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AIM: To describe the results of a feasibility phase and the expected results of a new approach to increase the participation rate in a Colorectal Cancer Organized Screening Program (CRCSP) through Facebook awareness messages. METHOD: This approach targets people aged 50-74 years, who reside in an urban deprived area and regularly connect to Facebook. The feasibility phase ran over 2 months (December 2018 and January 2019) in six municipalities (Seine-Saint-Denis, France). The full provisional campaign will run over a year. The approach consists of sending electronic awareness messages on the importance of screening for colorectal cancer using a specific Facebook module. Subjects who consent to screening complete a test-kit application form. The eligibility of each subject to participate in screening is determined by a doctor before the kit is sent out. RESULTS: A total of 39 900 people were reached by the feasibility phase campaign, and 9200 were able to watch at least one Facebook message/video. Of those, 4450 people logged to learn more about the CRCSP, 298 applied for a test kit, 160 test kit applicants were eligible to participate and the test completion rate was 41.9%. According to these feasibility results, 366 120 targeted people would connect regularly in the tested area, 141 541 of whom would be interested in a specific promotional message posted on Facebook. Requests could be made for 9770 kits, with 5246 people being eligible to participate in screening. The expected test-completion rate is estimated at 42%-89%. This would represent 5%-11% of the tests carried out in the area during the same period by 'classical' CRCSP. CONCLUSION: Implementation of the Facebook strategy would significantly improve the rate of participation in the CRCSP by mobilizing people with no previous participation, including younger subjects.

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Cytosine methylation plays an important role in the epigenetic regulation of eukaryotic gene expression. The methyl-CpG binding domain (MBD) is common to a family of eukaryotic transcriptional regulators. How MBD, a stretch of about 80 amino acids, recognizes CpGs in a methylation dependent manner, and as a function of sequence, is only partly understood. Here we show, using an Escherichia coli cell-free expression system, that MBD from the human transcriptional regulator MeCP2 performs as a specific, methylation-dependent repressor in conjunction with the BDNF (brain-derived neurotrophic factor) promoter sequence. Mutation of either base flanking the central CpG pair changes the expression level of the target gene. However, the relative degree of repression as a function of MBD concentration remains unaltered. Molecular dynamics simulations that address the DNA B fiber ratio and the handedness reveal cooperative transitions in the promoter DNA upon MBD binding that correlate well with our experimental observations. We suggest that not only steric hindrance, but also conformational changes of the BDNF promoter as a result of MBD binding are required for MBD to act as a specific inhibitory element. Our work demonstrates that the prokaryotic transcription machinery can reproduce features of epigenetic mammalian transcriptional regulatory elements.

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The effects of water availability during incubation on the water contents of neonatal snapping turtles at hatching were examined, along with the influence of hatchling water content on desiccation tolerance and terrestrial locomotor performance. The water contents of hatchlings from eggs incubated on wet substrates were both absolutely and proportionally greater than were those of hatchlings from eggs incubated on dry substrates. Hatchlings with greater water contents at hatching were able to survive longer and to lose more water before physiological performance was adversely affected by desiccation. Increased water contents in hatchlings with greater water availability during incubation may enhance survival by increasing the amount of water the animal can afford to lose before dehydration begins to adversely affect whole animal performance.

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Competition among managed care plans features the dynamic interaction among three primary forces: delivery system integration, managed care health plan risk sharing, and purchaser activism. To evaluate the cost containment potential for a particular market, decision makers need to understand the character of provider integration, the role of managed care insurance plans, and the extent of purchaser activism in contracting with health care providers. This paper provides benchmarks that analysts can use to assess markets, and applies them to the four largest markets in Wisconsin. It concludes that competition among managed care plans can lead to cost-effective care only if purchasers respond to differences in cost, for given quality, by switching from high-priced plans to lower-priced ones.

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The importance of avian egg components in the determination of hatchling size and quality has yet to be fully evaluated. In the first experiment, 20% of the albumen and/or the yolk was removed from chicken eggs to determine the impact of each egg component on metabolism and various size measures in near-term embryos. Results show that metabolic rate, dry body mass, and internal organ mass are largely independent of egg composition. Removal of albumen resulted in a decrease in wet body mass corresponding to decreases in water content in the body and the yolk sac, and decreased tibiotarsus length. Removal of yolk resulted in no change in body mass, but decreases in both wet and dry yolk sac mass. In a second experiment, removal of 15% of either egg component led to reductions in hatchling mass similar to those observed in whole near-term embryos. Albumen, as the primary source of water in the egg, is the primary determinant of hatchling size and may influence hatchling success through size-related limiting factors. Differences in yolk content may influence neonatal quality as a nutritional supplement, but seem not to result in greater tissue formation during embryonic development.

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The objective of this study was to examine whether the mode of obstetric delivery is related to resource costs, case mix, maternal length of stay, or neonatal morbidity. Patients (27,289) who delivered babies at nine hospitals within one health maintenance organization in 1989 were the source of data. Case-mix adjustment and outcome measures (maternal length of stay and neonatal morbidity) were computed from discharge abstract indicators, whereas cost data (direct professional hours) came from departmental financial reports. Costs and outcomes were adjusted by regression analysis for differences in case mix and then compared by correlation analysis. Neither adjusted nor unadjusted cesarean-section rates and obstetric cost per case were significantly correlated over the range of observed cesarean-section rates. Aggregate cesarean-section rates and outcome indicators were also statistically unrelated. Cesarean-section rate variation across hospitals was unrelated to the observed variation in obstetric costs, which were closely related to variations in staffing and less closely to differences in patient case mix and scale.

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Data Envelopment Analysis (DEA) identifies price and technical inefficiencies among decision-making units. With controls for differences in case-mix and standardized outcomes, DEA's "best practice" frontier can be interpreted as a "cost-effectiveness" frontier. This study illustrates the key concepts, identifies the decisions required to use the technique for medical care decision making, and presents an application to a system of nine hospitals that offer obstetric services.

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Third-party insurers typically pay at least 50% more for cesarean sections than for vaginal deliveries, suggesting that a reduced national cesarean-section rate could save payers more than $1 billion annually. This paper discusses the payment implications of a cost-effectiveness study, based on the experience within one health maintenance organization, in which cesarean-section rates were unrelated either to direct costs or to perinatal outcomes. Given these results, insurers should consider paying a flat fee for obstetric services unless differing risk levels or risk-adjusted outcomes justify different amounts.

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This study employs two risk-adjustment strategies to model the cost-effectiveness of obstetric services for eight hospitals in an urban health maintenance organization. Costs are adjusted by an index based on the expected length of a mother's stay, derived from a two stage regression analysis. Logistic regression of the probability of a cesarean-section on a set of clinical indicators constitutes the first stage. The second stage, an ordinary least squares regression, accounts for 30% of the variation in the logarithm of hours of stay but generates unbiased estimates for various subsets of cases. Adjusted costs per delivery range from roughly 22% below to 31% above the mean. Perinatal mortality rates--adjusted for differences in birthweight, sex, plurality, and race--serve as the outcome indicators. Risk-adjusted costs and risk-adjusted mortality rates are positively correlated with one another (r = .69, P = .06); in particular, the lowest cost hospital generated excellent outcomes. Adjusted cesarean-section rates, however, are not correlated with either adjusted costs (r = -.03, P = .95) or adjusted perinatal mortality rates (r = -.13, P = .75). These results suggest that cost management should focus on staff levels and mix more than on practice patterns and that care management should focus on practice patterns in relation to their influences on outcomes.

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