Net Advantage Research Articles

Patterns of Care for Radiotherapy in the Neoadjuvant and Adjuvant Treatment of Gastric Cancer: A Twelve-Year Nationwide Cohort Study in Korea.

PurposeAlthough Korea has the highest incidence of gastric cancer worldwide and D2-lymphadenectomies are routinely performed, radiotherapy (RT) practice patterns have not been well studied. Therefore, we examined RT usage trends for neoadjuvant/adjuvant patients and identified factors associated with RT. We also examined survival benefits and net medical cost advantages of adding RT.Materials and MethodsPatients diagnosed with gastric cancer who underwent gastrectomy from 2002-2013 were identified using National Health Insurance Service-National Sample Cohort.ResultsAnnually, 30.9 cases per 100,000 population in crude rate underwent gastrectomy in 230 hospitals and 49.8% received neoadjuvant/adjuvant therapy in 182 hospitals. For neoadjuvant/adjuvant patients, postoperative chemo-RT was administered in 4% of cases in 26 hospitals. No significant trends regarding treatment type were observed over time. Having undergone RT was inversely associated with being ≥ 60 years old and having a low income. Having undergone RT was positively related to having a Charlson comorbidity index ≥ 4, hospital location and hospital volume (≥ 2,000 beds). Significant portions of patients treated with RT in this nation (52%) were concentrated in one large-volume hospital. Use of RT linked to increased cost of primary treatment, yet not to reduced overall medical expense. RT did not influence both on overall and disease-specific survivals after adjusting for potential confounders (p > 0.05).ConclusionRT was uncommonly utilized as adjuvant or neoadjuvant treatment by physicians in Korea. Despite intrinsic drawback in this data, we did not find either survival benefit or net medical cost advantage by adding RT in adjuvant treatment.

Regulating Discrimination in Sport: Mandatory Rules or Discretionary Guidelines?

Sport, like all industries, is subject to domestic discrimination legislation, which in turn is derived from international treaties. Many sports have also developed internal policies, regulations and/or guidelines to help with the governance of discrimination issues. The Australian Football League (AFL) has had to deal with a number of recent racist situations involving spectators. It is suggested that the AFL should consider implementing an anti-racism policy aimed at spectators like the one developed by the International Cricket Council (ICC). Netball’s rules banning pregnant women from competing were held to be discriminatory and illustrate that guidelines providing recommendations can be a better solution for sports than mandatory rules or regulations. The case of Dutee Chand has meanwhile raised the question of whether women with naturally high levels of testosterone should be allowed to compete in women’s events. The decision of the Court of Arbitration for Sport (CAS) that regulations banning her from competing were discriminatory again highlights that guidelines, rather than regulations, can be a better solution for sports. In 2008 the issue of potential disability discrimination was raised when double amputee sprinter, Oscar Pistorius, sought to compete, with the aid of artificial limbs, at the able bodied Olympic Games. While CAS determined it had not been proven that Pistorius had a net advantage, it is suggested that test should have been whether he ran differently to able bodied athletes.

Transcriptional Control of Glucose and Energy Supply Prevents Oncogenic Signaling and B Cell Transformation

