Search

Background: This study aimed to investigate clinicopathological and molecular tumour features associated with intratumoral pks+Escherichia coli (pks+E.coli+), pks+E.coli- (non-E.coli bacteria harbouring the pks island), Enterotoxigenic Bacteroides fragilis (ETBF) and Fusobacterium nucleatum (F. nucleatum). Methods: We screened 1697 tumour-derived DNA samples from the Australasian Colorectal Cancer Family Registry, Melbourne Collaborative Cohort Study and the ANGELS study using targeted PCR. Results: Pks+E.coli+ was associated with male sex (P < 0.01) and APC:c.835-8 A > G somatic mutation (P = 0.03). The association between pks+E.coli+ and APC:c.835-8 A > G was specific to early-onset CRCs (diagnosed<45years, P = 0.02). The APC:c.835-A > G was not associated with pks+E.coli- (P = 0.36). F. nucleatum was associated with DNA mismatch repair deficiency (MMRd), BRAF:c.1799T>A p.V600E mutation, CpG island methylator phenotype, proximal tumour location, and high levels of tumour infiltrating lymphocytes (Ps < 0.01). In the stratified analysis by MMRd subgroups, F. nucleatum was associated with Lynch syndrome, MLH1 methylated and double MMR somatic mutated MMRd subgroups (Ps < 0.01). Conclusion: Intratumoral pks+E.coli+ but not pks+E.coli- are associated with CRCs harbouring the APC:c.835-8 A > G somatic mutation, suggesting that this mutation is specifically related to DNA damage from colibactin-producing E.coli exposures. F. nucleatum was associated with both hereditary and sporadic MMRd subtypes, suggesting the MMRd tumour microenvironment is important for F. nucleatum colonisation irrespective of its cause. [ABSTRACT FROM AUTHOR]

Water is essential for all ecosystem services, yet a comprehensive assessment of total (overall) water contributions to ecosystem services production has never been attempted. Quantification of the many ecosystem services impacted by water demands integrated hydrological simulations that implicitly characterize subsurface and surface water exchange. In this study, we use a fully integrated hydrological model—HydroGeoSphere (HGS)—to capture changes in subsurface water, surface water, and evapotranspiration (green water) combined with the economic valuation approach to assess ecosystem services over an 18-year period (2000–2017) in a mixed-use but predominantly agricultural watershed in eastern Ontario, Canada. Using the green water volumes and ecosystem services values as inputs, we calculate the marginal productivity of water, which is $0.45 per m3 (in 2022 Canadian dollars). The valuation results show that maximum green water is used during the dry years, with a value of $1.16 billion during a severe drought that struck in 2012. The average product of water for ecosystem services declines during the dry years. Because subsurface water is a major contributor to the green water supply, it plays a critical role in sustaining ecosystem services during drought conditions. For instance, during the 2012 drought, the subsurface water contribution to green water was estimated at $743 million, making up 72 % of the total value of green water used in that year. Conversely, the surface water contributions in green water provision over the modeling period are comparatively miniscule. This study informs watershed management on the sustainable use of subsurface water during droughts and provides an improved methodology for watershed-based integrated management of ecosystem services. [ABSTRACT FROM AUTHOR]

"When I got to Stanford, the classes weren't nearly as stimulating as they were at Wood-berry Forest," says an alumnus of both. He counts his years at the Virginia boys' [...]

Abstract Forced amalgamations among formerly independent municipalities in Ontario have been the most contested aspects of the Province's restructuring plan initiated in 1995. A major concern of residents has been [...]

Prepayment audits are done by Medicare carriers to check if physicians are billing correctly. Several steps should be followed by physicians to lessen problems that will be encountered in claim audits. First, the physician's staff should be informed of carriers' request for records. Second, records should not be changed after physicians receive an order for them. Third, a self-audit should be conducted by the physician to anticipate the possible things that an auditor will look for. Fourth, all correspondence should be duly recorded and sent with a cover letter., Experts tell how to prepare for an audit, when to pay and be done with it, when to pay and appeal, and when to fight. If you're getting more requests [...]

Several problems encountered by physicians while attending to patients were described and possible solutions offered. Among the problems cited were gun threats, problem patients, tight schedules and medical practice while training. For patients threatening physicians, the police should be notified. For problem patients, a group consensus on what to do is recommended. In case a doctor is treating very sick patients and still a health care agency presses for more productivity, changing jobs is recommended., Gun threat * Problem patients * Practice beyond training * Working while sick * Killer call schedule A patient threatens violence Q: I'm an FP. A patient was furious with [...]

Doctors who are employees should know that they have rights like other employees that are protected by federal laws. Among the labor laws that will most likely be referred to by doctors are the American with Disabilities Act (ADA),the Family and Medical Leave Act of 1993 (FMLA) and the Consolidated Omnibus Reconciliation Act of 1986 (COBRA). The ADA covers employees who have a medical condition that substantially limits them while the FMLA provides time off for new parents. COBRA, on the other hand, provides terminated employees health and dental benefits for one-and-a-half years., Laws shield you from discrimination, guard your pension, grant you family leave - even protect your status as an employee. Think an employer will treat you well because you're a [...]

Some physicians make blunders in their malpractice defense that may turn a jury against them. One of these is by showing arrogance on the witness stand. Others include demonstrating stupidity, laughing in court, showing discrimination against patients, making jokes about patients' appearance, wasting time explaining things, denying authoritativeness of own articles, altering chart notes, writing unusually lengthy chart notes, taking a lawsuit too seriously and giving up hope., Arrogance on the witness stand is just one way doctors make themselves the target of jurors' ire. If you want to sink your malpractice defense, try a display of arrogance. [...]

