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

Diabetes status and being up-to-date on colorectal cancer screening, 2012 Behavioral Risk Factor Surveillance System

INTRODUCTION: Although screening rates for colorectal cancer are increasing, 22 million Americans are not up-to-date with recommendations. People with diabetes are an important and rapidly growing group at increased risk for colorectal cancer. Screening status and predictors of being up-to-date on screening are largely unknown in this population. METHODS: This study used logistic regression modeling and data from the 2012 Behavioral Risk Factor Surveillance System to examine the association between diabetes and colorectal cancer screening predictors with being up-to-date on colorectal cancer screening according to criteria of the US Preventive Services Task Force for adults aged 50 or older. State prevalence rates of up-to-date colorectal cancer screening were also calculated and mapped. RESULTS: The prevalence of being up-to-date with colorectal cancer screening for all respondents aged 50 or older was 65.6%; for respondents with diabetes, the rate was 69.2%. Respondents with diabetes were 22% more likely to be up-to-date on colorectal cancer screening than those without diabetes. Among those with diabetes, having a routine checkup within the previous year significantly increased the odds of being up-to-date on colorectal cancer screening (odds ratio, 1.90). Other factors such as age, income, education, race/ethnicity, insurance status, and history of cancer were also associated with up-to-date status. CONCLUSION: Regardless of diabetes status, people who had a routine checkup within the past year were more likely to be up-to-date than people who had not. Among people with diabetes, the duration between routine checkups may be of greater importance than the frequency of diabetes-related doctor visits. Continued efforts should be made to ensure that routine care visits occur regularly to address the preventive health needs of patients with and patients without diabetes

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

Performance of HPGe Detectors in High Magnetic Fields

A new generation of high-resolution hypernuclear gamma$-spectroscopy experiments with high-purity germanium detectors (HPGe) are presently designed at the FINUDA spectrometer at DAPhiNE, the Frascati phi-factory, and at PANDA, the antiproton proton hadron spectrometer at the future FAIR facility. Both, the FINUDA and PANDA spectrometers are built around the target region covering a large solid angle. To maximise the detection efficiency the HPGe detectors have to be located near the target, and therefore they have to be operated in strong magnetic fields B ~ 1 T. The performance of HPGe detectors in such an environment has not been well investigated so far. In the present work VEGA and EUROBALL Cluster HPGe detectors were tested in the field provided by the ALADiN magnet at GSI. No significant degradation of the energy resolution was found, and a change in the rise time distribution of the pulses from preamplifiers was observed. A correlation between rise time and pulse height was observed and is used to correct the measured energy, recovering the energy resolution almost completely. Moreover, no problems in the electronics due to the magnetic field were observed.Comment: submitted to Nucl. Instrum. Meth. Phys. Res. A, LaTeX, 19 pages, 9 figure

Using an Accessible Room Multisensory Stimulation Environment to Reduce Dementia Associated Behaviors

Objectives: To reveal whether an accessible open floorplan Multisensory Stimulation Environment (MSSE) room design has a positive impact as a nonpharmacologic intervention for episodes of Behavioral and Psychological Symptoms of Dementia (BPSD) in older adults living in a Memory Care Assisted Living (MCAL) facility as well as reducing the need for direct care supervision. Methods: Retrospective pre/post cohort design of 24 residents living in a Midwest MCAL facility in the United States with a diagnosis of dementia and over 65 years of age, analyzed by secondary medical chart review for 12 months to assess impact of an accessible open floorplan MSSE room design. The pre/post design analyzed secondary data over two periods of time; 6 months prior to the MSSE installation and 6 months following the MSSE installation. Results: Following the installation of an open floorplan MSSE, the number of observed BPSD episodes changed from 367 (17%) pre-test to 298 (10%) post-test over a 12-month time period. The Comparison of Proportions test determined that the difference in the proportion of BPSD episodes documented was statistically significant with clinical implications. Conclusions: The accessible open floorplan MSSE room design, located within a single-site MCAL facility, utilized as a nonpharmacological intervention for BPSD, was found in this explorative study to be effective and potentially clinically meaningful in improving behavioral episodes for older adults diagnosed with dementia in MCAL settings

First Results on In-Beam gamma Spectroscopy of Neutron-Rich Na and Mg Isotopes at REX-ISOLDE

After the successful commissioning of the radioactive beam experiment at ISOLDE (REX-ISOLDE) - an accelerator for exotic nuclei produced by ISOLDE - first physics experiments using these beams were performed. Initial experiments focused on the region of deformation in the vicinity of the neutron-rich Na and Mg isotopes. Preliminary results show the high potential and physics opportunities offered by the exotic isotope accelerator REX in conjunction with the modern Germanium gamma spectrometer MINIBALL.Comment: 7 pages, RNB6 conference contributio

Coulomb excitation of 68^{68}Ni at safe energies

The $B(E2;0^+\to2^+)$ value in $^{68}$Ni has been measured using Coulomb excitation at safe energies. The $^{68}$Ni radioactive beam was post-accelerated at the ISOLDE facility (CERN) to 2.9 MeV/u. The emitted $\gamma$ rays were detected by the MINIBALL detector array. A kinematic particle reconstruction was performed in order to increase the measured c.m. angular range of the excitation cross section. The obtained value of 2.8$^{+1.2}_{-1.0}$ 10$^2$ e$^2$fm$^4$ is in good agreement with the value measured at intermediate energy Coulomb excitation, confirming the low $0^+\to2^+$ transition probability.Comment: 4 pages, 5 figure

A one-dimensional lattice model for a quantum mechanical free particle

Two types of particles, A and B with their corresponding antiparticles, are defined in a one dimensional cyclic lattice with an odd number of sites. In each step of time evolution, each particle acts as a source for the polarization field of the other type of particle with nonlocal action but with an effect decreasing with the distance: A -->...\bar{B} B \bar{B} B \bar{B} ... ; B --> A \bar{A} A \bar{A} A ... . It is shown that the combined distribution of these particles obeys the time evolution of a free particle as given by quantum mechanics.Comment: 8 pages. Revte

Coulomb excitation of 73Ga

The B(E2; Ii -> If) values for transitions in 71Ga and 73Ga were deduced from a Coulomb excitation experiment at the safe energy of 2.95 MeV/nucleon using post-accelerated beams of 71,73Ga at the REX-ISOLDE on-line isotope mass separator facility. The emitted gamma rays were detected by the MINIBALL-detector array and B(E2; Ii->If) values were obtained from the yields normalized to the known strength of the 2+ -> 0+ transition in the 120Sn target. The comparison of these new results with the data of less neutron-rich gallium isotopes shows a shift of the E2 collectivity towards lower excitation energy when adding neutrons beyond N = 40. This supports conclusions from previous studies of the gallium isotopes which indicated a structural change in this isotopical chain between N = 40 and N = 42. Combined with recent measurements from collinear laser spectroscopy showing a 1/2- spin and parity for the ground state, the extracted results revealed evidence for a 1/2-; 3/2- doublet near the ground state in 73 31Ga42 differing by at most 0.8 keV in energy