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BACKGROUND: Black-White disparities in heart disease treatment may be attributable to differences in physician referral networks. We mapped physician networks for Medicare patients and examined within-physician Black-White differences in patient sharing between primary care physicians and cardiologists. METHODS AND RESULTS: Using Medicare fee-for-service files for 2016 to 2017, we identified a cohort of Black and White patients with heart disease and the primary care physicians and cardiologists treating them. To ensure the robustness of within-physician comparisons, we restricted the sample to regional health care markets (ie, hospital referral regions) with at least 10 physicians sharing ≥3 Black and White patients. We used claims to construct 2 race-specific physician network measures: degree (number of cardiologists with whom a primary care physician shares patients) and transitivity (network tightness). Measures were adjusted for Black-White differences in physician panel size and calculated for all settings (hospital and office) and for office settings only. Of 306 US hospital referral regions, 226 and 145 met study criteria for all settings and office setting analyses, respectively. Black patients had more cardiology encounters overall (6.9 versus 6.6; P

Since the implementation of Medicare's Hospital Readmissions Reduction Program (HRRP), safety-net hospitals have received a disproportionate share of financial penalties for excess readmissions, raising concerns about the fairness of the policy. In response, the HRRP now stratifies hospitals into five quintiles by low-income Medicare (dual Medicare-Medicaid eligible) stay proportion and compares readmission rates within quintiles. To better understand the potential effects of the revised policy, we used difference-in-differences models to compare changes in 30-day readmission, 30-day mortality, and 90th-day community-dwelling rates after discharge of fee-for-service Medicare beneficiaries hospitalized for acute myocardial infarction, heart failure and pneumonia during 2007-2014, for hospitals in the highest (N = 677) and lowest (N = 678) dual-proportion quintiles before and after the original HRRP implementation in fiscal year 2013. We find that high dual-proportion hospitals lowered readmissions for all three conditions, while their patients' health outcomes remained largely stable. We also find that for heart failure, high dual-proportion hospitals reduced readmissions more than low dual-proportion hospitals, albeit with a relative increase in mortality. Contrary to concerns about fairness, our findings imply that, under the original HRRP, high dual-proportion hospitals improved readmissions performance generally without adverse effects on patients' health. Whether these gains could be retained under the new policy should be closely monitored.

The last few years have witnessed the rise of Neural Networks (NNs) applications for hydrological time series modeling. By virtue of their capabilities, NN models can achieve unprecedented levels of performance when learn how to solve increasingly complex rainfall-runoff processes via data, making them pivotal for the development of computational hydrologic tasks such as flood predictions. The NN models should, in order to be considered practical, provide a probabilistic understanding of the model mechanisms and predictions and hints on what could perturb the model. In this paper, we developed two probabilistic NN models, i.e., Neural Hierarchical Interpolation for Time Series Forecasting (N-HiTS) and Network-Based Expansion Analysis for Interpretable Time Series Forecasting (N-BEATS), and benchmarked them with long short-term memory (LSTM) for flood prediction across two headwater streams in Georgia and North Carolina, USA. To generate a probabilistic prediction, a Multi-Quantile Loss was used to assess the 95th percentile prediction uncertainty (95PPU) of multiple flooding events. We conducted extensive flood prediction experiments demonstrating the advantages of hierarchical interpolation and interpretable architecture, where both N-HiTS and N-BEATS provided an average accuracy improvement of almost 5 % (NSE) over the LSTM benchmarking model. On a variety of flooding events with different timing and magnitudes, both N-HiTS and N-BEATS demonstrated significant performance improvements over the LSTM benchmark and showcased their probabilistic predictions by specifying a likelihood parameter. [ABSTRACT FROM AUTHOR]

