Entire US Research Articles

Taming the Mobile Data Deluge With Drop Zones

Human communication has changed by the advent of smartphones. Using commonplace mobile device features, they started uploading large amounts of content that increases. This increase in demand will overwhelm capacity and limits the providers' ability to provide the quality of service demanded by their users. In the absence of technical solutions, cellular network providers are considering changing billing plans to address this. Our contributions are twofold. First, by analyzing user content upload behavior, we find that the user-generated content problem is a user behavioral problem. Particularly, by analyzing user mobility and data logs of 2 million users of one of the largest US cellular providers, we find that: 1) users upload content from a small number of locations; 2) because such locations are different for users, we find that the problem appears ubiquitous. However, we find that: 3) there exists a significant lag between content generation and uploading times, and 4) with respect to users, it is always the same users to delay. Second, we propose a cellular network architecture. Our approach proposes capacity upgrades at a select number of locations called Drop Zones. Although not particularly popular for uploads originally, Drop Zones seamlessly fall within the natural movement patterns of a large number of users. They are therefore suited for uploading larger quantities of content in a postponed manner. We design infrastructure placement algorithms and demonstrate that by upgrading infrastructure in only 963 base stations across the entire US, it is possible to deliver 50% of content via Drop Zones.

Macroeconomic costs to large scale disruptions of food production: The case of foot- and-mouth disease in the United States

We forecast the economic consequences of a widespread contamination of the food system based on a hypothetical outbreak of foot-and-mouth disease (FMD). Since the immediate effect on the livestock sector could affect the entire supply chain and US livestock, meat and dairy exports, we measure these impacts using GTAP, a multi-region, multi-sector computable general equilibrium (CGE) model of the global economy. The immediate “shocks” to the US livestock, raw milk and other animal products sectors indirectly affect all sectors of the economy, as well as international markets and trade. We decompose these effects due to each component of the initial shocks, and estimate the importance of these shocks to the national food system for the Mid-Atlantic Region using IMPLAN. Our GTAP results indicate that losses to the USA economy would be about $11.7 billion, and with the ripple effect throughout the rest of the world including beneficiary nations (Argentina, Brazil, Latin America, Australia and New Zealand) and losers (Canada, Mexico, European Union) would be 14.1 billion. We estimate the proportion of the domestic impact affecting the Mid-Atlantic Region. Based on a regional input–output model of that region, we estimate that total losses in value added are nearly $800 million; losses in labor income total about $565 million; and there are job losses of just over 12 thousand.

Invited Commentary: Influenza Vaccine and Guillain-Barre Syndrome--Is There a Risk?

After a new reassortant swine influenza A H1N1 virus caused outbreaks in Mexico and the United States in 2009, a vaccine was prepared from this virus to immunize the entire US population. Surveillance for Guillain-Barré syndrome (GBS) after receipt of this vaccine was carried out in 3 populations: the Vaccine Safety Datalink Project, the 10 Centers for Disease Control and Prevention Emerging Infections Program sites, and a network of large insurance companies. These studies found a small increase of approximately 1 case of GBS per million vaccinees above the baseline rate, which is similar to that observed after administration of seasonal influenza vaccines over the past several years. Enhanced surveillance for GBS was conducted in 2009-2010 because of the experience in 1976 of 362 GBS cases' occurring during the 6 weeks after influenza vaccination of 45 million persons, an 8.8-fold increase over background rates. The 1976 mass immunization had been conducted to prevent an influenza epidemic from another swine influenza A H1N1 recombinant virus. It can be concluded from these recent studies that influenza vaccination overall is of public health benefit, helping to reduce mortality and prevent the thousands of deaths that occur from annual seasonal influenza outbreaks, despite the possibility of a small increased risk of GBS associated with influenza vaccines.

