Liver Transplant Costs and Activity After United Network for Organ Sharing Allocation Policy Changes.

Importance: A new liver allocation policy was implemented by United Network for Organ Sharing (UNOS) in February 2020 with the stated intent of improving access to liver transplant (LT). There are growing concerns nationally regarding the implications this new system may have on LT costs, as well as access to a chance for LT, which have not been captured at a multicenter level. Objective: To characterize LT volume and cost changes across the US and within specific center groups and demographics after the policy implementation. Design, Setting, and Participants: This cross-sectional study collected and reviewed LT volume from multiple centers across the US and cost data with attention to 8 specific center demographics. Two separate 12-month eras were compared, before and after the new UNOS allocation policy: March 4, 2019, to March 4, 2020, and March 5, 2020, to March 5, 2021. Data analysis was performed from May to December 2022. Main Outcomes and Measures: Center volume, changes in cost. Results: A total of 22 of 68 centers responded comparing 1948 LTs before the policy change and 1837 LTs postpolicy, resulting in a 6% volume decrease. Transplants using local donations after brain death decreased 54% (P < .001) while imported donations after brain death increased 133% (P = .003). Imported fly-outs and dry runs increased 163% (median, 19; range, 1-75, vs 50, range, 2-91; P = .009) and 33% (median, 3; range, 0-16, vs 7, range, 0-24; P = .02). Overall hospital costs increased 10.9% to a total of $46 360 176 (P = .94) for participating centers. There was a 77% fly-out cost increase postpolicy ($10 600 234; P = .03). On subanalysis, centers with decreased LT volume postpolicy observed higher overall hospital costs ($41 720 365; P = .048), and specifically, a 122% cost increase for liver imports ($6 508 480; P = .002). Transplant centers from low-income states showed a significant increase in hospital (12%) and import (94%) costs. Centers serving populations with larger proportions of racial and ethnic minority candidates and specifically Black candidates significantly increased costs by more than 90% for imported livers, fly-outs, and dry runs despite lower LT volume. Similarly, costs increased significantly (>100%) for fly-outs and dry runs in centers from worse-performing health systems. Conclusions and Relevance: Based on this large multicenter effort and contrary to current assumptions, the new liver distribution system appears to place a disproportionate burden on populations of the current LT community who already experience disparities in health care. The continuous allocation policies being promoted by UNOS could make the situation even worse.

Dielectric coated conductive rod resonantly coupled with a cut transmission line as a tunable microwave bandstop filter and sensor.

The resonant interaction of a dielectric-coated conductive rod with the X-band microwave field is investigated. The magnetic field distribution of the Goubau standing radial surface waves was experimentally visualized by using a thermo-elastic optical indicator microscope, and the corresponding electric field distribution was determined via numerical simulations. These field distributions are characterized by a certain pattern of antinodes distinctive for standing waves. An analysis of these field distributions allows one to couple a coated rod with a cut Goubau line. A rod placed in the gap region perpendicular to the Goubau line results in a sharp rejection band in the transmission spectrum which is extremely sensitive to the changes in the surrounding media. The shifting rate of the resonance as a function of the dielectric shell thickness is approximately 1.4 GHz/mm. The Q-factor of copper rods depends on their size and dielectric shell thickness. Longer rods with more energy localization areas have higher Q-factors, typically 1.7 times higher (12.7 vs. 7.5). Moreover, incorporating a dielectric shell enhances energy confinement and can elevate the Q-factor by as much as 22 %. When a 25 mm Cu rod is situated inside a cut Goubau line system, the Q-factor values are significantly higher, with a ratio of 275 to 13. With the addition of a dielectric shell, the Q-factor can be elevated by 58 %. The versatility of the proposed controllable system makes it possible to tune the operating spectrum towards higher GHz and THz frequencies.

Characterization of interaction phenomena of electromagnetic waves with metamaterials via microwave near-field visualization technique.

