The Changing Composition and Capacity of Medicare Providers, 2012-2015

Objective: Over the past decade, U.S. medical school enrollment has increased nearly 30 percent, and the growth in mid-level new graduates was even faster. Many of these new graduates are currently serving the large and growing Medicare population. Yet, little evidence so far has documented the workforce that are serving Medicare population. In the anticipation of physician supply shortages, it is important to understand who are taking care of Medicare population recently, and whether there are changes in the overall capacity and patient risk profiles of Medicare providers. Methods: Data were from 2012-2015 Medicare Physician and Other Supplier Aggregate Tables at the Centers for Medicare & Medicaid Services website, which contain information on utilization, payment, and procedures provided to more than 10 Medicare Part B beneficiaries by U.S. physicians and nurses. We identified primary care physicians (i.e., family practice, internal medicine, general practitioners, and geriatric medicine), specialists, and mid-level providers (e.g., nurse practitioners, physician assistants, etc.) based on self-reported provider type in the data. We conducted trend analysis to examine the changes in the proportion of physicians and mid-level providers over time, and also compared utilization, payment amount, and patient risk profiles of physicians and nurses between 2012 and 2015, respectively. Findings: Over the study period, the number of providers with more than 10 Medicare patients increased from 709,982 in 2012 to 782,836 in 2015. The proportion of both primary care physicians and specialists declined consistently, while in contrast, the proportion of mid-level providers increased correspondingly, from 20% in 2012 to 24% in 2015. Compared to 2012, Physicians in 2015 served fewer Medicare patients, but provided more services to beneficiaries, and had no changes in payment received than in 2015. In contrast, mid-level providers served more patients, provided more services per patient, and received higher payments in 2015 than in 2012. Both physicians and mid-level providers served more patients diagnosed with depression, asthma, chronic kidney disease, and stroke in 2015 than in 2012. Conclusion: Medicare provider composition has been changing in recent years, where mid-level providers are playing an increasing role in serving Medicare beneficiaries. State legislatures and policymakers may consider expanding scope-of-practice for mid-level providers and also weigh the importance of innovating new payment policy to better reimburse mid-level providers. Future research is needed to compare the capacity of new and existing providers and the relationship between year of practicing and capacity building to serve more Medicare patients

Numerical simulations of the impacts of mountain on oasis effects in arid Central Asia

The oases in the mountain-basin systems of Central Asia are extremely fragile. Investigating oasis effects and oasis-desert interactions is important for understanding the ecological stability of oases. However, previous studies have been performed only in oasis-desert environments and have not considered the impacts of mountains. In this study, oasis effects were explored in the context of mountain effects in the northern Tianshan Mountains (NTM) using the Weather Research and Forecasting (WRF) model. Four numerical simulations are performed. The def simulation uses the default terrestrial datasets provided by the WRF model. The mod simulation uses actual terrestrial datasets from satellite products. The non-oasis simulation is a scenario simulation in which oasis areas are replaced by desert conditions, while all other conditions are the same as the mod simulation. Finally, the non-mountain simulation is a scenario simulation in which the elevation values of all grids are set to a constant value of 300 m, while all other conditions are the same as in the mod simulation. The mod simulation agrees well with near-surface measurements of temperature, relative humidity and latent heat flux. The Tianshan Mountains exert a cooling and wetting effects in the NTM region. The oasis breeze circulation (OBC) between oases and the deserts is counteracted by the stronger background circulation. Thus, the self-supporting mechanism of oases originating from the OBC plays a limited role in maintaining the ecological stability of oases in this mountain-basin system. However, the mountain wind causes the cold-wet'' island effects of the oases to extend into the oasis-desert transition zone at night, which is beneficial for plants in the transition region

Experimental demonstration of enhanced violations of Leggett-Garg inequalities in a PT\mathcal{PT}-symmetric trapped-ion qubit

The Leggett-Garg inequality (LGI) places a bound for the distinction between quantum systems and classical systems. Despite that the tests of temporal quantum correlations on LGIs have been studied in Hermitian realm, there are still unknowns for LGIs in non-Hermitian conditions due to the interplay between dissipation and coherence. For example, a theoretical hypothesis to be experimentally validated, suggests that within non-Hermitian systems, the non-unitary evolution of the system dynamics allows the boundaries of the LGIs to surpass the constraints imposed by traditional quantum mechanics. Here, we demonstrate the experimental violation of LGIs in a parity-time ($\mathcal{PT}$)-symmetric trapped-ion qubit system by measuring the temporal correlation of the evolving states at different times. We find that the upper bounds of the three-time parameter $K_3$ and the four-time parameter $K_4$ show enhanced violations with the increasing dissipation, and can reach the upper limit by infinitely approaching exceptional point. We also observe the distinct behavior of the lower bounds for $K_3$ and $K_4$. While the lower bound for $K_3$ remains constant, the case for $K_4$ shows an upward trend with increasing dissipation. These results reveal a pronounced dependence of the system's temporal quantum correlations on its dissipation to the environment. This opens up a potential pathway for harnessing dissipation to modulate quantum correlations and entanglement

Environmental-Friendly Catalytic Oxidation Processes Based on Hierarchical Titanium Silicate Zeolites at SINOPEC

Since it was claimed by EniChem in 1983 for the first time, titanium silicate‐1 (TS‐1) zeolite presented the most delightful catalytic performance in the area of selective organic oxidation reactions. To enhance the mass diffusion property, hierarchical titanium silicate with hollow cavities within crystal was prepared by using a post‐synthesis treatment in the presence of organic template, and then, it was commercially produced and employed in many industrial catalytic oxidation processes, such as propylene epoxidation, phenol hydroxylation, and cyclohexanone ammoximation. Moreover, we also developed several totally novel oxidation reactions on hollow titanium silicate (HTS) zeolite, i.e., Baeyer‐Villiger oxidation of cyclohexanone and chlorohydrination of allyl chloride with HCl and H2O2. In all cases, HTS shows much better catalytic performance than TS‐1, attributing to the mass diffusion intensification by introducing hollow cavities. On the other hand, enormous works on synthesizing hierarchical TS‐1 zeolites with open intracrystalline mesopores have been done via silanization treatment and recrystallization. Based on them, several bulk molecule oxidation processes with tert‐butyl hydroperoxide, such as epoxidation of fatty acid methyl ester (FAME) and large olefins, have been carried out. As a consequence, hierarchical TS‐1 zeolites supply a platform for developing environmental‐friendly catalytic oxidation processes to remarkably overcome the drawbacks of traditional routes

Converting metal-organic framework particles from hydrophilic to hydrophobic by an interfacial assembling route

Here we propose to modify the hydrophilicity of metal-organic framework (MOF) particles by an interfacial assembling route, which is based on the surface-active nature of MOF particles. It was found that hydrophilic UiO-66-NH₂ particles can be converted to hydrophobic particles through an oil-water interfacial assembling route. The underlying mechanism for the conversion of UiO-66-NH₂ was investigated by X-ray photoelectron spectroscopy and FT-IR spectroscopy. It was revealed that the close assembly of UiO-66-NH₂ particles at the oil-water interface strengthens the coordination between organic ligands and metal ions, which results in a decrease in the proportion of hydrophilic groups on UiO-66-NH₂ particle surfaces. Hydrophobic UiO-66-NH₂ particles show improved adsorption capacity for dyes in organic solvents compared with pristine UiO-66-NH₂ particles. It is expected that the interfacial assembling route can be applied to the synthesis of different kinds of MOF materials with tunable hydrophilicity or hydrophobicity required for diverse applications