Healthcare Price Transparency: Policy Approaches and Estimated Impacts on Spending

Healthcare price transparency discussions typically focus on increasing patients' access to information about their out-of-pocket costs, but that focus is too narrow and should include other audiences -- physicians, employers, health plans and policymakers -- each with distinct needs and uses for healthcare price information. Greater price transparency can reduce U.S. healthcare spending.For example, an estimated $100 billion could be saved over the next 10 years if three select interventions were undertaken. However, most of the projected savings come from making price information available to employers and physicians, according to an analysis by researchers at the former Center for Studying Health System Change (HSC). Based on the current availability and modest impact of plan-based transparency tools, requiring all private plans to provide personalized out-of-pocket price data to enrollees would reduce total health spending by an estimated$18 billion over the next decade. While $18 billion is a substantial dollar amount, it is less than a tenth of a percent of the$40 trillionin total projected health spending over the same period. In contrast, using state all-payer claims databases to gather and report hospital-specific prices might reduce spending by an estimated $61 billion over 10 years.The effects of price transparency depend critically on the intended audience, the decision-making context and how prices are presented. And the impact of price transparency can be greatly amplified if target audiences are able and motivated to act on the information. Simply providing prices is insufficient to control spending without other shifts in healthcare financing, including changes in benefit design to make patients more sensitive to price differences among providers and alternative treatments. Other reforms that can amplify the impact of price transparency include shifting from fee-for-service payments that reward providers for volume to payment methods that put providers at risk for spending for episodes of care or defined patient populations. While price transparency alone seems unlikely to transform the healthcare system, it can play a needed role in enabling effective reforms in value-based benefit design and provider payment

The natural history, sensory ecology and biogeography of the seed dispersal of large fruits in Fynbos

Seed dispersal is a crucial life-history stage for the regeneration of all reseeding plants. In the Fynbos Biome of the Greater Cape Floristic Region (GCFR) of South Africa, at least 100 plant species have seed traits that suggest they are scatterhoarded by small mammals. The aims of this thesis were to investigate the dispersal biology of large-fruited Fynbos plants by: 1) determining the spatial and taxonomic extent of scatter-hoarding through seed trials, investigating both dry, nut-like and semi-fleshy fruits; 2) trait-based analyses investigating selective drivers of seed colour polymorphisms in flat-winged, serotinous Leucadendron and 3) modeling the relative influence of environmental, biological and disturbance drivers in predicting the distributions of serotinous and scatterhoarded Leucadendron. Seed predation and scatter-hoarding by small mammals was widespread, yet locally patchy. Four new fynbos species with large, nut-like fruits were confirmed to be scatter-hoarded, by either Acomys subspinosus or Gerbilliscus paeba. Many species with small, nut-like fruits, with no clear dispersal or defense strategies, suffered intense seed predation by the nonhoarding small mammals, Rhabdomys pumilio and Micaelamys namaquensis. The large, dry, nut-like fruits of Ceratocaryum argenteum have a globally unique, alternative strategy for effective dispersal. The nuts emit a strong scent that mimics the scent of herbivore dung and exploits the olfactory sensory perception of dung beetles, which rolled and buried the seeds. The semi-fleshy fruits of the rock-restricted Heeria argentea were dispersed by the mutualistic M. namaquensis, which consumed only the pericarp, allowing for germination, as well as moving fruits to fire-protected, rocky outcrops. Many flat-winged Leucadendron seeds, with polymorphic brown or black seed coats, displayed background matching with post-fire soils. This plant defense likely reduces predation by visually cued avian granivores. Finally, modeling results suggest that the distributions of both serotinous and scatter-hoarded plants are strongly negatively and positively influenced by more intense seasonal drought and longer fire return interval in the GCFR, respectively. Overall, this thesis advances our understanding of large-fruited Fynbos plants, providing unique insights into their natural history, ecology, evolution, conservation and biogeography

Assessing Social-Emotional Abilities of Preschool-Aged Children Within a Social-Emotional Learning Framework

During the past decade, there has been an increasing amount of research demonstrating a positive relationship between early childhood social-emotional abilities and later life outcomes. As such, practitioners who work with preschool-aged children are called to understand the social-emotional abilities that constitute healthy development. Doing so provides practitioners with a social-emotional framework from which to work so that they may efficiently assess and intervene in these abilities. This manuscript grounds social-emotional abilities within the Collaborative for Academic, Social, and Emotional Learning’s (CASEL) Framework for Social-Emotional Learning (SEL). We describe the need for a multi-method, multi-sourced, multi-setting comprehensive social-emotional assessment of preschool-aged children and describe a rating scale that can be used as a part of the assessment process. The manuscript concludes with a discussion regarding the importance of intervening early to prepare preschool-aged children for future academic and life success