A new practical imaging technique was presented for metamaterial characterization and investigation by visualizations of the magnetic microwave near-field (H-MWNF) distributions on a metamaterial's surface using the method of thermo-elastic optical indicator microscopy (TEOIM). ITO-based transparent and ceramic-based opaque metamaterial structures were designed for magnetic near-field visualization. Depending on the incident microwave field polarization, the TEOIM system allows the characterization of the metamaterial properties and microwave interaction behavior. The working principle of the periodic structures was investigated through numerical simulations, and the obtained results exhibited strong agreement when compared with experimental observations. Moreover, the visualization of the H-MWNF revealed the potential to characterize and evaluate the absorption and transmission properties effectively.

Perceptions of Ethicality: The Role of Attire Style, Attire Appropriateness, and Context.

Professional attire has traditionally been regarded as a sign of ethicality. However, recent trends towards a more casual workplace may have altered the general public's attire-based perceptions. To determine whether these trends have rendered the association between professional attire and ethicality obsolete, we draw on signaling theory and we examine, in two laboratory studies with working samples, the main effects of attire style (i.e., business formal, business casual, casual) on perceptions of employee ethicality. We also assess the mediating effects of attire appropriateness, the moderating effects of context (industry type), as well as their combined moderated-mediation effects in the relation between attire style and the outcome of interest. We find that casual attire is perceived as less ethical than business casual attire in both studies but is perceived as less ethical than business formal attire in the first study only. Moreover, the effect of attire style on perceptions of ethicality is mediated by perceptions of attire appropriateness. Lastly, we found inconclusive results for the moderated-mediation model, which suggest a more intricate effect of industry type than originally proposed. Three subsequent focus groups with working professionals provided additional insights into our findings and revealed workplace-relevant outcomes associated with perceptions of ethicality. Theoretical and practical implications, study limitations, and future research avenues are discussed.

POLICING IN THE AGE OF THE GUN.

This Article examines how the rapid deregulation and rampant possession of firearms is likely going to impact policing, and the constitutional law that governs it. For the longest time, lawful gun carry, concealed or open, was exceedingly rare. For a police officer to see a gun was both to see danger, and a crime in progress. This link among guns, danger, and unlawful possession has shaped much of the law of policing. But now, this understanding of the world is in its last stages of unraveling. In nearly all states, guns are no longer unlawful to own and carry by default. In many, they are barely regulated. Recent Supreme Court Second Amendment decisions like New York State Rifle & Pistol Association v. Bruen serve only to hasten where state laws already were headed. For police, however, the harm guns can do exists irrespective of what the law has to say about the legality of carrying them. As a result, the nation's gun laws are on a collision course with the practice and law of policing. This Article explores how the constitutional law governing policing is changing and will change in the face of gun legalization. Part I of this Article explains the ubiquitous role guns play in the life of a police officer, and what actions guns lead police to take. Part II is about the legal doctrine of policing, both before and after firearm legalization. It details how the law shaped what police could do in order to protect themselves and others, and how that law is changing to accommodate legalization. Police now must operate in a terrain that increasingly is uncertain as to their lawful authority, and that in many instances may put them or others in jeopardy. Part III examines how the shifting laws of guns and policing might impact police behavior, likely resulting in ad hoc carve-outs for police authority that-if history is any guide-overwhelmingly will be imposed on Black and Brown communities.

Exact results and the effect of monomer-monomer bond type for a grafted ideal chain.

