Associations among Hospital Capacity, Utilization, and Mortality of US Medicare Beneficiaries, Controlling for Sociodemographic Factors.

To explore whether geographic variations in Medicare hospital utilization rates are due to differences in local hospital capacity, after controlling for socioeconomic status and disease burden, and to determine whether greater hospital capacity is associated with lower Medicare mortality rates

Statistical Issues in Assessing Hospital Performance

From the Preface: The Centers for Medicare and Medicaid Services (CMS), through a subcontract with Yale New Haven Health Services Corporation, Center for Outcomes Research and Evaluation (YNHHSC/CORE), is supporting a committee appointed by the Committee of Presidents of Statistical Societies (COPSS) to address statistical issues identified by the CMS and stakeholders about CMS’s approach to modeling hospital quality based on outcomes. In the spring of 2011, with the direct support of YNHHSC/ CORE, COPSS formed a committee comprised of one member from each of its constituent societies, a chair, and a staff member from the American Statistical Association, and held a preliminary meeting in April. In June, YNHHSC/CORE executed a subcontract with COPSS under its CMS contract to support the development of a White Paper on statistical modeling. Specifically, YNHHSC/CORE contracted with COPSS to “provide guidance on statistical approaches . . .when estimating performance metrics,” and “consider and discuss concerns commonly raised by stakeholders (hospitals, consumer, and insurers) about the use of “hierarchical generalized linear models in profiling hospital quality. The committee convened in June and August of 2011, and exchanged a wide variety of materials. To ensure the committee’s independence, YNHHSC/CORE did not comment on the white paper findings, and CMS pre-cleared COPSS’ publication of an academic manuscript based on the White Paper

Top-down, bottom-up and physical controls on diatom-diazotroph assemblage growth in the Amazon River plume

The nutrient-rich waters of the Amazon River plume (ARP) support dense blooms of diatom-diazotroph assemblages (DDAs) that introduce large quantities of new nitrogen to the planktonic ecosystem and, unlike other nitrogen-fixers, are likely to directly fuel vertical carbon flux. To investigate the factors controlling DDA blooms, we develop a five phytoplankton (cyanobacteria, diatoms, unicellular microbial diazotrophs, DDAs, and Trichodesmium), two zooplankton model and embed it within a 1/6° resolution physical model of the tropical and subtropical Atlantic. The model generates realistic DDA blooms in the ARP and also exhibits basin-wide primary production, nitrogen fixation, and grazing rates consistent with observed values. By following ARP water parcels with synthetic Lagrangian drifters released at the river mouth we are able to assess the relative impacts of grazing, nutrient supply, and physical forcing on DDA bloom formation. DDA bloom formation is stimulated in the nitrogen-poor and silica-rich water of the ARP by decreases in grazing pressure when mesozooplankton (which co-occur in high densities with coastal diatom blooms) concentrations decrease. Bloom termination is driven primarily by silica limitation of the DDAs. In agreement with in situ data, this net growth niche for DDAs exists in a salinity range from ∼20–34 PSU, although this co-occurrence is coincidental rather than causative. Because net growth rates are relatively modest, bloom formation in ARP water parcels depends critically on the time spent in this ideal habitat, with high DDA biomass only occurring when water parcels spent >23 days in the optimal habitat niche

Does clinical management improve outcomes following self-Harm? Results from the multicentre study of self-harm in England

