Healthcare utilization and spending by children with cancer on Medicaid

BackgroundChildren with cancer are a unique patient population with high resource, complex healthcare needs. Understanding their healthcare utilization could highlight areas for care optimization.ProcedureWe performed a retrospective, cross‐sectional analysis of the 2014 Truven Marketscan Medicaid Database to explore clinical attributes, utilization, and spending among children with cancer who were Medicaid enrollees. Eligible patients included children (ages 0–18 years) with cancer (Clinical Risk Group 8). Healthcare utilization and spending (per member per month, PMPM) were assessed overall and across specific healthcare services.ResultsChildren with cancer (n = 5,405) represent less than 1% of the 1,516,457 children with medical complexity in the dataset. Children with cancer had high services use: laboratory/radiographic testing (93.0%), outpatient specialty care (83.4%), outpatient therapy/treatment (53.4%), emergency department (43.7%), hospitalization (31.5%), home healthcare (9.5%). PMPM spending for children with cancer was $3,706 overall and$2,323 for hospital care.ConclusionChildren with cancer have high healthcare resource use and spending. Differences in geographic distribution of services for children with cancer and the trajectory of spending over the course of therapy are areas for future investigation aimed at lowering costs of care without compromising on health outcomes.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138316/1/pbc26569_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138316/2/pbc26569.pd

Frequent Emergency Department Utilizers Among Children with Cancer

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136404/1/pbc25929.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136404/2/pbc25929_am.pd

Spatiotemporal Dynamics of Mediterranean Shallow Coastal Fish Communities Along a Gradient of Marine Protection

The importance of habitat factors in designing marine reserves and evaluating their performance over time has been regularly documented. Over three biennial sampling periods, we examined the effects of vegetated coverage and habitat diversity (i.e., patchiness) on fish density, community composition, and species-specific patterns along a gradient of protection from harvest in the shallow Spanish southern Mediterranean, including portions of the Tabarca marine reserve. With the exception of two herbivores (Sarpa salpa and Symphodus tinca), vegetated cover did not significantly affect fish densities, while habitat diversity was an influential factor across all three sampling periods. Overall, fish density was more positively associated with more continuous vegetated or unvegetated habitats, and was greatest in areas of highest protection (Tabarca II – Isla Nao site). These patterns were usually observed for four abundant fish species (Boops boops, Chromis chromis, Oblada melanura, and S. salpa). Fish community composition was distinct in the most protected portion of the Tabarca reserve, where it was also most stable. Our findings align with previous investigations of the Tabarca reserve and its surrounding areas, and demonstrate its continued effectiveness in conserving fish biomass and habitat. Together with effective management, marine reserves can facilitate greater species abundance, more stable biological communities, and resilient ecosystems

A systematic review on health resilience to economic crises

Background The health effects of recent economic crises differ markedly by population group. The objective of this systematic review is to examine evidence from longitudinal studies on factors influencing resilience for any health outcome or health behaviour among the general population living in countries exposed to financial crises. Methods We systematically reviewed studies from six electronic databases (EMBASE, Global Health, MEDLINE, PsycINFO, Scopus, Web of Science) which used quantitative longitudinal study designs and included: (i) exposure to an economic crisis; (ii) changes in health outcomes/behaviours over time; (iii) statistical tests of associations of health risk and/or protective factors with health outcomes/behaviours. The quality of the selected studies was appraised using the Quality Assessment Tool for Quantitative Studies. PRISMA reporting guidelines were followed. Results From 14,584 retrieved records, 22 studies met the eligibility criteria. These studies were conducted across 10 countries in Asia, Europe and North America over the past two decades. Ten socio-demographic factors that increased or protected against health risk were identified: gender, age, education, marital status, household size, employment/occupation, income/ financial constraints, personal beliefs, health status, area of residence, and social relations. These studies addressed physical health, mortality, suicide and suicide attempts, mental health, and health behaviours. Women’s mental health appeared more susceptible to crises than men’s. Lower income levels were associated with greater increases in cardiovascular disease, mortality and worse mental health. Employment status was associated with changes in mental health. Associations with age, marital status, and education were less consistent, although higher education was associated with healthier behaviours. Conclusions Despite widespread rhetoric about the importance of resilience, there was a dearth of studies which operationalised resilience factors. Future conceptual and empirical research is needed to develop the epidemiology of resilience

