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

Sexual arousal and masculinity-femininity of women.

Studies with volunteers in sexual arousal experiments suggest that women are, on average, physiologically sexually aroused to both male and female sexual stimuli. Lesbians are the exception because they tend to be more aroused to their preferred sex than the other sex, a pattern typically seen in men. A separate research line suggests that lesbians are, on average, more masculine than straight women in their nonsexual behaviors and characteristics. Hence, a common influence could affect the expression of male-typical sexual and nonsexual traits in some women. By integrating these research programs, we tested the hypothesis that male-typical sexual arousal of lesbians relates to their nonsexual masculinity. Moreover, the most masculine-behaving lesbians, in particular, could show the most male-typical sexual responses. Across combined data, Study 1 examined these patterns in women’s genital arousal and self-reports of masculine and feminine behaviors. Study 2 examined these patterns with another measure of sexual arousal, pupil dilation to sexual stimuli, and with observer-rated masculinity-femininity in addition to self-reported masculinity-femininity. Although both studies confirmed that lesbians were more male-typical in their sexual arousal and nonsexual characteristics, on average, there were no indications that these 2 patterns were in any way connected. Thus, women’s sexual responses and nonsexual traits might be masculinized by independent factors

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

Groundwater residence time in the Kulnura-Mangrove Mountain Plateau (Gosford, NSW, Australia)

The Kulnura-Mangrove Mountain plateau consists of the catchments of Mangrove, Narara, Mooney Mooney, and Ourimbah Creeks, and Wyong River. Groundwater plays a key role in sustaining stream flow within these catchments. Estimates indicate up to 50% of annual stream flow is derived from baseflow. The local community water supply relies on the groundwater within the elevated Hawkesbury- Narrabeen sandstone plateau. Furthermore, the Gosford-Wyong Councils’ Water Authority (WSA) is the third largest in NSW and utilises many of the streams flowing from the sandstone plateau for municipal water supply. It is anticipated that the WSA will provide municipal water for 319 000 persons by the year 2010. The increasing volumes of groundwater being extracted and changing land use have the potential to cause damage to the fresh water aquifer through contamination and aquifer depletion. A hydrogeochemical survey (2006-2009) has been conducted in NSW Dept of Water and Energy (DWE) monitoring wells across the plateau in order to determine groundwater residence times. Groundwater was analysed for major ions, minor and trace elements, H2O 18O and 2H, 13CDIC, 87Sr/86Sr, 14CDIC, and 3H, and complemented with mineralogical and isotopic information obtained from soil and drill chips collected during well construction. Water stable isotopes confirm the meteoric origin of the groundwater with most values plotting on the local meteoric water line. Localised evaporative trends suggest recharge with evaporated groundwater stored in ponds. Shallow groundwaters have 3H and 14C activities consistent with modern recharge (Fig 1). Carbon “bomb pulse” signatures of up to 116.8 pmC are found in the central areas of the plateau. The thin soils, lack of carbonates in the intensely weathered near-surface Hawkesbury sandstone, and the shallow depth of the water samples is consistent with the 3H results measured, suggesting minimal dilution of the original 14C. Input of this data into a southern hemisphere bomb pulse model [1] suggest potential recharge during the 1990´s, coinciding with sustained wet conditions and above average rainfalls experienced during this period. Fig. 1. 14C vs 3H plot of groundwater samples in the Kulnura- Mangrove Mountain Plateau Deeper groundwaters have lower 14C and 3H activities in some cases close to background level (Fig. 1). The quantifiable 3H suggests residence times of <70 a. However, non-corrected 14C residence times are submodern (>500 a). This apparent discrepancy can be explained by either mixing with older waters or dissolution of carbonates. The good correlation of total dissolved inorganic carbon (TDIC) and Ca (R2=0.8), 13CTDIC in groundwater and mineralogy results from drill chips suggest that dissolution of dispersed carbonates is taking place. The deepest groundwaters show the most difference in residence time across the study area. The eastern and western plateaus yield old groundwater with 14C corrected residence times of around 9 ka and 4 ka respectively. However, the groundwater at equivalent depths in the central plateau was found to be considerably younger with residence times of <70 a

Airborne cow allergen, ammonia and particulate matter at homes vary with distance to industrial scale dairy operations: an exposure assessment

