The Effect of Health Insurance on Out of Pocket Expenditure

The dependent care provision of the Affordable Care Act went into effect September 2010. This change in insurance policy can be used as a natural experiment to examine the effect of health insurance on healthcare expenditures using a control function two-part model to address endogeneity

Regional data exchange to improve care for veterans after non-VA hospitalization: a randomized controlled trial

BACKGROUND: Coordination of care, especially after a patient experiences an acute care event, is a challenge for many health systems. Event notification is a form of health information exchange (HIE) which has the potential to support care coordination by alerting primary care providers when a patient experiences an acute care event. While promising, there exists little evidence on the impact of event notification in support of reengagement into primary care. The objectives of this study are to 1) examine the effectiveness of event notification on health outcomes for older adults who experience acute care events, and 2) compare approaches to how providers respond to event notifications. METHODS: In a cluster randomized trial conducted across two medical centers within the U.S. Veterans Health Administration (VHA) system, we plan to enroll older patients (≥ 65 years of age) who utilize both VHA and non-VHA providers. Patients will be enrolled into one of three arms: 1) usual care; 2) event notifications only; or 3) event notifications plus a care transitions intervention. In the event notification arms, following a non-VHA acute care encounter, an HIE-based intervention will send an event notification to VHA providers. Patients in the event notification plus care transitions arm will also receive 30 days of care transition support from a social worker. The primary outcome measure is 90-day readmission rate. Secondary outcomes will be high risk medication discrepancies as well as care transitions processes within the VHA health system. Qualitative assessments of the intervention will inform VHA system-wide implementation. DISCUSSION: While HIE has been evaluated in other contexts, little evidence exists on HIE-enabled event notification interventions. Furthermore, this trial offers the opportunity to examine the use of event notifications that trigger a care transitions intervention to further support coordination of care. TRIAL REGISTRATION: ClinicalTrials.gov NCT02689076. "Regional Data Exchange to Improve Care for Veterans After Non-VA Hospitalization." Registered 23 February 2016

Hubble Space Telescope Near-IR Transmission Spectroscopy of the Super-Earth HD 97658b

Recent results from the Kepler mission indicate that super-Earths (planets with masses between 1-10 times that of the Earth) are the most common kind of planet around nearby Sun-like stars. These planets have no direct solar system analogue, and are currently one of the least well-understood classes of extrasolar planets. Many super-Earths have average densities that are consistent with a broad range of bulk compositions, including both water-dominated worlds and rocky planets covered by a thick hydrogen and helium atmosphere. Measurements of the transmission spectra of these planets offer the opportunity to resolve this degeneracy by directly constraining the scale heights and corresponding mean molecular weights of their atmospheres. We present Hubble Space Telescope near-infrared spectroscopy of two transits of the newly discovered transiting super-Earth HD 97658b. We use the Wide Field Camera 3's scanning mode to measure the wavelength-dependent transit depth in thirty individual bandpasses. Our averaged differential transmission spectrum has a median 1 sigma uncertainty of 23 ppm in individual bins, making this the most precise observation of an exoplanetary transmission spectrum obtained with WFC3 to date. Our data are inconsistent with a cloud-free solar metallicity atmosphere at the 10 sigma level. They are consistent at the 0.4 sigma level with a flat line model, as well as effectively flat models corresponding to a metal-rich atmosphere or a solar metallicity atmosphere with a cloud or haze layer located at pressures of 10 mbar or higher.Comment: ApJ in press; revised version includes an updated orbital ephemeris for the plane

Phenotypic Characterization of Chicken Thymic Stromal Elements

Phenotypic profiles of the thymic stromal components provide an excellent approach to elucidating the nature of the microenvironment of this organ. To address this issue in chickens, we have produced an extensive panel of 18 mAb to the thymic stroma. These mAb have been extensively characterized with respect to their phenotypic specificities and reveal that the stromal cells are equally as complex as the T cells whose maturation they direct. They further demonstrate that, in comparison to the mammalian thymus, there is a remarkable degree of conservation in thymic architecture between phylogenetically diverse species. Eleven mAb reacted with thymic epithelial cells: MUI-73 was panepithelium, MUI-54 stained all cortical and medullary epithelium but only a minority of the subcapsule, MUI-52 was specific for isolated stellate cortical epithelial cells, MUI-62, -69, and -71 were specific for the medulla (including Hassall’s corpusclelike structures), MUI-51, -53, -70, and -75 reacted only with the type-I epithelium, or discrete regions therein, lining the subcapsular and perivascular regions and MUI-58 demonstrated the antigenic similarity between the subcapsule and the medulla. Seven other mAb identified distinct isolated stromal cells throughout the cortex and medulla. Large thymocyte-rich regions, which often spanned from the outer cortex to medulla, lacked epithelial cells. These mAb should prove invaluable for determining the functional significance of thymic stromal-cell subsets to thymopoiesis

Neuroblastoma patient outcomes, tumor differentiation, and ERK activation are correlated with expression levels of the ubiquitin ligase UBE4B.