Observational Constraints on Open Inflation Models

We discuss observational constraints on models of open inflation. Current data from large-scale structure and the cosmic microwave background prefer models with blue spectra and/or Omega_0 >= 0.3--0.5. Models with minimal anisotropy at large angles are strongly preferred.Comment: 4 pages, RevTeX, with 2 postscript figures included. Second Figure correcte

The Formation and Application of Polymeric Micro- and Nanoparticles

Nano- and microparticles are used in the pharmaceutical industry for sustained release drug delivery systems. For example, polymeric particles are currently used as an FDA-approved drug delivery system for leuprolide acetate to treat prostate cancer1. Our drug of interest is CPDI-02 (formerly known as EP67)—a C5a-derived decapeptide agonist of the C5a Receptor (CD88) that activates mononuclear phagocytes to produce an immune response while potentially minimizing neutrophil-mediated toxicity2. Currently in the Vetro Lab, CPDI-02 is being tested on pigs and mice to treat methicillin-resistant Staphylococcus aureus (MRSA) infections and as the adjuvant for a vaccine for cytomegalovirus (CMV). This investigation explored formulation parameters that impact particle size and loading of CPDI-02 in a traditional oil-in-water (O/W) emulsion. We also explored adapting the formulation using microfluidic chips to generate nano- and microparticles and improve run-to-run consistency in particle size.https://digitalcommons.unmc.edu/surp2022/1004/thumbnail.jp

From Local Velocities to Microwave Background

The mass density field as extracted from peculiar velocities in our cosmological neighborhood is mapped back in time to the CMB in two ways. First, the density power spectrum ($P_k$) is translated into a temperature angular power spectrum of sub-degree resolution ($C_l$) and compared to observations. Second, the local density field is translated into a temperature map in a patch on the last-scattering surface of a distant observer. A likelihood analysis of the Mark III peculiar velocity data have constrained the range of parameters for $P_k$ within the family of COBE-normalized CDM models (Zaroubi et al 1996), favoring a slight tilt in the initial spectrum, $n<1$. The corresponding range of $C_l$'s is plotted against current observations, indicating that the CMB data can tighten the constraints further: only models with ``small'' tilt ($n\sim 0.9$) and ``high'' baryonic content ($\Omega_b \sim 0.1$) could survive the two data sets simultaneously. The local mass density field that has been recovered from the velocities via a Wiener method is convolved with a Boltzmann calculation to recover $10'$ resolution temperature maps as viewed from different directions. The extent of the CMB patch and the amplitude of fluctuations depend on the choice of cosmological parameters, e.g., the local 100\hmpc sphere corresponds to $90'$ to $30'$ at the CMB for $\Omega$ between 1 and 0 respectively. The phases of the temperature map are correlated with those of the density field, contrary to the contribution of the Sachs-Wolfe effect alone. This correlation suggests the possibility of an inverse reconstruction of the underlying density field from CMB data with interesting theoretical implications.Comment: 16 pages, 6 figures. Submitted to Ap.

Effect of 3-Dimensional Virtual Reality Models for Surgical Planning of Robotic-Assisted Partial Nephrectomy on Surgical Outcomes: A Randomized Clinical Trial.

