Spending Patterns Among Medicare ACOs That Have Reduced Costs.

This study aimed to examine whether specific cost categories were disproportionately affected by accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) achieving overall spending reductions, and whether there were demonstrable differences in spending patterns between "low"- or "high"-cost ACOs. Using financial data obtained from the Centers for Medicare & Medicaid Services for ACOs launched between 2012 and 2015, and employing a cross-sectional study design, we determined which cost categories were associated with overall reductions in ACO spending. Linear regressions were conducted to discern whether reductions in inpatient and skilled nursing facility (SNF) costs were driven by reductions in the number of admissions or in the cost per admission.

Building a Prediction Model for Radiographically Confirmed Pneumonia in Peruvian Children: From Symptoms to Imaging.

Background: Community-acquired pneumonia remains the leading cause of death in children worldwide, and current diagnostic guidelines in resource-poor settings are neither sensitive nor specific. We sought to determine the ability to correctly diagnose radiographically confirmed clinical pneumonia when diagnostics tools were added to clinical signs and symptoms in a cohort of children with acute respiratory illnesses in Peru.

Methods: Children < 5 years of age with an acute respiratory illness presenting to a tertiary hospital in Lima, Peru, were enrolled.

Olfactory dysfunction in amyotrophic lateral sclerosis.

We utilized the well-validated University of Pennsylvania Smell Identification Test (UPSIT) to examine whether olfactory dysfunction occurs in ALS participants. After adjusting for relevant confounders in a multiple linear regression model, ALS participants scored significantly lower on the UPSIT compared with control participants, with an estimated mean difference of 2.31 points ( = 0.

Patient Safety/Quality Improvement Primer, Part I: What PS/QI Means to Your Otolaryngology Practice.

Patient safety/quality improvement (PS/QI) is the cornerstone of 21st-century health care. Otolaryngology-Head and Neck Surgery is excited to provide a dedicated PS/QI primer. The overarching goal for this PS/QI series is to provide a comprehensive and practical resource that assists readers, authors, and peer reviewers in understanding PS/QI research, its unique methodology, and the associated reporting standards for trustworthy performance measures.

Karnofsky performance status before and after liver transplantation predicts graft and patient survival.

Background & Aims: The Karnofsky performance status (KPS) has been used for almost 70 years for clinical assessment of patients. Our objective was to determine whether KPS is an independent predictor of post-liver transplant (LT) survival after adjusting for known confounders.

Method: Adult patients listed with the United Network for Organ Sharing (UNOS) from 2006 to 2016 were grouped into low (10-40%, n = 15,103), intermediate (50-70%, n = 22,183) and high (80-100%, n = 13,131) KPS groups based on KPS scores at the time of LT, after excluding those on ventilators or life support.

Author Correction: Super-achromatic monolithic microprobe for ultrahigh-resolution endoscopic optical coherence tomography at 800 nm.

The original version of this Article contained an error in the third sentence of the 'Animal studies' section of the Methods, which incorrectly read 'The sheep anesthesia was initiated with ketamine (25 mg kg) and then maintained by continuous intravascular (IV) infusion of propofol (800 mg kg h) during imaging.' The correct version states '800 µg kg h' in place of '800 mg kg h'. This has been corrected in both the PDF and HTML versions of the article.

Quantitative in vivo mapping of myocardial mitochondrial membrane potential.

Background: Mitochondrial membrane potential (ΔΨm) arises from normal function of the electron transport chain. Maintenance of ΔΨm within a narrow range is essential for mitochondrial function. Methods for in vivo measurement of ΔΨm do not exist.

Low prevalence of ideal cardiovascular health in Peru.

Background: The prevalence of and factors associated with ideal cardiovascular health (ICH) by sociodemographic characteristics in Peru is not well known.

Methods: The American Heart Association's ICH score comprised 3 ideal health factors (blood pressure, untreated total cholesterol and glucose) and 4 ideal health behaviours (smoking, body mass index, high physical activity and fruit and vegetable consumption). ICH was having 5 to 7 of the ideal health metrics.

Toward Bioelectronic Medicine-Neuromodulation of Small Peripheral Nerves Using Flexible Neural Clip.

Neural modulation technology and the capability to affect organ function have spawned the new field of bioelectronic medicine. Therapeutic interventions depend on wireless bioelectronic neural interfaces that can conformally and easily attach to small (few hundred micrometers) nerves located deep in the body without neural damage. Besides size, factors like flexibility and compliance to attach and adapt to visceral nerves associated moving organs are of paramount importance and have not been previously addressed.

Developing an eye-tracking algorithm as a potential tool for early diagnosis of autism spectrum disorder in children.

Background: Autism spectrum disorder (ASD) currently affects nearly 1 in 160 children worldwide. In over two-thirds of evaluations, no validated diagnostics are used and gold standard diagnostic tools are used in less than 5% of evaluations. Currently, the diagnosis of ASD requires lengthy and expensive tests, in addition to clinical confirmation.

Intracellular oxygen tension limits muscle contraction-induced change in muscle oxygen consumption under hypoxic conditions during Hb-free perfusion.

Under acute hypoxic conditions, the muscle oxygen uptake (mV˙O) during exercise is reduced by the restriction in oxygen-supplied volume to the mitochondria within the peripheral tissue. This suggests the existence of a factor restricting the mV˙O under hypoxic conditions at the peripheral tissue level. Therefore, this study set out to test the hypothesis that the restriction in mV˙O is regulated by the net decrease in intracellular oxygen tension equilibrated with myoglobin oxygen saturation (∆PO) during muscle contraction under hypoxic conditions.

