How Home Health Agencies’ Ownership Affects Practice Patterns

This study explores whether for‐profit home health agencies responded differently from non‐profit agencies to financial incentives embedded in the Medicare prospective payment system. Agencies were able to receive higher reimbursement per patient under the prospective payment system if they adjusted the number of therapy visits or the type of visits for a two‐month‐long episode. Agencies could also increase reimbursement by treating a patient for multiple episodes of care, because prospective payments were made on a per‐episode basis. Using the Medicare Claims and Provider of Services Files from 2001 to 2009, we examine differences between for‐profit and non‐profit agencies in these practice patterns during the first nine years of the prospective payment system. We find that for‐profit agencies were more likely to adopt most of these practice patterns than were non‐profit agencies. This finding suggests that for‐profit agencies were more responsive to financial incentives, and therefore disproportionately contributed to the increase in Medicare home health spending under the prospective payment system. Policymakers could consider revising the current prospective payment system that gives agencies incentives to distort practice patterns regardless of a patient’s health care needs.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138406/1/fisc12136_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138406/2/fisc12136-sup-0001-text.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138406/3/fisc12136.pd

Being Prepared and Staying Connected: Scouting’s Influence on Social Capital and Community Involvement

Objectives In recent years, scholars have become concerned about the effects that declining levels of social capital are having on community life in the United States. Data suggest that Americans are less likely to interact with neighbors and less likely to participate in community groups than they were in the past. Nevertheless, researchers have found that participation in some types of organizations has a positive impact on social capital and civic involvement. Each year, millions of American youth participate in programs designed to promote positive youth development. Here, we examine the effect that participation in one of the largest youth organizations, the Boy Scouts of America (BSA), has on adult social capital and community involvement. Methods Utilizing a national survey of adult males, we compare measures of social capital and community involvement for former Scouts and non‐Scouts. Results Our findings suggest that level of involvement in the Boy Scouts is significantly related to measures of adult social capital and community engagement. Conclusion Scouting tends to have a significant impact on the lives of its most committed members. Future research must continue to explore the long‐term effects of participation in youth organizations

Structured Voluntary Youth Activities and Positive Outcomes in Adulthood: An Exploratory Study of Involvement in Scouting and Subjective Well-Being

This study explores whether youth involvement in Scouting has positive consequences later in life. We examine whether the number of years of participation in Scouting is positively associated with human and social capital and recreational lifestyles in adulthood, and whether these are linked to subjective well-being: relational, emotional, and physical health. To explore this potential relationship, we estimated a structural equation model, analyzing data from a national sample of adult males. We found that youth involvement in Scouting is positively related to subjective well-being indirectly via the positive adult outcomes

An asymptotic analysis of composite beams with kinematically corrected end effects

AbstractA finite element-based beam analysis for anisotropic beams with arbitrary-shaped cross-sections is developed with the aid of a formal asymptotic expansion method. From the equilibrium equations of the linear three-dimensional (3D) elasticity, a set of the microscopic 2D and macroscopic 1D equations are systematically derived by introducing the virtual work concept. Displacements at each order are split into two parts, such as fundamental and warping solutions. First we seek the warping solutions via the microscopic 2D cross-sectional analyses that will be smeared into the macroscopic 1D beam equations. The variations of fundamental solutions enable us to formulate the macroscopic 1D beam problems. By introducing the orthogonality of asymptotic displacements to six beam fundamental solutions, the end effects of a clamped boundary are kinematically corrected without applying the sophisticated decay analysis method. The boundary conditions obtained herein are applied to composite beams with solid and thin-walled cross-sections in order to demonstrate the efficiency and accuracy of the formal asymptotic method-based beam analysis (FAMBA) presented in this paper. The numerical results are compared to those reported in literature as well as 3D FEM solutions

Testing for family influences on obesity: The role of genetic nurture

A large literature has documented strong positive correlations among siblings in health, including body mass index (BMI) and obesity. This paper tests whether that is explained by a specific type of peer effect in obesity: genetic nurture. Specifically, we test whether an individual’s weight is affected by the genes of their sibling, controlling for the individual’s own genes. Using genetic data in Add Health, we find no credible evidence that an individual’s BMI is affected by the polygenic risk score for BMI of their full sibling when controlling for the individual’s own polygenic risk score for BMI. Thus, we find no evidence that the positive correlations in BMI between siblings are attributable to genetic nurture within families.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149721/1/hec3889.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149721/2/hec3889_am.pd

A systematic topographical relationship between mouse lateral posterior thalamic neurons and their visual cortical projection targets.