Background and Hypothesis: B-cell identity is determined by a set of B-cell transcription factors including PAX5, IKZF1 and EBF1. However, B-lineage leukemia clones often carry secondary genetic lesions that result in reduced activity or inactivation of these transcription factors. Studying patient samples from clinical trials for B-lineage childhood (P9906; n=187) and adult (MDACC; n=92) leukemia, we found that genetic defects in one or more B-cell transcription factors represent near-obligate lesions in human acute lymphoblastic leukemia (209 of 279 B-lineage ALL cases). While previously of unknown significance, we found that adult ALL cases with known lesions in one or more of these transcription factors had higher activity of lactate dehydrogenase, and phospho-states indicated higher activity of IRS1, PDK1, and AKT, which contribute to glucose uptake. For this reason, we investigated whether B-cell transcription factors set metabolic constraints of oncogenic signaling in leukemia.Results: Reconstitution of wildtype PAX5 and IKZF1 in patient-derived B-lineage ALL cells carrying PAX5 and IKZF1deletions decreased phospho-AKT levels. Furthermore, protein levels of multiple positive regulators involved in glucose uptake and metabolism (including insulin receptor, glucose transporters and hexokinases) were downregulated upon reconstitution of PAX5 and IKZF1. Conversely, protein levels of negative regulators of glucose uptake and metabolism including NR3C1 and TXNIP were upregulated upon reinstatement of PAX5 and IKZF1 function. Analysis of ChIPseq data of human B cells revealed binding of multiple B-cell transcription factors including PAX5, IKZF1 and EBF1 to promoter regions of genes encoding positive regulators of glucose uptake and metabolism. Binding peaks for B-cell transcription factors were also observed at genes that encode negative regulators of glucose uptake and metabolism (NR3C1 and TXNIP). In addition, direct recruitment of PAX5 was confirmed by single-locus quantitative chromatin immunoprecipitation (qChIP).Reconstitution of wildtype PAX5 and IKZF1 in patient-derived B-lineage ALL cells caused depletion from the cell culture in competitive growth assays, in parallel with reduced glucose consumption and depletion of cellular ATP levels. On the contrary, overexpression of dominant-negative PAX5-ETV6 and IK6 in patient-derived B-lineage ALL cells expressing wildtype PAX5 and IKZF1 resulted in a net survival advantage, concomitant with increases in both glycolytic activity and cellular ATP levels. PAX5-mediated impaired survival fitness was significantly rescued by CRISPR-based activation of gene expression of insulin receptor, glucose transporter and hexokinases in patient-derived B-lineage ALL cells. Conversely, CRISPR/Cas9-mediated deletion of NR3C1 and TXNIP largely reversed the effects of PAX5. Finally, reduced survival fitness upon reconstitution of wild-type PAX5 and IKZF1 in patient-derived pre-B ALL cells was mostly rescued by metabolites that can enter the TCA cycle and thus provide ATP.Conclusions: In summary,B-cell-specific restriction of glycolytic energy supply represents a previously unrecognized metabolic barrier against malignant transformation. Our findings suggest a causative link between impaired glucose uptake and metabolism caused by B-cell transcription factors as well as cell death, and the known tumor suppressive function of PAX5 and IKZF1 in B-lineage ALL. DisclosuresNo relevant conflicts of interest to declare.

The rise of the second generation: aspirations, motivations and academic success of Chinese immigrants’ children in Hong Kong

ABSTRACTThe second-generation immigrants’ advantage in education has been observed in many destination countries, and often explained in terms of their family values and practices embedded with certain culture and positive selection on psychological factors. However, the roles of culture and selectivity have been hardly disentangled from each other. In this article, we examine the self-selection hypothesis in the context of Hong Kong, as its unique setting enables us to largely control for the effect of cultural factors and focus on the positive selection effect. We identify four psychological traits that could contribute to immigrants’ outstanding performance, and employ mediation analysis to investigate how much of the effect of immigrant status on academic achievement is mediated through these factors. Analysis of data from the Programme for International Student Assessment in Hong Kong reveals that, having strong motivations to find a better life and high aspirations for upward mobility can largely explain Chinese immigrant children’s academic success in Hong Kong, with educational aspiration playing a particularly important role. In addition, the net academic advantage of second-generation immigrants is larger among low socio-economic status (SES) families, and low SES immigrant parents have exceptionally high expectation and great dedication to their children’s education.

The consequences of facultative sex in a prey adapting to predation.

