Diagnosis isn\u27t enough: Understanding the connections between high health care utilization, chronic conditions and disabilities among U.S. working age adults

Background Under the ACA, new programs are being developed to enhance care coordination and reduce health care costs among people with chronic conditions, disabilities, and high utilization of health care. However, the relationships between these groups are not well understood. Objectives Our aims were to (1) identify high utilizers of health care in the U.S. working age (18–64) population, (2) examine the overlap between this group and people with chronic conditions and/or disabilities, (3) identify predictors of high service use or cost among these subpopulations, and (4) recommend approaches for stratification of individuals with high health care utilization. Methods Using pooled national data from the Medical Expenditure Panel Survey (2006–2008), we created indices to identify elevated or high utilization and cost groups. We performed descriptive analyses, bivariate comparisons and multivariate analyses to examine the relations between these populations and individuals with chronic conditions and/or disabilities. Results While the large majority of persons with high use/cost had chronic conditions, the minority of persons with chronic conditions had high health care utilization. However, among persons with chronic conditions, disability was a significant predictor of high utilization. Annual expenditures were significantly elevated among people with disabilities, particularly when activities of daily living were limited. Conclusions We conclude that medical diagnosis alone is insufficient for the development of eligibility criteria for, or the evaluation of, programs intended to better the delivery or coordination of services for high utilizers of health care services. New approaches are needed to assess functional limitations and identify ongoing needs for services and supports

KITD816V+ systemic mastocytosis associated with KITD816V+ acute erythroid leukaemia: first case report with molecular evidence for same progenitor cell derivation

Toll-like receptor (TLR)-9 recognizes CpG motifs in microbial DNA. TLR9 signalling stimulates innate antimicrobial immunity and modulates adaptive immune responses including autoimmunity against chromatin, e.g., in systemic lupus erythematosus (SLE). This review summarizes the available data for a role of TLR9 signalling in lupus and discusses the following questions that arise from these observations: 1) Is CpG-DNA/TLR9 interaction involved in infection-induced disease activity of lupus? 2) What are the risks of CpG motifs in vaccine adjuvants for lupus patients? 3) Is TLR9 signalling involved in the pathogenesis of lupus by recognizing self DNA

Signatures of Dark Matter Scattering Inelastically Off Nuclei

Direct dark matter detection focuses on elastic scattering of dark matter particles off nuclei. In this study, we explore inelastic scattering where the nucleus is excited to a low-lying state of 10-100 keV, with subsequent prompt de-excitation. We calculate the inelastic structure factors for the odd-mass xenon isotopes based on state-of-the-art large-scale shell-model calculations with chiral effective field theory WIMP-nucleon currents. For these cases, we find that the inelastic channel is comparable to or can dominate the elastic channel for momentum transfers around 150 MeV. We calculate the inelastic recoil spectra in the standard halo model, compare these to the elastic case, and discuss the expected signatures in a xenon detector, along with implications for existing and future experiments. The combined information from elastic and inelastic scattering will allow to determine the dominant interaction channel within one experiment. In addition, the two channels probe different regions of the dark matter velocity distribution and can provide insight into the dark halo structure. The allowed recoil energy domain and the recoil energy at which the integrated inelastic rates start to dominate the elastic channel depend on the mass of the dark matter particle, thus providing a potential handle to constrain its mass.Comment: 9 pages, 7 figures. Matches resubmitted version to Phys. Rev. D. One figure added; supplemental material (fits to the structure functions) added as an Appendi

Effects of mutational loss of nucleoside kinases on deoxyadenosine 5'-phosphate/deoxyadenosine substrate cycle in cultured CEM and V79 cells.

The functions of a deoxynucleoside kinase and a deoxynucleotidase can give rise to substrate cycles in which the two enzymes catalyze in opposite directions the irreversible interconversion of a deoxynucleoside 5'-monophosphate (dNMP) and its deoxynucleoside. Earlier evidence showed that pyrimidine dNMP cycles occur in cultured cells and participate in the regulation of the size of dNMP pools there by affecting the transport of deoxyribonucleosides across the cell membrane. Here, we apply an isotope flow method using labeled adenine as precursor of dAMP and DNA to quantify deoxyadenosine excretion as a measure of the catabolic activity of a putative dAMP/deoxyadenosine cycle. A comparison of human CEM lymphoblasts and hamster V79 fibroblasts, including mutant cells lacking kinases for the phosphorylation of deoxyadenosine, shows a much lower deoxyadenosine excretion in CEM cells (0.05% of dATP synthesized by reduction of ADP) as compared with V79 cells (4% of dATP). Mutational loss of deoxycytidine kinase increases these values to 0.3% in CEM cells and to 10% in V79 cells. This strongly suggests the presence of a dAMP/deoxyadenosine cycle in both CEM and V79 cells. Additional loss of adenosine kinase only marginally affects deoxyadenosine excretion in CEM cells. The small excretion of deoxyadenosine (also in the absence of both kinases) demonstrates that in CEM cells the in situ activity of the deoxynucleotidase affecting the dAMP/deoxyadenosine substrate cycle is very low and that the cycle has mainly an anabolic function there

Continuum and Emission-Line Properties of Broad Absorption Line Quasars

We investigate the continuum and emission-line properties of 224 broad absorption line quasars (BALQSOs) with 0.9<z<4.4 drawn from the Sloan Digital Sky Survey (SDSS) Early Data Release (EDR), which contains 3814 bona fide quasars. We find that low-ionization BALQSOs (LoBALs) are significantly reddened as compared to normal quasars, in agreement with previous work. High-ionization BALQSOs (HiBALs) are also more reddened than the average nonBALQSO. Assuming SMC-like dust reddening at the quasar redshift, the amount of reddening needed to explain HiBALs is E(B-V)~0.023 and LoBALs is E(B-V)~0.077 (compared to the ensemble average of the entire quasar sample). We find that there are differences in the emission-line properties between the average HiBAL, LoBAL, and nonBAL quasar. These differences, along with differences in the absorption line troughs, may be related to intrinsic quasar properties such as the slope of the intrinsic (unreddened) continuum; more extreme absorption properties are correlated with bluer intrinsic continua. Despite the differences among BALQSO sub-types and nonBALQSOs, BALQSOs appear to be drawn from the same parent population as nonBALQSOs when both are selected by their UV/optical properties. We find that the overall fraction of traditionally defined BALQSOs, after correcting for color-dependent selection effects due to different SEDs of BALQSO and nonBALQSOs, is 13.4+/-1.2% and shows no significant redshift dependence for 1.7<z<3.45. After a rough completeness correction for the effects of dust extinction, we find that approximately one in every six quasars is a BALQSO.Comment: 35 pages, 11 figures (1 color), 1 table; accepted by A