US regional differences in death rates from depression

Studies in a few countries (including the US) have reported that mortality rates in the population from psychiatric disorders are much higher when they are based on all causes of death ("multiple causes" or "mentions") coded on death certificates versus only the underlying cause. Studies appear to be lacking on geographic variation within the US in mortality rates from psychiatric disorders based on multiple causes of death. The present study examined the US age-standardized rate (ASR) for death with depression using multiple causes versus underlying cause alone in each of the Census Bureau's four regions and nine divisions. ASRs for schizophrenia were also examined for comparison. For the entire US, the ratio of the ASR based on multiple causes to the ASR based on underlying cause was 20.9 for depression and 9.2 for schizophrenia; in analyses by region and division, these ratios showed limited variation. The most consistent finding for both depression and schizophrenia was that ASRs, whether based on multiple causes or only on underlying cause, were highest in the Midwest region (especially the East North Central division) and lowest in the South (and in each of its three divisions). For ASRs (using multiple causes of death) from depression, these regional differences were evident within each of several levels of urbanization. For deaths with depression coded as other than the underlying cause, ASRs for each of the three most common underlying causes (cardiovascular diseases, intentional injuries, and neoplasms) were highest in the Midwest and lowest in the South. Studies are needed to determine if these regional differences in mortality from depression are due to regional differences in: certifier practices (i.e., in assigning causes of death among persons with psychiatric conditions); the prevalence (among persons with psychiatric disorders) of lifestyle-related factors (e.g., tobacco use and obesity) that mediate mortality risks; and/or in unmet need for psychiatric treatment and medical care for other chronic diseases in persons with psychiatric conditions. Similar studies are needed of regional variation within other countries.

Regional sources of nitrous oxide over the United States: Seasonal variation and spatial distribution

This paper presents top‐down constraints on the magnitude, spatial distribution, and seasonality of nitrous oxide (N2O) emissions over the central United States. We analyze data from tall towers in 2004 and 2008 using a high resolution Lagrangian particle dispersion model paired with both geostatistical and Bayesian inversions. Our results indicate peak N2O emissions in June with a strong seasonal cycle. The spatial distribution of sources closely mirrors data on fertilizer application with particularly large N2O sources over the US Cornbelt. Existing inventories for N2O predict emissions that differ substantially from the inverse model results in both seasonal cycle and magnitude. We estimate a total annual N2O budget over the central US of 0.9–1.2 TgN/yr and an extrapolated budget for the entire US and Canada of 2.1–2.6 TgN/yr. By this estimate, the US and Canada account for 12–15% of the total global N2O source or 32–39% of the global anthropogenic source as reported by the Intergovernmental Panel on Climate Change in 2007.

Healthcare cost attributable to recently-diagnosed breast cancer in a privately-insured population in the United States

Objective:To evaluate breast cancer-associated healthcare cost from the payer perspective for the initial year after diagnoses of invasive breast cancer.Background:Breast cancer is the second most common malignancy in American women. While lifetime burden-of-care studies have reported spending between $20,000 and $100,000 per patient, previous studies have not outlined first year cost in managing this disease in recently diagnosed patients.Methods:This study was a retrospective, matched cohort study of privately-insured patients. Data were from a large US employers’ health claims database (January 2003–September 2008). Breast cancer cases were identified by ICD-9-CM diagnostic codes on index and confirmatory claims. A control group was identified with a ratio of 3:1, matched by demographic and health plan characteristics. Comorbidities were analyzed using the Charlson comorbidity index and AHRQ Comorbidity Software. A multivariate, log-linked, generalized linear model evaluated cost contributions of breast cancer in relation to demographic factors, comorbidities, and plan type.Results:The study included 35,057 cases and 105,171 matched controls (mean age 52 years). Common comorbidities included hypertension, diabetes, hypothyroidism, chronic pulmonary disease, and deficiency anemia. In the generalized linear model, the adjusted difference in total healthcare cost was $42,401 per patient within a year, with outpatient services responsible for most of this sum. Breast cancer-associated incremental annual costs per patient in inpatient, outpatient, and prescription categories were $5100, $37,231, and $1037, respectively.Limitations:These results may not be representative of the entire US, as data were derived from breast cancer patients with private, employer-based health insurance, and lacked covariates including race/ethnicity, education, income, and disease stage.Conclusions:Recently diagnosed breast cancer represents a substantial economic burden for US healthcare payers.