The best way to keep Medicare's bloodhounds away is to become your own watchdog. Here's how to put a compliance plan in place. There's nothing like a 2,200 percent return [...]

A ruling handed down by the US Supreme Court in the Burlington Industries vs Ellerth case is applicable in virtually any case although it applied only to a specific sexual harassment case. The ruling provided that employers must prove that they exercised reasonable care to prevent and to correct promptly any sexual harassment taking place in the workplace. Techniques in the prevention of sexual harassment suits are presented., Even if a staffer takes you to court, you'll probably prevail if you had an anti-harassment program in place. The old saw that prevention is better than cure goes double [...]

Two physician group practices were surveyed on how primary-care capitation affects their bottom line. Generally, the higher a prepaid income gets, the higher the overhead expenses become. However, there are certain exceptions. Relatively high payment levels and fewer financial risks explain the modest costs of the first group. The second group attributed increase in overhead costs in new office equipment and computer-system upgrade and the growing staff requirements resulting from capitation contracts., In general, the more prepaid income, the higher your expenses. But there are important exceptions. To see how risk contracts affect the bottom line, we talked to two physician groups. [...]

Learning what to look for in financial reports will help prospective investors evaluate a company's financial health before they sign a contract. Being aware that income statements and statistics can be modified to hide the real state of a company is a must. It is not recommended to read financial reports alone without reading related information about the firm. Reading carefully cash flows, income statements and balance sheets and knowing accounting tricks applied to annual reports will help in knowing a company's real financial standing., The typical financial statement is a forest of numbers and fine print. If you know what to look for, though, you can make the right decision about investing or signing [...]

Finding a good life insurance policy entails an understanding of the basics of life insurance. A life insurance policy is generally founded on death benefit and is available either as low-loads or full-commission. There are two types of life insurance policies, namely, term insurance and cash-value insurance. While term insurance has a pre-set price for a finite number of years, cash-value insurance do not have fixed time periods, premiums stay the same throughout the coverage and they build up cash value., Sales agents can show you policies of boundless complexity. This primer will help you choose wisely. You insure your life to provide for loved ones' financial needs after you die. [...]

Managed care's declining reimbursement levels and long conversations over the phone with patients are urging physicians to charge for phone consultations. They feel that the charges will not be unreasonable since they are as responsible for the advice they give over the phone as for the advice they give in the office. However, most doctors want to maintain goodwill with their patients. Other doctors who suffered public humiliation from irate patients feel that the extra revenues were not the trouble after all., Medicare will reimburse for certain calls, and you might be able to negotiate payments with private insurers. But if you bill patients directly, expect some flak. FP Charles Davant III [...]

Juries often award vertiginous sums for malpractice suits which, in reality, are greatly reduced. The gap between awards given by the jury and the ultimate liability of the defendant is due to damage caps, steep award cuts during appeals and post-trial negotiations and future-value reporting of awards that will not be paid upfront. Damage caps vary from state to state. Some states have limited non-economic damages which has been challenged in courts and state legislatures. Therefore, physicians should get personal counsel to be better prepared for possible malpractice suits., Damages that exceed insurance coverage have put doctors on the hook for millions. Can anything get them off? In April 1998, a malpractice jury in California awarded more than $107 [...]

Physicians trimmed outlays in 1997, our survey shows, easing the drop in gross earnings. Primary-care doctors led the way. A funny thing happened on the way to the future: Doctors' [...]

Non-surgical claims are more frequent, and payouts larger, according to the biggest and most recent database available. The activities that primary-care physicians carry out during ordinary office visits are the [...]

Medical practices come in the form of incorporated and unincorporated groups. These are governed by state laws and their key differences lie on whether owners are personally liable for debts or taxes. Incorporated groups are classified into S corporations, C corporations and limited liability companies where owners are not personally liable for business debt or taxes. On the other hand, unincorporated groups which include general partnerships, sole proprietorships and limited liability partnerships, hold the owner personally responsible for all debts and taxes., What are the pros and cons of partnerships, C corporations, S corporations, and other business structures? This primer will help you sort out the options. Unlike the rose that by [...]

Doctors engaged in a moderately growing practice should know the rudiments of accrual accounting to keep track of tax and money matters more efficiently. Compared to cash-basis accounting, the accrual method is more practical since taxes are paid as money is earned. On the other hand, with cash-basis accounting, payment is not made until the money is actually in hand. Basic accounting terms such as double-entry bookkeeping should also be understood to have a better knowledge of accounting., If you're in a growing practice of moderate size, you need to know how this method works and why it can be superior to the simpler cash-on-the-barrelhead approach. With this [...]

Practice managers should possess exceptional qualities to manage a complex group of four to 15 doctors. A strong administrator should possess business skills and should function as an independent intellectual being since he has to mediate and smooth communications between doctors. They should also have decision-making abilities and supervisory skills since they are tasked with overseeing operational, personnel and financial matters. Managers are, therefore, required to have a broad experience with at least an associate's degree but not necessarily an M.B.A., Not only will she wrestle with all the practice's time-consuming administrative details, she'll also help the doctors see eye to eye. A practice manager's job is to free doctors to [...]

Office managers are valuable to a medical practice because they allow the physician to focus on the practice of medicine by taking care of the administrative functions. Managers take care of finances, day-to-day operations and supervise staff. In a small practice, the office manager is also expected to be knowledgeable of the functions of various staff and to act as substitute when one employee is absent., Her main function: Free you from hassles and let you concentrate on medicine. "Some achieve greatness," wrote Shakespeare in "Twelfth Night," "and some have greatness thrust upon 'em." Ruth Thibeault [...]