A species reproductive mode, along with its associated costs and benefits, can play a significant role in its evolution and survival. Facultative sexuality, being able to reproduce both sexually and asexually, has been deemed evolutionary favourable as the benefits of either mode may be fully realized. In fact, many studies have focused on identifying the benefits of sex and/or the forces selecting for increased rates of sex using facultative sexual species. The costs of either mode, however, can also have a profound impact on a population's evolutionary trajectory. Here, we used experimental evolution and fitness assays to investigate the consequences of facultative sexuality in prey adapting to predation. Specifically, we compared the adaptive response of algal prey populations exposed to constant rotifer predation and which had alternating cycles of asexual and sexual reproduction where sexual episodes were either facultative (sexual and asexual progeny simultaneously propagated) or obligate (only sexual progeny propagated). We found that prey populations with facultative sexual episodes reached a lower final relative fitness and suffered a greater trade-off in traits under selection, that is defence and competitive ability, as compared to prey populations with obligate sexual episodes. Our results suggest that costs associated with sexual reproduction (germination time) and asexual reproduction (selection interference) were amplified in the facultative sexual prey populations, leading to a reduction in the net advantage of sexuality. Additionally, we found evidence that the cost of sex was reduced in the obligate sexual prey populations because increased selection for sex was observed via the spontaneous production of sexual cells. These results show that certain costs associated with facultative sexuality can affect an organism's evolutionary trajectory.

Reconfiguration schemes evaluation based on preference ranking of key characteristics of reconfigurable manufacturing systems

To address the problem of how to build quantitative evaluation index models that reflect the essential characteristics of reconfigurable manufacturing system (RMS) and rank alternative reconfiguration schemes, which possess both advantages and disadvantages, an evaluation method based on the preference ranking organization method for enrichment evaluation (PROMETHEE) is proposed. Based on a consideration of the reconfiguration of the reconfigurable machine components and manufacturing cells, quantitative models of the key characteristics of an RMS (scalability, convertibility, diagnosability, modularity, integrability, and customization) are established, after which the quantitative models are used as the basis for constructing an RMS evaluation index system. The analytic hierarchy process (AHP) is used to assign the weights for these indices. During the evaluation process, PROMETHEE I is first applied to analyze the advantages and disadvantages of each alternative scheme. Then, PROMETHEE II is adopted to analyze the net advantages of the schemes. Finally, all of the alternative configurations are ranked according to the analysis results above. The workshop of an institute that has both research and production capabilities was used as an example to validate the effectiveness and practicability of the proposed method. The example contains 10 alternative reconfiguration schemes, and each scheme consists of six evaluation indices. The computation result shows that quantitative models of six key RMS characteristics are equipped with the ability of quantitative description of the RMS reconfiguration scheme, which gives intuitive decision-making information combined with PROMETHEE, including advantage and disadvantage between alternative schemes, for a decision-maker to select the satisfactory configuration. In addition, only a 7.2 % data loss during the evaluation data processing means the rationality of the selected evaluation index and evaluation algorithm.

ANALISIS KUANTITATIF SISTEM PEMBIAYAAN UNTUK KREDIT INVESTASI (ALAT BERAT) PADA BANK UMUM DAN LEASING

A Company which is enganged in the procurement of heavy equipment, it would faced with the problem in adding the heavy equipment. This research was conducted in order to determine which one is the more profitable financial institutions for the company when the loan interest rate is having fluctuation which is can not be predicted before. This research is a descriptive by using secondary data of credit calculation examples, leasing period ,prices of equipment, economic life, residual value, tax rate and interest rate of loan. The analysis technique use two techniques: first, quantitatives analysis which is consisted of calculating a bank loan, the calculation of leasing credit, cash flow prjections,net present value and the net advantage of leasing. The result of analysis technique indicated that the alternative financing commercial bank is more profitable for company with the net present value is lower than net leasing present value and the stable if the interest.Keyword: calculating a bank loan,the calculation of leasing credit, cash flow projection, net present value and the net advantage of leasing.

Investigating the Gender Gap in Agricultural Productivity: Evidence from Uganda

Women comprise 50 percent of the agricultural labor force in Sub-Saharan Africa, but manage plots that are reportedly on average 20 to 30 percent less productive. As a source of income inequality and aggregate productivity loss, the country-specific magnitude and drivers of this gender gap are of great interest. Using national data from the Uganda National Panel Survey for 2009/10 and 2010/11, the gap before controlling for endowments was estimated to be 17.5 percent. Panel data methods were combined with an Oaxaca decomposition to investigate the gender differences in resource endowment and return to endowment driving this gap. Although men have greater access to inputs, input use is so low and inverse returns to plot size so strong in Uganda that smaller female-managed plots have a net endowment advantage of 12 percent, revealing a larger unexplained gap of 29.5 percent. Two-fifths of this unexplained gap is attributed to differential returns to the child dependency ratio and one-fifth to differential returns to transport access, implying that greater child care responsibilities and difficulty accessing input and output markets from areas without transport are the largest drivers of the gap. Smaller and less robust drivers include differential uptake of cash crops, and differential uptake and return to improved seeds and pesticides.

