Health Care Contact Days Among Older Adults in Traditional Medicare : A Cross-Sectional Study.

BACKGROUND: Days spent obtaining health care outside the home can represent not only access to needed care but also substantial time, effort, and cost, especially for older adults and their care partners. Yet, these health care contact days have not been characterized. OBJECTIVE: To assess composition of, variation and patterns in, and factors associated with contact days among older adults. DESIGN: Cross-sectional study. SETTING: Nationally representative 2019 Medicare Current Beneficiary Survey data linked to claims. PARTICIPANTS: Community-dwelling adults aged 65 years and older in traditional Medicare. MEASUREMENTS: Ambulatory contact days (days with a primary care or specialty care office visit, test, imaging, procedure, or treatment) and total contact days (ambulatory days plus institutional days in a hospital, emergency department, skilled-nursing facility, or hospice facility); multivariable mixed-effects Poisson regression to identify patient factors associated with contact days. RESULTS: In weighted results, 6619 older adults (weighted: 29 694 084) had means of 17.3 ambulatory contact days (SD, 22.1) and 20.7 total contact days (SD, 27.5) in the year; 11.1% had 50 or more total contact days. Older adults spent most contact days on ambulatory care, including primary care visits (mean [SD], 3.5 [5.0]), specialty care visits (5.7 [9.6]), tests (5.3 [7.2]), imaging (2.6 [3.9]), procedures (2.5 [6.4]), and treatments (5.7 [13.3]). Half of the test and imaging days were not on the same days as office visits (48.6% and 50.1%, respectively). Factors associated with more ambulatory contact days included younger age, female sex, White race, non-Hispanic ethnicity, higher income, higher educational attainment, urban residence, more chronic conditions, and care-seeking behaviors (for example, go to the doctor…as soon as (I)…feel bad). LIMITATION: Study population limited to those in traditional Medicare. CONCLUSION: On average, older adults spent 3 weeks in the year getting care outside the home. These contact days were mostly ambulatory and varied widely not only by number of chronic conditions but also by sociodemographic factors, geography, and care-seeking behaviors. These results show factors beyond clinical need that may drive overuse and underuse of contact days and opportunities to optimize this person-centered measure to reduce patient burdens, for example, via care coordination. PRIMARY FUNDING SOURCE: National Institute on Aging

Turbulent mixing in a far‐field plume during the transition to upwelling conditions : microstructure observations from an AUV

Author Posting. © American Geophysical Union, 2018. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Geophysical Research Letters 45 (2018): 9765-9773, doi:10.1029/2018GL078543.A REMUS 600 autonomous underwater vehicle was used to measure turbulent mixing within the far‐field Chesapeake Bay plume during the transition to upwelling. Prior to the onset of upwelling, the plume was mixed by a combination of energetic downwelling winds and bottom‐generated shear resulting in a two‐layer plume structure. Estimates of turbulent dissipation and buoyancy flux from a nose‐mounted microstructure system indicate that scalar exchange within the plume was patchy and transient, with direct wind mixing constrained to the near surface by stratification within the plume. Changing wind and tide conditions contributed to temporal variability. Following the separation of the upper plume from the coast, alongshore shear became a significant driver of mixing on the shoreward edge of the plume.NSF Grant Numbers: OCE‐1334231, OCE‐1745258, OCE‐13343982019-03-2

Death Induced by CD95 or CD95 Ligand Elimination

SummaryCD95 (Fas/APO-1), when bound by its cognate ligand CD95L, induces cells to die by apoptosis. We now show that elimination of CD95 or CD95L results in a form of cell death that is independent of caspase-8, RIPK1/MLKL, and p53, is not inhibited by Bcl-xL expression, and preferentially affects cancer cells. All tumors that formed in mouse models of low-grade serous ovarian cancer or chemically induced liver cancer with tissue-specific deletion of CD95 still expressed CD95, suggesting that cancer cannot form in the absence of CD95. Death induced by CD95R/L elimination (DICE) is characterized by an increase in cell size, production of mitochondrial ROS, and DNA damage. It resembles a necrotic form of mitotic catastrophe. No single drug was found to completely block this form of cell death, and it could also not be blocked by the knockdown of a single gene, making it a promising way to kill cancer cells

Phenomenology of the Deuteron Electromagnetic Form Factors

A rigorous extraction of the deuteron charge form factors from tensor polarization data in elastic electron-deuteron scattering, at given values of the 4-momentum transfer, is presented. Then the world data for elastic electron-deuteron scattering is used to parameterize, in three different ways, the three electromagnetic form factors of the deuteron in the 4-momentum transfer range 0-7 fm^-1. This procedure is made possible with the advent of recent polarization measurements. The parameterizations allow a phenomenological characterization of the deuteron electromagnetic structure. They can be used to remove ambiguities in the form factors extraction from future polarization data.Comment: 18 pages (LaTeX), 2 figures Feb. 25: minor changes of content and in Table

A Study of the Quasi-elastic (e,e'p) Reaction on 12^{12}C, 56^{56}Fe and 97^{97}Au

We report the results from a systematic study of the quasi-elastic (e,e'p) reaction on $^{12}$C, $^{56}$Fe and $^{197}$Au performed at Jefferson Lab. We have measured nuclear transparency and extracted spectral functions (corrected for radiation) over a Q$^2$ range of 0.64 - 3.25 (GeV/c)$^2$ for all three nuclei. In addition we have extracted separated longitudinal and transverse spectral functions at Q$^2$ of 0.64 and 1.8 (GeV/c)$^2$ for these three nuclei (except for $^{197}$Au at the higher Q$^2$). The spectral functions are compared to a number of theoretical calculations. The measured spectral functions differ in detail but not in overall shape from most of the theoretical models. In all three targets the measured spectral functions show considerable excess transverse strength at Q$^2$ = 0.64 (GeV/c)$^2$, which is much reduced at 1.8 (GeV/c)$^2$.Comment: For JLab E91013 Collaboration, 19 pages, 20 figures, 3 table

Measurements of electron-proton elastic cross sections for 0.4<Q2<5.5(GeV/c)20.4 < Q^2 < 5.5 (GeV/c)^2

We report on precision measurements of the elastic cross section for electron-proton scattering performed in Hall C at Jefferson Lab. The measurements were made at 28 unique kinematic settings covering a range in momentum transfer of 0.4 $<$ $Q^2$ $<$ 5.5 $(\rm GeV/c)^2$. These measurements represent a significant contribution to the world's cross section data set in the $Q^2$ range where a large discrepancy currently exists between the ratio of electric to magnetic proton form factors extracted from previous cross section measurements and that recently measured via polarization transfer in Hall A at Jefferson Lab.Comment: 17 pages, 18 figures; text added, some figures replace