Comparison of performance of psychiatrists vs other outpatient physicians in the 2020 US Medicare Merit-Based Incentive Payment System

Importance: Medicare\u27s Merit-Based Incentive Payment System (MIPS) is a new, mandatory, outpatient value-based payment program that ties reimbursement to performance on cost and quality measures for many US clinicians. However, it is currently unknown how the program measures the performance of psychiatrists, who often treat a different patient case mix with different clinical considerations than do other outpatient clinicians. Objective: To compare performance scores and value-based reimbursement for psychiatrists vs other outpatient physicians in the 2020 MIPS. Design Setting and Participants: In this cross-sectional study, the Centers for Medicare & Medicaid Services Provider Data Catalog was used to identify outpatient Medicare physicians listed in the National Downloadable File between January 1, 2018, and December 31, 2020, who participated in the 2020 MIPS and received a publicly reported final performance score. Data from the 593 863 clinicians participating in the 2020 MIPS were used to compare differences in the 2020 MIPS performance scores and value-based reimbursement (based on performance in 2018) for psychiatrists vs other physicians, adjusting for physician, patient, and practice area characteristics. Exposures: Participation in MIPS. Main Outcomes and Measures: Primary outcomes were final MIPS performance score and negative (penalty), positive, and exceptional performance bonus payment adjustments. Secondary outcomes were scores in the MIPS performance domains: quality, promoting interoperability, improvement activities, and cost. Results: This study included 9356 psychiatrists (3407 [36.4%] female and 5 949 [63.6%] male) and 196 306 other outpatient physicians (69 221 [35.3%] female and 127 085 [64.7%] male) (data on age and race are not available). Compared with other physicians, psychiatrists were less likely to be affiliated with a safety-net hospital (2119 [22.6%] vs 64 997 [33.1%]) or a major teaching hospital (2148 [23.0%] vs 53 321 [27.2%]) and had lower annual Medicare patient volume (181 vs 437 patients) and mean patient risk scores (1.65 vs 1.78) ( Conclusions and Relevance: In this cross-sectional study that compared US psychiatrists with other outpatient physicians, psychiatrists had significantly lower 2020 MIPS performance scores, were penalized more frequently, and received fewer bonuses. Policy makers should evaluate whether current MIPS performance measures appropriately assess the performance of psychiatrists

Charge-Carrier Dynamics in 2D Hybrid Metal–Halide Perovskites

Hybrid metal–halide perovskites are promising new materials for use in solar cells; however, their chemical stability in the presence of moisture remains a significant drawback. Quasi two-dimensional (2D) perovskites that incorporate hydrophobic organic interlayers offer improved resistance to degradation by moisture, currently still at the cost of overall cell efficiency. To elucidate the factors affecting the optoelectronic properties of these materials, we have investigated the charge transport properties and crystallographic orientation of mixed methylammonium (MA)–phenylethylammonium (PEA) lead iodide thin films as a function of the MA-to-PEA ratio and, thus, the thickness of the “encapsulated” MA lead–halide layers. We find that monomolecular charge-carrier recombination rates first decrease with increasing PEA fraction, most likely as a result of trap passivation, but then increase significantly as excitonic effects begin to dominate for thin confined layers. Bimolecular and Auger recombination rate constants are found to be sensitive to changes in electronic confinement, which alters the density of states for electronic transitions. We demonstrate that effective charge-carrier mobilities remain remarkably high (near 10 cm2V−1s−1) for intermediate PEA content and are enhanced for preferential orientation of the conducting lead iodide layers along the probing electric field. The trade-off between trap reduction, electronic confinement, and layer orientation leads to calculated charge-carrier diffusion lengths reaching a maximum of 2.5 μm for intermediate PEA content (50%)

The ACS Virgo Cluster Survey III. Chandra and HST Observations of Low-Mass X-Ray Binaries and Globular Clusters in M87

The ACIS instrument on board the Chandra X-ray Observatory has been used to carry out the first systematic study of low-mass X-ray binaries (LMXBs) in M87. We identify 174 X-ray point-sources, of which ~150 are likely LMXBs. This LMXB catalog is combined with deep F475W and F850LP images taken with ACS on HST to examine the connection between LMXBs and globular clusters in M87. Of the 1688 globular clusters in our catalog, f_X = 3.6 +- 0.5% contain a LMXB and we find that the metal-rich clusters are 3 +- 1 times more likely to harbor a LMXB than their metal-poor counterparts. In agreement with previous findings for other galaxies, we find that brighter, more metal-rich clusters are more likely to contain a LMXB. For the first time, however, we are able to demonstrate that the probability, p_X, that a given cluster will contain a LMXB depends sensitively on the dynamical properties of the host cluster. Specifically, we use the HST images to measure the half-light radius, concentration index and central density, \rho_0, for each globular, and define a parameter, \Gamma, which is related to the tidal capture and binary-neutron star exchange rate. Our preferred form for p_X is then p_X \propto \Gamma \rho_0^{-0.42\pm0.11} (Z/Z_{\odot})^{0.33\pm0.1}. We argue that if the form of p_X is determined by dynamical processes, then the observed metallicity dependence is a consequence of an increased number of neutron stars per unit mass in metal-rich globular clusters. Finally, we find no compelling evidence for a break in the luminosity distribution of resolved X-ray point sources. Instead, the LMXB luminosity function is well described by a power law with an upper cutoff at L_X ~ 10^39 erg/s. (abridged)Comment: 23 pages, 21 figures. Accepted for publication in ApJ. Also available at http://www.physics.rutgers.edu/~pcote/acs/publications.htm