<p>Abstract</p> <p>Background</p> <p>Community exposures to environmental contaminants from industrial scale dairy operations are poorly understood. The purpose of this study was to evaluate the impact of dairy operations on nearby communities by assessing airborne contaminants (particulate matter, ammonia, and cow allergen, Bos d 2) associated with dairy operations inside and outside homes.</p> <p>Methods</p> <p>The study was conducted in 40 homes in the Yakima Valley, Washington State where over 61 dairies operate.</p> <p>Results</p> <p>A concentration gradient was observed showing that airborne contaminants are significantly greater at homes within one-quarter mile (0.4 km) of dairy facilities, outdoor Bos d 2, ammonia, and TD were 60, eight, and two times higher as compared to homes greater than three miles (4.8 km) away. In addition median indoor airborne Bos d 2 and ammonia concentrations were approximately 10 and two times higher in homes within one-quarter mile (0.4 km) compared to homes greater than three miles (4.8 km) away.</p> <p>Conclusions</p> <p>These findings demonstrate that dairy operations increase community exposures to agents with known human health effects. This study also provides evidence that airborne biological contaminants (i.e. cow allergen) associated with airborne particulate matter are statistically elevated at distances up to three miles (4.8 km) from dairy operations.</p

Feasibility study to inform the design of a UK multi-centre randomised controlled trial of prophylactic antibiotics for the prevention of recurrent cellulitis of the leg

Background: This paper describes the results of a feasibility study for a randomised controlled trial (RCT). Methods: Twenty-nine members of the UK Dermatology Clinical Trials Network (UK DCTN) expressed an interest in recruiting for this study. Of these, 17 obtained full ethics and Research & Development (R&D) approval, and 15 successfully recruited patients into the study. A total of 70 participants with a diagnosis of cellulitis of the leg were enrolled over a 5-month period. These participants were largely recruited from medical admissions wards, although some were identified from dermatology, orthopaedic, geriatric and general surgery wards. Data were collected on patient demographics, clinical features and willingness to take part in a future RCT. Results: Despite being a relatively common condition, cellulitis patients were difficult to locate through our network of UK DCTN clinicians. This was largely because patients were rarely seen by dermatologists, and admissions were not co-ordinated centrally. In addition, the impact of the proposed exclusion criteria was high; only 26 (37%) of those enrolled in the study fulfilled all of the inclusion criteria for the subsequent RCT, and were willing to be randomised to treatment. Of the 70 participants identified during the study as having cellulitis of the leg (as confirmed by a dermatologist), only 59 (84%) had all 3 of the defining features of: i) erythema, ii) oedema, and iii) warmth with acute pain/tenderness upon examination. Twenty-two (32%) patients experienced a previous episode of cellulitis within the last 3 years. The median time to recurrence (estimated as the time since the most recent previous attack) was 205 days (95% CI 102 to 308). Service users were generally supportive of the trial, although several expressed concerns about taking antibiotics for lengthy periods, and felt that multiple morbidity/old age would limit entry into a 3-year study. Conclusion: This pilot study has been crucial in highlighting some key issues for the conduct of a future RCT. As a result of these findings, changes have been made to i) the planned recruitment strategy, ii) the proposed inclusion criteria and ii) the definition of cellulitis for use in the future trial

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

Attachment style moderates partner presence effects on pain : A laser-evoked potentials study

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly citedSocial support is crucial for psychological and physical well-being. Yet, in experimental and clinical pain research, the presence of others has been found to both attenuate and intensify pain. To investigate the factors underlying these mixed effects, we administered noxious laser stimuli to 39 healthy women while their romantic partner was present or absent, and measured pain ratings and laser-evoked potentials to assess the effects of partner presence on subjective pain experience and underlying neural processes. Further, we examined whether individual differences in adult attachment style, alone or in interaction with the partner's level of attentional focus (manipulated to be either on or away from the participant) might modulate these effects. We found that the effects of partner presence versus absence on pain-related measures depended on adult attachment style but not partner attentional focus. The higher participants' attachment avoidance, the higher pain ratings and N2 and P2 local peak amplitudes were in the presence compared to the absence of the romantic partner. As laser-evoked potentials are thought to reflect activity relating to the salience of events, our data suggest that partner presence may influence the perceived salience of events threatening the body, particularly in individuals who tend to mistrust others.Peer reviewedFinal Published versio

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