Hydrological processes can be highly influenced by changes in land use land cover (LULC), which can make hydrological modelling also very sensitive to land cover characterization. Therefore, obtaining up-to-date LULC data is a crucial process in hydrological modelling, and as such, different sources of LULC data raises questions on their quality and applicability. This is especially true with new data sources, such as citizen science-based land cover maps. Therefore, this research aims to explore the influence of LULC data sources on hydrological models via their parameterization and by performing sensitivity analyses. Kiffissos catchment, in Greece, a poorly gauged and highly urbanized basin including the city of Athens, is the case study area. In total, 12 continuous hydrological models were developed by mainly varying their structure and parametrization (lumped and gridded) and using three LULC datasets: coordination of information on the environment (CORINE), Urban Atlas and Scent (citizen-based). It was found that excess precipitation is negligibly contributed to by soil saturation and is dominated by the runoff over impervious areas. Therefore, imperviousness was the main parameter influencing both sensitivity to land cover and parameterization. Lastly, although the parametrization as lumped and gridded models affected the representation of hydrological processes in pervious areas, it was not relevant in terms of excess precipitation. [ABSTRACT FROM AUTHOR]

(1) Background: Food waste (FW) in Romania is 70 Kg/capita/year, while 70% of food waste comes from public catering, retail services, and households (over 50%–47 million tons). The present study investigates the socio-demographic factors, behaviors, motivations, and attitudes related to food waste management in Romanian households. (2) Methods: A cross-sectional observational study was conducted using an online questionnaire via the Google Forms platform from 15 April 2023 to 15 May 2023. The questionnaire was designed to assess various aspects, such as some socio-demographic information (age, sex, occupation, area of residence, study level, household members number, children <18 years of age); the personal involvement and frequency of food purchases and homemade food cooking; the main sources that generate food waste; the motivation and frequency with which food waste occurs; the level of awareness regarding the impact of food waste; the respondents' intentions regarding sustainable behaviors and practices for food management; the level of information and familiarity of the respondents with the notions of validity and how these may influence their food consumption decisions. (3) Results: The results show that FW incidence is occasionally (42%), very rarely (43.33%), frequently (15%), and no food waste was reported by 2.66% of respondents. The 35–44 age category records the highest FW frequency, followed by 18–24. The most wasted are homemade food (29.67%), bread and bakery products (27.00%), and fruits and vegetables (14.33%). High involvement in purchasing and buying food following a previously established list reduces FW frequency. The same is valid for high daily involvement in food and homemade cooking. High interest in the FW problem and its perception as a waste of money leads to diminishing it, while guilty feelings increase the FW level (37.50% to 73.33%). (4) Conclusions: The present study shows that household food waste management is a multifactorial process that involves numerous socio-demographic, behavioral, and emotional aspects. Extensive data analysis supports our results, revealing deep self-reported information details and confirming its complex approach. [ABSTRACT FROM AUTHOR]

Photodynamic therapy (PDT) is an emerging treatment modality that utilizes light-sensitive compounds, known as photosensitizers, to produce reactive oxygen species (ROS) that can selectively destroy malignant or diseased tissues upon light activation. This study investigates the incorporation of two porphyrin structures, 5-(4-hydroxy-3-methoxyphenyl)-10,15,20-tris-(4-acetoxy-3-methoxyphenyl) porphyrin (P2.2.) and 5,10,15,20-tetrakis-(4-acetoxy-3-methoxyphenyl) porphyrin (P2.1.), into hydroxypropyl cellulose (HPC) hydrogels for potential use in topical photodynamic therapy (PDT). The structural and compositional properties of the resulting hydrogels were characterized using advanced techniques such as Fourier-transform infrared (FTIR) spectroscopy, X-ray diffraction (XRD), thermogravimetric analysis (TGA), atomic force microscopy (AFM), UV-Visible (UV-Vis) spectroscopy, and fluorescence spectroscopy. FTIR spectra revealed a slight shift of the main characteristic absorption bands corresponding to the porphyrins and their interactions with the HPC matrix, indicating successful incorporation and potential hydrogen bonding. XRD patterns revealed the presence of crystalline domains within the HPC matrix, indicating partial crystallization of the porphyrins dispersed within the amorphous polymer structure. TGA results indicated enhanced thermal stability of the HPC–porphyrin gels compared to 10% HPC gel, with additional weight loss stages corresponding to the thermal degradation of the porphyrins. Rheological analysis showed that the gels exhibited pseudoplastic behavior and thixotropic properties, with minimal impact on the flow properties of HPC by P2.1., but notable changes in viscosity and shear stress with P2.2. incorporation, indicating structural modifications. AFM imaging revealed a homogeneous distribution of porphyrins, and UV-Vis and fluorescence spectroscopy confirmed the retention of their photophysical properties. Pharmacotechnical evaluations showed that the hydrogels possessed suitable mechanical properties, optimal pH, high swelling ratios, and excellent spreadability, making them ideal for topical application. These findings suggest that the porphyrin-incorporated HPC hydrogels have significant potential as effective therapeutic agents for topical applications. [ABSTRACT FROM AUTHOR]

