Centers for Medicare & Medicaid Services' Models to Improve Late-stage Chronic Kidney Disease and End-stage Renal Disease Care: Leveraging Nephrology Payment Policy to Achieve Value.

This article describes two new and complementary initiatives from the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services-the ESRD Treatment Choices and Kidney Care Choices Models-which focus on Medicare beneficiaries with CKD and ESRD. These models, or time-limited tests, are aimed at testing whether modifying Medicare payment methodologies, while also rewarding certain clinical outcomes, will improve treatment and outcomes and reduce costs. Together, these initiatives comprise a major part of the larger federal effort to improve the lives of people with kidney disease.

Association of the Comprehensive End-Stage Renal Disease Care Model With Medicare Payments and Quality of Care for Beneficiaries With End-Stage Renal Disease.

Importance: Medicare beneficiaries with end-stage renal disease (ESRD) are a medically complex group accounting for less than 1% of the Medicare population but more than 7% of Medicare fee-for-service payments.

Objective: To evaluate the association of the Comprehensive End-Stage Renal Disease Care (CEC) model with Medicare payments, health care use, and quality of care.

Design, Setting, And Participants: In this economic evaluation, a difference-in-differences design estimated the change in outcomes for 73 094 Medicare fee-for-service beneficiaries aligned to CEC dialysis facilities between the baseline (from January 2014 to March 2015) and intervention periods (from October 2015 to December 2017) relative to 60 464 beneficiaries at matched dialysis facilities.

Using the photovoice method to advocate for change to a campus smoking policy.

Objective: The authors used the photovoice method as a strategy for empowering students to advocate for change of a campus smoking policy.

Participants: Participants included 49 college students and 160 photo-exhibit attendees during spring 2011.

Methods: Students were trained in the use of the photovoice method and a public exhibit was used to educate the campus community and advocate for change.

Anomalously weak solar convection.

Convection in the solar interior is thought to comprise structures on a spectrum of scales. This conclusion emerges from phenomenological studies and numerical simulations, though neither covers the proper range of dynamical parameters of solar convection. Here, we analyze observations of the wavefield in the solar photosphere using techniques of time-distance helioseismology to image flows in the solar interior.

Wave-like properties of solar supergranulation.

Supergranulation on the surface of the Sun is a pattern of horizontal outflows, outlined by a network of small magnetic features, with a distinct scale of 30 million metres and an apparent lifetime of one day. It is generally believed that supergranulation corresponds to a preferred 'cellular' scale of thermal convection; rising magnetic fields are dragged by the outflows and concentrated into 'ropes' at the 'cell' boundaries. But as the convection zone is highly turbulent and stratified, numerical modelling has proved to be difficult and the dynamics remain poorly understood.