Medieval demise of a Himalayan giant summit induced by mega-landslide.

Despite numerous studies on Himalayan erosion, it is not known how the very high Himalayan peaks erode. Although valley floors are efficiently eroded by glaciers, the intensity of periglacial processes, which erode the headwalls extending from glacial cirques to crest lines, seems to decrease sharply with altitude. This contrast suggests that erosion is muted and much lower than regional rock uplift rates for the highest Himalayan peaks, raising questions about their long-term evolution.

SAR and optical images correlation illuminates post-seismic landslide motion after the Mw 7.8 Gorkha earthquake (Nepal).

In the days to weeks following an earthquake, landslides can display specific post-seismic motions, including delayed initiations and post-seismic relaxations. These motions have an uncertain origin, sometimes attributed to specificities of the landslide basal interface or to fluid transports in the landslide basal shear zone. Here we address this question, by documenting the co- and post-seismic motions of slow-moving landslides accelerated by the Gorkha earthquake (Mw 7.

Bedload transport in rivers, size matters but so does shape.

Bedload transport modelling in rivers takes into account the size and density of pebbles to estimate particle mobility, but does not formally consider particle shape. To address this issue and to compare the relative roles of the density and shape of particles, we performed original sediment transport experiments in an annular flume using molded artificial pebbles equipped with a radio frequency identification tracking system. The particles were designed with four distinct shapes and four different densities while having the same volume, and their speeds and distances traveled under constant hydraulic conditions were analyzed.

Lake Tauca highstand (Heinrich Stadial 1a) driven by a southward shift of the Bolivian High.

Heinrich events are characterized by worldwide climate modifications. Over the Altiplano endorheic basin (high tropical Andes), the second half of Heinrich Stadial 1 (HS1a) was coeval with the highstand of the giant paleolake Tauca. However, the atmospheric mechanisms underlying this wet event are still unknown at the regional to global scale.

The Paradox of End-of-Life Hospital Treatment Intensity among Black Patients: A Retrospective Cohort Study.

Objective: Black patients are more likely than white patients to die in the hospital with intensive care and life-sustaining treatments and less likely to use hospice. Regional concentration of high end-of-life (EOL) treatment intensity practice patterns may disproportionately affect black patients. We calculated and compared race-specific hospital-level EOL treatment intensity in Pennsylvania.

Simulated Effects of Policies to Reduce Diabetes Risk Among Adults With Schizophrenia Receiving Antipsychotics.

Objective: Second-generation antipsychotics increase the risk of diabetes and other metabolic conditions among individuals with schizophrenia. Although metabolic testing is recommended to reduce this risk, low testing rates have prompted concerns about negative health consequences and downstream medical costs. This study simulated the effect of increasing metabolic testing rates on ten-year prevalence rates of prediabetes and diabetes (diabetes conditions) and their associated health care costs.

Prescribing of Clozapine and Antipsychotic Polypharmacy for Schizophrenia in a Large Medicaid Program.

Objective: Underuse of clozapine and overuse of antipsychotic polypharmacy are both indicators of poor quality of care. This study examined variation in prescribing clozapine and antipsychotic polypharmacy across providers, as well as factors associated with these practices.

Methods: Using 2010-2012 Pennsylvania Medicaid data, prescribers were identified if they wrote antipsychotic prescriptions for ten or more nonelderly adult patients with schizophrenia annually.

Patient, Physician and Organizational Influences on Variation in Antipsychotic Prescribing Behavior.

Background: Physicians face the choice of multiple ingredients when prescribing drugs in many therapeutic categories. For conditions with considerable patient heterogeneity in treatment response, customizing treatment to individual patient needs and preferences may improve outcomes.

Aims Of The Study: To assess variation in the diversity of antipsychotic prescribing for mental health conditions, a necessary although not sufficient condition for personalizing treatment.

A Comparison of Free-Standing versus Co-Located Long-Term Acute Care Hospitals.

Background: Long-term acute care hospitals (LTACs) provide specialized treatment for patients with chronic critical illness. Increasingly LTACs are co-located within traditional short-stay hospitals rather than operated as free-standing facilities, which may affect LTAC utilization patterns and outcomes.

Methods: We compared free-standing and co-located LTACs using 2005 data from the United States Centers for Medicare & Medicaid Services.

Where You Live Matters: Quality and Racial/Ethnic Disparities in Schizophrenia Care in Four State Medicaid Programs.

Objective: To determine whether (a) quality in schizophrenia care varies by race/ethnicity and over time and (b) these patterns differ across counties within states.

Data Sources: Medicaid claims data from California, Florida, New York, and North Carolina during 2002-2008.

Study Design: We studied black, Latino, and white Medicaid beneficiaries with schizophrenia.

Medication adherence and readmission after myocardial infarction in the Medicare population.

Objectives: To examine the relationship between 6-month medication adherence and 1-year downstream heart disease-related readmission among patients who survived a myocardial infarction (MI).

Study Design: Retrospective, nested case-control analysis of Medicare fee-for-service beneficiaries who were discharged alive post MI in 2008 (n = 168,882).

Methods: Patients in the case group had their first heart-disease-related readmission post MI discharge during the 6-to-9-month period or the 9-to-12-month period.