Work in and beyond the Second Machine Age: the politics of production and digital technologies

Erik Brynjolfsson and Andrew McAfee, in their widely read and politically impactful book The Second Machine Age, highlight the costs and benefits of digital technologies for the volume and quality of work and identify reforms designed to ensure that digital technologies deliver net advantages to workers and society more generally. This article offers a critique of their thesis. Specifically, it criticizes the authors for their neglect of the nexus between the politics of production and digital technologies. They fail, in short, to grasp the importance of power relations for the form, direction and outcomes of digital technologies. The article argues for an alternative view of the progress of digital technologies that is rooted in an understanding of the political economy of capitalism. In this respect, it draws on and applies ideas and concepts from Marxian political economy.

Rate Control versus Rhythm Control for Atrial Fibrillation after Cardiac Surgery

BackgroundAtrial fibrillation after cardiac surgery is associated with increased rates of death, complications, and hospitalizations. In patients with postoperative atrial fibrillation who are in stable condition, the best initial treatment strategy — heart-rate control or rhythm control — remains controversial.MethodsPatients with new-onset postoperative atrial fibrillation were randomly assigned to undergo either rate control or rhythm control. The primary end point was the total number of days of hospitalization within 60 days after randomization, as assessed by the Wilcoxon rank-sum test.ResultsPostoperative atrial fibrillation occurred in 695 of the 2109 patients (33.0%) who were enrolled preoperatively; of these patients, 523 underwent randomization. The total numbers of hospital days in the rate-control group and the rhythm-control group were similar (median, 5.1 days and 5.0 days, respectively; P=0.76). There were no significant between-group differences in the rates of death (P=0.64) or overall serious adverse events (24.8 per 100 patient-months in the rate-control group and 26.4 per 100 patient-months in the rhythm-control group, P=0.61), including thromboembolic and bleeding events. About 25% of the patients in each group deviated from the assigned therapy, mainly because of drug ineffectiveness (in the rate-control group) or amiodarone side effects or adverse drug reactions (in the rhythm-control group). At 60 days, 93.8% of the patients in the rate-control group and 97.9% of those in the rhythm-control group had had a stable heart rhythm without atrial fibrillation for the previous 30 days (P=0.02), and 84.2% and 86.9%, respectively, had been free from atrial fibrillation from discharge to 60 days (P=0.41).ConclusionsStrategies for rate control and rhythm control to treat postoperative atrial fibrillation were associated with equal numbers of days of hospitalization, similar complication rates, and similarly low rates of persistent atrial fibrillation 60 days after onset. Neither treatment strategy showed a net clinical advantage over the other. (Funded by the National Institutes of Health and the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT02132767.)

Teacher candidates research, teach, and learn in the nation's first net zero school

ABSTRACTTeacher candidates conducted field hours in the nation's first net zero school, which uses the same amount of energy, measured annually, as it produces. These teacher candidates saw firsthand integration of the net zero advantages by completing a Collaborative Research Project and a Net Zero Lesson, which incorporated the use of the net zero building features as part of the lesson plan criteria. As a result, teacher candidates experienced how students can learn from their constructed environment and how that learning could contribute to a more sustainable world.