We determine the equilibrium chain end probability density [Formula: see text] for a one-dimensional ideal chain of N monomers grafted to a planar surface. This distribution is also the distribution function of a three-dimensional chain where the tangential dimensions y, z are integrated out of the distribution. With a small modification of the analysis of Erukhimovich, Johner, and Joanny for free chains near a wall, we are able to obtain exact results for [Formula: see text] for any monomer number N though with the restriction that the monomer-monomer bonds lengths are exponentially distributed. In particular, we obtain exact values for [Formula: see text] and its derivative [Formula: see text] at the surface for any N and the full profile [Formula: see text] for selected values of N. To determine the effect of the bond distribution, we find [Formula: see text] numerically for Gaussian and uniformly distributed one-dimensional bonds and compare with the exact results for exponential bonds. We suggest several ways to quantify the effect of bond type based both on [Formula: see text] near the surface and in the scaling region [Formula: see text]. We then extract the large N limit of [Formula: see text] and show that it is similar to the chain end probability for continuous chains but shifted toward smaller x. We show the amount of shift is a measure of the magnitude of the correction to the continuous chain [Formula: see text]. We derive the value of the shift for exponential bonds and show that the value is different for other bond types. We argue the shift can be interpreted as an effective surface behind the actual surface.

3D visualization of microwave electric and magnetic fields by using a metasurface-based indicator.

Visualizations of the microwave electric and magnetic near-field distributions of radio-frequency (RF) filters were performed using the technique of thermoelastic optical indicator microscopy (TEOIM). New optical indicators based on periodic dielectric-metal structures were designed for electric field visualization. Depending on the structure orientation, such metasurface-based indicators allow separately visualization of the Ex and Ey components of the in-plane electric field. Numerical simulations were conducted to examine the working principle of the designed indicator structures, and the results were compared to the experimental, showing good agreement. In addition, the 3D visualization of the microwave near-field distribution was built, to show the field intensity and distribution dependencies on the distance from the RF filter.

Visualization of microwave near-field distribution in sodium chloride and glucose aqueous solutions by a thermo-elastic optical indicator microscope.

In this study, a new optical method is presented to determine the concentrations of NaCl and glucose aqueous solutions by using a thermo-elastic optical indicator microscope. By measuring the microwave near-field distribution intensity, concentration changes of NaCl and glucose aqueous solutions were detected in the 0-100 mg/ml range, when exposed to microwave irradiation at 12 GHz frequency. Microwave near-field distribution intensity decreased as the NaCl or glucose concentration increased due to the changes of the absorption properties of aqueous solution. This method provides a novel approach for monitoring NaCl and glucose in biological liquids by using a CCD sensor capable of visualizing NaCl and glucose concentrations without scanning.

Real-Time Noninvasive Measurement of Glucose Concentration Using a Modified Hilbert Shaped Microwave Sensor.

We developed a microwave glucose sensor based on the modified first-order Hilbert curve design and measured glucose concentration in aqueous solutions by using a real-time microwave near-field electromagnetic interaction technique. We observed S21 transmission parameters of the sensor at resonant frequencies depend on the glucose concentration. We could determine the glucose concentration in the 0-250 mg/dL concentration range at an operating frequency of near 6 GHz. The measured minimum detectable signal was 0.0156 dB/(mg/dL) and the measured minimum detectable concentration was 1.92 mg/dL. The simulation result for the minimum detectable signal and the minimum detectable concentration was 0.0182 dB/(mg/dL) and 1.65 mg/dL, respectively. The temperature instability of the sensor for human glycemia in situ measurement range (27-34 °C for fingers and 36-40 °C for body temperature ranges) can be improved by the integration of the temperature sensor in the microwave stripline platform and the obtained data can be corrected during signal processing. The microwave signal-temperature dependence is almost linear with the same slope for a glucose concentration range of 50-150 mg/dL. The temperature correlation coefficient is 0.05 dB/°C and 0.15 dB/°C in 27-34 °C and 36-40 °C temperature range, respectively. The presented system has a cheap, easy fabrication process and has great potential for non-invasive glucose monitoring.

Simultaneous imaging of magnetic field and temperature distributions by magneto optical indicator microscopy.