ObjectiveTo evaluate the association between racial residential segregation, a prominent manifestation of systemic racism, and the White-Black survival gap in a contemporary cohort of adults, and to assess the extent to which socioeconomic inequality explains this association.DesignThis was a cross sectional study of White and Black men and women aged 35-75 living in 102 large US Core Based Statistical Areas. The main outcome was the White-Black survival gap. We used 2009-2013 CDC mortality data for Black and White men and women to calculate age-, sex- and race adjusted White and Black mortality rates. We measured segregation using the Dissimilarity index, obtained from the Manhattan Institute. We used the 2009-2013 American Community Survey to define indicators of socioeconomic inequality. We estimated the CBSA-level White-Black gap in probability of survival using sequential linear regression models accounting for the CBSA dissimilarity index and race-specific socioeconomic indicators.ResultsBlack men and women had a 14% and 9% lower probability of survival from age 35 to 75 than their white counterparts. Residential segregation was strongly associated with the survival gap, and this relationship was partly, but not fully, explained by socioeconomic inequality. At the lowest observed level of segregation, and with the Black socioeconomic status (SES) assumed to be at the White SES level scenario, the survival gap is essentially eliminated.ConclusionWhite-Black differences in survival remain wide notwithstanding public health efforts to improve life expectancy and initiatives to reduce health disparities. Eliminating racial residential segregation and bringing Black socioeconomic status (SES) to White SES levels would eliminate the White-Black survival gap.

