Search

Nursing home residents face many barriers to accessing specialist physician outpatient care. However, little data exists on how specialty care use changes when individuals transition to a nursing home in the US.We studied specialist outpatient visits for new long-term care (LTC) residents within 1 year before and after their transition to nursing home residence using the Minimum Data Set v3.0 (MDS) and a 20% sample of Medicare fee-for-service claims in 2014-2018. To focus on residents requiring specialty care at baseline, we limited the cohort to residents with specialty care in the 13-24 months before LTC transition. We then measured the proportion of residents receiving at least one visit in the 12 months before the transition and the 12 months after the transition. We also examined subgroups of residents with a prior diagnosis likely requiring long-term specialty care (e.g., multiple sclerosis). Finally, we examined whether there was continuity of care within the same specialty care provider.Among 39,288 new LTC transitions identified in 2016-2017, 17,877 (45.5%) residents had a prior specialist visit 13-24 months before the transition. Among them, the proportion of residents with specialty visits decreased consistently in all specialties in the 12 months after the transition, ranging from a relative decrease of 14.4% for orthopedics to 67.9% for psychiatry. The relative decrease among patients with a diagnosis likely requiring specialty care ranged from 0.9% for neurology in patients with multiple sclerosis to 67.1% for psychiatry in patients with severe mental illness. Among residents who continued visiting a specialist, 78.9% saw the same provider as before the transition.The use of specialty care falls significantly after patients transition to a nursing home. Further research is needed to understand what drives this drop in use and whether interventions, such as telemedicine can ameliorate potential barriers to specialty care.

OBJECTIVES: The main objective of the study was to compare the accuracy of full-arch digital implant impressions for fixed dental prosthesis under in vitro and in vivo conditions. MATERIALS AND METHODS: Eight patients (five women and three men) with at least one edentulous arch and with 4-6 osseointegrated implants participated in this study. For each edentulous arch (n = 10), experimental screw-retained titanium bar with attached four scan bodies was fabricated. The bar containing four scan bodies was screw-retained intraorally on implants and scanned with Trios 3 intraoral scanner eight times (IOS group, in vivo). Then, the bar was attached to the master cast and scanned eight times again with the same intraoral scanner (MIOS group, in vitro). Finally, the bar with scan bodies was scanned 8 times with a laboratory scanner (reference). Precision and trueness were calculated for 3 distances and 3 angles between the scan bodies (1-2, 1-3, and 1-4) in IOS and MIOS groups. RESULTS: Precision and trueness for the largest distance (1-4) were found to be 44 ± 18 µm and 32 ± 19 µm for the IOS group and 31 ± 16 µm and 30 ± 14 µm for MIOS group, respectively. Precision and trueness for the angle between the most distant scan bodies (1-4) were 0.22 ± 0.14° and 0.18 ± 0.10° for the IOS group and 0.16 ± 0.11° and 0.07 ± 0.05° for MIOS group, respectively. CONCLUSIONS: Intraoral conditions moderately affected the precision and trueness of Trios 3 (3Shape) intraoral scanner. Results of in vitro accuracy studies cannot be directly transferred to the clinical field.

Screening for lung cancer (LC) by low-dose computed tomography (LDCT) has been demonstrated to reduce LC mortality in randomized clinical trials (RCTs), and its implementation is in preparation in many countries. However, definition of the target population, which was based on various combinations of age ranges and definitions of heavy smoking in the RCTs, is subject to ongoing debate. Using epidemiological data from Germany, we aimed to estimate prevalence of preclinical LC and positive predictive value (PPV) of LDCT in potential target populations defined by age and smoking history. Populations aged 50 to 69, 55 to 69, 50 to 74 and 55 to 79 years were considered in this analysis. Sex-specific prevalence of preclinical LC was estimated using LC incidence data within those age ranges and annual transition rates from preclinical to clinical LC obtained by meta-analysis. Prevalence of preclinical LC among heavy smokers (defined by various pack-year thresholds) within those age ranges was estimated by combining LC prevalence in the general population with proportions of heavy smokers and relative risks for LC among them derived from epidemiological studies. PPVs were calculated by combining these prevalences with sensitivity and specificity estimates of LDCT. Estimated prevalence of LC was 0.3% to 0.5% (men) and 0.2% to 0.3% (women) in the general population and 0.8% to 1.7% in target populations of heavy smokers. Estimates of PPV of LDCT were