Mapping of Small Nerve Trunks and Branches Using Adaptive Flexible Electrodes.

using different paris of contacts on a split-ring electrode, while simulatneous recordings are acquired by the neural ribbon electrodes on three different branches. Two hook electrodes are also implanted in the muscle to monitor the activated muscle responses. It shows that the high precision implantation of electrodes, increases the efficacy and reduces the incidence of side effects.

Validity of the Agency for Health Care Research and Quality Patient Safety Indicators and the Centers for Medicare and Medicaid Hospital-acquired Conditions: A Systematic Review and Meta-Analysis.

Background: The Agency for Health Care Research and Quality Patient Safety Indicators (PSIs) and Centers for Medicare and Medicaid Services Hospital-acquired Conditions (HACs) are increasingly being used for pay-for-performance and public reporting despite concerns over their validity. Given the potential for these measures to misinform patients, misclassify hospitals, and misapply financial and reputational harm to hospitals, these need to be rigorously evaluated. We performed a systematic review and meta-analysis to assess PSI and HAC measure validity.

The Relationship Between Socioeconomic Status and CV Risk Factors: The CRONICAS Cohort Study of Peruvian Adults.

Background: Variations in the distribution of cardiovascular disease and risk factors by socioeconomic status (SES) have been described in affluent societies, yet a better understanding of these patterns is needed for most low- and middle-income countries.

Objective: This study sought to describe the relationship between cardiovascular risk factors and SES using monthly family income, educational attainment, and assets index, in 4 Peruvian sites.

Methods: Baseline data from an age- and sex-stratified random sample of participants, ages ≥35 years, from 4 Peruvian sites (CRONICAS Cohort Study, 2010) were used.

Ascites in Children: A Single-Center Experience of 27 Years.

Objectives: The aim of our study was to describe the changing prevalence, demographic features, etiologies, and treatment of ascites in children hospitalized during a 27-year period at the Johns Hopkins Hospital (Baltimore, MD).

Methods: We retrospectively reviewed discharges from 1983 to 2010 to select patients whose records included a diagnosis of ascites. We assessed the etiologies and degrees of ascites (ascites grade 1 detectable only by radiologic tests; ascites grades 2 and 3 recognized by moderate and marked abdominal distension by physical examinations).

Metabolic Abnormalities Are Common among South American Hispanics Subjects with Normal Weight or Excess Body Weight: The CRONICAS Cohort Study.

Objective: We aimed to characterize metabolic status by body mass index (BMI) status.

Methods: The CRONICAS longitudinal study was performed in an age-and-sex stratified random sample of participants aged 35 years or older in four Peruvian settings: Lima (Peru's capital, costal urban, highly urbanized), urban and rural Puno (both high-altitude), and Tumbes (costal semirural). Data from the baseline study, conducted in 2010, was used.

Multiple chronic conditions and life expectancy: a life table analysis.

Background: The number of people living with multiple chronic conditions is increasing, but we know little about the impact of multimorbidity on life expectancy.

Objective: We analyze life expectancy in Medicare beneficiaries by number of chronic conditions.

Research Design: A retrospective cohort study using single-decrement period life tables.

Voucher incentives improve linkage to and retention in care among HIV-infected drug users in Chennai, India.

Background: Drug users (DUs), a population that accounts for some of the fastest-growing human immunodeficiency virus (HIV) epidemics globally, lag behind other populations with regard to HIV-related outcomes. We evaluated the role of voucher incentives on linkage and retention in care among DUs in India.

Methods: In this randomized clinical trial, 120 DUs who were aged ≥18 years, HIV-infected, antiretroviral therapy (ART) naive, and ART eligible and who reported drug use in the prior month were randomized to incentive (INC) or control (CTL) conditions for 12 months.

miRNA-Based Therapeutic Strategies.

Micro-RNAs (miRNAs) are short non-coding RNA species, thought to act primarily through downregulation of target mRNA species with subsequent decrease in encoded proteins. Recent studies revealed that miRNAs play pivotal roles in physiology and disease, and therapeutic targeting has started being investigated. Generally, the up-regulation of miRNAs is achieved through administration of synthetic miRNAs or administration of miRNA expressing vectors.

Quality of life in tuberculosis: patient and provider perspectives.

Tuberculosis (TB) is a persistent problem in the United States; however, little is known about its impact on functioning and quality of life (QOL) among people with TB. The purpose of this study is to describe the impact of TB on patients' QOL by using focus groups to assess the domains of QOL that are affected. Participants included patients (n = 10) who received treatment for active TB and physicians (n = 4) and nurses (n = 9) caring for patients with TB at a public health clinic in Baltimore, Maryland.

Preparation of interstrand cross-linked DNA oligonucleotide duplexes.

Reaction of cellular DNA with environmental and chemotherapeutic agents can give rise to a variety of lesions including interstrand cross-links. Because interstrand cross-links can prevent DNA strand separation and thus DNA transcription and replication, they represent a serious impediment to cell survival. Cells have developed mechanisms to repair interstrand cross-links in their DNA and in the case of tumor cells, this can lead to resistance to chemotherapeutic agents.

Evaluation of dry and wet transported intravaginal swabs in detection of Chlamydia trachomatis and Neisseria gonorrhoeae infections in female soldiers by PCR.

Screening women for sexually transmitted diseases (STD) in nonclinic settings is highly desirable because many infections are asymptomatic. This is especially true for military women, for whom logistical, social, and other job-related obstacles present barriers to accessing medical care. We assessed the accuracy of intravaginal swabs transported by mail in a wet versus a dry state for PCR (Amplicor CT/NG test) detection of chlamydia and gonorrhea infections in a cross-sectional study of 793 active-duty military women attending an STD clinic.