How Much is Post-Acute Care Use Affected by Its Availability?

To assess the relative impact of clinical factors versus non-clinical factors such as post acute care (PAC) supply - in determining whether patients receive care from skilled nursing facilities (SNFs) or inpatient rehabilitation facilities (IRFs) after discharge from acute care. Medicare acute hospital, IRF and SNF claims provided data on PAC choices; predictors of site of PAC chosen were generated from Medicare claims, provider of services, enrollment file, and Area Resource File data. We used multinomial logit models to predict post-acute care use by elderly patients after hospitalizations for stroke, hip fractures, or lower extremity joint replacements. A file was constructed linking Medicare acute and post-acute utilization data for all sample patients hospitalized in 1999. PAC availability is a more powerful predictor of PAC use than the clinical characteristics in many of our models. The effects of distance to providers and supply of providers are particularly clear in the choice between IRF and SNF care. The farther away the nearest IRF is, and the closer the nearest SNF is, the less likely a patient is to go to an IRF. Similarly, the fewer IRFs, and the more SNFs, there are in the patient's area the less likely the patient is to go to an IRF. In addition, if the hospital from which the patient is discharged has a related IRF or a related SNF the patient is more likely to go there. We find that the availability of PAC is a major determinant of whether patients use such care and which type of PAC facility they use. Further research is needed in order to evaluate whether these findings indicate that a greater supply of PAC leads to both higher use of institutional care and better outcomes or whether it leads to unwarranted expenditures of resources and delays in returning patients to their homes.

The Effects of a High Fat Meal on Blood Flow Regulation during Arm Exercise

A diet high in saturated fats results in endothelial dysfunction and can lead to atherosclerosis, a precursor to cardiovascular disease. Exercise training is a potent stimulus though to mitigate the negative effects of a high saturated fat diet; however, it is unclear how high-saturated fat meal (HSFM) consumption impacts blood flow regulation during a single exercise session. PURPOSE: This study sought to examine the impact of a single HSFM on peripheral vascular function during an acute upper limb exercise bout. METHODS: Ten young healthy individuals completed two sessions of progressive handgrip exercise. Subjects either consumed a HSFM (0.84 g of fat/kg of body weight) 4 hours prior or remained fasted before the exercise bout. Progressive rhythmic handgrip exercise (6kg, 12kg, 18kg) was performed for 3 minutes per stage at rate of 1 Hz. The brachial artery (BA) diameter and blood velocity was obtained using Doppler Ultrasound (GE Logiq e) and BA blood flow was calculated with these values. RESULTS: BA blood flow and flow mediated dilation (normalized for shear rate) during the handgrip exercise significant increased from baseline in all workloads, but no differences were revealed in response to the HSFM consumption. CONCLUSION: Progressive handgrip exercise augmented BA blood flow and flow mediated dilation in both testing days; however, there was no significant differences following the HSFM consumption. This suggests that upper limb blood flow regulation during exercise is unaltered by a high fat meal in young healthy individuals.https://scholarscompass.vcu.edu/gradposters/1060/thumbnail.jp

Asynchronous Training of Word Embeddings for Large Text Corpora

Word embeddings are a powerful approach for analyzing language and have been widely popular in numerous tasks in information retrieval and text mining. Training embeddings over huge corpora is computationally expensive because the input is typically sequentially processed and parameters are synchronously updated. Distributed architectures for asynchronous training that have been proposed either focus on scaling vocabulary sizes and dimensionality or suffer from expensive synchronization latencies. In this paper, we propose a scalable approach to train word embeddings by partitioning the input space instead in order to scale to massive text corpora while not sacrificing the performance of the embeddings. Our training procedure does not involve any parameter synchronization except a final sub-model merge phase that typically executes in a few minutes. Our distributed training scales seamlessly to large corpus sizes and we get comparable and sometimes even up to 45% performance improvement in a variety of NLP benchmarks using models trained by our distributed procedure which requires $1/10$ of the time taken by the baseline approach. Finally we also show that we are robust to missing words in sub-models and are able to effectively reconstruct word representations.Comment: This paper contains 9 pages and has been accepted in the WSDM201

