Mortality Differences Between Traditional Medicare and Medicare Advantage: A Risk-Adjusted Assessment Using Claims Data.

Medicare Advantage (MA) has grown rapidly since the Affordable Care Act; nearly one-third of Medicare beneficiaries now choose MA. An assessment of the comparative value of the 2 options is confounded by an apparent selection bias favoring MA, as reflected in mortality differences. Previous assessments have been hampered by lack of access to claims diagnosis data for the MA population. An indirect comparison of mortality as an outcome variable was conducted by modeling mortality on a traditional fee-for-service (FFS) Medicare data set, applying the model to an MA data set, and then evaluating the ratio of actual-to-predicted mortality in the MA data set. The mortality model adjusted for clinical conditions and demographic factors. Model development considered the effect of potentially greater coding intensity in the MA population. Further analysis calculated ratios for subpopulations. Predicted, risk-adjusted mortality was lower in the MA population than in FFS Medicare. However, the ratio of actual-to-predicted mortality (0.80) suggested that the individuals in the MA data set were less likely to die than would be predicted had those individuals been enrolled in FFS Medicare. Differences between actual and predicted mortality were particularly pronounced in low income (dual eligibility), nonwhite race, high morbidity, and Health Maintenance Organization (HMO) subgroups. After controlling for baseline clinical risk as represented by claims diagnosis data, mortality differences favoring MA over FFS Medicare persisted, particularly in vulnerable subgroups and HMO plans. These findings suggest that differences in morbidity do not fully explain differences in mortality between the 2 programs

Inhibition of Drosophila Wg Signaling Involves Competition between Mad and Armadillo/β-Catenin for dTcf Binding

Precisely regulated signal transduction pathways are crucial for the regulation of developmental events and prevention of tumorigenesis. Both the Transforming Growth Factor β (TGFβ)/Bone morphogenetic protein (BMP) and Wnt/Wingless (Wg) pathways play essential roles in organismal patterning and growth, and their deregulation can lead to cancers. We describe a mechanism of interaction between Drosophila Wg and BMP signaling in which Wg target gene expression is antagonized by BMP signaling. In vivo, high levels of both an activated BMP receptor and the BMP effector Mad can inhibit the expression of Wg target genes. Conversely, loss of mad can induce Wg target gene expression. In addition, we find that ectopic expression in vivo of the Wg transcription factor dTcf is able to suppress the inhibitory effect caused by ectopic Mad. In vitro binding studies revealed competition for dTcf binding between Mad and the Wnt effector β-catenin/Armadillo (Arm). Our in vivo genetic analyses and target gene studies support a mechanism consistent with the in vitro binding and competition studies, namely that BMP pathway components can repress Wg target gene expression by influencing the binding of Arm and dTcf

Song production by the North Pacific right whale, \u3ci\u3eEubalaena japonica\u3c/i\u3e

This paper describes song production by the eastern North Pacific right whale (NPRW, Eubalaena japonica) in the southeastern Bering Sea. Songs were localized in real-time to individuals using sonobuoys. Singers whose sex could be determined were all males. Autonomous recorder data from 17 year-long deployments were analyzed to document and characterize song types. Four distinct song types were documented over eight years (2009–2017) at five distinct locations. Each song type consists of a hierarchical structure of 1–3 different repeating phrases comprised predominantly of gunshot sounds; three of the four songs contained additional sound types (downsweep, moan, and low-frequency pulsive call). Songs were detected annually (July–January); all song types remained consistent over eight years. Two different songs often occurred simultaneously, produced by different individuals; the same song was never detected simultaneously at the same location. The same song type was detected on the same day and time at two distant locations, indicating multiple individuals can produce the same song. These findings provide support that males produce song; it remains unknown if females also sing. NPRW is the first right whale species documented to produce song. Based on current knowledge about song in mysticetes, it is hypothesized that these songs are reproductive displays

Effort, reward and self-reported mental health: a simulation study on negative affectivity bias

Background : In the present article, we propose an alternative method for dealing with negative affectivity (NA) biases in research, while investigating the association between a deleterious psychosocial environment at work and poor mental health. First, we investigated how strong NA must be to cause an observed correlation between the independent and dependent variables. Second, we subjectively assessed whether NA can have a large enough impact on a large enough number of subjects to invalidate the observed correlations between dependent and independent variables.Methods : We simulated 10,000 populations of 300 subjects each, using the marginal distribution of workers in an actual population that had answered the Siegrist's questionnaire on effort and reward imbalance (ERI) and the General Health Questionnaire (GHQ).Results : The results of the present study suggested that simulated NA has a minimal effect on the mean scores for effort and reward. However, the correlations between the effort and reward imbalance (ERI) ratio and the GHQ score might be important, even in simulated populations with a limited NA.Conclusions : When investigating the relationship between the ERI ratio and the GHQ score, we suggest the following rules for the interpretation of the results: correlations with an explained variance of 5% and below should be considered with caution; correlations with an explained variance between 5% and 10% may result from NA, although this effect does not seem likely; and correlations with an explained variance of 10% and above are not likely to be the result of NA biases. [Authors]]]> Mental Health ; Work ; Social Values ; Motivation ; Self Concept ; Burnout, Professional ; Transportation of Patients ; Psychology, Clinical eng https://serval.unil.ch/resource/serval:BIB_05B4BD754C46.P001/REF.pdf http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_05B4BD754C468 info:eu-repo/semantics/altIdentifier/urn/urn:nbn:ch:serval-BIB_05B4BD754C468 info:eu-repo/semantics/publishedVersion info:eu-repo/semantics/openAccess Copying allowed only for non-profit organizations https://serval.unil.ch/disclaimer application/pdf oai:serval.unil.ch:BIB_05B561E47FC8 2022-02-19T02:12:55Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_05B561E47FC8 Visual recovery from radiation-induced optic neuropathy. The role of hyperbaric oxygen therapy info:eu-repo/semantics/altIdentifier/pmid/8340486 Borruat, F. X. Schatz, N. J. Glaser, J. S. Feun, L. G. Matos, L. info:eu-repo/semantics/article article 1993-06 Journal of Clinical Neuro-Ophthalmology, vol. 13, no. 2, pp. 98-101 info:eu-repo/semantics/altIdentifier/pissn/0272-846X <![CDATA[Optic neuropathy resulting in permanent visual loss is an infrequent delayed complication of radiation therapy. Hyperbaric oxygen therapy (HBO) has been used to treat such a complication, but its efficacy is controversial. We report a patient who presented with radiation-induced optic neuropathy 17 months after irradiation for a left maxillary antrum melanoma. HBO fully reversed visual loss in the more recently involved eye, and slightly improved vision in the earlier affected eye

Phase transition and selection in a four-species cyclic Lotka-Volterra model

We study a four species ecological system with cyclic dominance whose individuals are distributed on a square lattice. Randomly chosen individuals migrate to one of the neighboring sites if it is empty or invade this site if occupied by their prey. The cyclic dominance maintains the coexistence of all the four species if the concentration of vacant sites is lower than a threshold value. Above the treshold, a symmetry breaking ordering occurs via growing domains containing only two neutral species inside. These two neutral species can protect each other from the external invaders (predators) and extend their common territory. According to our Monte Carlo simulations the observed phase transition is equivalent to those found in spreading models with two equivalent absorbing states although the present model has continuous sets of absorbing states with different portions of the two neutral species. The selection mechanism yielding symmetric phases is related to the domain growth process whith wide boundaries where the four species coexist.Comment: 4 pages, 5 figure