, genetic associations of differential leukocyte types, specifically monocyte count, are providing ...novel candidate genes and pathways to further investigate. Circulating monocytes play a critical role in vascular diseases such as in the formation of atherosclerotic plaque. We performed a joint and ancestry-stratified genome-wide association analyses to identify variants specifically associated with monocyte count in 11 014 subjects in the electronic Medical Records and Genomics Network. In the joint and European ancestry samples, we identified novel associations in the chromosome 16 interferon regulatory factor 8 (IRF8) gene (P-value = 2.78×10(-16), β = -0.22). Other monocyte associations include novel missense variants in the chemokine-binding protein 2 (CCBP2) gene (P-value = 1.88×10(-7), β = 0.30) and a region of replication found in ribophorin I (RPN1) (P-value = 2.63×10(-16), β = -0.23) on chromosome 3. The CCBP2 and RPN1 region is located near GATA binding protein2 gene that has been previously shown to be associated with coronary heart disease. On chromosome 9, we found a novel association in the prostaglandin reductase 1 gene (P-value = 2.29×10(-7), β = 0.16), which is downstream from lysophosphatidic acid receptor 1. This region has previously been shown to be associated with monocyte count. We also replicated monocyte associations of genome-wide significance (P-value = 5.68×10(-17), β = -0.23) at the integrin, alpha 4 gene on chromosome 2. The novel IRF8 results and further replications provide supporting evidence of genetic regions associated with monocyte count.
IJRP 10: Social Dynamics within Role-playing Communities
Table of Contents
Shekinah Hoffman, “Dedication”
This issue is dedicated to Dr. Matthew. M. LeClaire (1989-2018), with a special memorial from ...his close colleague Shekinah Hoffman, as well as biographical information about his many accomplishments from his parents, Guy M. and Mary Jo LeClaire.
Sarah Lynne Bowman, Evan Torner, and William J. White, “Editorial: Retrospective, Challenges, and Persistence”
This editorial discusses the history of the journal, including shifts in scope. The editors also thank the contributors and reviewers for their persistence in times of great challenge.
Aaron Trammell and Nikki Crenshaw, “The Damsel and the Courtesan: Quantifying Consent in Early Dungeons & Dragons”
This article applies critical gender theory to early fanzine discourse. The authors examine discussions around rules for sexual encounters that were seen to objectify women characters.
Steven L. Dashiell, “Hooligans at the Table: The Concept of Male Preserves in Tabletop Role-playing Games”
This paper examines sociolinguistics in tabletop role-playing communities, asserting that player behaviors such as “rules lawyering” and “gamesplaining” privilege exclusionary “nerd” masculinity.
William J. White, “Indie Gaming Meets the Nordic Scene: A Dramatistic Analysis”
This article analyzes a discussion between indie designers Ron Edwards from the Forge and Tobias Wrigstad from Jeepform. The author applies Kenneth Burke’s dramatic pendad to the rhetorical moves made by each participant.
Matthew M. LeClaire, “Live Action Role-playing: Transcending the Magic Circle”
This participant-observer ethnography examines the ways in which Dagorhir larpers explore identity and negotiate social dynamics withing their role-playing community.
Matthew Orr, Sara King, and Melissa McGonnell, “A Qualitative Exploration of the Perceived Social Benefits of Playing Table-top Role-playing Games”
This qualitative analysis discusses how participants perceived tabletop role-playing as beneficial to the development of their social competence.
Juliane Homann, “Not Only Play: Experiences of Playing a Professor Character at College of Wizardry with a Professional Background in Teaching”
This paper presents experiences of teachers who played professors at the larp College of Wizardry, applying concepts from studies of work and leisure.
The observing strategy of a galaxy survey influences the degree to which its resulting data can be used to accomplish any science goal. LSST is thus seeking metrics of observing strategies for ...multiple science cases in order to optimally choose a cadence. Photometric redshifts are essential for many extragalactic science applications of LSST's data, including but not limited to cosmology, but there are few metrics available, and they are not straightforwardly integrated with metrics of other cadence-dependent quantities that may influence any given use case. We propose a metric for observing strategy optimization based on the potentially recoverable mutual information about redshift from a photometric sample under the constraints of a realistic observing strategy. We demonstrate a tractable estimation of a variational lower bound of this mutual information implemented in a public code using conditional normalizing flows. By comparing the recoverable redshift information across observing strategies, we can distinguish between those that preclude robust redshift constraints and those whose data will preserve more redshift information, to be generically utilized in a downstream analysis. We recommend the use of this versatile metric to observing strategy optimization for redshift-dependent extragalactic use cases, including but not limited to cosmology, as well as any other science applications for which photometry may be modeled from true parameter values beyond redshift.