Sleep regularity and predictors of sleep efficiency and sleep duration in elite team sport athletes

Background Many elite athletes have suboptimal sleep duration and efficiency, potentially due to factors that may impact sleep onset and offset times. Variability in sleep onset and offset may negatively influence sleep. The sleep regularity index (SRI) is a novel metric for sleep regularity, however there are no published descriptions of SRI in elite athletes. Further, contributors to sleep efficiency and duration in elite athletes using objective measures have not been explored. Methods Sleep was monitored over a minimum of seven consecutive days (7 to 43)—in 203 elite team sport athletes (age range = 19–36 years; female, n = 79; male, n = 124, total sleep nights = 1975) using activity monitoring and sleep diaries. The sleep regularity index (SRI) was calculated to reflect the night-to-night shifts in sleep by accounting for changes in sleep onset and sleep offset. Sleep characteristics were compared between regular and irregular sleepers and important contributors to sleep efficiency and total sleep time were assessed using multiple linear regression models. Results The median sleep regularity index and interquartile range were 85.1 (81.4 to 88.8). When compared to irregular sleepers, regular sleepers demonstrated (1) significantly greater sleep efficiency (p = 0.006; 0.31 medium effect size [ES]), (2) significantly less variability in total sleep time (− p ≤ 0.001; − 0.69, large ES) and sleep efficiency (− 0.34, small ES), (3) similar total sleep time and (4) significantly less variation in sleep onset (p ≤ 0.001; − 0.73, large ES) and offset (p ≤ 0.001; − 0.74, large ES) times. Sleep characteristics explained 73% and 22% of the variance in total sleep time and sleep efficiency, respectively. The most important contributor to total sleep time was a later sleep offset time, while the most important contributors to sleep efficiency were an earlier bedtime and less variable sleep onset times. Conclusions Bedtime and a consistent sleep onset time are important factors associated with sleep efficiency in athletes, while sleep offset is an important factor for total sleep time. Coaches and staff can assist their athletes by providing training schedules that allow for both regularity and sufficiency of time in bed where possible

SNPs selected by information content outperform randomly selected microsatellite loci for delineating genetic identification and introgression in the endangered dark European honeybee (Apis mellifera mellifera)

The honeybee (Apis mellifera) has been threatened by multiple factors including pests and pathogens, pesticidesand loss of locally adapted gene complexes due to replacement and introgression. In western Europe, the geneticintegrity of the native A. m. mellifera (M-lineage) is endangered due to trading and intensive queen breeding withcommercial subspecies of eastern European ancestry (C-lineage). Effective conservation actions require reliablemolecular tools to identify pure-bred A. m. mellifera colonies. Microsatellites have been preferred for identificationof A. m. mellifera stocks across conservation centres. However, owing to high throughput, easy transferabilitybetween laboratories and low genotyping error, SNPs promise to become popular. Here, we compared the resolvingpower of a widely utilized microsatellite set to detect structure and introgression with that of different sets that com-bine a variable number of SNPs selected for their information content and genomic proximity to the microsatelliteloci. Contrary to every SNP data set, microsatellites did not discriminate between the two lineages in the PCA space.Mean introgression proportions were identical across the two marker types, although at the individual level,microsatellites’ performance was relatively poor at the upper range of Q-values, a result reflected by their lower pre-cision. Our results suggest that SNPs are more accurate and powerful than microsatellites for identification of A. m.mellifera colonies, especially when they are selected by information content.info:eu-repo/semantics/publishedVersio

Unraveling loss mechanisms arising from energy-level misalignment between metal halide perovskites and hole transport layers

