Aiming Higher: Results from a State Scorecard on Health System Performance, 2014

The Commonwealth Fund's Scorecard on State Health System Performance, 2014, assesses states on 42 indicators of health care access, quality, costs, and outcomes over the 2007–2012 period, which includes the Great Recession and precedes the major coverage expansions of the Affordable Care Act. Changes in health system performance were mixed overall, with states making progress on some indicators while losing ground on others. In a few areas that were the focus of national and state attention—childhood immunizations, hospital readmissions, safe prescribing, and cancer deaths— there were widespread gains. But more often than not, states exhibited little or no improvement. Access to care deteriorated for adults, while costs increased. Persistent disparities in performance across and within states and evidence of poor care coordination highlight the importance of insurance expansions, health care delivery reforms, and payment changes in promoting a more equitable, highquality health system

Sex differences in spatial abilities: Methodological problems in Hoffman et al.

Hoffman et al. (1) claimed to provide evidence that “nurture” (i.e., residing in a patrilineal vs. matrilineal tribe in India) critically affects sex differences in spatial abilities. Unfortunately, their conclusion is undermined by major problems with their measures of spatial ability and sex equality. The first and biggest problem is with their measure of spatial abilities. “Spatial abilities” are a complex cognitive domain, with facets ranging from location memory (favoring women) to navigation in 3D virtual space (favoring men) (2). The puzzle used by Hoffman et al. (1) is similar to the Object Assembly subtest of the Wechsler Adult Intelligence Scale (3); sex differences on this task are extremely small (d = 0.10), at least 10-fold smaller than those found for spatial measures showing the largest sex differences. It is odd that Hoffman et al. (1) chose to investigate sex differences with this kind of sex-insensitive task. The second problem is the lack of a control task. The insensitivity of the task used by Hoffman et al. (1) suggests that their finding that men outperform women in a patrilineal tribe but not a matrilineal tribe is not related to sex differences in spatial abilities per se but to other factors instead. Education, as they noted, is likely one of these. The use of a cognitive control task tapping nonspatial abilities would have allowed for an assessment of the specificity of the effect, but, unfortunately, such a task was not included. Third, defining sex equality as matrilineality is problematic, because cross-cultural studies generally show that equality (a multidimensional construct) is not systematically correlated with descent system (4). From the descriptions of Hoffman et al. (1), it appears that women in the matrilineal Khasi have more economic power and better education, but this ignores other sex equality dimensions, such as positions of political and religious leadership, domestic authority, and autonomy. Without such measures, it is unclear whether the Khasi are, in fact, more sexegalitarian than the Karbi. Furthermore, a recent 53-nation cross-cultural study has shown that sex differences favoring men on validated, reliable, multi-item spatial measures are positively associated with United Nation indices of sex development and empowerment (5), a pattern opposite to that reported by Hoffman et al. (1). For all these reasons, the study by Hoffman et al. (1) failed to support their conclusions

America's Underinsured: A State-by-State Look at Health Insurance Affordability Prior to the New Coverage Expansions

The Affordable Care Act insurance reforms seek to expand coverage and to improve the affordability of care and premiums. Before the implementation of the major reforms, data from U.S. census surveys indicated nearly 32 million insured people under age 65 were in households spending a high share of their income on medical care. Adding these "underinsured" people to the estimated 47.3 million uninsured, the state share of the population at risk for not being able to afford care ranged from 14 percent in Massachusetts to 36 percent to 38 percent in Idaho, Florida, Nevada, New Mexico, and Texas. Nationally, more than half of people with low incomes and 20 percent of those with middle incomes were either underinsured or uninsured in 2012. The report provides state baselines to assess changes in coverage and affordability and compare states as insurance expansions and market reforms are implemented.

Association of β-Amyloid Burden With Sleep Dysfunction and Cognitive Impairment in Elderly Individuals With Cognitive Disorders.