We report here a detailed analysis of the proteome adjustments that accompany chromoplast differentiation from chloroplasts during bell-pepper fruit ripening. While the two photosystems are disassembled and their constituents degraded, the cytochrome b6f complex, the ATPase complex as well as Calvin cycle enzymes are maintained at high levels up to fully mature chromoplasts. This is also true for ferredoxin (Fd) and Fd-dependent NADP reductase, suggesting that ferredoxin retains a central role in the chromoplasts redox metabolism. There is a significant increase in the amount of enzymes of the typical metabolism of heterotrophic plastids such as the oxidative pentose phosphate pathway (OPPP), amino acid and fatty acid biosynthesis. Enzymes of chlorophyll catabolism and carotenoid biosynthesis increase in abundance, supporting the pigment reorganization that goes together with chromoplast differentiation. The majority of plastid encoded proteins declines but constituents of the plastid ribosome and AccD increase in abundance. Furthermore, the amount of plastid terminal oxidase (PTOX) remains unchanged despite a significant increase in phytoene desaturase (PDS) levels, suggesting that the electrons from phytoene desaturation may be consumed by another oxidase. This may be a particularity of non-climacteric fruits such as bell pepper, that lack a respiratory burst at the onset of fruit ripening.

Promoting ecological resilience to increasing disturbance activity is a key management priority under warming climate. Across the Northern Hemisphere, tree mortality from widespread bark beetle outbreaks raises concerns for how forest management can foster resilience to future outbreaks. Density reduction (i.e., thinning) treatments can increase vigor of remaining trees, but the longevity of treatment efficacy for reducing susceptibility to future disturbance remains a key knowledge gap. Using one of the longest-running replicated experiments in old-growth subalpine forests, we measured stand structure following a recent (early 2000s) severe mountain pine beetle (MPB; Dendroctonus ponderosae) outbreak to examine the legacy of historical (1940s) thinning treatments on two components of resilience. We asked: 'How did historical thinning intensity affect (1) tree-scale survival probability and stand-scale survival proportion (collectively "resistance" to outbreak) for susceptible trees (lodgepole pine [Pinus contorta] ≥ 12 cm diameter) and (2) post-outbreak stand successional trajectories?' Overall outbreak severity was high (MPB killed 59% of susceptible individuals and 78% of susceptible basal area), and historical thinning had little effect on tree-scale and stand-scale resistance. Tree-scale survival probability decreased sharply with increasing tree diameter and did not differ from the control (uncut stands) in the historical thinning treatments. Stand-scale proportion of surviving susceptible trees and basal area did not differ from the control in historically thinned stands, except for treatments that removed nearly all susceptible trees, in which survival proportion approximately doubled. Despite limited effects on resistance to MPB outbreak, the legacy of historical treatments shifted dominance from large-diameter to small-diameter lodgepole pine by the time of outbreak, resulting in historically thinned stands with ~2× greater post-outbreak live basal area than control stands. MPB-driven mortality of large-diameter lodgepole pine in control stands and density-dependent mortality of small-diameter trees in historically thinned stands led to convergence in post-outbreak live tree stand structure. One exception was the heaviest historical thinning treatments (59-77% basal area removed), for which sapling dominance of shade-tolerant, unsusceptible conifers was lower than control stands. After six decades, thinning treatments have had minimal effect on resistance to bark beetle outbreaks, but leave persistent legacies in shaping post-outbreak successional trajectories.

Nanometer-thin rare-earth-transition metal (RE-TM) alloys with precisely controlled compositions and out-of-plane magnetic anisotropy are currently in the focus for ultrafast magnetophotonic applications. However, achieving lateral nanoscale dimensions, crucial for potential device downscaling, while maintaining designable optomagnetic functionality and out-of-plane magnetic anisotropy is extremely challenging. Here we integrate nanosized Tb$_{18}$Co$_{82}$ ferrimagnetic alloys, having strong out-of-plane magnetic anisotropy, within a gold plasmonic nanoantenna array to design micrometer-scale a magnetophotonic crystal that exhibit abrupt and narrow magneto-optical spectral features that are both magnetic field and light incidence direction controlled. The narrow Fano-type resonance arises through the interference of the individual nanoantenna's surface plasmons and a Rayleigh anomaly of the whole nanoantenna array, in both optical and magneto-optical spectra, which we demonstrate and explain using Maxwell-theory simulations. This robust magnetophotonic crystal opens the way for conceptually new high-resolution light incidence direction sensors, as well as for building blocks for plasmon-assisted all-optical magnetization switching in ferrimagnetic RE-TM alloys., Comment: 13 pages, 4 figures

