Evidence for deliberate burial of the dead by .

In this study, we describe new results of excavations in the Dinaledi Subsystem of the Rising Star cave system, South Africa. In two areas within the Hill Antechamber and the Dinaledi Chamber, this work uncovered concentrations of abundant fossils including articulated, matrix-supported skeletal regions consistent with rapid covering by sediment prior to the decomposition of soft tissue. We additionally re-examine the spatial positioning of skeletal material and associated sediments within the Puzzle Box area, from which abundant remains representing a minimum of six individuals were recovered in 2013 and 2014.

Racial and Ethnic Disparities in Preventive and Chronic Disease Care in Medicare Advantage vs. Traditional Medicare.

Background: Over half of Medicare beneficiaries are enrolled in Medicare Advantage (MA), with Black and Hispanic beneficiaries disproportionately in MA versus traditional Medicare (TM).

Objective: To examine Black-White and Hispanic-White disparities in preventive and chronic disease care by MA vs. TM.

Tuberculosis infection screening recommendations for targeted immunotherapies: comparison of U.S. prescribing information, clinical resources and quality measures.

Background: Targeted immunotherapies have transformed the treatment of many diseases. However, some increase the risk of tuberculosis (TB) disease. We sought to develop a comprehensive list of targeted immunotherapies with TB infection screening recommendations in U.

Preconception and Prenatal Medicaid Coverage for Medicaid-Insured Births.

Medicaid provides insurance for 40% of U.S. births.

Measurement Bias in Documentation of Social Risk Among Medicare Beneficiaries.

Importance: Health care organizations are increasingly measuring social risk using Z codes. Types of social risk captured in Z codes include issues related to employment, housing, education, or other psychosocial circumstances. Prior work has found low use of Z codes overall, but measurement may be biased in other ways that have implications for risk adjustment and resource allocation.

Factors Influencing Rural Hospitals' Decisions To Join An Alternative Payment Model: A Mixed-Methods Study.

Hospitals' participation in voluntary Alternative Payment Models has implications for model evaluation and performance. This mixed-methods study examined factors underlying hospitals' decision to participate in the Pennsylvania Rural Health Model (PARHM), a voluntary model under the Center for Medicare and Medicaid Innovation that combined hospital global budgets and care transformation plans. Quantitative analyses tested for pre-PARHM differences in characteristics, and qualitative analyses examined contextual factors identified in interviews with hospital administrators across participating and eligible nonparticipating hospitals.

VA-Purchased Community Care and Risk of Potentially Unsafe Concurrent Medication Use Among Veterans Receiving Opioids: A Regression Discontinuity Analysis.

Objective: To examine whether eligibility for Veterans Health Administration (VA) community care, which expanded Veterans' access to VA-funded care outside VA, increased the likelihood of Veterans concurrently filling prescriptions for opioids and central nervous system (CNS)-active medications.

Study Setting And Design: We used a regression discontinuity design to analyze Veterans across a distance threshold for community care eligibility in the Veterans Choice Program, under which Veterans residing > 40 miles from the closest VA medical facility staffed by ≥ 1 full-time primary care physician qualified for community care. We used local linear regression to test whether exceeding this 40-mile threshold was associated with discontinuities in the probability of receiving overlapping supplies of opioids and another CNS medication (benzodiazepine, muscle relaxant, antiepileptic, or sleep aid) for ≥ 30 days per year.

Enrollment in Dual-Eligible Special Needs Plans and Disenrollment Rates.

Importance: Medicare beneficiaries dually enrolled in Medicare and Medicaid have some of the highest care needs. Finding ways to support dually eligible beneficiaries in the Medicare Advantage (MA) program has become a policy goal.

Objective: To determine if enrollment in different MA plan types is associated with differences in disenrollment.

Breaking Barriers: Essential Reforms for a Competitive and Affordable Biosimilars Market.

Purpose Of Review: This update examines the current policy landscape for biosimilars, particularly those approved for treating rheumatoid arthritis. We review recent literature and recommend policies to align the biosimilars market with the goals of the Biologic Price Competition and Innovation Act (BPCIA). We examine updated evidence on biosimilar safety and effectiveness, recent FDA guidance on interchangeability, and challenges posed by anti-competitive behaviors and government regulations.

Experiences With VA-Purchased Community Care for US Veterans With Mental Health Conditions.

Importance: Veterans with mental health conditions (MHC) face unique challenges obtaining high-quality, coordinated health care. With a growing number of veterans receiving VA-purchased community care (CC) provided outside the Veterans Health Administration (VA), evidence is needed on how veterans in this high-prevalence, marginalized subgroup experience CC.

Objective: To compare experiences with CC over time for US veterans with and without MHC.

Reversibility and Enantioselectivity of Palladium-Catalyzed Allylic Aminations: Ligand, Base-Additive, and Solvent Effects.

The enantioselective, palladium-catalyzed reaction of benzylamine with ()-1,3-diphenylallyl ethyl carbonate was examined with 12 different chiral ligands across a range of scaffold types. In 8 out of 12 cases, the observed enantiomeric excess was 36-92% higher when DBU or CsCO was added. Nucleophile crossover experiments between the -benzyl-1,3-diphenylallylamine product and 4-methoxybenzylamine mechanistically linked the changes in enantioselectivity to reformation of the η-allylpalladium intermediate.

Loss of Subsidized Drug Coverage and Mortality among Medicare Beneficiaries.

Background: A total of 14 million Medicare beneficiaries receive the Low-Income Subsidy (LIS), which reduces cost sharing in Medicare Part D. Losing the LIS may impede medication access and affect mortality.

Methods: Using 2015-2023 Medicare data, we identified dual-eligible Medicare-Medicaid beneficiaries, who automatically receive the LIS, and calculated annual rates of Medicaid and LIS loss.