CO2 Enhancement of Forest Productivity Constrained by Limited Nitrogen Availability

Stimulation of terrestrial productivity by rising CO~2~ concentration is projected to reduce the airborne fraction of anthropogenic CO~2~ emissions; coupled climate-carbon (C) cycle models, including those used in the IPCC Fourth Assessment Report (AR4), are sensitive to this negative feedback on atmospheric CO~2~^1^. The representation of the so-called CO~2~ fertilization effect in the 11 models used in AR4 and subsequent models^2,3^ was broadly consistent with experimental evidence from four free-air CO~2~ enrichment (FACE) experiments, which indicated that net primary productivity (NPP) of forests was increased by 23 +/- 2% in response to atmospheric CO~2~ enrichment to 550 ppm^4^. Substantial uncertainty remains, however, because of the expectation that feedbacks through the nitrogen (N) cycle will reduce the CO~2~ stimulation of NPP^5,6^; these feedbacks were not included in the AR4 models and heretofore have not been confirmed by experiments in forests^7^. Here, we provide new evidence from a FACE experiment in a deciduous Liquidambar styraciflua (sweetgum) forest stand in Tennessee, USA, that N limitation has significantly reduced the stimulation of NPP by elevated atmospheric CO~2~ concentration (eCO~2~). Isotopic evidence and N budget analysis support the premise that N availability in this forest ecosystem has been declining over time, and declining faster in eCO~2~. Model analyses and evidence from leaf- and stand-level observations provide mechanistic evidence that declining N availability constrained the tree response to eCO2. These results provide a strong rationale and process understanding for incorporating N limitation and N feedback effects in ecosystem and global models used in climate change assessments

Small integral membrane protein 10 like 1 downregulation enhances differentiation of adipose progenitor cells

Small integral membrane protein 10 like 1 (SMIM10L1) was identified by RNA sequencing as the most significantly downregulated gene in Phosphatase and Tensin Homologue (PTEN) knockdown adipose progenitor cells (APCs). PTEN is a tumor suppressor that antagonizes the growth promoting Phosphoinositide 3-kinase (PI3K)/AKT/mechanistic Target of Rapamycin (mTOR) cascade. Diseases caused by germline pathogenic variants in PTEN are summarized as PTEN Hamartoma Tumor Syndrome (PHTS). This overgrowth syndrome is associated with lipoma formation, especially in pediatric patients. The mechanisms underlying this adipose tissue dysfunction remain elusive. We observed that SMIM10L1 downregulation in APCs led to an enhanced adipocyte differentiation in two- and three-dimensional cell culture and increased expression of adipogenesis markers. Furthermore, SMIM10L1 knockdown cells showed a decreased expression of PTEN, pointing to a mutual crosstalk between PTEN and SMIM10L1. In line with these observations, SMIM10L1 knockdown cells showed increased activation of PI3K/AKT/mTOR signaling and concomitantly increased expression of the adipogenic transcription factor SREBP1. We computationally predicted an α-helical structure and membrane association of SMIM10L1. These results support a specific role for SMIM10L1 in regulating adipogenesis, potentially by increasing PI3K/AKT/mTOR signaling, which might be conducive to lipoma formation in pediatric patients with PHTS

Integrated ground-based and remotely sensed data to support global studies of environmental change

Data centers routinely archive and distribute large databases of high quality and with rigorous documentation but, to meet the needs of global studies effectively and efficiently, data centers must go beyond these traditional roles. Global studies of environmental change require integrated databases of multiple data types that are accurately coordinated in terms of spatial, temporal and thematic properties. Such datasets must be designed and developed jointly by scientific researchers, computer specialists, and policy analysts. The presentation focuses on our approach for organizing data from ground-based research programs so that the data can be linked with remotely sensed data and other map data into integrated databases with spatial, temporal, and thematic characteristics relevant to global studies. The development of an integrated database for Net Primary Productivity is described to illustrate the process