Background Evidence to guide clinical management of self-harm is sparse, trials have recruited selected samples, and psychological treatments that are suggested in guidelines may not be available in routine practice. Aims To examine how the management that patients receive in hospital relates to subsequent outcome. Methods We identified episodes of self-harm presenting to three UK centres (Derby, Manchester, Oxford) over a 10 year period (2000 to 2009). We used established data collection systems to investigate the relationship between four aspects of management (psychosocial assessment, medical admission, psychiatric admission, referral for specialist mental health follow up) and repetition of self-harm within 12 months, adjusted for differences in baseline demographic and clinical characteristics. Results 35,938 individuals presented with self-harm during the study period. In two of the three centres, receiving a psychosocial assessment was associated with a 40% lower risk of repetition, Hazard Ratios (95% CIs): Centre A 0.99 (0.90–1.09); Centre B 0.59 (0.48–0.74); Centre C 0.59 (0.52–0.68). There was little indication that the apparent protective effects were mediated through referral and follow up arrangements. The association between psychosocial assessment and a reduced risk of repetition appeared to be least evident in those from the most deprived areas. Conclusion These findings add to the growing body of evidence that thorough assessment is central to the management of self-harm, but further work is needed to elucidate the possible mechanisms and explore the effects in different clinical subgroups

Trade-offs between risk of predation and starvation in larvae make the shelf break an optimal spawning location for Atlantic Bluefin tuna

Atlantic bluefin tuna (ABT) (Thunnus thynnus) travel long distances to spawn in oligotrophic regions of the Gulf of Mexico (GoM) which suggests these regions offer some unique benefit to offspring survival. To better understand how larval survival varies within the GoM a spatially explicit, Lagrangian, individual-based model was developed that simulates dispersal and mortality of ABT early life stages within realistic predator and prey fields during the spawning periods from 1993 to 2012. The model estimates that starvation is the largest cumulative source of mortality associated with an early critical period. However, elevated predation on older larvae is identified as the main factor limiting survival to late postflexion. As a result, first-feeding larvae have higher survival on the shelf where food is abundant, whereas older larvae have higher survival in the open ocean with fewer predators, making the shelf break an optimal spawning area. The modeling framework developed in this study explicitly simulates both physical and biological factors that impact larval survival and hence could be used to support ecosystem based management efforts for ABT under current and future climate conditions.Postprin

Influence of food quality on larval growth of Atlantic bluefin tuna (Thunnus thynnus) in the Gulf of Mexico

Larval abundances of Atlantic bluefin tuna (ABT) in the Gulf of Mexico are currently utilized to inform future recruitment by providing a proxy for the spawning potential of western ABT stock. Inclusion of interannual variations in larval growth is a key advance needed to translate larval abundance to recruitment success. However, little is known about the drivers of growth variations during the first weeks of life. We sampled patches of western ABT larvae in 3–4 day Lagrangian experiments in May 2017 and 2018, and assessed age and growth rates from sagittal otoliths relative to size categories of zooplankton biomass and larval feeding behaviors from stomach contents. Growth rates were similar, on average, between patches (0.37 versus 0.39 mm d−1) but differed significantly through ontogeny and were correlated with a food limitation index, highlighting the importance of prey availability. Otolith increment widths were larger for postflexion stages in 2018, coincident with high feeding on preferred prey (mainly cladocerans) and presumably higher biomass of more favorable prey type. Faster growth reflected in the otolith microstructures may improve survival during the highly vulnerable larval stages of ABT, with direct implications for recruitment processes.En prensa1,74

The band structure of BeTe - a combined experimental and theoretical study

Using angle-resolved synchrotron-radiation photoemission spectroscopy we have determined the dispersion of the valence bands of BeTe(100) along $\Gamma X$, i.e. the [100] direction. The measurements are analyzed with the aid of a first-principles calculation of the BeTe bulk band structure as well as of the photoemission peaks as given by the momentum conserving bulk transitions. Taking the calculated unoccupied bands as final states of the photoemission process, we obtain an excellent agreement between experimental and calculated spectra and a clear interpretation of almost all measured bands. In contrast, the free electron approximation for the final states fails to describe the BeTe bulk band structure along $\Gamma X$ properly.Comment: 21 pages plus 4 figure

Bluefin Tuna Larvae in Oligotrophic Ocean Foodwebs, Investigations of Nutrients to Zooplankton: Overview of the BLOOFINZ-Gulf of Mexico program

