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

An applied framework for Positive Education

The increasing momentum of the Positive Psychology movement has seen burgeoning research in positive mental health and adaptive functioning; a critical question is how this knowledge can now be applied in real-world settings. Positive Education seeks to combine principles of Positive Psychology with best-practice teaching and with educational paradigms to promote optimal development and flourishing in the school setting. Interest in Positive Education continues to grow in line with increasing recognition of the important role played by schools in fostering wellbeing, and the link between wellbeing and academic success. To date, however, a framework to guide the implementation of Positive Education in schools has been lacking. This paper provides an overview of the Geelong Grammar School (GGS) Model for Positive Education, an applied framework developed over five years of implementing Positive Education as a whole-school approach in one Australian school. Explicit and implicit teaching in combination with school-wide practices target six wellbeing domains, including positive emotions, positive engagement, positive accomplishment, positive purpose, positive relationships, and positive health, underpinned by a focus on character strengths. The Model provides a structured pathway for implementing Positive Education in schools, a framework to guide evaluation and research, and a foundation for further theoretical discussion and development

Resolving The Moth at Millimeter Wavelengths

HD 61005, also known as "The Moth," is one of only a handful of debris disks that exhibit swept-back "wings" thought to be caused by interaction with the ambient interstellar medium (ISM). We present 1.3 mm Submillimeter Array (SMA) observations of the debris disk around HD 61005 at a spatial resolution of 1.9 arcsec that resolve the emission from large grains for the first time. The disk exhibits a double-peaked morphology at millimeter wavelengths, consistent with an optically thin ring viewed close to edge-on. To investigate the disk structure and the properties of the dust grains we simultaneously model the spatially resolved 1.3 mm visibilities and the unresolved spectral energy distribution. The temperatures indicated by the SED are consistent with expected temperatures for grains close to the blowout size located at radii commensurate with the millimeter and scattered light data. We also perform a visibility-domain analysis of the spatial distribution of millimeter-wavelength flux, incorporating constraints on the disk geometry from scattered light imaging, and find suggestive evidence of wavelength-dependent structure. The millimeter-wavelength emission apparently originates predominantly from the thin ring component rather than tracing the "wings" observed in scattered light. The implied segregation of large dust grains in the ring is consistent with an ISM-driven origin for the scattered light wings.Comment: 10 pages, 6 figure

ALMA Observations of the Largest Proto-Planetary Disk in the Orion Nebula, 114-426: A CO Silhouette

We present ALMA observations of the largest protoplanetary disk in the Orion Nebula, 114-426. Detectable 345 GHz (856 micron) dust continuum is produced only in the 350 AU central region of the ~1000 AU diameter silhouette seen against the bright H-alpha background in HST images. Assuming optically thin dust emission at 345 GHz, a gas-to-dust ratio of 100, and a grain temperature of 20 K, the disk gas-mass is estimated to be 3.1 +/- 0.6 Jupiter masses. If most solids and ices have have been incorporated into large grains, however, this value is a lower limit. The disk is not detected in dense-gas tracers such as HCO+ J=4-3, HCN J=4-3, or CS =7-6. These results may indicate that the 114-426 disk is evolved and depleted in some light organic compounds found in molecular clouds. The CO J=3-2 line is seen in absorption against the bright 50 to 80 K background of the Orion A molecular cloud over the full spatial extent and a little beyond the dust continuum emission. The CO absorption reaches a depth of 27 K below the background CO emission at VLSR ~6.7 km/s about 0.52 arcseconds (210 AU) northeast and 12 K below the background CO emission at VLSR ~ 9.7 km/s about 0.34 arcseconds (140 AU) southwest of the suspected location of the central star, implying that the embedded star has a mass less than 1 Solar mass .Comment: 20 pages, 4 figure

ALMA Observations of the Orion Proplyds

We present ALMA observations of protoplanetary disks ("proplyds") in the Orion Nebula Cluster. We imaged 5 individual fields at 856um containing 22 HST-identified proplyds and detected 21 of them. Eight of those disks were detected for the first time at submillimeter wavelengths, including the most prominent, well-known proplyd in the entire Orion Nebula, 114-426. Thermal dust emission in excess of any free-free component was measured in all but one of the detected disks, and ranged between 1-163 mJy, with resulting disk masses of 0.3-79 Mjup. An additional 26 stars with no prior evidence of associated disks in HST observations were also imaged within the 5 fields, but only 2 were detected. The disk mass upper limits for the undetected targets, which include OB stars, theta1Ori C and theta1Ori F, range from 0.1-0.6 Mjup. Combining these ALMA data with previous SMA observations, we find a lack of massive (>3 Mjup) disks in the extreme-UV dominated region of Orion, within 0.03 pc of O-star theta1Ori C. At larger separations from theta1Ori C, in the far-UV dominated region, there is a wide range of disk masses, similar to what is found in low-mass star forming regions. Taken together, these results suggest that a rapid dissipation of disk masses likely inhibits potential planet formation in the extreme-UV dominated regions of OB associations, but leaves disks in the far-UV dominated regions relatively unaffected.Comment: ApJ, in pres