We report a simultaneous imaging method of the temperature and the magnetic field distributions based on the magneto optical indicator microscopy. The present method utilizes an optical indicator composed of a bismuth-substituted yttrium iron garnet thin film, and visualizes the magnetic field and temperature distributions through the magneto-optical effect and the temperature dependent optical absorption of the garnet thin film. By using a printed circuit board that carries an electric current as a device under test, we showed that the present method can visualize the magnetic field and temperature distribution simultaneously with a comparable temperature sensitivity (0.2 K) to that of existing conventional thermal imagers. The present technique provides a practical way to get a high resolution magnetic and thermal image at the same time, which is valuable in investigating how thermal variation results in a change of the operation state of a micrometer sized electronic device or material.

Temperature and microwave near field imaging by thermo-elastic optical indicator microscopy.

A high resolution imaging of the temperature and microwave near field can be a powerful tool for the non-destructive testing of materials and devices. However, it is presently a very challenging issue due to the lack of a practical measurement pathway. In this work, we propose and demonstrate experimentally a practical method resolving the issue by using a conventional CCD-based optical indicator microscope system. The present method utilizes the heat caused by an interaction between the material and an electromagnetic wave, and visualizes the heat source distribution from the measured photoelastic images. By using a slide glass coated by a metal thin film as the indicator, we obtain optically resolved temperature, electric, and magnetic microwave near field images selectively with a comparable sensitivity, response time, and bandwidth of existing methods. The present method provides a practical way to characterize the thermal and electromagnetic properties of materials and devices under various environments.

Adaptive microwave impedance memory effect in a ferromagnetic insulator.

Adaptive electronics, which are often referred to as memristive systems as they often rely on a memristor (memory resistor), are an emerging technology inspired by adaptive biological systems. Dissipative systems may provide a proper platform to implement an adaptive system due to its inherent adaptive property that parameters describing the system are optimized to maximize the entropy production for a given environment. Here, we report that a non-volatile and reversible adaptive microwave impedance memory device can be realized through the adaptive property of the dissipative structure of the driven ferromagnetic system. Like the memristive device, the microwave impedance of the device is modulated as a function of excitation microwave passing through the device. This kind of new device may not only helpful to implement adaptive information processing technologies, but also may be useful to investigate and understand the underlying mechanism of spontaneous formation of complex and ordered structures.

Medicare and commercial inpatient resource use: impact of hospital competition.

OBJECTIVES: To examine the influence of hospital competition on small-area inpatient resource use by payer. METHODS: We measured hospital competition and inpatient resource use using data from the 2008 Healthcare Cost and Utilization Project State Inpatient Databases. Generalized linear models adjusted for patient, population, and market characteristics were used to assess the relationship between inpatient resource use and hospital competition. RESULTS: Hospital competition had a similar influence on inpatient resource intensity for Medicare and privately insured patients. Hospitals in more competitive markets had significantly lower costs per discharge for both Medicare and privately insured patients. Hospital competition was not significantly associated with length of stay per discharge for either payer. CONCLUSION: Findings suggest that policies or incentives that promote or encourage competition in less competitive markets may reduce variation in resource use for both Medicare and private payers.

Application of a sensitive near-field microwave microprobe to the nondestructive characterization of microbial rhodopsin.

We study the opto-electrical properties of Natronomonas pharaonis sensory rhodopsin II (NpSRII) by using a near-field microwave microprobe (NFMM) under external light illumination. To investigate the possibility of application of NFMM to biological macromolecules, we used time dependent properties of NPSRII before/after light activation which has three distinct states - ground-state, M-state, and O-state. The diagnostic ability of NFMM is demonstrated by measuring the microwave reflection coefficient (S(11)) spectrum of NpSRII under steady-state illumination in the wavelength range of 350-650 nm. Moreover, we present microwave reflection coefficient S(11) spectra in the same wavelength range for two fast-photocycling rhodopsins: green light-absorbing proteorhodopsin (GPR) and Gloeobacter rhodopsin (GR). In addition the frequency sweep shift can be detected completely even for tiny amounts of sample (∼10(-3) OD of rhodopsin). Based on these results NFMM shows both very high sensitivity for detecting conformational changes and produces a good time-resolved spectrum.

