Dental safety net capacity: An innovative use of existing data to measure dentists’ clinical engagement in state Medicaid programs

Background The demand for dentists available for state Medicaid populations has long outpaced the supply of such providers. To help understand the workforce dynamics, this study sought to develop a novel approach to measuring dentists’ relative contribution to the dental safety net and, using this new measurement, identify demographic and practice characteristics predictive of dentists’ willingness to participate in Indiana's Medicaid program. Methods We examined Medicaid claims data for 1,023 Indiana dentists. We fit generalized ordered logistic regression models to measure dentists’ level of clinical engagement with Medicaid. Using a partial proportional odds specification model, we estimated proportional adjusted odds ratios for covariates and separate estimates for each contrast of nonproportional covariates. Results Though 75% of Medicaid‐enrolled dentists were active providers, only 27% of them had 800 or more claims during fiscal year 2015. As has been shown in previous studies, our findings from the proportional odds model reinforced certain demographic and practice characteristics to be predictive of dentists’ participation in state Medicaid programs. Conclusions In addition to confirming predictive factors for Medicaid enrollment, this study validated the clinical engagement measure as a reliable method to assess the level of Medicaid participation. Prior studies have been limited by self‐reported data and variations in Medicaid claims reporting

Measurements of the Electron-Helicity Dependent Cross Sections of Deeply Virtual Compton Scattering with CEBAF at 12 GeV

We propose precision measurements of the helicity-dependent and helicity independent cross sections for the ep->epg reaction in Deeply Virtual Compton Scattering (DVCS) kinematics. DVCS scaling is obtained in the limits Q^2>>Lambda_{QCD}^2, x_Bj fixed, and -\Delta^2=-(q-q')^22 GeV^2, W>2 GeV, and -\Delta^21 GeV^2. We will use our successful technique from the 5.75 GeV Hall A DVCS experiment (E00-110). With polarized 6.6, 8.8, and 11 GeV beams incident on the liquid hydrogen target, we will detect the scattered electron in the Hall A HRS-L spectrometer (maximum central momentum 4.3 GeV/c) and the emitted photon in a slightly expanded PbF_2 calorimeter. In general, we will not detect the recoil proton. The H(e,e'g)X missing mass resolution is sufficient to isolate the exclusive channel with 3% systematic precision

Breakfast Consumption Is Positively Associated with Usual Nutrient Intakes among Food Pantry Clients Living in Rural Communities

Background: Breakfast consumption has declined over the past 40 y and is inversely associated with obesity-related diet and health outcomes. The breakfast pattern of food pantry clients and its association with diet is unknown. Objective: The objective is to investigate the association of breakfast consumption with diet quality and usual nutrient intakes among food pantry clients (n = 472) living in rural communities. Methods: This was an observational study using cross-sectional analyses. English-speaking participants ≥18 y (or ≥19 y in Nebraska) were recruited from 24 food pantries in rural high-poverty counties in Indiana, Michigan, Missouri, Nebraska, Ohio, and South Dakota. Participants were surveyed at the pantry regarding characteristics and diet using 24-h recall. A second recall was self-completed or completed via assisted phone call within 2 wk of the pantry visit. Participants were classified as breakfast skippers when neither recall reported breakfast ≥230 kcal consumed between 04:00 and 10:00; breakfast consumers were all other participants. The Healthy Eating Index-2010 was modeled with breakfast pattern using multiple linear regression. Mean usual intake of 16 nutrients was estimated using the National Cancer Institute Method and compared across breakfast pattern groups. Usual nutrient intake was compared with the Estimated Average Requirement (EAR) or Adequate Intake (AI) to estimate the proportion of population not meeting the EAR or exceeding the AI. Results: A total of 56% of participants consumed breakfast. Compared with breakfast skippers, breakfast consumers had 10–59% significantly higher usual mean intakes of all nutrients (P ≤ 0.05), and had 12–21% lower prevalence of at-risk nutrient intakes except for vitamin D, vitamin E, and magnesium. Conclusions: Adult food pantry clients living in rural communities experienced hardships in meeting dietary recommendations. Breakfast consumption was positively associated with usual nutrient intakes in this population. This trial was registered at clinicaltrials.gov as NCT03566095

Joint associations of peripheral artery disease and accelerometry-based physical activity with mortality: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

BACKGROUND AND AIMS: Peripheral artery disease (PAD) and lower levels of physical activity are both associated with higher mortality. Yet, their joint prognostic impact has not been systematically examined, especially in Hispanics/Latinos, and with objective measures. We aimed to examine the joint associations of PAD and physical activity with mortality in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). METHODS: We studied 7,620 Hispanic/Latino adults aged 45-74 years at baseline (2008-2011) who underwent assessment of PAD with ankle-brachial index (ABI) and physical activity with hip-worn accelerometry. We calculated four physical activity measures: sedentary time, light activity, moderate/vigorous activity, and total activity counts. We quantified the relationship between ABI and mortality overall, and by tertiles of activity measures in restricted cubic splines, using multivariable Cox models accounting for sampling weights. We also assessed cross-categories of ABI and activity measures with mortality. RESULTS: During a median follow up of 7.1 years, 314 participants died. We observed a U-shaped association of ABI with mortality overall (e.g., hazard ratio 1.80 [95%CI 1.20-2.80] at ABI 0.7 vs 1.2). This U-shaped association was generally consistent after stratifying by activity measures, but an elevated mortality risk for higher ABI was not evident in the most active tertile based on sedentary time, time in light activity, and total activity counts. In the cross-category analysis of ABI and physical activity, the highest mortality risk was consistently seen in abnormal ABI (≤0.9 or >1.4) plus the least active tertile (e.g., HR 5.61 [3.31-9.51] for light activity), compared to referent ABI (0.9-1.4) plus the other more active two tertiles, with no interactions between ABI and activity measure. CONCLUSIONS: Abnormal ABI and lower accelerometry-based physical activity were independently and jointly associated with mortality in Hispanics, suggesting the importance of simultaneously evaluating leg vascular condition and physical activity

