Evaluation of real-time polymerase chain reaction for the diagnosis of protozoal myeloencephalitis in horses using cerebrospinal fluid.

Background: Equine protozoal myeloencephalitis (EPM) caused by Sarcocystis neurona remains an antemortem diagnostic challenge in some horses. Recent work suggested the use of real-time PCR (rtPCR) on cerebrospinal fluid (CSF) as a promising diagnostic tool.

Objective: To evaluate the sensitivity and specificity of S.

Jammed solids with pins: Thresholds, force networks, and elasticity.

The role of fixed degrees of freedom in soft or granular matter systems has broad applicability and theoretical interest. Here we address questions of the geometrical role that a scaffolding of fixed particles plays in tuning the threshold volume fraction and force network in the vicinity of jamming. Our two-dimensional simulated system consists of soft particles and fixed "pins," both of which harmonically repel overlaps.

Structured randomness: jamming of soft discs and pins.

Simulations are used to find the zero temperature jamming threshold, φj, for soft, bidisperse disks in the presence of small fixed particles, or "pins", arranged in a lattice. The presence of pins leads, as one expects, to a decrease in φj. Structural properties of the system near the jamming threshold are calculated as a function of the pin density.

Food Allergy Management at School.

Background: Approximately 8% of schoolchildren in the United States experience potentially life-threatening food allergies. They must diligently avoid allergenic foods and have prompt access to epinephrine to treat anaphylaxis. These prevention strategies must be sustained without interruption, posing a range of challenges at school.

Reconciling opposing perceptions of access to physical activity in a gentrifying urban neighborhood.

Objective: We sought to understand perspectives on access to physical activity in a gentrifying neighborhood.

Design: This qualitative descriptive study used street intercept interviews and photo documentation.

Sample: Participants included members (n = 19) of a gentrifying neighborhood in a northeastern city.

The association between Medicare accountable care organization enrollment and breast, colorectal, and prostate cancer screening.

Background: Despite the rapid diffusion of accountable care organizations (ACOs), the effect of ACO enrollment on cancer diagnosis, treatment, and survivorship remains unknown. The objective of this study was to determine whether Medicare Shared Savings Program (MSSP) ACO enrollment was associated with changes in screening for breast, colorectal, and prostate cancers.

Methods: The authors built a cohort of Medicare beneficiaries from 2006 through 2014 comprising 39,218,652 person-years of observation before and 17,252,345 person-years of observation after MSSP enrollment.

Does Spending More Get More? Health Care Delivery and Fiscal Implications From a Medicare Fee Bump.

While salient features of the Affordable Care Act include insurance expansions and private coverage reforms, various other provisions are embedded within the law. We focus on a temporary 10 percent fee increase for primary care visits supplied to publicly insured (Medicare) beneficiaries. Using administrative and survey data, we assess the price shock's impact on service volume, physician labor supply, and quality of care.

Cesarean Delivery Rates and Costs of Childbirth in a State Medicaid Program After Implementation of a Blended Payment Policy.

Background: Nearly half of US births are financed by Medicaid, and one-third of births occur by cesarean delivery, at double the cost of vaginal delivery. With the goal of reducing unnecessary cesarean use and improving value, in 2009 Minnesota's Medicaid program introduced a blended payment rate for uncomplicated births (ie, a single facility or professional services payment regardless of delivery mode).

Objective: We evaluated the effect of the blended payment policy on cesarean use and costs for Medicaid fee-for-service births.

Protozoal coinfection in horses with equine protozoal myeloencephalitis in the eastern United States.

Background: Infection by 2 or more protozoa is linked with increased severity of disease in marine mammals with protozoan encephalitis.

Hypothesis/objectives: To assess whether horses with equine protozoal myeloencephalitis (EPM) caused by Sarcocystis neurona also have evidence of infection with Neospora hughesi or Toxoplasma gondii. We hypothesized that horses with EPM would be more likely than horses with cervical vertebral stenotic myelopathy (CVSM) to be positive for antibodies to multiple protozoan parasites.

Focusing on Inattention: The Diagnostic Accuracy of Brief Measures of Inattention for Detecting Delirium.

Background: Delirium is frequently missed in most clinical settings. Brief delirium assessments are needed.

Objective: To determine the diagnostic accuracy of reciting the months of year backwards (MOTYB) from December to July (MOTYB-6) and December to January (MOTYB-12) for delirium as diagnosed by a psychiatrist and to explore the diagnostic accuracies of the following other brief attention tasks: (1) spell the word "LUNCH" backwards, (2) recite the days of the week backwards, (3) 10-letter vigilance "A" task, and (4) 5 picture recognition task.

Medicare Accountable Care Organization Enrollment and Appropriateness of Cancer Screening.

Importance: Despite rapid diffusion of Accountable Care Organizations (ACOs), whether ACO enrollment results in observable changes in cancer screening remains unknown.

Objective: To determine whether Medicare Shared Savings Program (MSSP) ACO enrollment changes the appropriateness of screening for breast, colorectal, and prostate cancers.

Design, Setting, And Participants: For this population-based analysis of Medicare beneficiaries, we used Medicare data from 2007 through 2014 and evaluated changes in screening associated with ACO enrollment using differences-in-differences (DD) analyses.

Fish Oil Supplementation Does Not Affect Cognitive Outcomes in Cardiac Surgery Patients in the Omega-3 Fatty Acids for Prevention of Post-Operative Atrial Fibrillation (OPERA) Trial.

Background: Cognitive decline has been reported following cardiac surgery, leading to great interest in interventions to minimize its occurrence. Long-chain n-3 (ω-3) polyunsaturated fatty acids (PUFAs) have been associated with less cognitive decline in observational studies, yet no trials have tested the effects of n-3 PUFAs on cognitive decline after surgery.