BACKGROUND: Several organizations have developed frameworks to systematically assess the value of new drugs. OBJECTIVE: To evaluate the convergent validity and interrater reliability of 4 value frameworks to understand the extent to which these tools can facilitate value-based treatment decisions in oncology. METHODS: Eight panelists used the American Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO), Institute for Clinical and Economic Review (ICER), and National Comprehensive Cancer Network (NCCN) frameworks to conduct value assessments of 15 drugs for advanced lung and breast cancers and castration-refractory prostate cancer. Panelists received instructions and published clinical data required to complete the assessments, assigning each drug a numeric or letter score. Kendalls Coefficient of Concordance for Ranks (Kendalls W) was used to measure convergent validity by cancer type among the 4 frameworks. Intraclass correlation coefficients (ICCs) were used to measure interrater reliability for each framework across cancers. Panelists were surveyed on their experiences. RESULTS: Kendalls W across all 4 frameworks for breast, lung, and prostate cancer drugs was 0.560 (P= 0.010), 0.562 (P = 0.010), and 0.920 (P < 0.001), respectively. Pairwise, Kendalls W for breast cancer drugs was highest for ESMO-ICER and ICER-NCCN (W = 0.950, P = 0.019 for both pairs) and lowest for ASCO-NCCN (W = 0.300, P = 0.748). For lung cancer drugs, W was highest pairwise for ESMO-ICER (W = 0.974, P = 0.007) and lowest for ASCO-NCCN (W = 0.218, P = 0.839); for prostate cancer drugs, pairwise W was highest for ICER-NCCN (W = 1.000, P < 0.001) and lowest for ESMO-ICER and ESMO-NCCN (W = 0.900, P = 0.052 for both pairs). When ranking drugs on distinct framework subdomains, Kendalls W among breast cancer drugs was highest for certainty (ICER, NCCN: W = 0.908, P = 0.046) and lowest for clinical benefit (ASCO, ESMO, NCCN: W = 0.345, P = 0.436). Among lung cancer drugs, W was highest for toxicity (ASCO, ESMO, NCCN: W = 0. 944, P < 0.001) and lowest for certainty (ICER, NCCN: W = 0.230, P = 0.827); and among prostate cancer drugs, it was highest for quality of life (ASCO, ESMO: W = 0.986, P = 0.003) and lowest for toxicity (ASCO, ESMO, NCCN: W = 0.200, P = 0.711). ICC (95% CI) for ASCO, ESMO, ICER, and NCCN were 0.800 (0.660-0.913), 0.818 (0.686-0.921), 0.652 (0.466-0.834), and 0.153 (0.045-0.371), respectively. When scores were rescaled to 0-100, NCCN provided the narrowest band of scores. When asked about their experiences using the ASCO, ESMO, ICER, and NCCN frameworks, panelists generally agreed that the frameworks were logically organized and reasonably easy to use, with NCCN rated somewhat easier. CONCLUSIONS: Convergent validity among the ASCO, ESMO, ICER, and NCCN frameworks was fair to excellent, increasing with clinical benefit subdomain concordance and simplicity of drug trial data. Interrater reliability, highest for ASCO and ESMO, improved with clarity of instructions and specificity of score definitions. Continued use, analyses, and refinements of these frameworks will bring us closer to the ultimate goal of using value-based treatment decisions to improve patient care and outcomes. DISCLOSURES: This work was funded by Eisai Inc. Copher and Knoth are employees of Eisai Inc. Bentley, Lee, Zambrano, and Broder are employees of Partnership for Health Analytic Research, a health services research company paid by Eisai Inc. to conduct this research. For this study, Cohen, Huynh, and Neville report fees from Partnership for Health Analytic Research. Outside of this study, Cohen receives grants and direct consulting fees from various companies that manufacture and market pharmaceuticals. Mei reports a grant from Eisai Inc. during this study. The other authors have no disclosures to report. Study concept and design were contributed by Bentley and Broder, with assistance from Elkin and Cohen. Bentley took the lead in data collection, along with Elkin, Huynh, Mukherjea, Neville, Mei, Popescu, Lee, and Zambrano. Data interpretation was performed by Bentley and Broder, along with Elkin, Cohen, Copher, and Knoth. The manuscript was written primarily by Bentley, along with Elkin and Broder, and revised by Bentley, Broder, Elkin, Cohen, Copher, and Knoth. Select components of this works methods were presented at ISPOR 19th Annual European Congress held in Vienna, Austria, October 29-November 2, 2016, and Society for Medical Decision Making 38th Annual North American Meeting held in Vancouver, Canada, October 23-26, 2016.

Copyright of Farmacia is the property of Societatea de Stiinte Farmaceutice Romania and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Methotrexate is an immunosuppressive drug with remarkable therapeutic results in the treatment of autoimmune and proliferative skin diseases. Although it has been more than half a century since it was first introduced into the therapeutic arsenal of dermatologists, there are currently no standardized therapeutic protocols regarding the prescription of methotrexate in dermatology, with the exception of psoriasis treatment. This review aims to highlight the indications and benefits of methotrexate beyond psoriasis, with a focus on a wide range of inflammatory, vesiculobullous, and proliferative dermatological pathologies. [ABSTRACT FROM AUTHOR]