On the Origin and Evolution of the Mosquito Male-determining Factor Nix

The mosquito family Culicidae is divided into 2 subfamilies named the Culicinae and Anophelinae. Nix, the dominant male-determining factor, has only been found in the culicines Aedes aegypti and Aedes albopictus, 2 important arboviral vectors that belong to the subgenus Stegomyia. Here we performed sex-specific whole-genome sequencing and RNAseq of divergent mosquito species and explored additional male-inclusive datasets to investigate the distribution of Nix. Except for the Culex genus, Nix homologs were found in all species surveyed from the Culicinae subfamily, including 12 additional species from 3 highly divergent tribes comprising 4 genera, suggesting Nix originated at least 133 to 165 million years ago (MYA). Heterologous expression of 1 of 3 divergent Nix open reading frames (ORFs) in Ae. aegypti resulted in partial masculinization of genetic females as evidenced by morphology and double-sex splicing. Phylogenetic analysis suggests Nix is related to femaleless (fle), a recently described intermediate sex-determining factor found exclusively in anopheline mosquitoes. Nix from all species has a conserved structure, including 3 RNA-recognition motifs (RRMs), as does fle. However, Nix has evolved at a much faster rate than fle. The RRM3 of both Nix and fle are distantly related to the single RRM of a widely distributed and conserved splicing factor transformer-2 (tra2). The RRM3-based phylogenetic analysis suggests this domain in Nix and fle may have evolved from tra2 or a tra2-related gene in a common ancestor of mosquitoes. Our results provide insights into the evolution of sex determination in mosquitoes and will inform broad applications of mosquito-control strategies based on manipulating sex ratios toward nonbiting males

Making Free Trade Fair

Philosophers have done very little work on what makes trade fair. Perhaps the most extensive discussion is Malgorzata Kurjanska and Mathias Risse’s article, “Fairness in Trade II: export subsidies and the fair trade movement.”2 In their article, Kurjanska and Risse consider the case for trade subsidies and the Fair Trade movement. They suggest that it is not permissible for developed countries to give their producers subsidies because doing so does not strike an appropriate balance between meeting the needs of the global poor and protecting domestic workers (Kurjanska and Risse, 2008: 34). Kurjanska and Risse also argue that the case for Fair Trade hinges, primarily, on whether or not it is part of the best development strategy for poor countries. They do not think Fair Trade is part of the best development strategy and, so, they believe purchasing Fair Trade certified goods is only acceptable because doing so does not constitute a large share of the market in traded goods. This chapter argues that the case against subsidies and Fair Trade Kurjanska and Risse present is much weaker than they make out. To the contrary, it argues that giving some subsidies and purchasing some Fair Trade certified goods may even be necessary to make trade fair. Section 11.2 starts by saying a few words about the normative framework Kurjanska and Risse adopt

Using quantile regression to investigate racial disparities in medication non-adherence

<p>Abstract</p> <p>Background</p> <p>Many studies have investigated racial/ethnic disparities in medication non-adherence in patients with type 2 diabetes using common measures such as medication possession ratio (MPR) or gaps between refills. All these measures including MPR are quasi-continuous and bounded and their distribution is usually skewed. Analysis of such measures using traditional regression methods that model mean changes in the dependent variable may fail to provide a full picture about differential patterns in non-adherence between groups.</p> <p>Methods</p> <p>A retrospective cohort of 11,272 veterans with type 2 diabetes was assembled from Veterans Administration datasets from April 1996 to May 2006. The main outcome measure was MPR with quantile cutoffs Q1-Q4 taking values of 0.4, 0.6, 0.8 and 0.9. Quantile-regression (QReg) was used to model the association between MPR and race/ethnicity after adjusting for covariates. Comparison was made with commonly used ordinary-least-squares (OLS) and generalized linear mixed models (GLMM).</p> <p>Results</p> <p>Quantile-regression showed that Non-Hispanic-Black (NHB) had statistically significantly lower MPR compared to Non-Hispanic-White (NHW) holding all other variables constant across all quantiles with estimates and p-values given as -3.4% (p = 0.11), -5.4% (p = 0.01), -3.1% (p = 0.001), and -2.00% (p = 0.001) for Q1 to Q4, respectively. Other racial/ethnic groups had lower adherence than NHW only in the lowest quantile (Q1) of about -6.3% (p = 0.003). In contrast, OLS and GLMM only showed differences in mean MPR between NHB and NHW while the mean MPR difference between other racial groups and NHW was not significant.</p> <p>Conclusion</p> <p>Quantile regression is recommended for analysis of data that are heterogeneous such that the tails and the central location of the conditional distributions vary differently with the covariates. QReg provides a comprehensive view of the relationships between independent and dependent variables (i.e. not just centrally but also in the tails of the conditional distribution of the dependent variable). Indeed, without performing QReg at different quantiles, an investigator would have no way of assessing whether a difference in these relationships might exist.</p

Novel Role of NOX in Supporting Aerobic Glycolysis in Cancer Cells with Mitochondrial Dysfunction and as a Potential Target for Cancer Therapy

NAD(P)H oxidase plays a role in cancer metabolism by providing NAD+ to support increased glycolysis