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

Simulations of black hole fueling in isolated and merging galaxies with an explicit, multiphase ISM

We study gas inflows onto supermassive black holes using hydrodynamics simulations of isolated galaxies and idealized galaxy mergers with an explicit, multiphase interstellar medium (ISM). Our simulations use the recently developed ISM and stellar evolution model called Stars and MUltiphase Gas in GaLaxiEs (SMUGGLE). We implement a novel super-Lagrangian refinement scheme that increases the gas mass resolution in the immediate neighborhood of the black holes (BHs) to accurately resolve gas accretion. We do not include black hole feedback in our simulations. We find that the complex and turbulent nature of the SMUGGLE ISM leads to highly variable BH accretion. BH growth in SMUGGLE converges at gas mass resolutions $\lesssim3\times10^3{\rm M_\odot}$. We show that the low resolution simulations combined with the super-Lagrangian refinement scheme are able to produce central gas dynamics and BH accretion rates very similar to that of the uniform high resolution simulations. We further explore BH fueling by simulating galaxy mergers. The interaction between the galaxies causes an inflow of gas towards the galactic centres and results in elevated and bursty star formation. The peak gas densities near the BHs increase by orders of magnitude resulting in enhanced accretion. Our results support the idea that galaxy mergers can trigger AGN activity, although the instantaneous accretion rate depends strongly on the local ISM. We also show that the level of merger-induced enhancement of BH fueling predicted by the SMUGGLE model is much smaller compared to the predictions by simulations using an effective equation of state model of the ISM.Comment: 16 pages, 10 figure

Stellar Bars in Isolated Gas-Rich Spiral Galaxies Do Not Slow Down

Elongated bar-like features are ubiquitous in galaxies, occurring at the centers of approximately two-thirds of spiral disks. Due to gravitational interactions between the bar and the other components of galaxies, it is expected that angular momentum and matter will redistribute over long (Gyr) timescales in barred galaxies. Previous work ignoring the gas phase of galaxies has conclusively demonstrated that bars should slow their rotation over time due to their interaction with dark matter halos. We have performed a simulation of a Milky Way-like galactic disk hosting a strong bar which includes a state-of-the-art model of the interstellar medium and a live dark matter halo. In this simulation the bar pattern does not slow down over time, and instead remains at a stable, constant rate of rotation. This behavior has been observed in previous simulations using more simplified models for the interstellar gas, but the apparent lack of secular evolution has remained unexplained. We propose that the gas phase of the disk and the dark matter halo act in concert to stabilize the bar pattern speed and prevent the bar from slowing down or speeding up. We find that in a Milky Way-like disk, a gas fraction of only about 5% is necessary for this mechanism to operate. Our result naturally explains why nearly all observed bars rotate rapidly and is especially relevant for our understanding of how the Milky Way arrived at its present state.Comment: 12 pages, 13 figures, submitted to MNRAS; comments welcom

Ni-Phosphide catalysts as versatile systems for gas-phase CO2 conversion: Impact of the support and evidences of structure-sensitivity

We report for the first time the support dependent activity and selectivity of Ni-rich nickel phosphide catalysts for CO2 hydrogenation. New catalysts for CO2 hydrogenation are needed to commercialise the reverse water–gas shift reaction (RWGS) which can feed captured carbon as feedstock for traditionally fossil fuel-based processes, as well as to develop flexible power-to-gas schemes that can synthesise chemicals on demand using surplus renewable energy and captured CO2. Here we show that Ni2P/SiO2 is a highly selective catalyst for RWGS, producing over 80% CO in the full temperature range of 350–750 °C. This indicates a high degree of suppression of the methanation reaction by phosphide formation, as Ni catalysts are known for their high methanation activity. This is shown to not simply be a site blocking effect, but to arise from the formation of a new more active site for RWGS. When supported on Al2O3 or CeAl, the dominant phase of as synthesized catalysts is Ni12P5. These Ni12P5 catalysts behave very differently compared to Ni2P/SiO2, and show activity for methanation at low temperatures with a switchover to RWGS at higher temperatures (reaching or approaching thermodynamic equilibrium behaviour). This switchable activity is interesting for applications where flexibility in distributed chemicals production from captured CO2 can be desirable. Both Ni12P5/Al2O3 and Ni12P5/CeAl show excellent stability over 100 h on stream, where they switch between methanation and RWGS reactions at 50–70% conversion. Catalysts are characterized before and after reactions via X-ray Diffraction (XRD), X-ray Photoelectron Spectroscopy (XPS), temperature-programmed reduction and oxidation (TPR, TPO), Transmission Electron Microscopy (TEM), and BET surface area measurement. After reaction, Ni2P/SiO2 shows the emergence of a crystalline Ni12P5 phase while Ni12P5/Al2O3 and Ni12P5/CeAl both show the crystalline Ni3P phase. While stable activity of the latter catalysts is demonstrated via extended testing, this Ni enrichment in all phosphide catalysts shows the dynamic nature of the catalysts during operation. Moreover, it demonstrates that both the support and the phosphide phase play a key role in determining selectivity towards CO or CH4.Financial support for this work was provided by the Department of Chemical and Process Engineering at the University of Surrey and CO2ChemUK through the EPSRC grant EP/P026435/1 as well as the Royal Society Research Grant RSGR1180353. This work was also partially sponsored by Ministry of Science and Innovation through the projects PID2019-108453 GB-C21 and JC2019-040560-I. This work was also partially sponsored by the European Commission through the H2020-MSCA-RISE-2020 BIOALL project (Grant Agreement: 101008058. SASOL is also acknowledged for kindly providing the Al2O3-based supports