Higher-order visual thalamus communicates broadly and bi-directionally with primary and extrastriate cortical areas in various mammals. In primates, the pulvinar is a topographically and functionally organized thalamic nucleus that is largely dedicated to visual processing. Still, a more granular connectivity map is needed to understand the role of thalamocortical loops in visually guided behavior. Similarly, the secondary visual thalamic nucleus in mice (the lateral posterior nucleus, LP) has extensive connections with cortex. To resolve the precise connectivity of these circuits, we first mapped mouse visual cortical areas using intrinsic signal optical imaging and then injected fluorescently tagged retrograde tracers (cholera toxin subunit B) into retinotopically-matched locations in various combinations of seven different visual areas. We find that LP neurons representing matched regions in visual space but projecting to different extrastriate areas are found in different topographically organized zones, with few double-labeled cells (~4-6%). In addition, V1 and extrastriate visual areas received input from the ventrolateral part of the laterodorsal nucleus of the thalamus (LDVL). These observations indicate that the thalamus provides topographically organized circuits to each mouse visual area and raise new questions about the contributions from LP and LDVL to cortical activity

Wetting-layer transformation for Pb nanocrystals grown on Si(111)

doi:10.1063/1.1812593We present the results of in situ x-ray scattering experiments that investigate the growth of Pb nanocrystalline islands on Si(111). It is conclusively shown that the Pb nanocrystals do not reside on top of a Pb wetting layer. The nucleating Pb nanocrystals transform the highly disordered Pb wetting layer beneath the islands into well-ordered fcc Pb. The surface then consists of fcc Pb islands directly on top of the Si surface with the disordered wetting layer occupying the region between the islands. As the Pb nanocrystals coalesce at higher coverage we observe increasing disorder that is consistent with misfit strain relaxation. These results have important implications for predicting stable Pb island heights

MRI radiomic features are independently associated with overall survival in soft tissue sarcoma

Purpose: Soft tissue sarcomas (STS) represent a heterogeneous group of diseases, and selection of individualized treatments remains a challenge. The goal of this study was to determine whether radiomic features extracted from magnetic resonance (MR) images are independently associated with overall survival (OS) in STS. Methods and Materials: This study analyzed 2 independent cohorts of adult patients with stage II-III STS treated at center 1 (N = 165) and center 2 (N = 61). Thirty radiomic features were extracted from pretreatment T1-weighted contrast-enhanced MR images. Prognostic models for OS were derived on the center 1 cohort and validated on the center 2 cohort. Clinical-only (C), radiomics-only (R), and clinical and radiomics (C+R) penalized Cox models were constructed. Model performance was assessed using Harrell\u27s concordance index. Results: In the R model, tumor volume (hazard ratio [HR], 1.5) and 4 texture features (HR, 1.1-1.5) were selected. In the C+R model, both age (HR, 1.4) and grade (HR, 1.7) were selected along with 5 radiomic features. The adjusted c-indices of the 3 models ranged from 0.68 (C) to 0.74 (C+R) in the derivation cohort and 0.68 (R) to 0.78 (C+R) in the validation cohort. The radiomic features were independently associated with OS in the validation cohort after accounting for age and grade (HR, 2.4; Conclusions: This study found that radiomic features extracted from MR images are independently associated with OS when accounting for age and tumor grade. The overall predictive performance of 3-year OS using a model based on clinical and radiomic features was replicated in an independent cohort. Optimal models using clinical and radiomic features could improve personalized selection of therapy in patients with STS

A conserved morphogenetic mechanism for epidermal ensheathment of nociceptive sensory neurites.

Interactions between epithelial cells and neurons influence a range of sensory modalities including taste, touch, and smell. Vertebrate and invertebrate epidermal cells ensheath peripheral arbors of somatosensory neurons, including nociceptors, yet the developmental origins and functional roles of this ensheathment are largely unknown. Here, we describe an evolutionarily conserved morphogenetic mechanism for epidermal ensheathment of somatosensory neurites. We found that somatosensory neurons in Drosophila and zebrafish induce formation of epidermal sheaths, which wrap neurites of different types of neurons to different extents. Neurites induce formation of plasma membrane phosphatidylinositol 4,5-bisphosphate microdomains at nascent sheaths, followed by a filamentous actin network, and recruitment of junctional proteins that likely form autotypic junctions to seal sheaths. Finally, blocking epidermal sheath formation destabilized dendrite branches and reduced nociceptive sensitivity in Drosophila. Epidermal somatosensory neurite ensheathment is thus a deeply conserved cellular process that contributes to the morphogenesis and function of nociceptive sensory neurons