CMS Hospital Value-Based Programs: Refinements Are Needed To Reduce Health Disparities And Improve Outcomes.

Several Centers for Medicare and Medicaid Services (CMS) programs aim to transform how health care is delivered by adjusting Medicare inpatient hospital payments through a system of rewards and penalties based on performance on measures of quality. These programs are the Hospital Readmissions Reduction Program, the Hospital Value-Based Purchasing Program, and the Hospital-Acquired Condition Reduction Program. We analyzed value-based program penalty results for various groups of hospitals across these three programs and assessed the impact of patient and community health equity risk factors on hospital penalties.

Mass fluxes of dissolved arsenic discharging to the Meghna River are sufficient to account for the mass of arsenic in riverbank sediments.

Shallow (<30 m) reducing groundwater commonly contains abundant dissolved arsenic (As) in Bangladesh. We hypothesize that dissolved As in iron (Fe)-rich groundwater discharging to rivers is trapped onto Fe(III)-oxyhydroxides which precipitate in shallow riverbank sediments under the influence of tidal fluctuations. Therefore, the goal of this study is to compare the calculated mass of sediment-bound As that would be sequestered from dissolved groundwater As that discharges through riverbanks of the Meghna River to the observed mass of As trapped within riverbank sediments.

Recreational Drug and Psychosocial Profile in Chronic Hepatitis C Patients Seeking Antiviral Therapy.

Background And Aims: Practitioners treating hepatitis C (HCV) provide healthcare to a special population with high rates of substance abuse and psychiatric disorders. We investigated the psychosocial profile in HCV patients and tested what variables affect commencement of antiviral therapy.

Material And Methods: Recreational drug use (RDU), marijuana (THC), alcohol use, and psychiatric history were initially investigated with a questionnaire prior to history and physical.

The Impact of the Degree of Aquifer Confinement and Anisotropy on Tidal Pulse Propagation.

Oceanic tidal fluctuations which propagate long distances up coastal rivers can be exploited to constrain hydraulic properties of riverbank aquifers. These estimates, however, may be sensitive to degree of aquifer confinement and aquifer anisotropy. We analyzed the hydraulic properties of a tidally influenced aquifer along the Meghna River in Bangladesh using: (1) slug tests combined with drilling logs and surface resistivity to estimate Transmissivity (T); (2) a pumping test to estimate T and Storativity (S) and thus Aquifer Diffusivity (D ); and (3) the observed reduction in the amplitude and velocity of a tidal pulse to calculate D using the Jacob-Ferris analytical solution.

Perceptual asymmetries influence task choice: the effect of lateralised presentation of hierarchical stimuli.

The current study examined how hemispheric asymmetries in perceptual processing affect control processes associated with voluntary task choice during multitask behaviour. In a voluntary task-switching paradigm, where participants are free to choose which task to perform on each trial, participants identified either the global-or local-level features of hierarchical stimuli presented to either the left or right visual field. Hemispheric asymmetries in perception of lateralised hierarchical stimuli were evident in reaction times.

Chronic stress increases pituitary adenylate cyclase-activating peptide (PACAP) and brain-derived neurotrophic factor (BDNF) mRNA expression in the bed nucleus of the stria terminalis (BNST): roles for PACAP in anxiety-like behavior.

Exposure to chronic stress has been argued to produce maladaptive anxiety-like behavioral states, and many of the brain regions associated with stressor responding also mediate anxiety-like behavior. Pituitary adenylate cyclase activating polypeptide (PACAP) and its specific G protein-coupled PAC(1) receptor have been associated with many of these stress- and anxiety-associated brain regions, and signaling via this peptidergic system may facilitate the neuroplasticity associated with pathological affective states. Here we investigated whether chronic stress increased transcript expression for PACAP, PAC(1) receptor, brain-derived neurotrophic factor (BDNF), and tyrosine receptor kinase B (TrkB) in several nuclei.