Medicare Expenditures and Healthcare Utilization in a Multi-ethnic Community-based Population with Dementia from Incidence to Death

Introduction: While individuals live with dementia for many years, utilization and expenditures from disease onset through the end-of-life period have not been examined in ethnically diverse samples. Methods: We used a multiethnic, population-based, prospective study of cognitive aging (Washington Heights-Inwood Columbia Aging Project) linked to Medicare claims to examine total Medicare expenditures and health care utilization among individuals with clinically diagnosed incident dementia from disease onset to death. Results: High-intensity treatment (hospitalizations, life-sustaining procedures) was common and mean Medicare expenditures per year after diagnosis was $69,000. Non-Hispanic blacks exhibited higher spending relative to Hispanics and non-Hispanic whites 1 year after diagnosis. Non-Hispanic blacks had higher total (mean=$205,000) Medicare expenditures from diagnosis to death compared with non-Hispanic whites (mean=$118,000). Hispanics’ total expenditures and utilization after diagnosis was similar to non-Hispanic whites despite living longer with dementia. Discussion: Health care spending for patients with dementia after diagnosis through the end-of-life is high and varies by ethnicity

Beyond incommensurability: Jerusalem and Stockholm from an ordinary cities perspective

This paper’s core argument is that we should start creating theories that encompass different cities and include them in a more flexible and relational comparative framework. This must include a new urban terminology which does not continue the all-too-fashionable labelling of cities on a continuum between first world and third world, global North-West and South-East or as I emphasize below, including what have been labelled extremely contested cities in a more flexible and relational ordinary cities framework. To introduce such a comparative approach, I will examine Jerusalem and Stockholm via three contrastive and relational patterns: institutional segregation; urban violence; and non-governmental organization involvement in planning. In so doing, I point towards the necessity to open up research on extreme urban conflicts, suggesting that when assessing specific contextual patterns, those labelled as extremely contested cities (such as Jerusalem) share more similarities with other more ordinary cities (represented by Stockholm) than was previously perceived, often stemming from ethnic, racial and class conflicts revolving around issues of politics, culture and identity, among others

Effect of sampling effort and sampling frequency on the composition of the planktonic crustacean assemblage: a case study of the river Danube

Although numerous studies have focused on the seasonal dynamics of riverine zooplankton, little is known about its short-term variation. In order to examine the effects of sampling frequency and sampling effort, microcrustacean samples were collected at daily intervals between 13 June and 21 July of 2007 in a parapotamal side arm of the river Danube, Hungary. Samples were also taken at biweekly intervals from November 2006 to May 2008. After presenting the community dynamics, the effect of sampling effort was evaluated with two different methods; the minimal sample size was also estimated. We introduced a single index (potential dynamic information loss; to determine the potential loss of information when sampling frequency is reduced. The formula was calculated for the total abundance, densities of the dominant taxa, adult/larva ratios of copepods and for two different diversity measures. Results suggest that abundances may experience notable fluctuations even within 1 week, as do diversities and adult/larva ratios

Large scale patterns in vertical distribution and behavior of mesopelagic scattering layers

Recent studies suggest that previous estimates of mesopelagic biomasses are severely biased, with the new, higher estimates underlining the need to unveil behaviourally mediated coupling between shallow and deep ocean habitats. We analysed vertical distribution and diel vertical migration (DVM) of mesopelagic acoustic scattering layers (SLs) recorded at 38 kHz across oceanographic regimes encountered during the circumglobal Malaspina expedition. Mesopelagic SLs were observed in all areas covered, but vertical distributions and DVM patterns varied markedly. The distribution of mesopelagic backscatter was deepest in the southern Indian Ocean (weighted mean daytime depth: WMD 590 m) and shallowest at the oxygen minimum zone in the eastern Pacific (WMD 350 m). DVM was evident in all areas covered, on average ~50% of mesopelagic backscatter made daily excursions from mesopelagic depths to shallow waters. There were marked differences in migrating proportions between the regions, ranging from ~20% in the Indian Ocean to ~90% in the Eastern Pacific. Overall the data suggest strong spatial gradients in mesopelagic DVM patterns, with implied ecological and biogeochemical consequences. Our results suggest that parts of this spatial variability can be explained by horizontal patterns in physical-chemical properties of water masses, such as oxygen, temperature and turbidity.En prensa2,927

