Ambulatory care, insurance, and avoidable emergency department utilization in North Carolina

Objective: To examine whether and how avoidable emergency department (ED) utilization is associated with ambulatory or primary care (APC) utilization, insurance, and interaction effects. Design and sample: A cross-sectional analysis of electronic health records from 70,870 adults residing in Mecklenburg County, North Carolina, who visited an ED within a large integrated healthcare system in 2017. Methods: APC utilization was measured as total visits, categorized as: 0, 1, and > 1. Insurance was defined as the method of payment for the ED visit as: Medicaid, Medicare, private, or uninsured. Avoidable ED utilization was quantified as a score (aED), calculated as the sum of New York University Algorithm probabilities multiplied by 100. Quantile regression models were used to predict the 25th, 50th, 75th, 95th, and 99th percentiles of avoidable ED scores with APC visits and insurance as predictors (Model 1) and with an interaction term (Model 2). Results: Having >1 APC visit was negatively associated with aED at the lower percentiles and positively associated at higher percentiles. A higher aED was associated with having Medicaid insurance and a lower aED was associated with having private insurance, compared to being uninsured. In stratified models, having >1 APC visit was negatively associated with aED at the 25th percentile for the uninsured and privately insured, but positively associated with aED at higher percentiles among the uninsured, Medicaid-insured, and privately insured. Conclusions: The association between APC utilization and avoidable ED utilization varied based on segments of the distribution of ED score and differed significantly by insurance type

Calibrating the zenith of dinosaur diversity in the Campanian of the Western Interior Basin by CA-ID-TIMS U-Pb geochronology

The spectacular fossil fauna and flora preserved in the Upper Cretaceous terrestrial strata of North America’s Western Interior Basin record an exceptional peak in the diversification of fossil vertebrates in the Campanian, which has been termed the ‘zenith of dinosaur diversity’. The wide latitudinal distribution of rocks and fossils that represent this episode, spanning from northern Mexico to the northern slopes of Alaska, provides a unique opportunity to gain insights into dinosaur paleoecology and to address outstanding questions regarding faunal provinciality in connection to paleogeography and climate. Whereas reliable basin-wide correlations are fundamental to investigations of this sort, three decades of radioisotope geochronology of various vintages and limited compatibility has complicated correlation of distant fossil-bearing successions and given rise to contradictory paleobiogeographic and evolutionary hypotheses. Here we present new U–Pb geochronology by the CA-ID-TIMS method for 16 stratigraphically well constrained bentonite beds, ranging in age from 82.419 ± 0.074 Ma to 73.496 ± 0.039 Ma (2σ internal uncertainties), and the resulting Bayesian age models for six key fossil-bearing formations over a 1600 km latitudinal distance from northwest New Mexico, USA to southern Alberta, Canada. Our high-resolution chronostratigraphic framework for the upper Campanian of the Western Interior Basin reveals that despite their contrasting depositional settings and basin evolution histories, significant age overlap exists between the main fossil-bearing intervals of the Kaiparowits Formation (southern Utah), Judith River Formation (central Montana), Two Medicine Formation (western Montana) and Dinosaur Park Formation (southern Alberta). Pending more extensive paleontologic collecting that would allow more rigorous faunal analyses, our results support a first-order connection between paleoecologic and fossil diversities and help overcome the chronostratigraphic ambiguities that have impeded the testing of proposed models of latitudinal provinciality of dinosaur taxa during the Campanian

Diferenciación de especies Diatraea spp. Que afectan los cultivo de caña en la región del Gualiva

Se realizó un diagnóstico de las especies de Diatraea spp, encontradas durante la recolección directa de estados inmaduros en cañas listas para beneficio y cañas de 7 a 9 meses después del corte. La recolección de los espécimenes, se hizo directamente sobre los tallos de cañas en cultivos de la variedad POJ en los municipios de Villeta y Nimaima Cundinamarca, por un tiempo de ocho meses empezando en el mes de Octubre de 2006 y finalizando en el mes de Junio de 2007, con un total de ochenta larvas recolectadas. Se reconocieron tres especies de barrenador Diatraea saccharalis, D. indigenella y una especie que se encuentra en proceso de reconocimiento; en la recolección se obtuvieron promedios de porcentaje de 75,71%, 22,81 y 1,44%, respectivamente. El diagnóstico consistió en observar las diferencias morfológicas mas relevantes de cada una de las tres especies

Very high rotational frequencies and band termination in 73Br

Rotational bands in 73Br have been investigated up to spins of 65/2 using the EUROBALL III spectrometer. One of the negative-parity bands displays the highest rotational frequency 1.85 MeV reported to date in nuclei with mass number greater than 25. At high frequencies, the experimental dynamic moment of inertia for all bands decrease to very low values, indicating a loss of collectivity. The bands are described in the configuration-dependent cranked Nilsson-Strutinsky model. The calculations indicate that one of the negative-parity bands is observed up to its terminating single-particle state at spin 63/2. This result establishes the first band termination case in the A = 70 mass region.Comment: 6 pages, 6 figures, submitted to Phys. Rev. C as a Rapid Communicatio

The utility of Google Trends data to examine interest in cancer screening

OBJECTIVES: We examined the utility of January 2004 to April 2014 Google Trends data from information searches for cancer screenings and preparations as a complement to population screening data, which are traditionally estimated through costly population-level surveys. SETTING: State-level data across the USA. PARTICIPANTS: Persons who searched for terms related to cancer screening using Google, and persons who participated in the Behavioral Risk Factor Surveillance System (BRFSS). PRIMARY AND SECONDARY OUTCOME MEASURES: (1) State-level Google Trends data, providing relative search volume (RSV) data scaled to the highest search proportion per week (RSV100) for search terms over time since 2004 and across different geographical locations. (2) RSV of new screening tests, free/low-cost screening for breast and colorectal cancer, and new preparations for colonoscopy (Prepopik). (3) State-level breast, cervical, colorectal and prostate cancer screening rates. RESULTS: Correlations between Google Trends and BRFSS data ranged from 0.55 for ever having had a colonoscopy to 0.14 for having a Pap smear within the past 3 years. Free/low-cost mammography and colonoscopy showed higher RSV during their respective cancer awareness months. RSV for Miralax remained stable, while interest in Prepopik increased over time. RSV for lung cancer screening, virtual colonoscopy and three-dimensional mammography was low. CONCLUSIONS: Google Trends data provides enormous scientific possibilities, but are not a suitable substitute for, but may complement, traditional data collection and analysis about cancer screening and related interests

The first oviraptorosaur (Dinosauria Theropoda) bonebed:evidence of gregarious behaviour in a maniraptoran theropod

A monodominant bonebed of Avimimus from the Nemegt Formation of Mongolia is the first oviraptorosaur bonebed described and the only recorded maniraptoran bonebed from the Late Cretaceous. Cranial elements recovered from the bonebed provide insights on the anatomy of the facial region, which was formerly unknown in Avimimus. Both adult and subadult material was recovered from the bonebed, but small juveniles are underrepresented. The taphonomic and sedimentological evidence suggests that the Avimimus bonebed represents a perimortem gregarious assemblage. The near absence of juveniles in the bonebed may be evidence of a transient age-segregated herd or 'flock', but the behaviour responsible for this assemblage is unclear. Regardless, the Avimimus bonebed is the first evidence of gregarious behaviour in oviraptorosaurs, and highlights a potential trend of increasing gregariousness in dinosaurs towards the end of the Mesozoic.</p