Copyright of Farmacia is the property of Societatea de Stiinte Farmaceutice Romania and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Farmacia is the property of Societatea de Stiinte Farmaceutice Romania and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A significant proportion of the world's population has no access to grid-based electricity and so relies on off-grid lighting solutions. Rechargeable lamp technology is gaining popularity as an alternative off-grid lighting model in developing countries. In this paper, we explore consumer behavior and the operational inefficiencies that result under this model. Specifically, we are interested in (i) measuring the impact of inconvenience (of traveling to recharge the lamp) along with the impact of liquidity constraints (because of poverty) on lamp usage and (ii) evaluating the efficacy of strategies that address these factors. We build a structural model of consumers' recharge decisions that incorporates several operational features of the low-income regions. We conducted large-scale field experiments in Rwanda in partnership with a local rechargeable lamp operator and use the resultant data to estimate and test our model. We find that the complete removal of inconvenience and liquidity constraints from the current business model results in 73% and 126% increases in both recharges and revenue, thereby suggesting that these constraints are major sources of inefficiency. By implementing simple operations-based strategies—such as starting more recharge centers, visiting consumers periodically to collect their lamps for recharge, and allowing consumers to partially recharge their lamps and pay flexibly for the recharge—more than half the benefit of completely eliminating the inefficiencies can be attained. By contrast, the price- and capacity-based strategies that vary the economic variables (i.e., the amount paid per recharge and the amount of light obtained in return) but not the operational model perform far worse than the aforementioned strategies. Overall, our analysis emphasizes the importance of managing operations effectively even in markets with cash-constrained consumers, in which firms may have a natural tendency to focus more on reducing prices. This paper was accepted by Vishal Gaur, operations management. Funding: This work was supported by the International Growth Centre; Wharton School, University of Pennsylvania; and Institut Européen d'Administration des Affaires; The Environment and Energy Partnership; Grand Challenges Canada (Stars in Global Health); INSEAD's Emerging Markets Institute; INSEAD's Randomized Controlled Trials Laboratory; the INSEAD–Wharton Alliance, and International Growth Centre. Supplemental Material: The online appendix and data are available at https://doi.org/10.1287/mnsc.2023.4844. [ABSTRACT FROM AUTHOR]

BackgroundDespite a large body of research showing racial/ethnic and socioeconomic disparities in cancer treatment quality, the relative role of physician-level variations in care is unclear.ObjectiveTo examine the effect of physicians on disparities in breast and colorectal cancer care.SubjectsLinked SEER Medicare data were used to identify Medicare beneficiaries diagnosed with colorectal and breast cancer during 1995-2007 and their treating physicians.Research designWe identified treating physicians from Medicare claims data. We measured the use of NIH guideline-recommended therapies from SEER and Medicare claims data, and used logistic models to examine the relationship between race/ethnicity, socioeconomic status, and cancer quality of care. We used physician fixed effects to account for between-physician variations in treatment.ResultsMinority and low socioeconomic status beneficiaries with breast and colorectal cancer were less likely to receive any recommended treatments as compared with whites. Overall, between-physician variation explained

ObjectiveThe study assessed racial-ethnic differences in receipt of mental health services among children enrolled in systems of care under the Children's Mental Health Initiative (CMHI).MethodsSurvey data for 3,920 CMHI enrollees were used to estimate the association between race-ethnicity and the number of days in the 12 months postenrollment during which the child received individual psychotherapy, family and group psychotherapy, medication monitoring, assessment and evaluation, case management, residential treatment, and inpatient care. Two-part regressions with fixed site effects were estimated to adjust for geography and baseline population differences, including child and caregiver characteristics.ResultsCompared with white non-Latino children, African Americans had lower odds of using any individual psychotherapy (odds ratio [OR]=.73, p=.019), family and group psychotherapy (OR=.79, p=.043), and medication monitoring (OR=.51, p