Race and Social Problems

Latinos represent one of the fastest growing population segments in the United States. The 50 million or so Latinos in the United States, which comprise about 15% of the US population, are here to stay and these numbers will continue to grow. As a group, they have now surpassed the African American population. Up to about 1990, Latinos or Hispanics were mostly geographically confined to the US. Southwest and a handful of places outside that region (New York, Chicago and South Florida), but they now reside throughout the United States. Despite stereotypes about Latinos as immigrants, most are actually born in the United States including those whose families have been here for several generations. Nonetheless, there is a large immigrant component, including many whom are unauthorized, which feeds Latino population growth and complicates American attitudes and perceptions about the Latino population. Latinos are a diverse group of many nationalities, but the Mexican segment comprises fully 65% of the entire Latino population and is among the most disadvantaged. Moreover, Mexicans comprise about half of the entire US undocumented population, they have the longest and largest immigration trajectory and they have been largely concentrated in the Southwest US, though that is changing as Mexican immigrants are increasingly populating new desinations, especially in the South. For these reasons several of the articles focus on that population. Because of the wide diversity of the Latino population, we are thus careful to avoid generalization. We use the terms Latino and Hispanic interchangeably throughout this paper, even though technically they may refer to somewhat different populations. Hispanic may include the small number of Spanish people while excluding the small Brazilian population while Latino does the inverse. Perhaps with these tiny exceptions, they refer to virtually the same populations. An important issue is that this pan-ethnic label was crafted by the Spanish language media, businesses, the US Census and political leaders, as a way of simplifying the categorization of a population (for various reasons) that was mostly known and continues to mostly identify by its national origins (Mora, in progress). Though there are certainly objections to the use of either term, the authors of these chapters tend to favor one or the other, a decision they may have made for various reasons. Whether you call them Latinos or Hispanics, Americans often voice strong feelings about their presence. Pundits like Samuel Huntington and Patrick Buchanan have written strongly against immigration from Latin America. They argue that Latin Americans, particularly Mexicans, are unwilling to assimilate and they therefore represent a serious threat to the American nation. Their followers are numerous, as a scan at the immigration blogs and some mainstream media reveal. Moreover, an anti-immigration brand of politics has resulted in stringent laws against the undocumented, which end up affecting the larger Latino population in various ways, as the cases of Arizona and Alabama vividly show. On the other side of public opinion, many Americans tout the United States as a nation of immigrants, in which successive waves made contributions to American culture, its economy and its democracy. Employers, today as in the past, clearly see immigrants as fueling the economy in many sectors. Latinos, who comprise the majority of the current wave, are seen as no different from previous immigrants. Unfortunately, there are many Americans on either side of a polarized debate and not enough that have an informed or nuanced opinion. Moreover, opinions about immigration and Latinos are E. Telles (&) Princeton University, Princeton, NJ, USA e-mail: etelles@princeton.edu

Tumor necrosis factor blocker dose escalation among biologic naïve rheumatoid arthritis patients in commercial managed-care plans in the 2 years following therapy initiation