Quadriceps exercise intolerance in patients with chronic obstructive pulmonary disease: the potential role of altered skeletal muscle mitochondrial respiration

This study sought to determine if qualitative alterations in skeletal muscle mitochondrial respiration, associated with decreased mitochondrial efficiency, contribute to exercise intolerance in patients with chronic obstructive pulmonary disease (COPD). Using permeabilized muscle fibers from the vastus lateralis of 13 patients with COPD and 12 healthy controls, complex I (CI) and complex II (CII)-driven State 3 mitochondrial respiration were measured separately (State 3:CI and State 3:CII) and in combination (State 3:CI+CII). State 2 respiration was also measured. Exercise tolerance was assessed by knee extensor exercise (KE) time to fatigue. Per milligram of muscle, State 3:CI+CII and State 3:CI were reduced in COPD (P \u3c 0.05), while State 3:CII and State 2 were not different between groups. To determine if this altered pattern of respiration represented qualitative changes in mitochondrial function, respiration states were examined as percentages of peak respiration (State 3:CI+CII), which revealed altered contributions from State 3:CI (Con 83.7 ± 3.4, COPD 72.1 ± 2.4%Peak, P \u3c 0.05) and State 3:CII (Con 64.9 ± 3.2, COPD 79.5 ± 3.0%Peak, P \u3c 0.05) respiration, but not State 2 respiration in COPD. Importantly, a diminished contribution of CI-driven respiration relative to the metabolically less-efficient CII-driven respiration (CI/CII) was also observed in COPD (Con 1.28 ± 0.09, COPD 0.81 ± 0.05, P \u3c 0.05), which was related to exercise tolerance of the patients (r = 0.64, P \u3c 0.05). Overall, this study indicates that COPD is associated with qualitative alterations in skeletal muscle mitochondria that affect the contribution of CI and CII-driven respiration, which potentially contributes to the exercise intolerance associated with this disease

The Comparison of High-Intensity Interval Exercise vs. Continuous Moderate-Intensity Exercise on C1q/TNF-Related Protein-9 Expression and Flow-Mediated Vasodilation in Obese Individuals

PURPOSE: A recent novel adipocytokine, C1q/TNF-related protein-9 (CTRP9), has been shown to increase activation of endothelial nitric oxide synthase and reduce vasoconstrictors (e.g., endothelin-1). In addition, CTRP9 may play a compensatory role in obesity-related endothelial dysfunction. Although there is limited information regarding exercise-mediated CTRP9, high-intensity interval exercise (HIIE) has been shown to be as or more effective than continuous moderate-intensity exercise (CME) in improving indicators of endothelial function (e.g., brachial artery flow-mediated dilation [BAFMD]). Therefore, the purpose of this study was to investigate the effect of acute HIIE vs. CME on serum CTRP9 and BAFMD responses in obese individuals. METHODS: Sixteen young male subjects (9 obese and 7 normal-weight) participated in a counterbalanced and caloric equated experiment: HIIE (30 minutes, 4 intervals of 4 minutes at 80-90% of VO2max with 3 minutes rest between intervals) and CME (38 minutes at 50-60% VO2max). Serum CTRP9 and BAFMD, were measured prior to, immediately following exercise, and 1 hour and 2 hours into recovery. RESULTS: The concentration of serum CTRP9 was significantly increased immediately following acute HIIE and CME in both obese and normal-weight groups (p = 0.003). Furthermore, both significant treatment by time and group by time interactions for BAFMD were observed following both exercise protocols (p = 0.018; p = 0.009; respectively), with a greater CME-induced BAFMD response at 2 hours into recovery in obese compared to normal-weight subjects. Additionally, a positive correlation in percent change (baseline to peak value) between CTRP9 and BAFMD was found following acute CME (r = 0.589, p = 0.016). CONCLUSIONS: Acute HIIE is as effective as CME to upregulate CTRP9 expression in both obese and normal-weight individuals, although CTRP9 may potentially improve CME-mediated BAFMD. The novel results from this study provide a foundation for additional examination of the mechanisms of exercise-mediated CTRP9 on endothelial function