Monte Carlo simulation to analyze the cost-benefit of radioactive seed localization versus wire localization for breast-conserving surgery in fee-for-service health care systems compared with accountable care organizations.

OBJECTIVE: In breast-conserving surgery for nonpalpable breast cancers, surgical reexcision rates are lower with radioactive seed localization (RSL) than wire localization. We evaluated the cost-benefit of switching from wire localization to RSL in two competing payment systems: a fee-for-service (FFS) system and a bundled payment system, which is typical for accountable care organizations. MATERIALS AND METHODS: A Monte Carlo simulation was developed to compare the cost-benefit of RSL and wire localization. Equipment utilization, procedural workflows, and regulatory overhead differentiate the cost between RSL and wire localization. To define a distribution of possible cost scenarios, the simulation randomly varied cost drivers within fixed ranges determined by hospital data, published literature, and expert input. Each scenario was replicated 1000 times using the pseudorandom number generator within Microsoft Excel, and results were analyzed for convergence. RESULTS: In a bundled payment system, RSL reduced total health care cost per patient relative to wire localization by an average of $115, translating into increased facility margin. In an FFS system, RSL reduced total health care cost per patient relative to wire localization by an average of $595 but resulted in decreased facility margin because of fewer surgeries. CONCLUSION: In a bundled payment system, RSL results in a modest reduction of cost per patient over wire localization and slightly increased margin. A fee-for-service system suffers moderate loss of revenue per patient with RSL, largely due to lower reexcision rates. The fee-for-service system creates a significant financial disincentive for providers to use RSL, although it improves clinical outcomes and reduces total health care costs.

A chromosomal investigation of some European Leiodidae (Coleoptera), with particular focus on Spanish subterranean Leptodirini.

Karyotypes are shown for Leiodes calcarata (Erichson, 1845), Catops coracinus Kellner, 1846, Cantabrogeus luquei (Salgado, 1993), Espanoliella luquei Salgado & Fresneda, 2005, Fresnedaella lucius Salgado, Labrada & Luque, 2011, Notidocharis uhagoni (Sharp 1872), Quaestus (Quaesticulus) pasensis Salgado, Labrada & Luque, 2010, all of which are shown to have a diploid number of 20 autosomes plus Xy (♂) or XX (♀) sex chromosomes, as well as an as yet undescribed triploid species of the genus Cantabrogeus Salgado, 2000. These results are contrasted with published information, all on Leptodirini, which lists 10 species as having diploid numbers of 22 + Xy or XX. It is shown that the higher chromosome number (n = 11 + X or y) previously reported refers exclusively to the more derived Leptodirini ("infraflagellates") whereas the lower number (n = 10 + X or y) refers to the less derived surface-dwelling forms and the less derived Leptodirini ("supraflagellates").

Genome-wide linkage analysis of global gene expression in loin muscle tissue identifies candidate genes in pigs.

BACKGROUND: Nearly 6,000 QTL have been reported for 588 different traits in pigs, more than in any other livestock species. However, this effort has translated into only a few confirmed causative variants. A powerful strategy for revealing candidate genes involves expression QTL (eQTL) mapping, where the mRNA abundance of a set of transcripts is used as the response variable for a QTL scan. METHODOLOGY/PRINCIPAL FINDINGS: We utilized a whole genome expression microarray and an F(2) pig resource population to conduct a global eQTL analysis in loin muscle tissue, and compared results to previously inferred phenotypic QTL (pQTL) from the same experimental cross. We found 62 unique eQTL (FDR <10%) and identified 3 gene networks enriched with genes subject to genetic control involved in lipid metabolism, DNA replication, and cell cycle regulation. We observed strong evidence of local regulation (40 out of 59 eQTL with known genomic position) and compared these eQTL to pQTL to help identify potential candidate genes. Among the interesting associations, we found aldo-keto reductase 7A2 (AKR7A2) and thioredoxin domain containing 12 (TXNDC12) eQTL that are part of a network associated with lipid metabolism and in turn overlap with pQTL regions for marbling, % intramuscular fat (% fat) and loin muscle area on Sus scrofa (SSC) chromosome 6. Additionally, we report 13 genomic regions with overlapping eQTL and pQTL involving 14 local eQTL. CONCLUSIONS/SIGNIFICANCE: Results of this analysis provide novel candidate genes for important complex pig phenotypes.