Label-free DNA microarray bioassays using a near-field scanning microwave microscope.

A near-field scanning microwave microscope (NSMM) is used to readout and visualize homemade 10-mer oligonucleotide microarrays and an Agilent 60-mer DNA microarray as a realistic test of NSMM applicability to multiplexed sequence analysis. Sensitive characterization of DNA coverage and high resolution mapping of DNA spots in the microarray were realized by measuring the change of microwave reflection coefficient (S11) at about 4 GHz operating frequency. Hybridization between target (free) and capture (immobilized) sequences leads to changes in the microwave reflection coefficient, which were measured by the NSMM. These changes are caused by hybridization-induced modification of the dielectric permittivity profile of the DNA film. The dynamic range based on analysis of the 10-mer microarrays is over 3 orders of magnitude with the detection limit estimated below 0.01 strands/µm². The NSMM method should be readily capable of detecting target coverages down to 98% of probe coverage. We also directly image the patterned DNA microarray by NSMM with a 2 µm resolution. The complementary optical image of the DNA microarray visualized by using a relative fluorescent intensity metric agrees well with the NSMM results.

Noninvasive in vitro measurement of pig-blood d-glucose by using a microwave cavity sensor.

We have developed an electromagnetic microwave cavity sensor based on the resonant frequency shift for real time measurement of the glycemia in pig blood. We could determine the concentration of d-glucose in pig blood in the range of 150-550mg/dl at the resonance frequency near 4.75GHz with a bandwidth of 300MHz. The change in the d-glucose concentration in blood brings microwave reflection coefficient S(11) changes of about 6.26dB and resonance frequency shifts of about 11.25MHz due to the electromagnetic interaction between the cavity resonator and the blood filled plastic tube inserted into the cavity. This proposed system provides a unique approach for real time noninvasive and contactless glucose monitoring.

Non-invasive in vitro sensing of D-glucose in pig blood.

We have developed an electromagnetic resonant spiral sensor and have measured the glycemia in pig blood and the concentration of D-glucose in aqueous solution by using a real-time electromagnetic interaction phenomenon between the microwave sensor and the liquid. We could determine the concentration of glucose with a minimal resolution of 5 mg/dl in the 100-600 mg/dl concentration range at operating frequencies of about 7.65 GHz (for the glucose aqueous solution) and 7.77 GHz (for the pig blood sample). The change in the glucose concentration brings the changes of the microwave reflection coefficient due to the electromagnetic interaction between the resonator and the glucose solution. The in vitro results show the measured signal-to-noise ratio of about 34 dB, and the minimum detectible signal level of about 0.022 dB/(mg/dl). Our proposed system provides a unique approach for non-invasive and non-contact glucose monitoring, and it may serve as a bloodless glucometer.

Detection of DNA-hybridization using a near-field scanning microwave microscope.

A near-field scanning microwave microscope (NSMM) is used to detect sequence-specific hybridization between surface-immobilized and free DNA single strands. Hybridization between target (free) and capture (immobilized) sequences leads to changes in the reflection coefficient (S11) which are measured by the NSMM. These changes are caused by hybridization-induced modification of the dielectric constant profile of the DNA film. NSMM instrumentation does not require labeling of target sequences with fluorophores or other tagging groups. The physical basis of reflection coefficient changes underpinning the NSMM approach is discussed.

Visualization of magnetic domains by near-field scanning microwave microscope.

A near-field scanning microwave microscope (NSMM) system was used for the investigation of magnetic properties of a hard disk (HD) under an external magnetic field. To demonstrate local microwave characterization of magnetic domains by NSMM, we scanned the HD surface by measuring the microwave reflection coefficient S(11) of the NSMM at an operating frequency near 4.4GHz. The NSMM offers a reliable means for quantitative measurement of magnetic domains with high spatial resolution and sensitivity.