Objective: We sought to determine whether perioperative n-3 PUFA supplementation reduces postoperative cognitive decline in patients postcardiac surgery.

Osteoclast inhibitor treatment among men with metastatic castration-resistant prostate cancer.

Background: National Comprehensive Cancer Network guidelines recommend monthly osteoclast inhibitor treatment (OIT) in men with metastatic castration-resistant prostate cancer (mCRPC) to prevent skeletal related events (SREs). We assessed adherence to guidelines by quantifying treatment for SRE prevention in a population-based cohort of men with mCRPC.

Methods: Using Surveillance, Epidemiology, and End Results-Medicare data, we identified men aged >65 with prostate cancer as a primary cause of death during 2006-2010.

The influence of provider characteristics and market forces on response to financial incentives.

Objectives: Alternative payment models, such as accountable care organizations, use financial incentives as levers for change to facilitate the transition from volume to value. However, implementation raises concerns about adverse changes in market competition and the resultant physician response. We sought to identify physician characteristics and market-level factors associated with variation in response to financial incentives for cancer care that may ultimately be leveraged in risk-shared payment models.

Phosphorylated neurofilament H (pNF-H) as a potential diagnostic marker for neurological disorders in horses.

The current study aimed at the investigating the potential use of phosphorylated neurofilament H (pNF-H) as a diagnostic biomarker for neurologic disorders in the horse. Paired serum and cerebrospinal fluid (CSF) samples (n=88) and serum only (n=30) were obtained from horses diagnosed with neurologic disorders and clinically healthy horses as control. The neurologic horses consisted of equine protozoal myeloencephalitis (EPM) (38 cases) and cervical vertebral malformation (CVM) (23 cases).

IL-6 variant is associated with metastasis in breast cancer patients.

Introduction: Although tumor metastases remain significant drivers of mortality, the genetic factors that increase the risks of metastases are not fully identified. Interleukin 6 (IL-6) has emerged as an important factor in breast cancer progression with IL-6 single nucleotide polymorphism (SNP) variants shown to affect survival. We hypothesized that SNPs of the IL-6 promoter at rs1800795 in breast cancer patients are associated with distant metastases.

Polysubstance Use Among US Women of Reproductive Age Who Use Opioids for Nonmedical Reasons.

Objectives: To determine the prevalence and patterns of polysubstance use among US reproductive-aged women who use opioids for nonmedical purposes.

Methods: We used the National Survey of Drug Use and Health (2005-2014) data on female respondents aged 18 to 44 years reporting nonmedical opioid use in the past 30 days (unweighted n = 4498). We categorized patterns of polysubstance use in the past 30 days, including cigarettes, binge drinking, and other legal and illicit substances and reported prevalence adjusted for age, race/ethnicity, and educational attainment.

Cardiac rehabilitation and readmissions after heart transplantation.

Background: Exercise-based cardiac rehabilitation (CR) is under-utilized. CR is indicated after heart transplantation, but there are no data regarding CR participation in transplant recipients. We characterized current CR utilization among heart transplant recipients in the United States and the association of CR with 1-year readmissions using the 2013-2014 Medicare files.

Recent Changes in Prostate Cancer Screening Practices and Epidemiology.

Purpose: Prostate specific antigen based screening for prostate cancer has had a significant impact on the epidemiology of the disease. Its use has been associated with a significant decrease in prostate cancer mortality but has also resulted in the over diagnosis and overtreatment of indolent prostate cancer, exposing many men to the harms of treatment without benefit. The USPSTF (U.

Nonmedical Use of Prescription Opioids among Pregnant U.S. Women.

Objectives: Nonmedical use of opioids during pregnancy is associated with adverse outcomes for women and infants, making it a prominent target for prevention and identification. Using a nationally representative sample, we determined characteristics of U.S.

Physician Competition in the Era of Accountable Care Organizations.

Objective: To calculate physician concentration levels for all U.S. markets using detailed data on integration and accountable care organization (ACO) participation.

Surgeon Participation in Early Accountable Care Organizations.

Objective: We aimed to characterize the landscape of surgeon participation in early accountable care organizations (ACOs) and to identify specialty-, organization-, and market-specific factors associated with ACO participation.

Background: Despite rapid deployment of alternative payment models (APMs), little is known about the prevalence of surgeon participation, and key drivers behind surgeon participation in APMs.

Methods: Using data from SK&A, a research firm, we evaluated the near universe of US practices to characterize ACO participation among 125,425 US surgeons in 2015.

Non-medical opioid use and sources of opioids among pregnant and non-pregnant reproductive-aged women.

Background: The morbidity and mortality burden of the US opioid epidemic falls heavily on reproductive-age women. Information on the patterns of and sources for non-medical use of prescription opioids among reproductive age women, including pregnant women, will inform public health and prevention efforts to mitigate the effects of the opioid epidemic. This study characterized non-medical use of prescription opioids among reproductive-age U.

Urinary retention and catheter use among U.S. female Medicare beneficiaries: Prevalence and risk factors.

Aims: To identify the prevalence of and risk factors for urinary retention and catheterization among female Medicare beneficiaries.

Methods: We identified women with a diagnosis of urinary retention in a 5% sample of Medicare claims in 2012. Women were categorized into three groups based on the occurrence and duration of urinary catheterization within a 1 year period: 1) no catheterization; 2) short-term catheterization (ie, one or more catheterizations in less than 30 days); and 3) chronic catheterization (catheterizations in multiple 30 day periods within 1 year).