Metal halide perovskites are promising light absorbers for multijunction photovoltaic applications because of their remarkable bandgap tunability, achieved through compositional mixing on the halide site. However, poor energy-level alignment at the interface between wide-bandgap mixed-halide perovskites and charge-extraction layers still causes significant losses in solar-cell performance. Here, the origin of such losses is investigated, focusing on the energy-level misalignment between the valence band maximum and the highest occupied molecular orbital (HOMO) for a commonly employed combination, FA0.83Cs0.17Pb(I1-xBrx)3 with bromide content x ranging from 0 to 1, and poly[bis(4-phenyl)(2,4,6-trimethylphenyl)amine] (PTAA). A combination of time-resolved photoluminescence spectroscopy and numerical modeling of charge-carrier dynamics reveals that open-circuit voltage (VOC) losses associated with a rising energy-level misalignment derive from increasing accumulation of holes in the HOMO of PTAA, which then subsequently recombine non-radiatively across the interface via interfacial defects. Simulations assuming an ideal choice of hole-transport material to pair with FA0.83Cs0.17Pb(I1-xBrx)3 show that such VOC losses originating from energy-level misalignment can be reduced by up to 70 mV. These findings highlight the urgent need for tailored charge-extraction materials exhibiting improved energy-level alignment with wide-bandgap mixed-halide perovskites to enable solar cells with improved power conversion efficiencies

Genetic Variation in the ASTN2 Locus in Cardiovascular, Metabolic and Psychiatric Traits: Evidence for Pleiotropy Rather Than Shared Biology

Background: The link between cardiometabolic and psychiatric illness has long been attributed to human behaviour, however recent research highlights shared biological mechanisms. The ASTN2 locus has been previously implicated in psychiatric and cardiometabolic traits, therefore this study aimed to systematically investigate the genetic architecture of ASTN2 in relation to a wide range of relevant traits. Methods: Baseline questionnaire, assessment and genetic data of 402111 unrelated white British ancestry individuals from the UK Biobank was analysed. Genetic association analyses were conducted using PLINK 1.07, assuming an additive genetic model and adjusting for age, sex, genotyping chip, and population structure. Conditional analyses and linkage disequilibrium assessment were used to determine whether cardiometabolic and psychiatric signals were independent. Results: Associations between genetic variants in the ASTN2 locus and blood pressure, total and central obesity, neuroticism, anhedonia and mood instability were identified. All analyses support the independence of the cardiometabolic traits from the psychiatric traits. In silico analyses provide support for the central obesity signal acting through ASTN2, however most of the other signals are likely acting through other genes in the locus. Conclusions: Our systematic analysis demonstrates that ASTN2 has pleiotropic effects on cardiometabolic and psychiatric traits, rather than contributing to shared pathology

Photovoltaic Performance of FAPbI3 Perovskite Is Hampered by Intrinsic Quantum Confinement

Formamidinium lead trioiodide (FAPbI3) is a promising perovskite for single-junction solar cells. However, FAPbI3 is metastable at room temperature and can cause intrinsic quantum confinement effects apparent through a series of above-bandgap absorption peaks. Here, we explore three common solution-based film-fabrication methods, neat N,N-dimethylformamide (DMF)–dimethyl sulfoxide (DMSO) solvent, DMF-DMSO with methylammonium chloride, and a sequential deposition approach. The latter two offer enhanced nucleation and crystallization control and suppress such quantum confinement effects. We show that elimination of these absorption features yields increased power conversion efficiencies (PCEs) and short-circuit currents, suggesting that quantum confinement hinders charge extraction. A meta-analysis of literature reports, covering 244 articles and 825 photovoltaic devices incorporating FAPbI3 films corroborates our findings, indicating that PCEs rarely exceed a 20% threshold when such absorption features are present. Accordingly, ensuring the absence of these absorption features should be the first assessment when designing fabrication approaches for high-efficiency FAPbI3 solar cells

A Two-Phase Innate Host Response to Alphavirus Infection Identified by mRNP-Tagging In Vivo

A concept fundamental to viral pathogenesis is that infection induces specific changes within the host cell, within specific tissues, or within the entire animal. These changes are reflected in a cascade of altered transcription patterns evident during infection. However, elucidation of this cascade in vivo has been limited by a general inability to distinguish changes occurring in the minority of infected cells from those in surrounding uninfected cells. To circumvent this inherent limitation of traditional gene expression profiling methods, an innovative mRNP-tagging technique was implemented to isolate host mRNA specifically from infected cells in vitro as well as in vivo following Venezuelan equine encephalitis virus (VEE) infection. This technique facilitated a direct characterization of the host defense response specifically within the first cells infected with VEE, while simultaneous total RNA analysis assessed the collective response of both the infected and uninfected cells. The result was a unique, multifaceted profile of the early response to VEE infection in primary dendritic cells, as well as in the draining lymph node, the initially targeted tissue in the mouse model. A dynamic environment of complex interactions was revealed, and suggested a two-step innate response in which activation of a subset of host genes in infected cells subsequently leads to activation of the surrounding uninfected cells. Our findings suggest that the application of viral mRNP-tagging systems, as introduced here, will facilitate a much more detailed understanding of the highly coordinated host response to infectious agents