The role of data in health care disparities in medicaid managed care

BACKGROUND: The Affordable Care Act includes provisions to standardize the collection of data on health care quality that can be used to measure disparities. We conducted a qualitative study among leaders of Medicaid managed care plans, that currently have access to standardized quality data stratified by race and ethnicity, to learn how they use it to address disparities. METHODS: We conducted semi-structured interviews with 21 health plan leaders across 9 Medicaid managed care plans in California. We used purposive sampling to maximize heterogeneity in geography and plan type (e.g., non-profit, commercial). We performed a thematic analysis based on iterative coding by two investigators. RESULTS: We found 4 major themes. Improving overall quality was tightly linked to a focus on standardized metrics that are integral to meeting regulatory or financial incentives. However, reducing disparities was not driven by standardized data, but by a mix of factors. Data were frequently only examined by race and ethnicity when overall performance was low. Disparities were attributed to either individual choices or cultural and linguistic factors, with plans focusing interventions on recently immigrated groups. CONCLUSIONS: While plans' efforts to address overall quality were often informed by standardized data, actions to reduce disparities were not, at least partly because there were few regulatory or financial incentives driving meaningful use of data on disparities. Standardized data, as envisaged by the Affordable Care Act, could become more useful for addressing disparities if they are combined with policies and regulations that promote health care equity

Micromagnetic study of the influence of crystal defects on coercivity in magnetite

A one-dimensional micromagnetic model is used to calculate the thermal dependence of microcoercivity (hc) produced by the unpinning of a domain wall (DW) from various types of defects in magnetite. Equilibrium solutions are found that minimize the magnetoelastic, anisotropy, exchange, magnetostatic, and external field energies with respect to the wall width (w) and position of the wall relative to the defect. The defect may be a single dislocation, dislocation dipole, planar defect, or planar defect bounded by two parallel dislocations. Wall pinning is produced by (1) microstress fields of dislocations, (2) local changes in exchange and anisotropy constants within a planar defect region, or (3) a combination of both effects. The calculations, using temperature-dependent parameters, predict the thermal dependence of hc (T) as a function of grain size, domain wall width, defect spacing, and type of defect. Results show that, for grain sizes between 1 and 100 μm, hc(T) is usually a function of the wall width raised to some power n. The particular value of n is found to be a function of the DW-defect interaction spacing (d/w), type of defect, and grain size. Also, within this size range, the wall width expands with temperature more gradually than classical theory predicts. The microcoercivity results are used with the theory of Xu and Merrill (1990) to predict the thermal dependence of the macroscopic coercivity Hc in magnetite. For grains with low defect densities, such as recrystallized magnetites, negative dislocation dipoles with d/w≈0.1–1 produce a thermal dependence of coercivity that agrees with experimental results. In the high defect density limit, a population of positive and negative dislocation dipoles with a distribution of dipole widths produce an Hc (T) dependence consistent with experimental data from crushed and glass ceramic magnetites.This research was supported by National Science Foundation grant EAR-9017389. Support for the IRM is provided by grants from the Keck Foundation and the National Science Foundation. This is contribution 9206 of the Institute for Rock Magnetism

Revisiting the mechanism of reversed thermoremanent magnetization based on observations from synthetic ferrian ilmenite (y = 0.7)