IMPACT OF PAK-INDIA RELATIONSHIP ON RICE TRADE ON ECONOMY OF PAKISTAN BY USING COMPUTABLE GENERAL EQUILIBIUM MODEL (CGE)

This exploration researches the Impact of PAK-INDIA Rice exchange on Economy of Pakistan. Information were gathered from GTAP-7 database. Information were gathered from 60 rice exporters by utilizing straightforward irregular strategy and information were investigated by utilizing GEM-programming. Distinctive reproduction keep running on GTAP-7 database and different duty rates connected. It was uncovered that if India were evacuating the touchy rundown thing, in this situation both nations would have positive effect on GDP, Export, Import. The outcomes demonstrates that there is sure effect of Rice fare to India. It was further uncovered that if Pakistan is given MFN status to India, Pakistan's import diminished and Export expanded and general positive effect on Economy. The principal situation is when typical exchanging connection with India will be restored; it implies that both nations will give the MFN (Most Favored Nations) status to one another. In the second situation, the SAFTA will be agent and there will be unhindered commerce in the middle of India and Pakistan and both nations will uproot all levies and custom obligations from every others' imports. The Global exchange examination GTAP model is utilized to dissect the conceivable effect of SAFTA on Pakistan in a multi nation, multi segment connected General harmony casing work. Results in light of this exploration uncover that on SAFTA, grounds, here will be net fare advantages in Pakistan's economy.

Does Culture Matter in Economic Behavior?

In this article we address the following question: does culture play a role in economic behavior? We conclude that culture influences economic behavior in all three areas of economic activity: work, consumption, and leisure. Our proof lies not so much in replicating certain experimental results, but in documenting in real-world circumstances how culture influences economic behavior. Attention to the role of culture in economic affairs acknowledges that humans are more than the one-dimensional, autonomous, individuals, as premised in mainstream economics, whose very existence is temporal, whose role in economic affairs is strictly instrumental, and whose behavior is virtually the same across cultures. We have argued that humans are two-dimensional twice over. First, humans are individual beings and social beings: solitary and communal, self-made and culture-bound, autonomous and dependent, rational and emotional, self-centered and other-centered. Second, humans are both matter and spirit. The duality of the human person, rooted in individuality and sociality, affords an opportunity to unify economic theory wherein individuality is the focus of microeconomics and sociality is the center of macroeconomics. Putting the isolated individual at the very heart of economics closes down that opportunity and assures that mainstream economic theory will remain truncated indefinitely. The makeover of mainstream economics will take place once neo-classical economists accept that the ultimate end of economic systems relates not to maximum personal net advantage but to integral human development.

Net Comparative Advantage Index: Overcoming the Drawbacks of the Existing Indices

In this paper, we examine a number of indices used for measuring comparative advantages of a country in international trade for a good and propose the new net comparative advantage index that has several strong features. First, it reflects net trade, and that’s why it is more theoretically grounded than indices calculated only from export data. Second, it is consistent with Kunimoto (1977) theoretical framework that is highly appreciated among trade economists. Third, it is not totally focused on a single commodity (that is, it takes world trade structure into consideration), unlike net export index. Fourth, it accounts for economic openness, using GDP as a scale variable. Fifth, it is hardly exposed to structural distortions. Finally, its sign is consistent with the sign of the net trade. We compare the new index with CEPII theoretically grounded econometric indicator and show that the proposed index has better empirical characteristics and is much easier to calculate and interpret.

Microbiota’s No Wasting Policy

Schieber et al. demonstrate that a specific gut microbiota bacterial strain induces a host-mediated protection mechanism against inflammation-driven wasting syndrome. This salutary effect confers a net survival advantage against bacterial infection, without interfering with the host's pathogen load, revealing that host-microbiota interactions regulate disease tolerance to infection.

Assessing the Terrorist Threat: Impact of the Group's Organizational Design?

Each terrorist organization faces a critical tradeoff between effectively managing the organization's violent behavior while remaining secure from counterterrorism efforts. Drawing on organization theory and terrorism literature, this article develops theoretical linkages between the organizational design of a terrorist group and this critical tradeoff. It considers the impact of four key design parameters: membership, operational space and time, formalization, and centralization. The first two structural parameters construct the physical anatomy of a terrorist organization. The latter two structuring parameters prescribe or restrict the behavior within this organizational context. Net advantages by means of rising structural design parameter values are increasingly offset by the organizational strength and security vulnerabilities that inherently follow from the rising structuring parameters.

Does the avoidance of sexual costs increase fitness in asexual invaders?

