Do Physician-based or Hospital-based Provider Service Networks Better Control Medicaid Expenditures?

In a recent demonstration project, Florida Medicaid enrollees were required to pick a managed care plan that was either a Health Maintenance Organization (HMO) or a Provider Service Network (PSN). PSNs are a form of managed care very similar to Accountable Care Organizations (ACOs) that provides health care services directly through a provider or network of organizations to a defined population without a “middle man” such as a third party insurance company and health plan. There are two types of PSNs: Physician-based PSNs and Healthcare system-based PSNs. Physician-based PSNs are created and controlled by physicians groups. Healthcare system-based PSNs are based on safety net hospitals and their outpatient clinics. Health system-based PSNs are integrated delivery systems, which are organizations that combine healthcare providers into one organization and may provide more efficient care with lower cost of care due to economies of scale. The objective of this study was to examine the differences in healthcare expenditures by enrollees in physician-based and health system-based PSNs. Using a difference in difference approach our study found that compared to enrollees in physician-based PSNs, enrollees in health system-based PSNs lowered expenditures to a greater extent over time compared to physician-based PSNs. Findings from this study provide important information to states considering implementing alternative delivery models to control Medicaid costs

Reactions to graphic and text health warnings for cigarettes, sugar-sweetened beverages, and alcohol:An online randomized experiment of US adults.

We aimed to examine reactions to graphic versus text-only warnings for cigarettes, SSBs, and alcohol. A convenience sample of US adults completed an online survey in 2018 (n=1,352 in the analytic sample). We randomly assigned participants to view a: 1) text-only warning without efficacy information (i.e., message intended to increase consumers’ confidence in their ability to stop using the product), 2) text-only warning with efficacy information, 3) graphic warning without efficacy information, or 4) graphic warning with efficacy information. Participants viewed their assigned warning on cigarettes, SSBs, and alcohol, in a random order. Across product types, graphic warnings were perceived as more effective than text-only warnings (p<.001) and led to lower believability, greater reactance (i.e., resistance), more thinking about harms, and lower product appeal (all p<.05); policy support did not differ. Compared to SSB and alcohol warnings, cigarette warnings led to higher perceived message effectiveness, believability, fear, thinking about harms, policy support, and greater reductions in product appeal (all p<.05). The efficacy information did not influence any outcomes. Graphic warnings out-performed text-only warnings on key predictors of behavior despite causing more reactance

Evidence for a broadly distributed Samoan-plume signature in the northern Lau and North Fiji Basins

Author Posting. © American Geophysical Union, 2014. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Geochemistry, Geophysics, Geosystems 15 (2014): 986–1008, doi:10.1002/2013GC005061.Geochemical enrichment of lavas in the northern Lau Basin may reflect the influx of Samoan-plume mantle into the region. We report major and trace element abundances and He-Sr-Nd-Hf-Pb-isotopic measurements for 23 submarine volcanic glasses covering 10 locations in the northern Lau and North Fiji Basins, and for three samples from Wallis Island, which lies between Samoa and the Lau Basin. These data extend the western limit of geochemical observations in the Basins and improve the resolution of North-South variations in isotopic ratios. The Samoan hot spot track runs along the length of the northern trace of the Lau and North Fiji Basins. We find evidence for a Samoan-plume component in lavas as far West as South Pandora Ridge (SPR), North Fiji Basin. Isotopic signatures in SPR samples are similar to those found in Samoan Upolu shield lavas, but show a slight shift toward MORB-like compositions. We explain the origin of the enriched signatures by a model in which Samoan-plume material and ambient depleted mantle undergo decompression melting during upwelling after transiting from beneath the thick Pacific lithosphere to beneath the thin lithosphere in the northern Lau and North Fiji Basins. Other lavas found in the region with highly depleted isotopic signatures may represent isolated pockets of depleted mantle in the basins that evaded this enrichment process. We further find that mixing between the two components in our model, a variably degassed high-3He/4He Samoan component and depleted MORB, can explain the diversity among geochemical data from the northern Lau Basin.M.G.J. acknowledges support from NSF grants OCE-1061134, OCE-1153894, and EAR-1145202 and J.B.T. acknowledges support from the French Agence Nationale de la Recherche (grant ANR-10-BLANC-0603 M&Ms—Mantle Melting—Measurements, Models, Mechanisms).2014-10-1

A comparison of three policy approaches for tobacco retailer reduction ☆

a b s t r a c t a r t i c l e i n f o Available online 14 February 2015 Keywords: Tobacco Policy Public health Background. The Institute of Medicine recommends that public health agencies restrict the number and regulate the location of tobacco retailers as a means of reducing tobacco use. However, the best policy strategy for tobacco retailer reduction is unknown. Purpose. The purpose of this study is to test the percent reduction in the number and density of tobacco retailers in North Carolina resulting from three policies: (1) prohibiting sales of tobacco products in pharmacies or stores with a pharmacy counter, (2) restricting sales of tobacco products within 1000 ft of schools, and (3) regulating to 500 ft the minimum allowable distance between tobacco outlets. Methods. This study uses data from two lists of tobacco retailers gathered in 2012, one at the statewide level, and another &quot;gold standard&quot; three-county list. Retailers near schools were identified using point and parcel boundaries in ArcMap. Python programming language generated a random lottery system to remove retailers within 500 ft of each other. Analyses were conducted in 2014. Results. A minimum allowable distance policy had the single greatest impact and would reduce density by 22.1% at the state level, or 20.8% at the county level (range 16.6% to 27.9%). Both a pharmacy and near-schools ban together would reduce density by 29.3% at the state level, or 29.7% at the county level (range 26.3 to 35.6%). Conclusions. The implementation of policies restricting tobacco sales in pharmacies, near schools, and/or in close proximity to another tobacco retailer would substantially reduce the number and density of tobacco retail outlets