Socioeconomic Determinants of Survival in Laryngeal Squamous Cell Carcinoma Patients

Objective: To determine whether comorbidities, socioeconomic factors, and race affect median survival times and overall survival outcomes for patients with laryngeal squamous cell carcinoma treated at a single institution with a large African American population. Study Design: Retrospective cohort study Setting: Tertiary care medical center. Subjects and Methods: Six-hundred nineteen patients treated for laryngeal squamous cell carcinoma at a single institution between 1999 and 2013. Kaplan-Meier survival curve analysis and Cox proportional hazard models were used. Results: Median survival time decreased with age ≥ 65 years (P \u3c .001), stage 3 or 4 (P \u3c .001),clinical T stage 3 or 4 (P \u3c .001), and clinical N stage 1, 2, or 3 (P \u3c .001). Living in zip code with increasing proportion of residents with high school degree or less (P \u3c .001),increasing proportion of residents living below the poverty level (P \u3c .001), and increasing Charlson Comorbidity Index (P \u3c .001) were associated with increased risk of death. Increasing median household income was associated with decreased increased risk of death (P \u3c .001). Caucasian, rather than African American, race was associated with decreased median survival time (P = .01). Conclusion: Socioeconomic factors and medical comorbidities were negative prognostic indicators of survival in patients with laryngeal squamous cell carcinoma. Contrary to previous reports, African American race was associated with improved overall survival in univariate analysis. However, once socioeconomic factors were controlled for, race conferred no effect on survival. Rather, living in neighborhoods with higher median household income was protective.https://scholarlycommons.henryford.com/merf2019hcd/1001/thumbnail.jp

School playgrounds and physical activity policies as predictors of school and home time activity

<p>Abstract</p> <p>Background</p> <p>Previous work has suggested that the number of permanent play facilities in school playgrounds and school-based policies on physical activity can influence physical activity in children. However, few comparable studies have used objective measures of physical activity or have had little adjustment for multiple confounders.</p> <p>Methods</p> <p>Physical activity was measured by accelerometry over 5 recess periods and 3 full school days in 441 children from 16 primary schools in Dunedin, New Zealand. The number of permanent play facilities (swing, fort, slide, obstacle course, climbing wall etc) in each school playground was counted on three occasions by three researchers following a standardized protocol. Information on school policies pertaining to physical activity and participation in organized sport was collected by questionnaire.</p> <p>Results</p> <p>Measurement of school playgrounds proved to be reliable (ICC 0.89) and consistent over time. Boys were significantly more active than girls (P < 0.001), but little time overall was spent in moderate-vigorous physical activity (MVPA). Boys engaged in MVPA for 32 (SD 17) minutes each day of which 17 (10) took place at school compared with 23 (14) and 11 (7) minutes respectively in girls. Each additional 10-unit increase in play facilities was associated with 3.2% (95% CI 0.0-6.4%) more total activity and 8.3% (0.8-16.3%) more MVPA during recess. By contrast, school policy score was not associated with physical activity in children.</p> <p>Conclusion</p> <p>The number of permanent play facilities in school playgrounds is associated with higher physical activity in children, whereas no relationship was observed for school policies relating to physical activity. Increasing the number of permanent play facilities may offer a cost-effective long-term approach to increasing activity levels in children.</p

The Southern Ocean Observing System (SOOS)

[in “State of the Climate in 2014” : Special Supplement to the Bulletin of the American Meteorological Society Vol. 96, No. 7, July 2015

Partial Dynamical Symmetry and Mixed Dynamics

Partial dynamical symmetry describes a situation in which some eigenstates have a symmetry which the quantum Hamiltonian does not share. This property is shown to have a classical analogue in which some tori in phase space are associated with a symmetry which the classical Hamiltonian does not share. A local analysis in the vicinity of these special tori reveals a neighbourhood of phase space foliated by tori. This clarifies the suppression of classical chaos associated with partial dynamical symmetry. The results are used to divide the states of a mixed system into ``chaotic'' and ``regular'' classes.Comment: 10 pages, Revtex, 3 figures, Phys. Rev. Lett. in pres