Importance: Evidence shows that sleep dysfunction and β-amyloid (Aβ) deposition work synergistically to impair brain function in individuals with normal cognition, increasing the risk of developing dementia later in life. However, whether Aβ continues to play an integral role in sleep dysfunction after the onset of cognitive decline in individuals with dementia is unclear. Objective: To determine whether Aβ deposition in the brain is associated with subjective measures of sleep quality and cognition in elderly individuals with cognitive disorders. Design, Setting, and Participants: A nested survey study was conducted at the Cognitive Disorders and Comprehensive Alzheimer Disease Center of Thomas Jefferson University Hospital in Philadelphia, Pennsylvania. Participants included patients aged 65 years and older with cognitive disorders verified by neuropsychological testing. Eligible participants were identified from a referral center-based sample of patients who underwent fluorine 18-labeled florbetaben positron emission tomography imaging at Thomas Jefferson University Hospital as part of the multicenter Imaging Dementia-Evidence for Amyloid Scanning study. Data collection and analysis occurred between November 2018 and March 2019. Main Outcomes and Measures: Sleep quality was measured via responses to sleep questionnaires, Aβ deposition was measured via fluorine 18-labeled florbetaben positron emission tomography, and cognition was measured via Mini-Mental State Examination (MMSE) performance. Results: Of the 67 eligible participants, 52 (77.6%) gave informed consent to participate in the study. Of the 52 enrolled participants (mean [SD] age, 76.6 [7.4] years), 27 (51.9%) were women. Daytime sleepiness was associated with Aβ deposition in the brainstem (B = 0.0063; 95% CI, 0.001 to 0.012; P = .02), but not MMSE performance (B = -0.01; 95% CI, -0.39 to 0.37; P = .96). The number of nocturnal awakenings was associated with Aβ deposition in the precuneus (B = 0.11; 95% CI, 0.06 to 0.17; P \u3c .001) and poor MMSE performance (B = -2.13; 95% CI, -3.13 to -1.13; P \u3c .001). Mediation analysis demonstrated an indirect association between Aβ deposition and poor MMSE performance that relied on nocturnal awakenings as an intermediary (B = -3.99; 95% CI, -7.88 to -0.83; P = .01). Conclusions and Relevance: Nighttime sleep disruption may mediate the association between Aβ and cognitive impairment, suggesting that there is an underlying sleep-dependent mechanism that links Aβ burden in the brain to cognitive decline. Further elucidation of this mechanism may improve understanding of disease processes associated with Aβ accumulation

Sex differences in mathematics and reading achievement are inversely related: within- and across-nation assessment of 10 years of PISA data

We analyzed one decade of data collected by the Programme for International Student Assessment (PISA), including the mathematics and reading performance of nearly 1.5 million 15 year olds in 75 countries. Across nations, boys scored higher than girls in mathematics, but lower than girls in reading. The sex difference in reading was three times as large as in mathematics. There was considerable variation in the extent of the sex differences between nations. There are countries without a sex difference in mathematics performance, and in some countries girls scored higher than boys. Boys scored lower in reading in all nations in all four PISA assessments (2000, 2003, 2006, 2009). Contrary to several previous studies, we found no evidence that the sex differences were related to nations’ gender equality indicators. Further, paradoxically, sex differences in mathematics were consistently and strongly inversely correlated with sex differences in reading: Countries with a smaller sex difference in mathematics had a larger sex difference in reading and vice versa. We demonstrate that this was not merely a between-nation, but also a within-nation effect. This effect is related to relative changes in these sex differences across the performance continuum: We did not find a sex difference in mathematics among the lowest performing students, but this is where the sex difference in reading was largest. In contrast, the sex difference in mathematics was largest among the higher performing students, and this is where the sex difference in reading was smallest. The implication is that if policy makers decide that changes in these sex differences are desired, different approaches will be needed to achieve this for reading and mathematics. Interventions that focus on high-achieving girls in mathematics and on low achieving boys in reading are likely to yield the strongest educational benefits

Male bisexual arousal: A matter of curiosity?