Background T1‐weighted dynamic contrast‐enhanced (DCE) perfusion magnetic resonance imaging (MRI) has been broadly utilized in the evaluation of brain tumors. We aimed at assessing the diagnostic accuracy of DCE‐MRI in discriminating between low‐grade gliomas (LGGs) and high‐grade gliomas (HGGs), between tumor recurrence and treatment‐related changes, and between primary central nervous system lymphomas (PCNSLs) and HGGs. Methods We performed this study based on the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis of Diagnostic Test Accuracy Studies criteria. We systematically surveyed studies evaluating the diagnostic accuracy of DCE‐MRI for the aforementioned entities. Meta‐analysis was conducted with the use of a random effects model. Results Twenty‐seven studies were included after screening of 2945 possible entries. We categorized the eligible studies into three groups: those utilizing DCE‐MRI to differentiate between HGGs and LGGs (14 studies, 546 patients), between recurrence and treatment‐related changes (9 studies, 298 patients) and between PCNSLs and HGGs (5 studies, 224 patients). The pooled sensitivity, specificity, and area under the curve for differentiating HGGs from LGGs were 0.93, 0.90, and 0.96, for differentiating tumor relapse from treatment‐related changes were 0.88, 0.86, and 0.89, and for differentiating PCNSLs from HGGs were 0.78, 0.81, and 0.86, respectively. Conclusions Dynamic contrast‐enhanced‐Magnetic resonance imaging is a promising noninvasive imaging method that has moderate or high accuracy in stratifying gliomas. DCE‐MRI shows high diagnostic accuracy in discriminating between HGGs and their low‐grade counterparts, and moderate diagnostic accuracy in discriminating recurrent lesions and treatment‐related changes as well as PCNSLs and HGGs., Dynamic contrast‐enhanced‐Magnetic resonance imaging has high diagnostic accuracy in grading gliomas and moderate accuracy in surveillance of high‐grade gliomas and differentiation from primary central nervous system lymphomas. DCE‐MRI is a promising noninvasive imaging technique in diagnosing different types of brain tumors.

The use of 4‐day CoSynch + Controlled internal drug release (CIDR) + timed artificial insemination (TAI) in dairy heifers has resulted in adequate pregnancy rates compared with the 5‐day CoSynch + CIDR + TAI protocol. The objective of this study was to compare follicular growth, timing of ovulation and serum progesterone (P4), estradiol (E2) and luteinizing hormone (LH) concentrations in dairy heifers treated with modified 4‐ or 5‐day CoSynch + CIDR protocols (CIDR for 4 or 5 days, PGF 2 α at CIDR removal and GnRH + TAI 72 h later). Twelve cycling Holstein heifers were randomly assigned to either the 4‐ or 5‐day Co‐Synch+CIDR (n = 6/treatment) to receive an intravaginal insert CIDR ® containing 1.38 g of P4 for 4 or 5 days, respectively. At CIDR removal, 25 mg of PGF 2 α was injected IM; 72 h after CIDR removal, heifers received 100 μg of GnRH IM and timed artificial insemination (TAI). Follicular growth and timing of ovulation were assessed using transrectal ultrasonography. Blood samples were collected at the time of CIDR insertion and at frequent time points after CIDR removal for determination of P4 (at TAI), E2 (every 12 h) and LH (every 6 h during the first and second day and every 2 h on the third day). Heifers in the 4‐day group had smaller follicles from CIDR insert removal to ovulation compared with heifers in the 5‐day treatment. Five of six heifers (83.3%) in the 4‐day treatment ovulated at 90–96 h post CIDR insert removal, whereas most heifers in the 5‐day treatment (4/6; 66.6%) ovulated at 84–90 h post CIDR insert withdrawal. Heifers in the 5‐day treatment reached greater peak LH concentration between 48 and 72 h after CIDR insert removal and lesser E2 concentration at TAI than heifers in the 4‐day treatment. In conclusion, heifers in the 4‐day treatment had smaller follicular diameter at 0, 30, 36, 42 and 48 h after CIDR insert removal, longer interval from CIDR insert removal to ovulation, greater E2 concentrations at TAI, and lesser peak LH concentration than heifers in the 5‐day treatment. These results represent a baseline for further studies to determine if prolonging the interval to TAI by 6 h in the 4‐day CoSynch+CIDR would improve pregnancy risk.

