Health outcomes under full-risk Medicare Advantage vs traditional Medicare.

Objectives:  To compare quality and health resource utilization among beneficiaries under 2-sided risk Medicare Advantage (MA) payment arrangements (at-risk MA) vs traditional Medicare (TM).

Study Design: Retrospective cross-sectional regression analyses of claims and enrollment data from 2016 to 2019 examining 20 performance measures. All patients were cared for by the same 17 physician groups and 15,488 physicians across 35 health insurers.

Potential spillover effects on traditional Medicare when physicians bear Medicare Advantage risk.

Objective: The relationship between Medicare Advantage (MA) risk payment arrangements and outcomes for patients in traditional Medicare (TM) has not been empirically examined. The objective of this study was to determine whether providers with greater exposure to MA risk payments are associated with superior outcomes for their TM patients.

Study Design: Retrospective, cross-sectional regression analysis.

Post-Operative Bleed Risks Associated with Perioperative Nonsteroidal Anti-Inflammatory Drugs: A Narrative Review.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used medications that function by inhibiting cyclooxygenase enzymes. Although they are highly effective in managing pain and inflammation, their potential for increasing bleeding risks continues to be a concern. Due to the increased risk for bleeding complications following surgical procedures, the safety of perioperative NSAIDs is debated.

Transbaffle, Endocardial Systemic Right Ventricle Cardiac Resynchronization Therapy in D-Transposition of the Great Arteries.

Background: Systemic right ventricular (SRV) cardiomyopathy commonly complicates d-transposition of the great arteries with previous atrial switch repair. Cardiac resynchronization therapy (CRT) is an effective therapy but may be difficult to achieve conventionally via coronary sinus (CS) lead implantation.

Case Summary: A 58-year-old man with a history of d-transposition of the great arteries and prior Mustard procedure presented with progressive dyspnea and QRS duration >200 milliseconds.

Utilizing Instagram Stories to deliver educational content to medical students in pediatrics: curricular design and evaluation.

Utilization of social media has been described in medical education, but Instagram as an educational platform for the pediatric clerkship has not yet been reported. We created a 29-item Instagram Story curriculum with summative examination-relevant topics to supplement the pediatric clerkship for third-year medical students. Engagement in the Instagram curriculum was assessed by measuring Storyviews, calculating Story retention rates (number of users who viewed al lslides/number of users who viewed the first slide  100) and analyzing mini-quizperformance.

Prescribing Blood Flow-Restricted Cycling Using Rating of Perceived Exertion Balances the Physiological and Perceptual Demands in Young Healthy Adults.

To compare the physiological and perceptual responses during fixed-power and perceptually regulated cycling, both without and with blood flow restriction (CON, BFR, CON and BFR). Twelve recreationally active men cycled for 10 min at the power corresponding to the first ventilatory threshold or, for CON and BFR the perceived exertion level reported during CON. Blood flow restriction was set at 60% of estimated arterial occlusion pressure.

Equal Opportunity and Luck: Empirical Exploration Using the Canadian Longitudinal Study on Aging.

Equality of opportunity (EOp) is a broad category of egalitarian theories that has attracted considerable attention in recent decades. Empirical implementations of EOp primarily focus on the explained component of inequality, classifying determinants of the outcome (e.g.

Associations Among Minority Stress, Allostatic Load, and Drug and Alcohol Use in Sexual Minorities: Protocol for the Queer Health Study-a Longitudinal Feasibility Evaluation.

Background: Substance use rates among sexual minorities are disproportionately greater than that of their heterosexual counterparts. Minority stress theory posits that one explanation for disproportionate substance use in sexual minority populations is a result of increased social stress associated with holding a minoritized identity. This minority stress has been linked to a myriad of negative mental health outcomes, including alcohol and drug use.

New monstersaur specimens from the Kaiparowits Formation of Utah reveal unexpected richness of large-bodied lizards in Late Cretaceous North America.

Monstersauria (Squamata, Anguimorpha) fossils are present in most Upper Cretaceous sedimentary basins in western North America, but despite almost a century of collection, their record remains extremely fragmentary. Here, we describe new material belonging to large-bodied monstersaurs, including a new taxon, gen. et sp.

Conserved C143 forms a branched intermediate in Hedgehog autoprocessing: A cancer drug discovery target against Hedgehog signaling.

Hedgehog (Hh) signaling plays fundamental roles in embryonic development while its abnormal activation in adults is associated with cancer. Hh targeting drugs have gained FDA approval but resistance emerged quickly, underlining the need for novel types of Hh inhibitors. Hh signaling is initiated by the Hh ligand, generated from the autoprocessing of Hh precursor.

Direct Procurement and Perfusion Using Hypothermic Oxygenated Perfusion for DCD Cardiac Allografts in North America.