BackgroundUBE4B is an E3/E4 ubiquitin ligase whose gene is located in chromosome 1p36.22. We analyzed the associations of UBE4B gene and protein expression with neuroblastoma patient outcomes and with tumor prognostic features and histology.MethodsWe evaluated the association of UBE4B gene expression with neuroblastoma patient outcomes using the R2 Platform. We screened neuroblastoma tumor samples for UBE4B protein expression using immunohistochemistry. FISH for UBE4B and 1p36 deletion was performed on tumor samples. We then evaluated UBE4B expression for associations with prognostic factors and with levels of phosphorylated ERK in neuroblastoma tumors and cell lines.ResultsLow UBE4B gene expression is associated with poor outcomes in patients with neuroblastoma and with worse outcomes in all patient subgroups. UBE4B protein expression was associated with neuroblastoma tumor differentiation, and decreased UBE4B protein levels were associated with high-risk features. UBE4B protein levels were also associated with levels of phosphorylated ERK.ConclusionsWe have demonstrated associations between UBE4B gene expression and neuroblastoma patient outcomes and prognostic features. Reduced UBE4B protein expression in neuroblastoma tumors was associated with high-risk features, a lack of differentiation, and with ERK activation. These results suggest UBE4B may contribute to the poor prognosis of neuroblastoma tumors with 1p36 deletions and that UBE4B expression may mediate neuroblastoma differentiation

Cosmological expansion on a dilatonic brane-world

In this paper we study brane-world scenarios with a bulk scalar field, using a covariant formalism to obtain a 4D Einstein equation via projection onto the brane. We discuss, in detail, the effects of the bulk on the brane and how the scalar field contribute to the gravitational effects. We also discuss choice of conformal frame and show that the frame selected by the induced metric provides a natural choice. We demonstrate our formalism by applying it to cosmological scenarios of Randall-Sundrum and Horava-Witten type models. Finally we consider the cosmology of models where the scalar field couples non-minimally to the matter on the brane. This gives rise to a novel scenario where the universe expands from a finite scale factor with an initial period of accelerated expansion, thus avoiding the singularity and flatness problem of the standard big bang model.Comment: 20 pages - Version to appear in Classical and Quantum Gravity. New section added on conformal rescaling of the metric. Some other minor changes made and references adde

A Substellar Companion in a 1.3 yr Nearly-circular Orbit of HD 16760

We report the detection of a substellar companion orbiting the G5 dwarf HD 16760 from the N2K sample. Precise Doppler measurements of the star from Subaru and Keck revealed a Keplerian velocity variation with a period of 466.47+-0.35 d, a semiamplitude of 407.71+-0.84 m/s, and an eccentricity of 0.084+-0.003. Adopting a stellar mass of 0.78+-0.05 M_Sun, we obtain a minimum mass for the companion of 13.13+-0.56 M_JUP, which is close to the planet/brown-dwarf transition, and the semimajor axis of 1.084+-0.023 AU. The nearly circular orbit despite the large mass and intermediate orbital period makes this companion unique among known substellar companions.Comment: 14 pages, 2 figures, accepted for publication in Ap

Impairment of Coronary Arteriolar Endothelium-Dependent Dilation after Multi-Walled Carbon Nanotube Inhalation: A Time-Course Study

Engineered nanomaterials have been developed for widespread applications due to many highly unique and desirable characteristics. The purpose of this study was to assess pulmonary inflammation and subepicardial arteriolar reactivity in response to multi-walled carbon nanotube (MWCNT) inhalation and evaluate the time course of vascular alterations. Rats were exposed to MWCNT aerosols producing pulmonary deposition. Pulmonary inflammation via bronchoalveolar lavage and MWCNT translocation from the lungs to systemic organs was evident 24 h post-inhalation. Coronary arterioles were evaluated 24–168 h post-exposure to determine microvascular response to changes in transmural pressure, endothelium-dependent and -independent reactivity. Myogenic responsiveness, vascular smooth muscle reactivity to nitric oxide, and α-adrenergic responses all remained intact. However, a severe impact on endothelium-dependent dilation was observed within 24 h after MWCNT inhalation, a condition which improved, but did not fully return to control after 168 h. In conclusion, results indicate that MWCNT inhalation not only leads to pulmonary inflammation and cytotoxicity at low lung burdens, but also a low level of particle translocation to systemic organs. MWCNT inhalation also leads to impairments of endothelium-dependent dilation in the coronary microcirculation within 24 h, a condition which does not fully dissipate within 168 h. The innovations within the field of nanotechnology, while exciting and novel, can only reach their full potential if toxicity is first properly assessed