Large-scale evaluation of automated clinical note de-identification and its impact on information extraction

Objective: (1) To evaluate a state-of-the-art natural language processing (NLP)-based approach to automatically de-identify a large set of diverse clinical notes. (2) To measure the impact of de-identification on the performance of information extraction algorithms on the de-identified documents. Material and methods A cross-sectional study that included 3503 stratified, randomly selected clinical notes (over 22 note types) from five million documents produced at one of the largest US pediatric hospitals. Sensitivity, precision, F value of two automated de-identification systems for removing all 18 HIPAA-defined protected health information elements were computed. Performance was assessed against a manually generated ‘gold standard’. Statistical significance was tested. The automated de-identification performance was also compared with that of two humans on a 10% subsample of the gold standard. The effect of de-identification on the performance of subsequent medication extraction was measured. Results: The gold standard included 30 815 protected health information elements and more than one million tokens. The most accurate NLP method had 91.92% sensitivity (R) and 95.08% precision (P) overall. The performance of the system was indistinguishable from that of human annotators (annotators' performance was 92.15%(R)/93.95%(P) and 94.55%(R)/88.45%(P) overall while the best system obtained 92.91%(R)/95.73%(P) on same text). The impact of automated de-identification was minimal on the utility of the narrative notes for subsequent information extraction as measured by the sensitivity and precision of medication name extraction. Discussion and conclusion NLP-based de-identification shows excellent performance that rivals the performance of human annotators. Furthermore, unlike manual de-identification, the automated approach scales up to millions of documents quickly and inexpensively

Evaluation of a novel intervention providing insight into the tobacco industry to prevent the uptake of smoking in school-aged children: a mixed-methods study

Objectives: Evidence from the US Truth® campaign suggests that interventions focusing on tobacco industry practices and ethics may be effective in preventing youth smoking uptake. We developed, piloted and evaluated a school-based intervention based on this premise. Methods: Exploratory study Students in Years 7–8 (aged 11–13) in two UK schools received Operation Smoke Storm, comprising three 50-minute classroom-based sessions in Year 7, an accompanying family booklet and a 1-hour classroom-based booster session in Year 8. We compared the risk and odds of ever smoking and susceptibility to smoking in Year 8 students in study schools post-intervention compared with students in control schools. Focus groups and interviews with students, teachers and parents evaluated the acceptability of the intervention. Results: In intervention schools the combined prevalence of ever smoking and susceptibility increased from 18.2% in Year 7 to 33.8% in Year 8. There was no significant difference in the odds of a Year 8 student in an intervention school being an ever smoker or susceptible never smoker compared with controls [adjusted OR 1.28, 95%CI 0.83-1.97, p=0.263] and no significant difference in the odds of ever smoking (aOR 0.82, 95%CI 0.42-1.58, p=0.549). Teachers highlighted differences by academic ability in how well the messages presented were understood. Use of the family component was low but was received positively by parents who engaged with it. Conclusions: Operation Smoke Storm is an acceptable resource for delivering smoking-prevention education but it does not appear to have reduced smoking and susceptibility

H2-rich syngas production from biogas reforming: overcoming coking and sintering using bimetallic Ni-based catalysts

Dry reforming of methane is a very appealing catalytic route biogas (mainly composed by greenhouse gases: carbon dioxide and methane) conversion into added value syngas, which could be further upgraded to produce liquid fuels and added value chemicals. However, the major culprits of this reaction are coking and active phase sintering that result in catalysts deactivation. Herein we have developed a highly stable bimetallic Ni–Rh catalyst supported on mixed CeO2–Al2O3 oxide using low-noble metal loadings. The addition of small amounts of rhodium to nickel catalysts prevents coke formation and improves sintering resistance, achieving high conversions over extended reaction times hence resulting in promising catalysts for biogas upgrading. © 2023 The Author(s)Ministerio de Ciencia e Innovación (MICIN). España PLEC2021-008086, RYC2018- 024387-I, PID2019-108502RJ-I00European Commission (EC) BIOALL project (Grant Agreement: 101008058