A comparison of three policy approaches for tobacco retailer reduction

The Institute of Medicine recommends that public health agencies restrict the number and regulate the location of tobacco retailers as a means of reducing tobacco use. However, the best policy strategy for tobacco retailer reduction is unknown

Super-Kamiokande atmospheric neutrino data, zenith distributions, and three-flavor oscillations

We present a detailed analysis of the zenith angle distributions of atmospheric neutrino events observed in the Super-Kamiokande (SK) underground experiment, assuming two-flavor and three-flavor oscillations (with one dominant mass scale) among active neutrinos. In particular, we calculate the five angular distributions associated to sub-GeV and multi-GeV \mu-like and e-like events and to upward through-going muons, for a total of 30 accurately computed observables (zenith bins). First we study how such observables vary with the oscillation parameters, and then we perform a fit to the experimental data as measured in SK for an exposure of 33 kTy (535 days). In the two-flavor mixing case, we confirm the results of the SK Collaboration analysis, namely, that \nu_\mu\nu_\tau oscillations are preferred over \nu_\mu\nu_e, and that the no oscillation case is excluded with high confidence. In the three-flavor mixing case, we perform our analysis with and without the additional constraints imposed by the CHOOZ reactor experiment. In both cases, the analysis favors a dominance of the \nu_\mu\nu_\tau channel. Without the CHOOZ constraints, the amplitudes of the subdominant \nu_\munu_e and \nu_e\nu_\tau transitions can also be relatively large, indicating that, at present, current SK data do not exclude sizable \nu_e mixing by themselves. After combining the CHOOZ and SK data, the amplitudes of the subdominant transitions are constrained to be smaller, but they can still play a nonnegligible role both in atmospheric and other neutrino oscillation searches. In particular, we find that the \nu_e appearance probability expected in long baseline experiments can reach the testable level of ~15%.Comment: 35 pages (RevTeX), including 20 ps figures (with epsfig.sty

Lipid Remodeling in Hepatocyte Proliferation and Hepatocellular Carcinoma

Background and Aims: Hepatocytes undergo profound metabolic rewiring when primed to proliferate during compensatory regeneration and in hepatocellular carcinoma (HCC). However, the metabolic control of these processes is not fully understood. In order to capture the metabolic signature of proliferating hepatocytes, we applied state-of-the-art systems biology approaches to models of liver regeneration, pharmacologically and genetically activated cell proliferation, and HCC. Approach and Results: Integrating metabolomics, lipidomics, and transcriptomics, we link changes in the lipidome of proliferating hepatocytes to altered metabolic pathways including lipogenesis, fatty acid desaturation, and generation of phosphatidylcholine (PC). We confirm this altered lipid signature in human HCC and show a positive correlation of monounsaturated PC with hallmarks of cell proliferation and hepatic carcinogenesis. Conclusions: Overall, we demonstrate that specific lipid metabolic pathways are coherently altered when hepatocytes switch to proliferation. These represent a source of targets for the development of therapeutic strategies and prognostic biomarkers of HCC

Atmospheric neutrino observations and flavor changing interactions

Flavor changing (FC) neutrino-matter interactions can account for the zenith-angle dependent deficit of atmospheric neutrinos observed in the SuperKamiokande experiment, without directly invoking neither neutrino mass, nor mixing. We find that FC $\nu_\mu$-matter interactions provide a good fit to the observed zenith angle distributions, comparable in quality to the neutrino oscillation hypothesis. The required FC interactions arise naturally in many attractive extensions of the Standard Model.Comment: RevTex, 4 pages, 2 postscript figures, some minor modifications in the text and few new references are added, no change in the results and conclusions, final version to be published in Phys. Rev. Let

An Anglo-Saxon execution cemetery at Walkington Wold, Yorkshire

This paper presents a re-evaluation of a cemetery excavated over 30 years ago at Walkington Wold in east Yorkshire. The cemetery is characterized by careless burial on diverse alignments, and by the fact that most of the skeletons did not have associated crania. The cemetery has been variously described as being the result of an early post-Roman massacre, as providing evidence for a ‘Celtic’ head cult or as an Anglo-Saxon execution cemetery. In order to resolve the matter, radiocarbon dates were acquired and a re-examination of the skeletal remains was undertaken. It was confirmed that the cemetery was an Anglo-Saxon execution cemetery, the only known example from northern England, and the site is set into its wider context in the paper

Neutrino Interactions at Ultrahigh Energies

We report new calculations of the cross sections for deeply inelastic neutrino-nucleon scattering at neutrino energies between 10^{9}\ev and 10^{21}\ev. We compare with results in the literature and assess the reliability of our predictions. For completeness, we briefly review the cross sections for neutrino interactions with atomic electrons, emphasizing the role of the $W$-boson resonance in $\bar{\nu}_{e}e$ interactions for neutrino energies in the neighborhood of 6.3\pev. Adopting model predictions for extraterrestrial neutrino fluxes from active galactic nuclei, gamma-ray bursters, and the collapse of topological defects, we estimate event rates in large-volume water \v{C}erenkov detectors and large-area ground arrays.Comment: 32 pages, 11 figures, uses RevTeX and boxedep