Conflicting evidence exists regarding whether bisexual-identified men are sexually aroused to both men and women. We hypothesized that a distinct characteristic, level of curiosity about sexually diverse acts, distinguishes bisexual-identified men with and without bisexual arousal. Study 1 assessed men's (n = 277) sexual arousal via pupil dilation to male and female sexual stimuli. Bisexual men were, on average, higher in their sexual curiosity than other men. Despite this general difference, only bisexual-identified men with elevated sexual curiosity showed bisexual arousal. Those lower in curiosity had responses resembling those of homosexual men. Study 2 assessed men's (n = 72) sexual arousal via genital responses and replicated findings of Study 1. Study 3 provided information on the validity on our measure of sexual curiosity by relating it to general curiosity and sexual sensation seeking (n = 83). Based on their sexual arousal and personality, at least two groups of men identify as bisexual

GRAVITY: the Calibration Unit

We present in this paper the design and characterisation of a new sub-system of the VLTI 2nd generation instrument GRAVITY: the Calibration Unit. The Calibration Unit provides all functions to test and calibrate the beam combiner instrument: it creates two artificial stars on four beams, and dispose of four delay lines with an internal metrology. It also includes artificial stars for the tip-tilt and pupil guiding systems, as well as four metrology pick-up diodes, for tests and calibration of the corresponding sub-systems. The calibration unit also hosts the reference targets to align GRAVITY to the VLTI, and the safety shutters to avoid the metrology light to propagate in the VLTI-lab. We present the results of the characterisation and validtion of these differrent sub-units.Comment: 12 pages, 11 figures. Proceeding of SPIE 9146 "Optical and Infrared Interferometry IV

The GRAVITY metrology system: modeling a metrology in optical fibers

GRAVITY is the second generation VLT Interferometer (VLTI) instrument for high-precision narrow-angle astrometry and phase-referenced interferometric imaging. The laser metrology system of GRAVITY is at the heart of its astrometric mode, which must measure the distance of 2 stars with a precision of 10 micro-arcseconds. This means the metrology has to measure the optical path difference between the two beam combiners of GRAVITY to a level of 5 nm. The metrology design presents some non-common paths that have consequently to be stable at a level of 1 nm. Otherwise they would impact the performance of GRAVITY. The various tests we made in the past on the prototype give us hints on the components responsible for this error, and on their respective contribution to the total error. It is however difficult to assess their exact origin from only OPD measurements, and therefore, to propose a solution to this problem. In this paper, we present the results of a semi-empirical modeling of the fibered metrology system, relying on theoretical basis, as well as on characterisations of key components. The modeling of the metrology system regarding various effects, e.g., temperature, waveguide heating or mechanical stress, will help us to understand how the metrology behave. The goals of this modeling are to 1) model the test set-ups and reproduce the measurements (as a validation of the modeling), 2) determine the origin of the non-common path errors, and 3) propose modifications to the current metrology design to reach the required 1nm stability.Comment: 20 pages, 19 figures. Proceeding of SPIE 9146 "Optical and Infrared Interferometry IV

A novel de novo KDM5C variant in a female with global developmental delay and ataxia: a case report

Background Pathogenic variants in KDM5C are a cause of X-linked intellectual disability in males. Other features in males include short stature, dysmorphic features, seizures and spasticity. In some instances, female relatives were noted to have learning difficulties and mild intellectual disabilities, but full phenotypic descriptions were often incomplete. Recently, detailed phenotypic features of five affected females with de novo variants were described. (Clin Genet 98:43–55, 2020) Four individuals had a protein truncating variant and 1 individual had a missense variant. All five individuals had developmental delay/intellectual disability and three neurological features. Case presentation Here we report a three-year-old female with global developmental delay, hypotonia and ataxia. Through whole exome sequencing, a de novo c.1516A > G (p.Met506Val) variant in KDM5C was identified. This missense variant is in the jumonji-C domain of this multi domain protein where other missense variants have been previously reported in KDM5C related disorder. The KDM5C gene is highly intolerant to functional variation which suggests its pathogenicity. The probands motor delays and language impairment is consistent with other reported female patients with de novo variants in KDM5C. However, other features reported in females (distinctive facial features, skeletal abnormalities, short stature and endocrine features) were absent. To the best of our knowledge, our proband is the first female patient reported with a diagnosis of ataxia. Conclusions This case report provides evidence for an emerging and phenotypic variability that adds to the literature of the role of KDM5C in females with neurodevelopmental disorders as well as movement disorders