Infectious and inflammatory dermatoses featuring skin lesions with loss of tissue expose skin layers to microbial invasions, disrupt the normal skin microbiome, and potentially lead to sepsis. However, literature data on the incidence of cutaneous-onset sepsis are scarce. This retrospective observational study assessed hospital admissions for primary skin lesions without bacterial infections and sepsis during 2020–2022 in the largest emergency hospital in NE Romania. Of 509 patients, 441 had infected lesions, 78 had sepsis caused by venous ulcers from microbial eczema cellulitis, superinfected bullous dermatoses, erysipelas, and erythroderma. Cultured samples revealed S. aureus, P. aeruginosa, and E. coli; and K. pneumoniae and S. β-hemolytic associated with sepsis, even if this was rarer. Clinical manifestations included ulcerations, erosions, fissures, excoriations, bullae, vesicles, pruritus, tumefaction, edema, fever, chills, pain, adenopathy, and mildly altered mental status. Underlying chronic heart failure, atrial fibrillation, anemia, and type-1 diabetes mellitus were comorbidities associated with infection and sepsis. Significant associations and risk factors, including their combined effects, are discussed to draw attention to the need for further research and adequate management to prevent sepsis in adult patients of any age presenting with infected skin lesions (especially cellulitis) and comorbidities (especially type 1 diabetes mellitus and anemia). [ABSTRACT FROM AUTHOR]

Copyright of Farmacia is the property of Societatea de Stiinte Farmaceutice Romania and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Autoimmune bullous diseases (ABDs) are a rare but significant group of dermatoses that pose great challenges to the treating dermatologist. ABDs are characterized by the presence of tissue-bound and circulating autoantibodies directed against disease-specific target antigens of the skin. Most epidemiological studies have focused on a single ABD. More than that, there are few data about the incidence and prevalence of autoimmune blistering diseases in Romania. Methods: In this study, between 2015 and 2019, we retrospectively investigated a total of 225 patients with autoimmune bullous diseases from the northeastern region of Romania. The diagnosis was based on the clinical and histo- and immunohistological findings. Results: Pemphigus was the most frequently encountered ABD, with an incidence of 8.16/1,000,000 inhabitants, representing 58.7% (132 cases), followed by 24% cases of bullous pemphigoid (54 cases), 15.4% of patients were diagnosed with dermatitis herpetiformis (37 cases), and 0.9% other subepidermal autoimmune bullous dermatoses. The average age of onset of pemphigus vulgaris was 59.4 years, the majority of patients being male, while the average age of patients diagnosed with bullous pemphigoid was 73.8 years, the majority being female. Conclusions: Pemphigus vulgaris is the most frequently encountered ABDs in the northeast of Romania, with a higher incidence than in Western European countries, and this may be due to specific peculiarities of the geographical area, as well as to a genetic susceptibility of the population in this region. [ABSTRACT FROM AUTHOR]

The hydrology of the catchments is primarily shaped by the intricate and dynamic interactions between surface water and groundwater. This is particularly evident in lowland catchments, where these interactions assume a complex nature. This study investigated the complex interaction between surface water and groundwater in the transboundary catchment Aa of Weerijs, shared by the Netherlands and Belgium. A hydrological model, MIKE SHE coupled with MIKE 11, was calibrated and validated over twelve years using streamflow, groundwater levels, and evapotranspiration data. The model performance was analyzed using model efficiency parameters i.e., correlation coefficient and Nash-Sutcliffe Efficiency coefficient. The model performed well, with satisfactory simulations of streamflow, groundwater levels, and evapotranspiration dynamics. Groundwater levels rose in winter and declined from April to September due to increased evapotranspiration in summer. Precipitation drove the water balance, with 60 % lost through evapotranspiration. Base flow from subsurface drainage networks significantly contributed to river water. Spatial variability in precipitation minimally impacted streamflow but caused localized fluctuations in groundwater levels. Higher spatial resolution precipitation data led to fluctuations due to local recharge points, yet overall catchment hydrology was unaffected. The findings highlight the importance of surface water-groundwater interactions in lowland catchments. The developed model provides insights for water resource planning and climate change adaptation in the catchment. [ABSTRACT FROM AUTHOR]