Health institutions, such as hospitals and hospital systems, are investing in programs to address upstream drivers of health. These drivers include the macrolevel forces that comprise ...social-structural influences on health institutions; government policies; and the social, physical, economic, and environmental factors that affect health. Historically, health institutions have mostly invested in mitigating the harmful aspects of social determinants of health—the most publicized upstream driver of health—for their patients. From 2017 to 2019, they collectively spent $2.5 billion on programs targeting the social determinants of health. 1 Although only a tiny fraction of the $100 billion in profit that was generated by U.S. hospitals in 2019, 2 investments in this area are significant given that social, economic, and environmental factors account for 80% of a person's modifiable contributors to health outcomes. 3 Health institution investment and activity in the political determinants of health (PDoH), an even more fundamental and perhaps impactful driver of health, are therefore critical to understand.
Medicare Advantage (MA) plans often establish restrictive networks of covered providers. Some policy makers have raised concerns that networks may have become excessively restrictive over time, ...potentially interfering with patients' access to providers. Because of data limitations, little is known about the breadth of MA networks. Taking a novel approach, we used Medicare Part D claims data for 2011-15 to examine how primary care physician networks have changed over time and what demographic and plan characteristics are associated with varying levels of network breadth. Our findings indicate that the share of MA plans with broad networks increased from 80.1 percent in 2011 to 82.5 percent in 2015. Enrollment in broad-network plans grew from 54.1 percent to 64.9 percent over the same period. In an adjusted analysis, we detected no significant time trend. In addition, narrow networks were associated with urbanicity, higher income, higher physician density, and more competition among plans. Health maintenance organizations had narrower networks than did point-of-service plans, whose networks were narrower than those of preferred provider organizations.
Synthesis of large-area transition-metal dichalcogenides (TMDs) with controlled orientation is a significant challenge to their industrial applications. Substrate plays a vital role in determining ...the final quality of monolayer materials grown via the chemical vapor deposition process by controlling their orientation, crystal structure, and grain boundary. This study determined the binding energy and equilibrium distance for tungsten diselenide (WSe2) monolayers on crystalline and amorphous silicon dioxide and aluminum dioxide substrates. Differently oriented WSe2 monolayers are considered to investigate the role of the substrate in the orientation, binding strength, and equilibrium distance. This study can pave the way to synthesizing high-quality two-dimensional (2D) materials for electronic and chemical applications.
Placenta‑derived exosomes play an important role in cellular communication both in the mother and the fetus. Their concentration and composition are altered in several pregnancy disorders, such as ...gestational diabetes mellitus (GDM). The isolation and characterization of placental exosomes from serum, plasma and tissues from patients with GDM have been previously described; however, to the best of our knowledge, to date, there is no study available on placental exosomes isolated from urine of patients with GDM. In the present study, placental exosomes were purified from urine the 1st, 2nd and 3rd trimester of gestation. Placental exosomes were characterized by transmission electron microscopy in cryogenic mode and by western blot analysis, confirming the presence of exosomal vesicles. The expression profile of five microRNAs (miR‑516‑5p, miR‑517‑3p, miR‑518‑5p, miR‑222‑3p and miR‑16‑5p) was determined by RT‑qPCR. In healthy pregnant women, the expression of the miRNAs increased across gestation, apart from miR‑516‑5p, which was not expressed at the 2nd trimester. All the miRNAs examined were downregulated in patients with GDM at the 3rd trimester of gestation. The downregulated miRNAs affected several metabolic pathways closely associated with the pathophysiology of GDM. This provides further evidence of the regulatory role of miRNAs in the GDM. This also suggests that the of urinary exosomes may be an excellent source of biomarkers and therapeutic targets.
Synthesis of large-area transition-metal dichalcogenides (TMDs) with controlled orientation is a significant challenge to their industrial applications. Substrate plays a vital role in determining ...the final quality of monolayer materials grown via the chemical vapor deposition process by controlling their orientation, crystal structure, and grain boundary. This study determined the binding energy and equilibrium distance for tungsten diselenide (WSe
) monolayers on crystalline and amorphous silicon dioxide and aluminum dioxide substrates. Differently oriented WSe
monolayers are considered to investigate the role of the substrate in the orientation, binding strength, and equilibrium distance. This study can pave the way to synthesizing high-quality two-dimensional (2D) materials for electronic and chemical applications.
Evaluating the representativeness of species assemblages and species richness in a network of protected areas is key to reach a balanced and equitable network design. However, representativeness has ...not been assessed for sharks, rays and chimaeras (chondrichthyans), one of the most threatened vertebrate classes. Here, we evaluate the representativeness of chondrichthyan biodiversity in the current network of closed fishing areas (CFAs), and marine protected areas (MPAs), and on a proposed network of relevant conservation areas (RCAs) in the Southwest Atlantic, a large, globally significant region for chondrichthyan conservation. For each Southwest Atlantic bioregion, we estimated the geographic distribution of species richness, and related CFA, MPA and RCA coverage with species richness, using generalized linear and generalized additive models. Within each bioregion, large expanses of high species richness were, in general, not covered by CFAs, and one bioregion had no CFA coverage whatsoever. Three out of the six bioregions had null MPA coverage. Local areas of high species richness had negligible MPA coverage. RCA coverage of local high-richness areas was much higher than either MPA or CFA coverage. This represented a marked improvement; however, vast areas of high bioregional species richness had no coverage, and one bioregion lacked any RCA coverage. Current CFAs and MPAs do not provide adequate protection for the chondrichthyan biodiversity of the Southwest Atlantic, and must be improved to reach full representativeness. Global conservation agendas promoting big MPAs in remote seas should be integrated to regional networks to avoid unbalancing and halting future MPA networks.