Objective:This study uses real-world US managed-care claims data to estimate dose escalation rates over the first and second years of therapy among biologic naïve rheumatoid arthritis (RA) patients initiating tumor necrosis factor (TNF) blocker therapy with etanercept, adalimumab, or infliximab.Methods:Non-elderly adult (age 18–65 years) RA patients initiating etanercept, adalimumab, or infliximab from July 1, 2005 to April 30, 2009, were identified using the MarketScan Commercial Database. National and regional dose-escalation patterns were evaluated 12 and 24 months after initiation. In the single-instance method, dose escalation was defined as having one average weekly dose 115%, 130%, or 150% greater than the initial average weekly dose. By the two-instances method, dose escalation was defined as having two consecutive claims with an average weekly dose 115% or 130% greater than the initial average weekly dose.Results:A total of 2747 patients met the inclusion criteria (mean age 50 years [SD = 10]; 74% female). More patients initiated etanercept (44%) than adalimumab (37%) or infliximab (20%). Using the single-instance method, dose escalation at 12 months ranges were 0.8–1.5% for etanercept, 10.8–12.5% for adalimumab, and 16.4–42.5% for infliximab; ranges at 24 months were 0.8–2.1% for etanercept, 14.3–17.5% for adalimumab, and 26.4–57.6% for infliximab. The two-instances method showed a similar relationship among the treatment cohorts at both 12 and 24 months, with lower dose-escalation rates for etanercept (0.8%, 0.8%) than adalimumab (8.7%, 13.3%) or infliximab (22.9%, 37.6%) at the 130% threshold (p < 0.001). Dose-escalation rates for etanercept, adalimumab, and infliximab were consistent across US geographic regions.Conclusion:Patients initiating etanercept had lower rates of dose escalation than patients initiating adalimumab or infliximab in the first and second year following therapy initiation, as well as across US geographic regions. These results may not be generalizable to the entire US RA population.

Getting tough on pain

More than a decade after the discovery of nociceptors, physicians still have very few options for treating chronic pain. Recent research on pain perception might finally be leading to new therapeutic strategies and drugs.

Straight talk with...Patrick Soon-Shiong

Patrick Soon-Shiong has only one mode of thinking: big. The South Africa-born surgeon-scientist has founded two multi-billion-dollar pharmaceutical firms and is now setting his sights on transforming the entire US biomedical system with a modern, high-speed data network. Amber Dance sat down with Soon-Shiong to talk about how uniting physicians and scientists will surmount the most pressing challenges in biomedicine and cancer research. Patrick Soon-Shiong has only one mode of thinking: big. The South Africa-born surgeon-scientist pioneered islet transplants to treat diabetes and nanoparticle drug delivery for cancer, and he has founded two multi-billion-dollar pharmaceutical firms—Abraxis BioScience, now part of Celgene Corporation headquartered in New Jersey, and American Pharmaceutical Partners, acquired by the German company Fresenius Kabi. He's now setting his sights on transforming the entire US biomedical system from bench to bedside, starting with a modern, high-speed data network. Together with his wife, Michele Chan, the Los Angeles–based entrepeneur founded the Chan Soon-Shiong (CSS) Institute for Advanced Health in early 2011. The project has already spent a quarter of a billion dollars, much of it Soon-Shiong's. With locations thus far at the Saint John's Health Center in Santa Monica, California and the University of Arizona College of Medicine in Phoenix, the CSS Institute aims to network everyone with a stake in health care—from bench researchers to clinicians and patients to insurers—so that they can collaborate using easily-shared health records, medical images, genomes and any other kind of data. The Institute is in the midst of launching its first major project, the Cancer Knowledge Alliance Network. But that's just the beginning. Amber Dance sat down with Soon-Shiong to talk about how uniting physicians and scientists will surmount the most pressing challenges in biomedicine and cancer research.