Fractal analyses reveal independent complexity and predictability of gait

Locomotion is a natural task that has been assessed for decades and used as a proxy to highlight impairments of various origins. So far, most studies adopted classical linear analyses of spatio-temporal gait parameters. Here, we use more advanced, yet not less practical, non-linear techniques to analyse gait time series of healthy subjects. We aimed at finding more sensitive indexes related to spatio-temporal gait parameters than those previously used, with the hope to better identify abnormal locomotion. We analysed large-scale stride interval time series and mean step width in 34 participants while altering walking direction (forward vs. backward walking) and with or without galvanic vestibular stimulation. The Hurst exponent α and the Minkowski fractal dimension D were computed and interpreted as indexes expressing predictability and complexity of stride interval time series, respectively. These holistic indexes can easily be interpreted in the framework of optimal movement complexity. We show that α and D accurately capture stride interval changes in function of the experimental condition. Walking forward exhibited maximal complexity (D) and hence, adaptability. In contrast, walking backward and/or stimulation of the vestibular system decreased D. Furthermore, walking backward increased predictability (α) through a more stereotyped pattern of the stride interval and galvanic vestibular stimulation reduced predictability. The present study demonstrates the complementary power of the Hurst exponent and the fractal dimension to improve walking classification. Our developments may have immediate applications in rehabilitation, diagnosis, and classification procedures

Catalonia rescaling Spain : is it feasible to accommodate its "stateless citizenship"?

The Spanish nation-state is gradually being rescaled by Catalonia's “secession crisis.” Recently and dramatically, in the aftermath of the “illegal” and “constitutive referendum” that took place on 1 October 2017, 2,286,217 Catalan citizens attempted to exercise the “right to decide” to ultimately become “stateless citizens.” This paper examines this rescaling process that has been forming in Barcelona since 10 July 2010 when 1 million Catalan citizens marched to claim their “right to decide” on secession. This paper concludes that, at present, it is not feasible for the Spanish nation-state to accommodate Catalonia's “stateless citizenship.”

Towards Urban Geopolitics of Encounter: Spatial Mixing in Contested Jerusalem

The extent to which 'geographies of encounter' facilitate tolerance of diversity and difference has long been a source of debate in urban studies and human geography scholarship. However, to date this contestation has focused primarily on hyper-diverse cities in the global north-west. Adapting this debate to the volatile conditions of the nationally-contested city, this paper explores intergroup encounters between Israelis and Palestinians in Jerusalem. The paper suggests that in the context of hyper-polarisation of the nationally-contested urban space, the study of encounter should focus on macro-scale structural forces. In Jerusalem, we stress the role of ethnonationality and neoliberalism as key producers of its asymmetric and volatile yet highly resilient geography of intergroup encounters. In broader sense, as many cities worldwide experience a resurgence of ethnonationalism, illuminating the structural production of encounter may demarcate a broader function for reading contemporary urban geopolitics

Temperature, recreational fishing and diapause egg connections : dispersal of spiny water fleas (Bythotrephes longimanus)

© The Author(s), 2011. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License. The definitive version was published in Biological Invasions 13 (2011): 2513-2531, doi:10.1007/s10530-011-0078-8.The spiny water flea (Bythotrephes longimanus) is spreading from Great Lakes coastal waters into northern inland lakes within a northern temperature-defined latitudinal band. Colonization of Great Lakes coastal embayments is assisted by winds and seiche surges, yet rapid inland expansion across the northern states comes through an overland process. The lack of invasions at Isle Royale National Park contrasts with rapid expansion on the nearby Keweenaw Peninsula. Both regions have comparable geology, lake density, and fauna, but differ in recreational fishing boat access, visitation, and containment measures. Tail spines protect Bythotrephes against young of the year, but not larger fish, yet the unusual thick-shelled diapausing eggs can pass through fish guts in viable condition. Sediment traps illustrate how fish spread diapausing eggs across lakes in fecal pellets. Trillions of diapausing eggs are produced per year in Lake Michigan and billions per year in Lake Michigamme, a large inland lake. Dispersal by recreational fishing is linked to use of baitfish, diapausing eggs defecated into live wells and bait buckets, and Bythothephes snagged on fishing line, anchor ropes, and minnow seines. Relatively simple measures, such as on-site rinsing of live wells, restricting transfer of certain baitfish species, or holding baitfish for 24 h (defecation period), should greatly reduce dispersal.Study of Lakes Superior and Michigan was funded from NSF OCE-9726680 and OCE-9712872 to W.C.K., OCE-9712889 to J. Churchill. Geographic survey sampling and Park studies in the national parks during 2008-2010 were funded by a grant from the National Park Service Natural Resource Preservation Program GLNF CESU Task Agreement No. J6067080012