International audienceThis study investigates the magnetic behavior of three well-characterized synthetic single-phase ferrian ilmenite (y = 0.7) specimens over the temperature range between 10 K and 573 K. Careful experiments measuring induced and remanent magnetizations in variable temperatures, applied magnetic fields, and pretreatment conditions are conducted in order to elucidate the mechanism leading to reversed thermoremanent magnetization (RTRM). Magnetic ordering temperatures of the cation ordered domains, in all three samples, are estimated at 380 K, suggesting that their Curie temperatures (T C) are independent of the sample's thermal history. This is not the case for cation disordered boundaries resulting from quenching from high temperatures. These cation disordered domains have estimated magnetic ordering temperatures of 418 K (Q1300), 410 K (Q1050), and 425 K (Q900). The data unambiguously support a less than perfect ferrimagnetic–antiferromagnetic exchange interaction as the fundamental source of RTRM. Furthermore, the magnetic field strength of the ''effective'' exchange anisotropies in such polycrystalline samples are estimated at $2.7 mT (Q1300),$12 mT (Q1050), and 0 mT (Q900). However, from the results presented herein we conclude that favorable conditions for the acquisition of RTRM are dependent not only on the strength of the exchange anisotropy but also on the crucial role played by the size of the cation ordered domains. INDEX TERMS: 1519 Geomagnetism and Paleomagnetism: Magnetic mineralogy and petrology; 1540 Geomagnetism and Paleomagnetism: Rock and mineral magnetism; 1714 History of Geophysics: Geomagnetism and paleomagnetism; KEYWORDS: ferrian ilmenite, reversed thermoremanent magnetization, exchange anisotropy Citation: Lagroix, F., S. K. Banerjee, and B. M. Moskowitz (2004), Revisiting the mechanism of reversed thermoremanent magnetization based on observations from synthetic ferrian ilmenite (y = 0.7)

Depth Distribution of Magnetofossils in Near-Surface Sediments From the Blake/Bahama Outer Ridge, Western North Atlantic Ocean, Determined by Low-Temperature Magnetism

Fe-oxide and Fe-sulfide trace minerals in sediments and sedimentary rocks provide proxy records of biogeochemical processes, record past variations in the geomagnetic field, and can serve as proxies for climatic variations. An important class of these Feoxides is produced by bacteria. Magnetic particles produced by magnetotactic bacteria have been proposed as a primary recorder of the geomagnetic field in many terrestrial marine sediments, and have also been suggested to represent fossil evidence of life on the planet Mars. To better understand their distribution and preservation in the sediment column, and their relationship to other biochemical processes, we present rock-magnetic data that document the occurrence and abundance of fossil biogenic magnetite (magnetofossils) in marine sediments from the Blake/Bahama Outer Ridge. Magnetic hysteresis and low-temperature magnetism both indicate that the occurrence of magnetofossils is closely linked to the depth of the modern Fe-redox boundary within the sediment column, and that a fraction of the magnetic minerals in the sediment column above the Fe-redox boundary are in the form of intact and relatively unaltered chains of nanophase magnetite crystals. Below the Fe-redox boundary the abundance of these magnetofossils is markedly decreased. The important conclusions of this work are to demonstrate that nondestructive rock-magnetic methods can be used to successfully document the occurrence and relative abundance of magnetofossils in geologic materials

Hydrogen generation and iron partitioning during experimental serpentinization of an olivine-pyroxene mixture