Background: Donation after circulatory death (DCD) is a viable avenue for recovery of cardiac allografts for transplantation. Previous methods have utilized direct procurement and perfusion (DPP) using commercially available normothermic perfusion systems or in situ normothermic regional perfusion. A novel portable hypothermic oxygenated perfusion device (HOPE) (XVIVO Perfusion) has been developed and is in clinical trials for preservation of cardiac allografts.

Meta-analysis of a megafish: assessing patterns and predictors of Alligator Gar movement across multiple populations.

Background: Freshwater megafishes are among some of the most commercially and ecologically important aquatic organisms yet are disproportionately threatened with range and population reduction. Anthropogenic alterations of rivers influencing migrations are among the most significant causes for these declines. However, migratory fishes do not always respond similarly to movement barriers and thus it is necessary to develop models to predict movements of freshwater migratory fishes in the face of anthropogenic alteration.

Variations in the Medical Device Authorization and Reimbursement Landscape: A Case Study of 2 Cardiovascular Devices Across 4 Countries.

Background: The authorization process and coverage/reimbursement mechanisms for medical devices play critical roles in device adoption and usage. However, international variation in these processes remains poorly characterized, especially with regard to data transparency and the effects of reimbursement on usage.

Methods: This study examined publicly available databases, governmental agency recommendations and policies, and press releases from the United States, Canada, the United Kingdom, and the Netherlands to compare the regulatory approval processes and coverage/reimbursement mechanisms for 2 novel cardiovascular devices introduced in the early and late 2000's: the Watchman left atrial appendage occlusion device and the Impella percutaneous ventricular assist device.

Transcriptional regulation of the cylindrospermopsin biosynthesis (cyr) gene cluster in Raphidiopsis raciborskii AWT205.

Cyanobacterial harmful algal blooms (HABs), producing the hepatotoxin cylindrospermopsin (CYN), are among the most frequently reported globally. Although the gene cluster encoding CYN biosynthesis (cyr) has been sequenced, many aspects of CYN regulation are unresolved. This study investigates cyr transcriptional regulation in the cyanobacterium, Raphidiopsis raciborskii AWT205, through in silico analysis, reverse transcription quantitative PCR (RT-qPCR), and DNA-affinity capture assays (DACAs).

Medicare Risk Arrangement and Use and Outcomes Among Physician Groups.

Importance: Many physician groups are in 2-sided risk payment arrangements with Medicare Advantage plans (at-risk MA). Analysis of quality and health resource use under such arrangements may inform ongoing Medicare policy concerning payment and service delivery.

Objective: To compare quality and efficiency measures under 2 payment models: at-risk MA and fee-for-service (FFS) MA.

Intravenous Magnesium Sulfate as an Adjunct to Intravenous Ketamine for Acute Pain: A Case Series.

Intravenous (IV) magnesium sulfate, a versatile electrolyte, plays a pivotal role across various medical domains. From cardiac care to obstetrics, gastrointestinal to pulmonary therapies, the impact is far-reaching among acute care services. Notably, in the postoperative phase of care, it shares intriguing similarities with ketamine as an NMDA receptor antagonist.

Internalized Homonegativity is Indirectly Associated with Smoking Status through Somatic Anxiety.

Objective: In this study, we examined how internalized homonegativity (IH), a non-adaptive cognitive response to lesbian, gay, and bisexual (LGB) minority stressors, related to the manifestation of somatic anxiety symptoms and reduced the likelihood of being a former smoker.

Methods: Participants (N = 77) smoked ≥ 100 cigarettes in their lifetime, some of whom successfully quit their use (N = 23 former smokers). The Lesbian, Gay, and Bisexual Identity Scale and the State-Trait Inventory for Cognitive and Somatic Anxiety were used to assess IH and somatic anxiety.

Anti-seizure effects of norepinephrine-induced free fatty acid release.

The brain's ability to rapidly transition between sleep, quiet wakefulness, and states of high vigilance is remarkable. Cerebral norepinephrine (NE) plays a key role in promoting wakefulness, but how does the brain avoid neuronal hyperexcitability upon arousal? Here, we show that NE exposure results in the generation of free fatty acids (FFAs) within the plasma membrane from both astrocytes and neurons. In turn, FFAs dampen excitability by differentially modulating the activity of astrocytic and neuronal Na, K, ATPase.

Navigating the Postoperative Management of Remifentanil-Induced Hyperalgesia: A Case Report.

Opioid induced hyperalgesia in the postoperative setting presents a significant challenge for clinicians managing postoperative pain in opioid tolerant patients. Remifentanil is a fentanyl analog frequently utilized in anesthesia for its favorable pharmacokinetic profile. However, as described in the case report, it may also increase the risk of postoperative hyperalgesia.