The high prevalence of sexual reproduction is considered a paradox mainly for two reasons. First, asexuals should enjoy various growth benefits because they seemingly rid themselves of the many inefficiencies of sexual reproduction—the so-called costs of sex. Second, there seems to be no lack of asexual origins because losses of sexual reproduction have been described in almost every larger eukaryotic taxon. Current attempts to resolve this paradox concentrate on a few hypotheses that provide universal benefits that would compensate for these costs and give sexual reproduction a net advantage. However, are new asexual lineages really those powerful invaders that could quickly displace their sexual ancestors? Research on the costs of sex indicates that sex is often stabilized by highly lineage-specific mechanisms. Two main categories can be distinguished. First are beneficial traits that evolved within a particular species and became tightly associated with sex (e.g., a mating system that involves sexual selection, or a sexual diapausing stage that allows survival through harsh periods). If such traits are absent in asexuals, simple growth efficiency considerations will not capture the fitness benefits gained by skipping sexual reproduction. Second, lineage-specific factors might prevent asexuals from reaching their full potential (e.g., dependence on fertilization in sperm-dependent parthenogens). Such observations suggest that the costs of sex are highly variable and often lower than theoretical considerations suggest. This has implications for the magnitude of universal benefits required to resolve the paradox of sex.

Utilization of psychotropic drugs by patients consulting for sleeping disorders in homeopathic and conventional primary care settings: the EPI3 cohort study

Utilization of sedative hypnotic drugs for sleeping disorders (SD) raises concerns, particularly among older people. This study compared utilization of conventional psychotropic drugs for SD among patients seeking care from general practitioners (GPs) who strictly prescribe conventional medications (GP-CM), regularly prescribe homeopathy in a mixed practice (GP-Mx), or are certified homeopathic GPs (GP-Ho). This was a French population-based cohort study of GPs and their patients consulting for SD, informed through the Pittsburgh sleep quality index (PSQI) questionnaire. Information on psychotropic drugs utilization was obtained from a standardized telephone interview at inclusion, one, three and 12 months. 346 patients consulting for SD were included. Patients in the GP-Ho group experienced more often severe SD (41.3%) than patients in the GP-CM group (24.3%). Adjusted multivariate analyses showed that patients who chose to be managed by GP-Ho were less likely to use psychotropic drugs over 12 months as opposed to the GP-CM group, with Odds ratio (OR)=0.25; 95% confidence interval (CI): 0.14 to 0.42. Patients in the GP-Mx group also used less psychotropic drugs but the result was not statistically significant (OR=0.67; 95% CI: 0.39-1.16). Rates of clinical improvement of the SD did not differ between groups. Patients with SD who chose to consult GPs certified in homeopathy consumed less psychotropic drugs and had a similar evolution of their condition to patients treated with conventional medical management. This result may translate in a net advantage with reduction of adverse events related to psychotropic drugs.

Impact of allogeneic stem cell transplantation on survival of patients less than 65 years of age with primary myelofibrosis

AbstractAllogeneic hematopoietic stem cell transplantation (SCT) is the only curative option for patients with primary myelofibrosis (PMF), but information on its net advantage over conventional therapies is lacking. Using ad hoc statistical analysis, we determined outcomes in 438 patients <65 years old at diagnosis who received allogenic SCT (n = 190) or conventional therapies (n = 248). Among patients at low risk per the Dynamic International Prognostic Scoring System (DIPSS) model, the relative risk of death after allogenic SCT vs those treated with nontransplant modalities was 5.6 (95% CI, 1.7-19; P = .0051); for intermediate-1 risk it was 1.6 (95% CI, 0.79-3.2; P = .19), for intermediate-2 risk, 0.55 (95% CI, 0.36-0.83; P = .005), and for high risk, 0.37 (95% CI, 0.21-0.66; P = .0007). Thus, patients with intermediate-2 or high-risk PMF clearly benefit from allogenic SCT. Patients at low risk should receive nontransplant therapy, whereas individual counseling is indicated for patients at intermediate-1 risk.

Yeast killer elements hold their hosts hostage.

Yeast killer elements hold their hosts hostage.