Western Atlantic bluefin tuna (ABT) undertake long-distance migrations from rich feeding grounds in the North Atlantic to spawn in oligotrophic waters of the Gulf of Mexico (GoM). Stock recruitment is strongly affected by interannual variability in the physical features associated with ABT larvae, but the nutrient sources and food-web structure of preferred habitat, the edges of anticyclonic loop eddies, are unknown. Here, we describe the goals, physical context, design and major findings of an end-to-end process study conducted during peak ABT spawning in May 2017 and 2018. Mesoscale features in the oceanic GoM were surveyed for larvae, and five multi-day Lagrangian experiments measured hydrography and nutrients; plankton biomass and composition from bacteria to zooplankton and fish larvae; phytoplankton nutrient uptake, productivity and taxon-specific growth rates; micro- and mesozooplankton grazing; particle export; and ABT larval feeding and growth rates. We provide a general introduction to the BLOOFINZ-GoM project (Bluefin tuna Larvae in Oligotrophic Ocean Foodwebs, Investigation of Nitrogen to Zooplankton) and highlight the finding, based on backtracking of experimental waters to their positions weeks earlier, that lateral transport from the continental slope region may be more of a key determinant of available habitat utilized by larvae than eddy edges per se.Postprint1,74

Precision measurement of 65^{65}Zn electron-capture decays with the KDK coincidence setup

$^{65}$Zn is a common calibration source, moreover used as a radioactive tracer in medical and biological studies. In many cases, $\gamma$-spectroscopy is a preferred method of $^{65}$Zn standardization, which relies directly on the branching ratio of $J \pi (^{65}\text{Zn} ) = 5/2^- \rightarrow J \pi (^{65}\text{Cu}) = 5/2^-$ via electron capture (EC*). We measure the relative intensity of this branch to that proceeding directly to the ground state (EC$^0$) using a novel coincidence technique, finding $I_{\text{EC}^0}/I_{\text{EC*}} = 0.9684 \pm 0.0018$. Re-evaluating the decay scheme of $^{65}$Zn by adopting the commonly evaluated branching ratio of $I_{\beta^+}= 1.4271(7)\%$ we obtain $I_{\text{EC*}} = (50.08 \pm 0.06)\%$, and I_\text{EC^0} = (48.50 \pm 0.06) \%. The associated 1115 keV gamma intensity agrees with the previously reported NNDC value, and is now accessible with a factor of ~2 increase in precision. Our re-evaluation removes reliance on the deduction of this gamma intensity from numerous measurements, some of which disagree and depend directly on total activity determination. The KDK experimental technique provides a new avenue for verification or updates to the decay scheme of $^{65}$Zn, and is applicable to other isotopes.Comment: Uses similar methodology to the 40K measurement by the KDK Collaboration (Stukel et al PRL 2023, arXiv:2211.10319; Hariasz et al PRC 2023, arXiv:2211.10343), as such there may be some similarity in figures and tex

Trade-Offs Between Risks of Predation and Starvation In Larvae Make the Shelf Break an Optimal Spawning Location For Atlantic Bluefin Tuna

Atlantic bluefin tuna (ABT) (Thunnus thynnus) travel long distances to spawn in oligotrophic regions of the Gulf of Mexico (GoM) which suggests these regions offer some unique benefit to offspring survival. To better understand how larval survival varies within the GoM a spatially explicit, Lagrangian, individual-based model was developed that simulates dispersal and mortality of ABT early life stages within realistic predator and prey fields during the spawning periods from 1993 to 2012. The model estimates that starvation is the largest cumulative source of mortality associated with an early critical period. However, elevated predation on older larvae is identified as the main factor limiting survival to late postflexion. As a result, first-feeding larvae have higher survival on the shelf where food is abundant, whereas older larvae have higher survival in the open ocean with fewer predators, making the shelf break an optimal spawning area. The modeling framework developed in this study explicitly simulates both physical and biological factors that impact larval survival and hence could be used to support ecosystem based management efforts for ABT under current and future climate conditions