Can Biomarkers Identify Women at Increased Stroke Risk? The Women's Health Initiative Hormone Trials

Objective: The Women's Health Initiative hormone trials identified a 44% increase in ischemic stroke risk with combination estrogen plus progestin and a 39% increase with estrogen alone. We undertook a case-control biomarker study to elucidate underlying mechanisms, and to potentially identify women who would be at lower or higher risk for stroke with postmenopausal hormone therapy (HT). Design: The hormone trials were randomized, double-blind, and placebo controlled. Setting: The Women's Health Initiative trials were conducted at 40 clinical centers in the United States. Participants: The trials enrolled 27,347 postmenopausal women, aged 50-79 y. Interventions: We randomized 16,608 women with intact uterus to conjugated estrogens 0.625 mg with medroxyprogesterone acetate 2.5 mg daily or placebo, and 10,739 women with prior hysterectomy to conjugated estrogens 0.625 mg daily or placebo. Outcome Measures: Stroke was ascertained during 5.6 y of follow-up in the estrogen plus progestin trial and 6.8 y of follow-up in the estrogen alone trial. Results: No baseline clinical characteristics, including gene polymorphisms, identified women for whom the stroke risk from HT was higher. Paradoxically, women with higher baseline levels of some stroke-associated biomarkers had a lower risk of stroke when assigned to estrogen plus progestin compared to placebo. For example, those with higher IL-6 were not at increased stroke risk when assigned to estrogen plus progestin (odds ratio 1.28) but were when assigned to placebo (odds ratio 3.47; p for difference = 0.02). Similar findings occurred for high baseline PAP, leukocyte count, and D-dimer. However, only an interaction of D-dimer during follow-up interaction with HT and stroke was marginally significant (p = 0.03). Conclusions: Biomarkers did not identify women at higher stroke risk with postmenopausal HT. Some biomarkers appeared to identify women at lower stroke risk with estrogen plus progestin, but these findings may be due to chance

The Influence of Manga on the Graphic Novel

This material has been published in The Cambridge History of the Graphic Novel edited by Jan Baetens, Hugo Frey, Stephen E. Tabachnick. This version is free to view and download for personal use only. Not for re-distribution, re-sale or use in derivative works. © Cambridge University PressProviding a range of cogent examples, this chapter describes the influences of the Manga genre of comics strip on the Graphic Novel genre, over the last 35 years, considering the functions of domestication, foreignisation and transmedia on readers, markets and forms

Stochastic SIR-based Examination of the Policy Effects on the COVID-19 Spread in the U.S. States

Since the global outbreak of the novel COVID-19, many research groups have studied the epidemiology of the virus for short-term forecasts and to formulate the effective disease containment and mitigation strategies. The major challenge lies in the proper assessment of epidemiological parameters over time and of how they are modulated by the effect of any publicly announced interventions. Here we attempt to examine and quantify the effects of various (legal) policies/orders in place to mandate social distancing and to flatten the curve in each of the U.S. states. Through Bayesian inference on the stochastic SIR models of the virus spread, the effectiveness of each policy on reducing the magnitude of the growth rate of new infections is investigated statistically. This will inform the public and policymakers, and help them understand the most effective actions to fight against the current and future pandemics. It will aid the policy-makers to respond more rapidly (select, tighten, and/or loosen appropriate measures) to stop/mitigate the pandemic early on

Tropicalization of the barrier islands of the northern Gulf of Mexico: A comparison of herbivory and decomposition rates between smooth cordgrass (Spartina alterniflora) and black mangrove (Avicennia germinans).

The expansion of black mangrove Avicennia germinans into historically smooth cordgrass Spartina alterniflora-dominated marshes with warming temperatures heralds the migration of the marsh-mangrove ecotone northward in the northern Gulf of Mexico. With this shift, A. germinans is expected to outcompete S. alterniflora where it is able to establish, offering another prevalent food source to first order consumers. In this study, we find A. germinans leaves to be preferable to chewing herbivores, but simultaneously, chewing herbivores cause more damage to S. alterniflora leaves. Despite higher nitrogen content, A. germinans leaves decomposed slower than S. alterniflora leaves, perhaps due to other leaf constituents or a different microbial community. Other studies have found the opposite in decomposition rates of the two species' leaf tissue. This study provides insights into basic trophic process, herbivory and decomposition, at the initial stages of black mangrove colonization into S. alterniflora salt marsh