Cicada (Cididade) is an insect that has lacked exhaustive characterization despite its consumption in various regions of Mexico and other parts of the world. This study aims to determine the chemical ...composition of cicada (Cicadidae) flour and determine the structural characteristics and in vitro digestibility of the proteins present in cicada (Cicadidae) flour. Cicada flour exhibited a higher protein content (63.51 ± 0.22 g 100 g−1 flour). FTIR analysis revealed that β-turns and β-sheets dominate the protein secondary structure in insect flour. In vitro protein digestibility was assessed using the INFOGEST protocol and demonstrated high levels of digestion, with values around 95 % of hydrolysis for cicadas. These findings highlight cicada flour as a valuable protein source that offers an alternative to traditional animal protein production methods. Therefore, it can be a potential ingredient for incorporation into various food matrices.
•Cicada has a high protein content (∼63.51 g. 100 g−1 flour).•Cicada proteins have 95 % digestibility.•Cicada proteins have predominant β-helix structures.•Cicada flour can be used as an alternative protein source in food production.
Abstract
Background
Frailty is increasingly recognized as a useful measure of vulnerability in older adults. Multiple claims-based frailty indices (CFIs) can readily identify individuals with ...frailty, but whether 1 CFI improves prediction over another is unknown. We sought to assess the ability of 5 distinct CFIs to predict long-term institutionalization (LTI) and mortality in older Veterans.
Methods
Retrospective study conducted in U.S. Veterans ≥65 years without prior LTI or hospice use in 2014. Five CFIs were compared: Kim, Orkaby (Veteran Affairs Frailty Index VAFI), Segal, Figueroa, and the JEN-FI, grounded in different theories of frailty: Rockwood cumulative deficit (Kim and VAFI), Fried physical phenotype (Segal), or expert opinion (Figueroa and JFI). The prevalence of frailty according to each CFI was compared. CFI performance for the coprimary outcomes of any LTI or mortality from 2015 to 2017 was examined. Because Segal and Kim include age, sex, or prior utilization, these variables were added to regression models to compare all 5 CFIs. Logistic regression was used to calculate model discrimination and calibration for both outcomes.
Results
A total of 3 million Veterans were included (mean age 75, 98% male participants, 80% White, and 9% Black). Frailty was identified for between 6.8% and 25.7% of the cohort with 2.6% identified as frail by all 5 CFIs. There was no meaningful difference between CFIs in the area under the receiver operating characteristic curve for LTI (0.78–0.80) or mortality (0.77–0.79).
Conclusions
Based on different frailty constructs, and identifying different subsets of the population, all 5 CFIs similarly predicted LTI or death, suggesting each could be used for prediction or analytics.
Detecting and determining changes in the occurrence and abundance of species is a priority for effective management of resources and for conservation of biodiversity. In the absence of long-term ...monitoring data, potential population declines may be very difficult to establish. Therefore, alternative information on occurrence of species to infer population trends is highly valued. Records of sharks (i.e., Notorynchus cepedianus, Carcharias taurus, Galeorhinus galeus, and Carcharhinus brachyurus) off northern Argentina from a recreational fishing magazine (Weekend), between 1973 and 2008, were reviewed with the aim of evaluating population trends with opportunistic data sources. For each shark species, the number of occurrences per year in the magazine was registered. Our analyses were based on a nonprobabilistic method (McPherson and Myers’ approach) designed to determine population trends with opportunistic sighting records. In this approach we included the number of classified ads offering fishing guide services published per year in the magazine as a measure of observation effort. For each species, we fitted generalized linear models with a Poisson error structure and a log link, where the response variable was the number of occurrences per year, the explanatory variable was the year, and the logarithm of the number of fishing guide ads was specified as an offset in each model. For both approaches, the models estimated that populations of the four shark species have suffered declines. Estimates produced by these models will help to determine the magnitude of population changes where a paucity of data prevents more precise analysis.
We examined associations of individual, psychosocial, and social factors with unprotected anal intercourse (UAI) among young men who have sex with men in New York City.
Using baseline assessment data ...from 592 young men who have sex with men participating in an ongoing prospective cohort study, we conducted multivariable logistic regression analyses to examine the associations between covariates and likelihood of recently engaging in UAI with same-sex partners.
Nineteen percent reported recent UAI with a same-sex partner. In multivariable models, being in a current relationship with another man (adjusted odds ratio AOR = 4.87), an arrest history (AOR = 2.01), greater residential instability (AOR = 1.75), and unstable housing or homelessness (AOR = 3.10) was associated with recent UAI. Although high levels of gay community affinity and low internalized homophobia were associated with engaging in UAI in bivariate analyses, these associations did not persist in multivariable analyses.
Associations of psychosocial and socially produced conditions with UAI among a new generation of young men who have sex with men warrant that HIV prevention programs and policies address structural factors that predispose sexual risk behaviors.
Full text
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CEKLJ, FSPLJ, ODKLJ, UL, VSZLJ
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