Temperature variability implies greater economic damages from climate change.

A number of influential assessments of the economic cost of climate change rely on just a small number of coupled climate-economy models. A central feature of these assessments is their accounting of the economic cost of epistemic uncertainty-that part of our uncertainty stemming from our inability to precisely estimate key model parameters, such as the Equilibrium Climate Sensitivity. However, these models fail to account for the cost of aleatory uncertainty-the irreducible uncertainty that remains even when the true parameter values are known. We show how to account for this second source of uncertainty in a physically well-founded and tractable way, and we demonstrate that even modest variability implies trillions of dollars of previously unaccounted for economic damages.

An update on genetic risk assessment and prevention: the role of genetic testing panels in breast cancer.

Introduction: In the past 5 years, multi-gene panels have replaced the practice of BRCA1 and BRCA2 genetic testing in cases of suspected inherited breast cancer susceptibility. A variety of genes have been included on these panels without certainty of their clinical utility. Pertinent current and historical literature was reviewed to provide an up-to-date snapshot of the changing landscape of the use of gene panel tests in the context of breast cancer. Areas covered: Following a recent review of the evidence, 10 genes have been found to have definitive evidence of increased breast cancer risk with variable penetrance. Here, we review the recent changes to the practice of multi-gene panel use in breast cancer diagnoses, including an update on next generation sequencing, alternative models of genetic testing, considerations when ordering these panel tests, and recommendations for management in identified carriers for a variety of genes. A comparison of screening recommendations and carrier frequencies from recent studies is also explored. Lastly, we consider what the future of hereditary oncologic genetic testing holds. Expert opinion: The transition to multi-gene panels in breast cancer patients has improved the likelihood of capturing a rare variant in a well-established gene associated with hereditary breast cancer (e.g. BRCA1 and BRCA2, TP53). There is also an increase in the likelihood of uncovering an uncertain result. This could be in the form of a variant of uncertain significance, or a pathogenic variant in a gene with questionable breast cancer risk-association. Concurrently, a changing landscape of who orders genetic tests will improve access to genetic testing. This pervasiveness of genetic testing must be accompanied with increased genetic literacy in all health-care providers, and access to support from genetics professionals for management of patients and at-risk family members.

Environmental enrichment and response cost: immediate and subsequent effects on stereotypy.

We assessed the immediate and subsequent effects of environmental enrichment (EE) as a stand-alone intervention and when EE was combined with response cost (RC) for 5 participants using a 2-component multiple-schedule design. Environmental enrichment failed to decrease any participant's immediate engagement in stereotypy; however, the addition of RC decreased the immediate engagement in stereotypy for all participants. After the withdrawal of EE plus RC, stereotypy did not immediately increase for 3 of 5 participants.

The management of blood safety in the presence of uncertain risk: a United kingdom perspective.

Millions of patients in the UK benefit from the use of both plasma derivatives and blood components that are seen as critical interventions in current medicine. Measures are in place to significantly reduce the risks associated with blood transfusion and plasma derivatives; however, these measures themselves are not risk free. Over the past 20 years, advances in technology and regulation have seen major reductions in the risks associated with transfusion. International blood services, industry, and regulators strive to maintain safety levels through constant monitoring, assessment, and response to changing risk factors. Regulation of screening tests together with the development and introduction of nucleic acid technique tests for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus has improved blood safety. However, other risks, including the changing epidemiology of transfusion-transmitted infections, bacterial contamination of platelets, incorrect blood component transfusion, and variant Creutzfeldt-Jakob disease, require further attention. Risks such as these are often complex, and there is a difficult balance to be struck between donors/recipients' benefit and adequacy of blood supply. The introduction of any new safety measure therefore requires robust, evidence-based evaluation of associated benefit, both clinical and economical. This review presents a UK perspective on how the safety of the blood supply is maintained in the face of uncertain risks.

Topological isomorphisms of human brain and financial market networks.

Although metaphorical and conceptual connections between the human brain and the financial markets have often been drawn, rigorous physical or mathematical underpinnings of this analogy remain largely unexplored. Here, we apply a statistical and graph theoretic approach to the study of two datasets - the time series of 90 stocks from the New York stock exchange over a 3-year period, and the fMRI-derived time series acquired from 90 brain regions over the course of a 10-min-long functional MRI scan of resting brain function in healthy volunteers. Despite the many obvious substantive differences between these two datasets, graphical analysis demonstrated striking commonalities in terms of global network topological properties. Both the human brain and the market networks were non-random, small-world, modular, hierarchical systems with fat-tailed degree distributions indicating the presence of highly connected hubs. These properties could not be trivially explained by the univariate time series statistics of stock price returns. This degree of topological isomorphism suggests that brains and markets can be regarded broadly as members of the same family of networks. The two systems, however, were not topologically identical. The financial market was more efficient and more modular - more highly optimized for information processing - than the brain networks; but also less robust to systemic disintegration as a result of hub deletion. We conclude that the conceptual connections between brains and markets are not merely metaphorical; rather these two information processing systems can be rigorously compared in the same mathematical language and turn out often to share important topological properties in common to some degree. There will be interesting scientific arbitrage opportunities in further work at the graph-theoretically mediated interface between systems neuroscience and the statistical physics of financial markets.

An evaluation of operating room safety and efficiency: pilot utilization of a structured focus group format and three-dimensional video mock-up to inform design decision.

OBJECTIVE: The purpose of this investigation was to identify safety and efficiency-related design features for inclusion in operating room (OR) construction documents. BACKGROUND: Organizations are confronted with an array of challenges when planning an OR, including inefficiencies in operations, adverse events, and a variety of innovations to choose from. Currently, techniques that can be used in design practice and to inform design decision making for implementable OR solutions are limited. METHODS: The project team used a structured focus group format with mixed methods to solicit 19 varying surgical team members' reactions to a three-dimensional video mock-up of a proposed OR. Data from the 19 participants were analyzed using stepwise multiple regression and content analysis of open-ended responses. RESULTS AND DISCUSSION: Results demonstrate that several features of the proposed OR design predict meaningful outcomes, including flexibility and satisfaction with the OR setup, adverse event prevention, team performance, and distractions and interruptions. Participants' suggested solutions include universal booms to support anesthetic and perfusion capabilities, a fixed circulating nursing workstation that faces the patient and is at the foot of the operating room table, a wall-mounted monitor across from the surgeon, and wiring to support a touch-screen control arm in OR surgical fields. CONCLUSIONS: Findings from structured focus groups with mixed methods lead to implementable design solutions for construction documentation. The expeditious qualities and objectivity of the format are value-adds to the design decision-making process. Future research should use various techniques such as virtual technologies and building information modeling.