Generalizability of Epidemiological Findings and Public Health Decisions: An Illustration From the Rochester Epidemiology Project

ObjectiveTo illustrate the problem of generalizability of epidemiological findings derived from a single population using data from the Rochester Epidemiology Project and from the US Census. MethodsWe compared the characteristics of the Olmsted County, Minnesota, population with the characteristics of populations residing in the state of Minnesota, the Upper Midwest, and the entire United States. ResultsAge, sex, and ethnic characteristics of Olmsted County were similar to those of the state of Minnesota and the Upper Midwest from 1970 to 2000. However, Olmsted County was less ethnically diverse than the entire US population (90.3% vs 75.1% white), more highly educated (91.1% vs 80.4% high school graduates), and wealthier ($51,316 vs $41,994 median household income; 2000 US Census data). Age- and sex-specific mortality rates were similar for Olmsted County, the state of Minnesota, and the entire United States. ConclusionWe provide an example of analyses and comparisons that may guide the generalization of epidemiological findings from a single population to other populations or to the entire United States.

Prenatal diagnosis of Down syndrome: a systematic review of termination rates (1995–2011)

The objective of this study was to review the published literature on pregnancy termination following a prenatal diagnosis of Down syndrome in the United States. A systematic search of US English-language articles (1995-2011) was conducted to identify primary research studies that reported data for pregnancies with definitive prenatal diagnosis of Down syndrome with subsequent pregnancy termination. Studies that provided indirect estimates of pregnancy termination, such as mathematical models, were excluded. The weighted mean termination rate was calculated across studies. Twenty-four studies were accepted. The weighted mean termination rate was 67% (range: 61%-93%) among seven population-based studies, 85% (range: 60%-90%) among nine hospital-based studies, and 50% (range: 0%-100%) among eight anomaly-based studies. Evidence suggests that termination rates have decreased in recent years. Termination rates also varied with maternal age, gestational age, and maternal race/ethnicity. This systematic review presents the largest synthesis of United States data on termination rates following a prenatal diagnosis of Down syndrome. Evidence suggests that termination rates are lower than noted in a previous review that was based on less contemporary studies and had an international focus. Heterogeneity across studies suggests that a summary termination rate may not be applicable to the entire US population.

Translational Genomics is Not a Spectator Sport: A Call to Action

Translational Genomics is Not a Spectator Sport: A Call to Action

Land of Disenchantment: Latina/o Identities and Transformations in Northern New Mexico (review)

Reviewed by: Land of Disenchantment: Latina/o Identities and Transformations in Northern New Mexico Silvia Spitta Keywords Michael L. Trujillo, Silvia Spitta, Land of Disenchantment, New York socialites, foreign artists, intellectuals, Española, drugs, tricultural harmony, folk life, Marco Cholo, poverty, violence, drug abuse, migration, genizaro, trickster, jokes Trujillo, Michael L. Land of Disenchantment: Latina/o Identities and Transformations in Northern New Mexico. Albuquerque: U of New Mexico P, 2009. 265 pp. Michael L. Trujillo's engaging study Land of Disenchantment is an extended meditation on and important debunking of the notion of New Mexico as an enchanted space. The view of an exotic New Mexico was created in large measure by New York socialites and foreign artists and intellectuals who settled there from the 1920s on. This migration would only increase exponentially between the world wars. The artworks this group produced, the important collections of Hispanic and pueblo Indian folk arts they amassed, and the museums they founded, all led to the establishment of New Mexico as a magical place. This idea, underpinned by visions of tricultural harmony, has spread to the entire US, and New Mexico is now seen (and increasingly marketed) as a place that does not correspond to the space and time of the greater US. The result is that New Mexico's exoticism is so often confused with Mexico's alleged exoticism that the state's license plate has to clarify: "New Mexico, USA: Land of Enchantment." Trujillo grapples with an ethnographic tradition that—inadvertently, perhaps—reproduces the idea of New Mexico as an enchanted space when it focuses on village and folk life. This privileging of the idyllic, magical aspects of the state stands in stark contrast to the dearth of anthropological studies of Española and other poorer cities in the Greater Española Valley. It is reflected in the marketing of Taos and Santa Fe as tourist destinations while poor areas are marginalized from this circuit, thereby reinforcing cycles of poverty. Trujillo's focus on Española and his alternative ethnography is informed not only by the stories he grew up hearing at home in centralWashington state of what life had been like in New Mexico for his parents and parts of his extended family, but also by several years spent in New Mexico working variously as a reporter for the newspaper The Rio Grande Sun; a detox attendant and facilitator of drug rehabilitation groups in Española; and at the University of New Mexico in a drug treatment study. These experiences with what largely constitutes the negative, disenchanted [End Page 162] underside of New Mexico overlooked by promoters of its enchantment inform the main chapters in the book, making it very readable (and fun to read). Indeed, this ethnography's focus on what Trujillo theorizes as the "negative" is perhaps best embodied by jokes told in the area that go like this: "Who discovered Española?" And people reply, "Marco Cholo." But the negative is also most visible in the shocking statistics that show Rio Arriba County, which is the focus of his study, to be one of the "poorest counties in New Mexico," and what is perhaps even more troubling, that the entire state of New Mexico "maintains some of the worst poverty rates in the United States" (11). As Trujillo explains, jokes bracket his ethnography, introducing and ending it, because jokes ensue precisely in those spaces where, as Mary Douglas pointed out, deep disparities rub up against one another. Indeed, the poverty and crime rates of the state serve as a form of disenchantment of the enchanted. Trujillos's Española, therefore, "is a place where discourses of tradition and the most painful aspects of modernity seem to intermingle, boil, and saturate the landscape" (3). The chapters that conform this image of a disenchanted New Mexico focus on the terrible poverty, violence, and drug abuse that permeate the area. The first chapter traces the history that would lead to the dismemberment of the foot of a prominent statue to Oñate (conqueror of New Mexico in the 16th century). The second is on the celebration of Holy Friday in Chimayó when a terrible murder that shakes the region is...