© The Author(s), 2020. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in McCollom, T. M., Klein, F., Moskowitz, B., Berquo, T. S., Bach, W., & Templeton, A. S. Hydrogen generation and iron partitioning during experimental serpentinization of an olivine-pyroxene mixture. Geochimica Et Cosmochimica Acta, 282, (2020): 55-75, doi:10.1016/j.gca.2020.05.016.A series of laboratory experiments was conducted to investigate serpentinization of olivine–pyroxene mixtures at 230 °C, with the objective of evaluating the effect of mixed compositions on Fe partitioning among product minerals, H2 generation, and reaction rates. An initial experiment reacted a mixture of 86 wt.% olivine and 14 wt.% orthopyroxene (Opx) with the same initial grain size for 387 days. The experiment resulted in extensive reaction (∼53% conversion), and solids recovered at termination of the experiment were dominated by Fe-bearing chrysotile and relict olivine along with minor brucite and magnetite. Only limited amounts of H2 were generated during the first ∼100 days of the experiment, but the rate of H2 generation then increased sharply coincident with an increase in pH from mildly alkaline to strongly alkaline conditions. Two shorter term experiments with the same reactants (26 and 113 days) produced a mixture of lizardite and talc that formed a thin coating on relict olivine and Opx grains, with virtually no generation of H2. Comparison of the results with reaction path models indicates that the Opx reacted about two times faster than olivine, which contrasts with some previous studies that suggested olivine should react more rapidly than Opx at the experimental conditions. The models also indicate that the long-term experiment transitioned from producing serpentine ± talc early in the early stages to precipitation of serpentine plus magnetite, with brucite beginning to precipitate only late in the experiment as Opx was depleted. The results indicate that overall reaction of olivine and Opx was initially relatively slow, but reaction rates accelerated substantially when the pH transitioned to strongly alkaline conditions. Serpentine and brucite precipitated from the olivine-Opx mixture had higher Fe contents than observed in olivine-only experiments at mildly alkaline pH, but had comparable Fe contents to reaction of olivine at strongly alkaline pH implying that higher pH may favor greater partitioning of Fe into serpentine and brucite and less into magnetite. Despite the presence of brucite, dissolved silica activities during the long-term olivine-Opx experiment maintained levels well above serpentine-brucite equilibrium. Instead, silica activities converged on levels close to metastable equilibrium between brucite and olivine. It is proposed that silica levels during the experiment may have been regulated by exchange of SiO2 between the fluid and a silica-depleted, brucite-like surface layer on dissolving olivine.This research was supported by the U. S. National Science Foundation Marine Geology and Geophysics program through grant NSF-OCE 0927744 and by the NASA Astrobiology Institute through Cooperative Agreement NNA15BB02A. Additional support to TMM from the Hanse Wissenschaftskolleg (Delmenhorst, Germany) at an early stage of this project is gratefully acknowledged. FK acknowledges support through Grant NSF-OCE 1427274. The IRM is supported by the Instruments and Facilities Program of the NSF Division of Earth Science. This is IRM contribution 1711. We very much appreciate the comments of Fabrice Brunet, Gleb Pokrovski and an anonymous reviewer that helped us refine our interpretations and improve communication of the results

Diffusion tensor and volumetric magnetic resonance imaging using an MR-compatible hand-induced robotic device suggests training-induced neuroplasticity in patients with chronic stroke

Stroke is the third leading cause of mortality and a frequent cause of long-term adult impairment. Improved strategies to enhance motor function in individuals with chronic disability from stroke are thus required. Post-stroke therapy may improve rehabilitation and reduce long-term disability; however, objective methods for evaluating the specific impact of rehabilitation are rare. Brain imaging studies on patients with chronic stroke have shown evidence for reorganization of areas showing functional plasticity after a stroke. In this study, we hypothesized that brain mapping using a novel magnetic resonance (MR)-compatible hand device in conjunction with state-of-the-art magnetic resonance imaging (MRI) can serve as a novel biomarker for brain plasticity induced by rehabilitative motor training in patients with chronic stroke. This hypothesis is based on the premises that robotic devices, by stimulating brain plasticity, can assist in restoring movement compromised by stroke-induced pathological changes in the brain and that these changes can then be monitored by advanced MRI. We serially examined 15 healthy controls and 4 patients with chronic stroke. We employed a combination of diffusion tensor imaging (DTI) and volumetric MRI using a 3-tesla (3T) MRI system using a 12-channel Siemens Tim coil and a novel MR-compatible hand-induced robotic device. DTI data revealed that the number of fibers and the average tract length significantly increased after 8 weeks of hand training by 110% and 64%, respectively (p<0.001). New corticospinal tract (CST) fibers projecting progressively closer to the motor cortex appeared during training. Volumetric data analysis showed a statistically significant increase in the cortical thickness of the ventral postcentral gyrus areas of patients after training relative to pre-training cortical thickness (p<0.001). We suggest that rehabilitation is possible for a longer period of time after stroke than previously thought, showing that structural plasticity is possible even after 6 months due to retained neuroplasticity. Our study is an example of personalized medicine using advanced neuroimaging methods in conjunction with robotics in the molecular medicine era