Changes in blood pressure, medication adherence, and cardiovascular-related health care use associated with the 2018 angiotensin receptor blocker recalls and drug shortages among patients with hypertension.

Background: One of the largest-ever retail drug shortages began in 2018 when several angiotensin II receptor blockers (ARBs) for treating hypertension, heart failure, and chronic kidney disease-valsartan, losartan, and irbesartan-were recalled for carcinogenic impurities. The long-term consequences of the ARB shortages and whether certain groups experienced more adverse outcomes is unknown.

Objective: To evaluate changes in adherence and health outcomes after ARB recalls and to identify patients who experienced greater changes in access and adverse clinical outcomes.

Patient-Reported Characteristics Across Dual-Eligible Medicare Advantage Plan Types.

Importance: A growing proportion of full-benefit dual-eligible Medicare and Medicaid beneficiaries (ie, individuals receiving Medicare and full Medicaid) are enrolled in Medicare Advantage (MA). MA plans vary in capacity and incentives to coordinate Medicare and Medicaid services, but little is known about the characteristics of dual-eligible beneficiaries across plan types.

Objectives: To compare the health and demographic characteristics of full-benefit dual-eligible beneficiaries across 4 MA plan types varying in Medicare-Medicaid service coordination and spending requirements.

Reply.

We argue for universal latent tuberculosis infection (LTBI) screening prior to administration of biologic or targeted synthetic DMARDs (b/tsDMARDs). First, though evidence about the risk of LTBI reactivation for newer b/tsDMARDs is accumulating these studies are conducted in populations in which patients have been screened and treated for LTBI meaning the true risk of reactivation is difficult to assess with current studies. Second, while there are algorithms to predict the risk of active TB in non-endemic populations, these models use a broad category of immunosuppression and the result of LTBI screening limiting their utility for identifying who to screen.

Housing-Related Disparities in Receipt of Breast Cancer Screening Among Women Medicaid Beneficiaries.

Purpose: People experiencing housing insecurity (PEHI) may face barriers to preventive cancer screening, but the extent to which PEHI receive screening at the population level is understudied. Therefore, this study examined disparities in utilization of breast cancer screening associated with housing insecurity (HI) among women beneficiaries enrolled in a large Medicaid program.

Methods: We assessed receipt of biennial mammography among women Medicaid beneficiaries, age 50-64 years, in administrative Medicaid data linked to encounter-level records on housing-related services in Pennsylvania (PA; Homelessness Management Information System [HMIS]) from 2011 to 2019.

Indicators of Functional Disability by Receipt of Disability Benefits Among Individuals With Systemic Lupus Erythematosus.

Objective: We estimated the prevalence of potential functional disability among those with systemic lupus erythematosus (SLE), by receipt of disability benefits.

Methods: Participants (N = 443, mean age 46.2 years, 91.

Growth Of Chronic Condition Special Needs Plans Among Dual-Eligible Beneficiaries, 2011-24.

Policy makers are actively investing in care programs that integrate Medicare and Medicaid benefits, with the goal of providing better-coordinated care for Medicare-Medicaid dual-eligible beneficiaries. However, nonintegrated plans have become increasingly popular among dual eligibles. One such plan type is the Chronic Condition Special Needs Plan (C-SNP)-a type of Medicare Advantage plan designed for people with specific chronic conditions.

Cretaceous Antarctic bird skull elucidates early avian ecological diversity.

Fossils representing Cretaceous lineages of crown clade birds (Aves) are exceptionally rare but are crucial to elucidating major ecological shifts across early avian divergences. Among the earliest known putative crown birds is Vegavis iaai, a foot-propelled diver from the latest Cretaceous (69.2-68.

Association of a State-Wide Alternative Payment Model for Rural Hospitals With Bypass for Elective Surgeries.

Objective: This study aimed to measure the changes in rural hospital bypass for 11 common elective surgeries following the implementation of the Pennsylvania Rural Health Model (PARHM), a global budget payment model.

Study Setting And Design: We leveraged a natural experiment arising from the phase-in of PHARM in Pennsylvania. We conducted a comparative interrupted time series analysis to assess changes in rural hospital bypass, comparing trends in rural hospital bypass among patients in hospital service areas (HSAs) with PARHM-participating hospitals to patients in control HSAs with hospitals eligible for but not participating in PARHM.

Medicare Resource Use Differs by English Reading Proficiency.

Background And Objectives: Medicare coverage decisions are complex. The Centers for Medicare & Medicaid Services (CMS) provides a hotline, handbook, and website to help Medicare beneficiaries understand their benefits and coverage options, yet it is unclear what factors affect beneficiary use of these resources. We examined limited English speaking and English reading proficiency status as predictors of CMS Medicare informational resource use in a nationally representative sample of Medicare beneficiaries.

Health Care Utilization and Costs for Older Adults Aging Into Medicare After the Affordable Care Act.

Importance: The Affordable Care Act (ACA) expanded Medicaid and Marketplace insurance to nonelderly adults in 2014, but whether these policies improved outcomes later in life is unknown.

Objective: To examine whether exposure to ACA expansions during middle age (50-64 years) was associated with changes in health, utilization, and spending after these adults entered Medicare at 65 years of age.

Design, Setting, And Participants: This serial analysis of the Health and Retirement Study cohort linked to Medicare enrollment and claims data from January 1, 2010, to December 31, 2018.

Medicaid Unwinding Experiences in Dual-Eligible Older Adults.

Importance: Dual-eligible older adults rely on Medicaid to pay for Medicare premiums and cost sharing in addition to supplemental services including dental and long-term care. However, the unique experiences of dual-eligible older adults with Medicaid unwinding remain unknown.

Objective: To assess the awareness and experiences of dual-eligible older adults with Medicaid redetermination.