Captive offshoring by US multinationals: measuring the domestic employment impacts of vertical FDI

The complex nature of ‘international outsourcing’ makes it difficult to quantify its employment and broader impacts on national economies. Indeed, available evidence on the extent of ‘offshoring’ by US firms is scant, rendering analyses of its economic impacts as largely unreliable. Attempts to gauge its domestic employment effects have been limited both by definitional problems and data limitations, even when the immeasurable dimensions of offshoring are ignored. This work offers a quantitative assessment of the importance of ‘captive offshoring’ in relation to the entire US economy. Using government data that report foreign affiliate sales back to US parents, we provide ‘back of the envelope’ estimates of the domestic employment effects of vertically motivated foreign direct investment. Although this trend has accelerated most rapidly within the services sector, the findings suggest that ‘high-tech’ manufacturing industries are a major and growing source of job loss.

Too big and too interconnected to fail: historical and ethical analysis of sustainability risk to the US financial system

The financial crisis which manifested in the USA in 2008, revealed the extent to which the largest and most interconnected financial institutions in the USA had become ‘too big to fail’, i.e., so systematically and significantly interwoven with each other and the entire US and global financial and economic system that their very survival was seen as essential to the sustainability of the entire financial system and to public welfare. We argue that it is essential to understand the financial crisis that began in 2008 from a historical and ethical perspective. We conclude that, in light of individual and collective moral hazards, the overall governance framework that protects the sustainability of the financial system should explicitly adopt as a moral imperative the principle that any financial institution should be able to fail without such failure threatening the entire financial system.

The Epidemiology of Upper Extremity Injuries Presenting to the Emergency Department in the United States