Importance: Planning complex operations such as robotic-assisted partial nephrectomy requires surgeons to review 2-dimensional computed tomography or magnetic resonance images to understand 3-dimensional (3-D), patient-specific anatomy. Objective: To determine surgical outcomes for robotic-assisted partial nephrectomy when surgeons reviewed 3-D virtual reality (VR) models during operative planning. Design, Setting, and Participants: A single-blind randomized clinical trial was performed. Ninety-two patients undergoing robotic-assisted partial nephrectomy performed by 1 of 11 surgeons at 6 large teaching hospitals were prospectively enrolled and randomized. Enrollment and data collection occurred from October 2017 through December 2018, and data analysis was performed from December 2018 through March 2019. Interventions: Patients were assigned to either a control group undergoing usual preoperative planning with computed tomography and/or magnetic resonance imaging only or an intervention group where imaging was supplemented with a 3-D VR model. This model was viewed on the surgeon\u27s smartphone in regular 3-D format and in VR using a VR headset. Main Outcomes and Measures: The primary outcome measure was operative time. It was hypothesized that the operations performed using the 3-D VR models would have shorter operative time than those performed without the models. Secondary outcomes included clamp time, estimated blood loss, and length of hospital stay. Results: Ninety-two patients (58 men [63%]) with a mean (SD) age of 60.9 (11.6) years were analyzed. The analysis included 48 patients randomized to the control group and 44 randomized to the intervention group. When controlling for case complexity and other covariates, patients whose surgical planning involved 3-D VR models showed differences in operative time (odds ratio [OR], 1.00; 95% CI, 0.37-2.70; estimated OR, 2.47), estimated blood loss (OR, 1.98; 95% CI, 1.04-3.78; estimated OR, 4.56), clamp time (OR, 1.60; 95% CI, 0.79-3.23; estimated OR, 11.22), and length of hospital stay (OR, 2.86; 95% CI, 1.59-5.14; estimated OR, 5.43). Estimated ORs were calculated using the parameter estimates from the generalized estimating equation model. Referent group values for each covariate and the corresponding nephrometry score were summed across the covariates and nephrometry score, and the sum was exponentiated to obtain the OR. A mean of the estimated OR weighted by sample size for each nephrometry score strata was then calculated. Conclusions and Relevance: This large, randomized clinical trial demonstrated that patients whose surgical planning involved 3-D VR models had reduced operative time, estimated blood loss, clamp time, and length of hospital stay. Trial Registration: ClinicalTrials.gov identifiers (1 registration per site): NCT03334344, NCT03421418, NCT03534206, NCT03542565, NCT03556943, and NCT03666104

Black Holes in Galaxy Mergers: Evolution of Quasars

Based on numerical simulations of gas-rich galaxy mergers, we discuss a model in which quasar activity is tied to the self-regulated growth of supermassive black holes in galaxies. Nuclear inflow of gas attending a galaxy collision triggers a starburst and feeds black hole growth, but for most of the duration of the starburst, the black hole is heavily obscured by surrounding gas and dust which limits the visibility of the quasar, especially at optical and UV wavelengths. Eventually, feedback energy from accretion heats the gas and expels it in a powerful wind, leaving a 'dead quasar'. Between buried and dead phases there is a window during which the galaxy would be seen as a luminous quasar. Because the black hole mass, radiative output, and distribution of obscuring gas and dust all evolve strongly with time, the duration of this phase of observable quasar activity depends on both the waveband and imposed luminosity threshold. We determine the observed and intrinsic lifetimes as a function of luminosity and frequency, and calculate observable lifetimes ~10 Myr for bright quasars in the optical B-band, in good agreement with empirical estimates and much smaller than the black hole growth timescales ~100 Myr, naturally producing a substantial population of 'buried' quasars. However, observed and intrinsic energy outputs converge in the IR and hard X-ray bands as attenuation becomes weaker and chances of observation greatly increase. We obtain the distribution of column densities along sightlines in which the quasar is seen above a given luminosity, and find that our result agrees remarkably well with observed estimates of the column density distribution from the SDSS for appropriate luminosity thresholds. (Abridged)Comment: 12 pages, 7 figures. Accepted for publication in ApJ (September 2005). Replacement with minor revisions from referee repor

A 700 year record of Southern Hemisphere extratropical climate variability

Annually dated ice cores from West and East Antarctica provide proxies for past changes in atmospheric circulation over Antarctica and portions of the Southern Ocean, temperature in coastal West and East Antarctica, and the frequency of South Polar penetration of El Niño events. During the period AD 1700–1850, atmospheric circulation over the Antarctic and at least portions of the Southern Hemisphere underwent a mode switch departing from the out-of-phase alternation of multi-decadal long phases of EOF1 and EOF2 modes of the 850 hPa field over the Southern Hemisphere (as defined in the recent record by Thompson and Wallace, 2000; Thompson and Solomon, 2002) that characterizes the remainder of the 700 year long record. From AD 1700 to 1850, lower-tropospheric circulation was replaced by in-phase behavior of the Amundsen Sea Low component of EOF2 and the East Antarctic High component of EOF1. During the first phase of the mode switch, both West and East Antarctic temperatures declined, potentially in response to the increased extent of sea ice surrounding both regions. At the end of the mode switch, West Antarctic coastal temperatures rose and East Antarctic coastal temperatures fell, respectively, to their second highest and lowest of the record. Polar penetration of El Niño events increased during the mode switch. The onset of the AD 1700–1850 mode switch coincides with the extreme state of the Maunder Minimum in solar variability. Late 20th-century West Antarctic coastal temperatures are the highest in the record period, and East Antarctic coastal temperatures close to the lowest. Since AD 1700, extratropical regions of the Southern Hemisphere have experienced significant climate variability coincident with changes in both solar variability and greenhouse gase