Aims Diabetes distress affects approximately 36% of adults with diabetes and is associated with worse diabetes self-management and poor glycaemic control. We characterized participants' diabetes distress and studied the relationship between social support and diabetes distress. Methods In this cross-sectional study, we surveyed a population-based sample of adults with type 2 diabetes covered by Alabama Medicaid. We used the Diabetes Distress Scale assessing emotional burden, physician-related, regimen-related and interpersonal distress. We assessed participants' level of diabetes-specific social support and satisfaction with this support, categorized as low or moderate-high. We performed multivariable logistic regression of diabetes distress by level of and satisfaction with social support, adjusting for demographics, disease severity, self-efficacy and depressive symptoms. Results In all, 1147 individuals participated; 73% were women, 41% White, 58% Black and 3% Hispanic. Low level of or satisfaction with social support was reported by 11% of participants; 7% of participants had severe diabetes distress. Participants with low satisfaction with social support were statistically significantly more likely to have severe diabetes distress than those with moderate-high satisfaction, adjusted odds ratio 2.43 (95% CI 1.30, 4.54). Conclusions Interventions addressing diabetes distress in adults with type 2 diabetes may benefit from a focus on improving diabetes-specific social support.

Understanding drivers of disturbances across scales is critical as environmental constraints change in a warming climate. Outbreaks of native bark beetles (Curculionidae: Scolytinae) are key natural disturbances that shape the structure and function of conifer forests across the northern hemisphere. While drivers of bark beetle outbreaks have been studied extensively at spatial scales ranging from stands to continents, within‐stand processes governing individual tree mortality in an outbreak are less well understood. Here, we use a spatially explicit long‐term monitoring dataset of a lodgepole pine (Pinus contorta var. latifolia) forest (>9000 individually mapped trees in three 2‐ha plots) impacted by a severe mountain pine beetle (Dendroctonus ponderosae) outbreak to explore interactions among fine scale drivers of beetle‐caused tree mortality. Using a Bayesian spatial modeling approach, we evaluated how tree scale and tree neighborhood scale characteristics interact with tree size to mediate host tree susceptibility to mountain pine beetle outbreak in the Southern Rocky Mountains (USA). We found evidence that both tree growth rate preceding the outbreak and neighborhood structure (within a 10 meter radius of the host tree) mediate the effect of tree size, and that the direction and magnitude of these mediating effects vary with tree size. Tree scale mortality probability increased with pre‐outbreak growth rate for small to medium sized host trees (~10–25 cm diameter), but that same effect was not detected for large trees. Conversely, tree scale mortality probability increased with greater neighborhood density, with the most pronounced effects for medium to large sized host trees (~15–30 cm diameter). Within‐stand topographic variability was not an important predictor of mortality probability; among stands, however, the stand in the driest topographic position experienced the greatest overall mortality. By explicitly considering how within‐stand heterogeneity mediates individual tree scale susceptibility to bark beetle outbreak, our findings bridge an important gap in understanding multi‐scale drivers of disturbance dynamics.

Background Diuretic treatment is the mainstay for management of congestive heart failure in horses, and its use has been restricted to injectable medications because no currently data supports the use of PO administered loop diuretics. Objectives To determine the pharmacokinetic and pharmacodynamic properties of PO administered torsemide and, determine if PO administered torsemide, could be used as an alternative to injectable diuretics in the horse. Animals Six healthy adult mares. Methods A 2‐phase, prospective study, that consisted of pharmacokinetic profiling of a single dose (6 mg/kg PO) and pharmacodynamic effects of long‐term torsemide administration (2 mg/kg PO q12h) for 6 days in healthy horses. Results Pharmacokinetic analysis identified a peak concentration (C max) of 10.14 µg/mL (range, 6.79–14.69 µg/mL) and elimination half‐life (T 1/2) 9.2 hours (range, 8.4–10.4 hours). The area under the plasma drug concentration over time curve (AUC) was 80.7 µg × h/mL (range, 56.5–117.2 µg × h/mL). A statistically significant increase in urine volume and decrease in urine specific gravity were found from day 0 (baseline) to day 6 (P

Reconstructing canonical binary compounds by inserting a third agent can significantly modify their electronic and phonon structures. Therefore, it has inspired the semiconductor communities in various fields. Introducing this paradigm will potentially revolutionize thermoelectrics as well. Using a solution synthesis, Bi2 S3 was rebuilt by adding disordered Bi and weakly bonded I. These new structural motifs and the altered crystal symmetry induce prominent changes in electrical and thermal transport, resulting in a great enhancement of the figure of merit. The as-obtained nanostructured Bi13 S18 I2 is the first non-toxic, cost-efficient, and solution-processable n-type material with z T=1.0.