Stephanie J. Loomis1, Lana M. Olson2, Louis R. Pasquale1, Janey Wiggs1, Daniel Mirel3, Andrew Crenshaw3, Melissa Parkin3, Brandon Rahhal3, Stephanie Tetreault4, Peter Kraft4, Shelley S. Tworoger5, ...Jonathan L. Haines2 and Jae H. Kang51Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA. 2Center for Human Genetics Research, Vanderbilt University Medical Center, 2215 Garland Avenue, Nashville, Tennessee, 37232, USA. 3Center for Genotyping and Analysis, Broad Institute of Massachusetts Institute of Technology and Harvard University, 7 Cambridge Center, Cambridge, Massachusetts 02142, USA. 4Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115. 5Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115. AbstractIt is unclear if buccal cell samples contain sufficient human DNA with adequately sized fragments for high throughput genetic bioassays. Yet buccal cell sample collection is an attractive alternative to gathering blood samples for genetic epidemiologists engaged in large-scale genetic biomarker studies. We assessed the genotyping efficiency (GE) and genotyping concordance (GC) of buccal cell DNA samples compared to corresponding blood DNA samples, from 32 Nurses' Health Study (NHS) participants using the Illumina Infinium 660W-Quad platform. We also assessed how GE and GC accuracy varied as a function of DNA concentration using serial dilutions of buccal DNA samples. Finally we determined the nature and genomic distribution of discordant genotypes in buccal DNA samples. The mean GE of undiluted buccal cell DNA samples was high (99.32%), as was the GC between the paired buccal and blood samples (99.29%). GC between the dilutions versus the undiluted buccal DNA was also very high (.97%), though both GE and GC notably declined at DNA concentrations less than 5 ng/µl. Most (.95%) genotype determinations in buccal cell samples were of the "missing call" variety (as opposed to the "alternative genotype call" variety) across the spectrum of buccal DNA concentrations studied. Finally, for buccal DNA concentration above 1.7 ng/ul, discordant genotyping calls did not cluster in any particular chromosome. Buccal cell-derived DNA represents a viable alternative to blood DNA for genotyping on a high-density platform.
Scratch Encore Franklin, Diana; Weintrop, David; Palmer, Jennifer ...
Proceedings of the 51st ACM Technical Symposium on Computer Science Education,
02/2020
Conference Proceeding
While several introductory computer science curricula exist for children in K-8, there are few options that go beyond sequence, loops, and basic conditionals. The goal of this project is to not only ...fill this gap with a high-quality curriculum supported by complete instructional materials, but to also do so with an equity-balanced curriculum. That is, a curriculum that values advancing equity equally with student learning outcomes. In this paper, we introduce barriers to equity in public school classrooms, pedagogical approaches to culturally-relevant curricula, and how our Scratch Encore curriculum is designed to support equity-balanced learning. Finally, we present results of our pilot year, including early evidence of students taking advantage of the culturally-relevant design aspects.
It is unclear if buccal cell samples contain sufficient human DNA with adequately sized fragments for high throughput genetic bioassays. Yet buccal cell sample collection is an attractive alternative ...to gathering blood samples for genetic epidemiologists engaged in large-scale genetic biomarker studies. We assessed the genotyping efficiency (GE) and genotyping concordance (GC) of buccal cell DNA samples compared to corresponding blood DNA samples, from 32 Nurses' Health Study (NHS) participants using the Illumina Infinium 660W-Quad platform. We also assessed how GE and GC accuracy varied as a function of DNA concentration using serial dilutions of buccal DNA samples. Finally we determined the nature and genomic distribution of discordant genotypes in buccal DNA samples. The mean GE of undiluted buccal cell DNA samples was high (99.32%), as was the GC between the paired buccal and blood samples (99.29%). GC between the dilutions versus the undiluted buccal DNA was also very high (>97%), though both GE and GC notably declined at DNA concentrations less than 5 ng/mul. Most (>95%) genotype determinations in buccal cell samples were of the "missing call" variety (as opposed to the "alternative genotype call" variety) across the spectrum of buccal DNA concentrations studied. Finally, for buccal DNA concentration above 1.7 ng/ul, discordant genotyping calls did not cluster in any particular chromosome. Buccal cell-derived DNA represents a viable alternative to blood DNA for genotyping on a high-density platform.
It is unclear if buccal cell samples contain sufficient human DNA with adequately sized fragments for high throughput genetic bioassays. Yet buccal cell sample collection is an attractive alternative ...to gathering blood samples for genetic epidemiologists engaged in large-scale genetic biomarker studies. We assessed the genotyping efficiency (GE) and genotyping concordance (GC) of buccal cell DNA samples compared to corresponding blood DNA samples, from 32 Nurses' Health Study (NHS) participants using the Illumina Infinium 660W-Quad platform. We also assessed how GE and GC accuracy varied as a function of DNA concentration using serial dilutions of buccal DNA samples. Finally we determined the nature and genomic distribution of discordant genotypes in buccal DNA samples. The mean GE of undiluted buccal cell DNA samples was high (99.32%), as was the GC between the paired buccal and blood samples (99.29%). GC between the dilutions versus the undiluted buccal DNA was also very high (>97%), though both GE and GC notably declined at DNA concentrations less than 5 ng/μl. Most (>95%) genotype determinations in buccal cell samples were of the “missing call” variety (as opposed to the “alternative genotype call” variety) across the spectrum of buccal DNA concentrations studied. Finally, for buccal DNA concentration above 1.7 ng/ul, discordant genotyping calls did not cluster in any particular chromosome. Buccal cell-derived DNA represents a viable alternative to blood DNA for genotyping on a high-density platform.
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