Functional MRI of Rehabilitation in Chronic Stroke Patients Using Novel MR-Compatible Hand Robots

We monitored brain activation after chronic stroke by combining functional magnetic resonance imaging (fMRI) with a novel MR-compatible, hand-induced, robotic device (MR_CHIROD). We evaluated 60 fMRI datasets on a 3 T MR system from five right-handed patients with left-sided stroke ≥6 months prior and mild to moderate hemiparesis. Patients trained the paretic right hand at approximately 75% of maximum strength with an exercise ball for 1 hour/day, 3 days/week for 4 weeks. Multi-level fMRI data were acquired before, during training, upon completion of training, and after a non-training period using parallel imaging employing GeneRalized Autocalibrating Partially Parallel Acquisitions (GRAPPA) while the participant used the MR_CHIROD. Training increased the number of activated sensorimotor cortical voxels, indicating functional cortical plasticity in chronic stroke patients. The effect persisted four weeks after training completion, indicating the potential of rehabilitation in inducing cortical plasticity in chronic stroke patients

Functional MRI of Rehabilitation in Chronic Stroke Patients Using Novel MR-Compatible Hand Robots

We monitored brain activation after chronic stroke by combining functional magnetic resonance imaging (fMRI) with a novel MR-compatible, hand-induced, robotic device (MR_CHIROD). We evaluated 60 fMRI datasets on a 3 T MR system from five right-handed patients with left-sided stroke ≥6 months prior and mild to moderate hemiparesis. Patients trained the paretic right hand at approximately 75% of maximum strength with an exercise ball for 1 hour/day, 3 days/week for 4 weeks. Multi-level fMRI data were acquired before, during training, upon completion of training, and after a non-training period using parallel imaging employing GeneRalized Autocalibrating Partially Parallel Acquisitions (GRAPPA) while the participant used the MR_CHIROD. Training increased the number of activated sensorimotor cortical voxels, indicating functional cortical plasticity in chronic stroke patients. The effect persisted four weeks after training completion, indicating the potential of rehabilitation in inducing cortical plasticity in chronic stroke patients

<i>De Novo</i> and Rare Variants at Multiple Loci Support the Oligogenic Origins of Atrioventricular Septal Heart Defects

Congenital heart disease (CHD) has a complex genetic etiology, and recent studies suggest that high penetrance de novo mutations may account for only a small fraction of disease. In a multi-institutional cohort surveyed by exome sequencing, combining analysis of 987 individuals (discovery cohort of 59 affected trios and 59 control trios, and a replication cohort of 100 affected singletons and 533 unaffected singletons) we observe variation at novel and known loci related to a specific cardiac malformation the atrioventricular septal defect (AVSD). In a primary analysis, by combining developmental coexpression networks with inheritance modeling, we identify a de novo mutation in the DNA binding domain of NR1D2 (p.R175W). We show that p.R175W changes the transcriptional activity of Nr1d2 using an in vitro transactivation model in HUVEC cells. Finally, we demonstrate previously unrecognized cardiovascular malformations in the Nr1d2tm1-Dgen knockout mouse. In secondary analyses we map genetic variation to protein-interaction networks suggesting a role for two collagen genes in AVSD, which we corroborate by burden testing in a second replication cohort of 100 AVSDs and 533 controls (p = 8.37e-08). Finally, we apply a rare-disease inheritance model to identify variation in genes previously associated with CHD (ZFPM2, NSD1, NOTCH1, VCAN, and MYH6), cardiac malformations in mouse models (ADAM17, CHRD, IFT140, PTPRJ, RYR1 and ATE1), and hypomorphic alleles of genes causing syndromic CHD (EHMT1, SRCAP, BBS2, NOTCH2, and KMT2D) in 14 of 59 trios, greatly exceeding variation in control trios without CHD (p = 9.60e-06). In total, 32% of trios carried at least one putatively disease-associated variant across 19 loci,suggesting that inherited and de novo variation across a heterogeneous group of loci may contribute to disease risk