Impact of Removing Cost Sharing Under the Affordable Care Act (Aca) on Mammography and Pap Test Use

Background The Affordable Care Act (ACA) required private insurers and Medicare to cover recommended preventive services without any cost sharing to improve utilization of these services. This study is an attempt to identify the impact of removing cost sharing on mammography and pap test utilization rates. Methods Counterfactual analysis was used to predict what would have been the screening rates in post-ACA if ACA was not there. This was done by estimating a model that examines determinants of dependent variable for the pre-ACA year (pre-ACA year is 2009). The estimated model was then used to predict the dependent variable for the post-ACA year using individual characteristics and other relevant variables unlikely to be affected by ACA (post-ACA year is 2016). Effect of ACA is defined as the difference between the values of dependent variables in post-ACA and the predicted values of dependent variables in the post-ACA year using counterfactual. Results The counterfactual analysis show that the utilization of mammogram and pap test did not improve following ACA. Conclusion Removal of cost-sharing under the ACA did not improve mammography or pap test rates. Therefore, financial barrier may not be an important factor in affecting utilization of the screening tests and policy makers should focus on other non-financial barriers in order to improve coverage of the tests

Impact of Medicaid Coverage Expansion Under the Affordable Care Act on Mammography and Pap Tests Utilization Among Low-Income Women

Introduction The Affordable Care Act (ACA) expanded the coverage of Medicaid to include entire population with income below 138% of federal poverty line. It remains unclear whether this policy change has improved access to and utilization of health care, particularly use of mammography and Pap tests among poor women. Methods We used a difference-in-difference (DID) design to estimate the impact of Medicaid expansion on mammography and Pap tests utilization among low-income women. Expansion states are the treatment group and non-expansion states are the control group. The years 2012–13 are the pre-expansion period and 2015–16 are the post-expansion period for the purpose of estimating the DID parameters. Results The difference-in-difference estimate show that likelihood of utilizing mammograms did not change significantly among low-income women after the implementation of Medicaid expansion (DID coefficient -0.0476 with t-statistics at -1.26), Pap test decreased (coefficient -0.0615, t-statistics -2.76), and Medicaid enrollment has increased significantly among low-income women living in expansion states (coefficient 0.0889 with t-value of 3.68). Conclusion Expansion of Medicaid was associated with increased Medicaid enrollment but did not yield near-term improvement in use of mammography and Pap tests among low-income women. Factors beyond health insurance coverage may be important in determining the likelihood of obtaining these screenings. Policy makers should try to identify other barriers to cancer screenings among low-income women in the USA

The extended X-ray emission around HDF130 at z=1.99: an inverse Compton ghost of a giant radio source in the Chandra Deep Field North

One of the six extended X-ray sources found in the Chandra DeepField North is centred on HDF130, which has recently been shown to be a massive galaxy at z=1.99 with a compact radio nucleus. The X-ray source has a roughly double-lobed structure with each lobe about 41 arcsec long, or 345 kpc at the redshift of HDF130. We have analyzed the 2 Ms X-ray image and spectrum of the source and find that it is well fit by a power-law continuum of photon index 2.65 and has a 2--10 keV luminosity of 5.4x10^{43}ergps (if at z=1.99). Any further extended emission within a radius of 60 arcsec has a luminosity less than half this value, which is contrary to what is expected from a cluster of galaxies. The source is best explained as an inverse Compton ghost of a giant radio source, which is no longer being powered, and for which Compton losses have downgraded the energetic electrons, \gamma> 10^4, required for high-frequency radio emission. The lower energy electrons, \gamma~1000, produce X-rays by inverse Compton scattering on the Cosmic Microwave Background. Depending on the magnetic field strength, some low frequency radio emission may remain. Further inverse Compton ghosts may exist in the Chandra deep fields.Comment: 4 pages, 2 figures, accepted for publication in MNRA

Cosmic evolution of submillimeter galaxies and their contribution to stellar mass assembly

The nature of galaxies selected at submillimeter wavelengths (SMGs, S_850 > 3 mJy), some of the bolometrically most luminous objects at high redshifts, is still elusive. In particular their star formation histories and source of emission are not accurately constrained. In this paper we introduce a new approach to analyse the SMG data. Namely, we present the first self-consistent UV-to-radio spectral energy distribution fits of 76 SMGs with spectroscopic redshifts using all photometric datapoints from ultraviolet to radio simultaneously. We find that they are highly star-forming (median star formation rate 713 MSun yr^-1 for SMGs at z>0.5), moderately dust-obscured (median A_V~2 mag), hosting significant stellar populations (median stellar mass 3.7x10^11 MSun) of which only a minor part has been formed in the ongoing starburst episode. This implies that in the past, SMGs experienced either another starburst episode or merger with several galaxies. The properties of SMGs suggest that they are progenitors of present-day elliptical galaxies. We find that these bright SMGs contribute significantly to the cosmic star formation rate density (~20%) and stellar mass density (~30-50%) at redshifts 2-4. Using number counts at low fluxes we find that as much as 80% of the cosmic star formation at these redshifts took place in SMGs brighter than 0.1 mJy. We find evidence that a linear infrared-radio correlation holds for SMGs in an unchanged form up to redshift of 3.6, though its normalization is offset from the local relation by a factor of ~2.1 towards higher radio luminosities. We present a compilation of photometry data of SMGs and determinations of cosmic SFR and stellar mass densities.Comment: Accepted to A&A. 14 pages (+23 pages as appendix), 7 figures, 6 tables. Table A1-A5 can be found in the source file in the machine-readable form. For SED templates, see http://archive.dark-cosmology.dk/ or the source file. v3: major improvements: 1) the incompleteness correction applied; 2) the (higher) local q-value correctly assigned; 3) estimates of A_V adde

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570