The epidemiology of upper extremity injuries presenting to emergency departments in the USA is not well studied. The purpose of this investigation was to estimate the incidence rates of upper extremity injuries presenting to emergency departments. The National Electronic Injury Surveillance System (NEISS)-a database of emergency department visits based on a sample of hospitals selected and weighted to represent the entire US population in order to allow estimates of overall incidence-was queried for all upper extremity injuries presenting to US emergency departments in 2009. Injury types were analyzed for each region of the upper extremity, and incidence rates were calculated based on population estimates from the US Census. A query of the NEISS resulted in 92,601 records of upper extremity injury treated at an emergency department in the USA in 2009, which translates to an estimated total of 3,468,996 such injuries that year. This corresponds to an incidence of 1,130 upper extremity injuries per 100,000 persons per year. The most common region injured was the finger (38.4%). The most common upper extremity injury was a fracture (29.2%). Specific injuries with high incidence rates (all per 100,000 per year) included finger lacerations (221), wrist fractures (72), finger fractures (68), and lower arm fractures (64). Home is the most common setting for an upper extremity injury. The NEISS provides estimates of the incidences of upper extremity injuries that may be useful for public health initiatives.

Impact of the 2008–2009 Economic Recession on Screening Colonoscopy Utilization Among the Insured

Economic factors might affect the use of recommended preventative services. We sought to determine whether the recent severe economic recession was associated with diminished screening colonoscopy rates among an insured population and to assess the relationship between out-of-pocket (OOP) costs and screening colonoscopy use. Administrative data from 106 health plans (IMS LifeLink Health Plan Claims Database) were analyzed to determine monthly rates of screening colonoscopies performed on beneficiaries ages 50 to 64 years between January 2005 and November 2007 (prerecession), as well as from December 2007 through June 2009 (recession). Segmented regression models were used to evaluate changes in screening colonoscopy rates, as well as the relationship between screening and OOP costs before and during the recession. Compared with prerecession trends, during the recession screening colonoscopy rates decreased by 68.9 colonoscopies/1 million individuals per month (95% confidence interval, -84.6 to -53.1; P < .001). Application of study estimates to the entire US population indicated that during the recession, commercially insured patients aged 50 to 64 years underwent approximately 500,000 fewer screening colonoscopies. Compared with those with low OOP costs, those with high OOP procedure costs had lower rates of screening before and during the recession, and had a greater reduction in screening rates during the recession (P = .035). During the recession of December 2007 to June 2009, insured individuals reduced their use of screening colonoscopy compared with the 2 years before the recession began. OOP costs were related inversely to screening use, especially during the recession. Policies to reduce cost sharing could increase adherence to recommended preventive services such as colonoscopy examinations.

PGI1 incidence and Cost of Treatment-Emergent Comorbid Events in an Insured Population Receiving Treatment for Chronic Hepatitis C (CHC) Virus Infection

• Overall, these findings consistently indicate that a substantial proportion of patients discontinue therapy. Although we could not distinguish between patients discontinuing therapy due to adverse events and those discontinuing because of lack of virologic response, our findings support the concept that adverse events lead to therapy discontinuation.9 • Better-tolerated therapies that reduce healthcare system costs and improve patient experience are desirable. • Limitations: A commercially insured population may not be representative of the entire US population nor of treatment patterns in other countries. Claims do not provide data on genotype, so patients treated beyond 24 weeks were presumed to have genotype 1, 4, or 6. Miscoding or undercoding of claims may affect the accuracy of cost estimates.

Taking it to the streets: The case for modeling in the geosciences undergraduate curriculum

The United States faces a crisis in education: a dire shortage of students sufficiently prepared in the STEM (Science, Technology, Engineering and Mathematics) disciplines to competitively enter the workforce (National Education Technology Plan, 2010). At the same time, there is increasing demand for well-trained geoscientists in a variety of careers related to the environment and natural resources. Many efforts, including the recently released Earth Science and Climate Literacy Principles, seek to promote better Earth science education, as well as to strengthen the Earth science literacy of the entire US population. Yet even those undergraduate students who choose to major in geology or related geoscience disciplines rarely acquire sufficient quantitative skills to be truly competitive graduate students or professionals. Experience with modeling, during their undergraduate careers, could greatly increase the quantitative literacy of geoscience majors and help them appreciate the real world applicability of mathematics and computational methods in their future careers in the geosciences.