A comparative assessment of adverse event classification in the out-of-hospital setting.

Objectives: We sought to test reliability of two approaches to classify adverse events (AEs) associated with helicopter EMS (HEMS) transport.

Methods: The first approach for AE classification involved flight nurses and paramedics (RN/Medics) and mid-career emergency physicians (MC-EMPs) independently reviewing 50 randomly selected HEMS medical records. The second approach involved RN/Medics and MC-EMPs meeting as a group to openly discuss 20 additional medical records and reach consensus-based AE decision.

Disparities in quality of care among publicly insured adults with schizophrenia in four large U.S. states, 2002-2008.

Objective: To examine racial/ethnic disparities in quality of schizophrenia care and assess the size of observed disparities across states and over time.

Data Sources: Medicaid claims data from CA, FL, NY, and NC.

Study Design: Observational repeated cross-sectional panel cohort study of white, black, and Latino fee-for-service adult beneficiaries with schizophrenia.

How familiar are clinician teammates in the emergency department?

Objectives: Lack of familiarity between teammates is linked to worsened safety in high risk settings. The emergency department (ED) is a high risk healthcare setting where unfamiliar teams are created by diversity in clinician shift schedules and flexibility in clinician movement across the department. We sought to characterise familiarity between clinician teammates in one urban teaching hospital ED over a 22 week study period.

Measuring adverse events in helicopter emergency medical services: establishing content validity.

Introduction: We sought to create a valid framework for detecting adverse events (AEs) in the high-risk setting of helicopter emergency medical services (HEMS).

Methods: We assembled a panel of 10 expert clinicians (n = 6 emergency medicine physicians and n = 4 prehospital nurses and flight paramedics) affiliated with a large multistate HEMS organization in the Northeast US. We used a modified Delphi technique to develop a framework for detecting AEs associated with the treatment of critically ill or injured patients.

Effects of Medicare Part D coverage gap on medication adherence.

Objectives: To evaluate the effects of the Medicare Part D coverage gap on pharmacy use among a national sample of Medicare beneficiaries and on medication adherence among 2 subsamples with heart failure and/or diabetes.

Study Design: Pre-post design, with comparison group and propensity score weighting.

Methods: We used a 5% random sample of elderly Medicare beneficiaries enrolled in stand-alone Part D plans in 2007.

Network analysis of team communication in a busy emergency department.

Background: The Emergency Department (ED) is consistently described as a high-risk environment for patients and clinicians that demands colleagues quickly work together as a cohesive group. Communication between nurses, physicians, and other ED clinicians is complex and difficult to track. A clear understanding of communications in the ED is lacking, which has a potentially negative impact on the design and effectiveness of interventions to improve communications.

The effect of race-ethnicity on the comparative effectiveness of clozapine among Medicaid beneficiaries.

Objective: Effectiveness trials have confirmed the superiority of clozapine in schizophrenia treatment, but little is known about whether the drug's superiority holds across racial-ethnic groups. This study examined the effectiveness by race-ethnicity of clozapine relative to other antipsychotics among adult patients in maintenance antipsychotic treatment.

Methods: Black, Latino, and white Florida Medicaid beneficiaries with schizophrenia receiving maintenance treatment with clozapine or other antipsychotics between July 1, 2000, and June 30, 2005, were identified.

Medicare Part D and potentially inappropriate medication use in the elderly.

Objectives: Inappropriate medication use, which is common in older adults, may be responsive to out-of-pocket costs. We examined the impact of Medicare Part D on inappropriate medication use among Medicare beneficiaries.

Study Design: Pre-post with comparison group.

The effect of the US Medicare Part D coverage gaps on medication use among patients with depression and heart failure.

Background: Medication use among Medicare beneficiaries has increased and adherence has improved since the implementation of the Medicare Part D prescription drug benefit in 2006. However, the structure of the benefit, particularly, the coverage gap, is still problematic. It is critical to understand how beneficiaries with coexisting conditions respond to the coverage gap and whether their response differs by type of medications.

Disability, race/ethnicity, and medication adherence among Medicare myocardial infarction survivors.

Background: Long-term medication therapy for patients with post-myocardial infarction (MI) can prolong life. However, recent data on long-term adherence are limited, particularly among some subpopulations. We compared medication adherence among Medicare MI survivors by disability status, race/ethnicity, and income.

Visits to retail clinics grew fourfold from 2007 to 2009, although their share of overall outpatient visits remains low.

Retail clinics have rapidly become a fixture of the US health care delivery landscape. We studied visits to retail clinics and found that they increased fourfold from 2007 to 2009, with an estimated 5.97 million retail clinic visits in 2009 alone.

Effects of Medicare Part D coverage gap on medication and medical treatment among elderly beneficiaries with depression.

Context: Maintenance antidepressant pharmacotherapy in late life prevents recurrent episodes of major depression. The coverage gap in Medicare Part D could increase the likelihood of reducing appropriate use of antidepressants, thereby exposing older adults to an increased risk for relapse of depressive episodes.

Objectives: To determine whether (1) beneficiaries reduce antidepressant use in the gap, (2) the reduction in antidepressant use is similar to the reduction in heart failure medications and antidiabetics, (3) the provision of generic coverage reduces the risk of reduction of medication use, and (4) medical spending increases in the gap.