Total and Out-of-Pocket Costs Surrounding Emergency Department Care Among Older Adults Enrolled in Traditional Medicare and Medicare Advantage.

STUDY OBJECTIVE: We sought to quantify differences in total and out-of-pocket health care costs associated with treat-and-release emergency department (ED) visits among older adults with traditional Medicare and Medicare Advantage. METHODS: We conducted a repeated cross-sectional analysis of treat-and-release ED visits using 2015 to 2020 data from the Medicare Current Beneficiary Survey. We measured total and out-of-pocket health care spending during 3 time periods: the 30 days prior to the ED visit, the treat-and-release ED visit itself, and the 30 days after the ED visit. Stratified by traditional Medicare or Medicare Advantage status, we determined median total costs and the proportion of costs that were out-of-pocket. RESULTS: Among the 5,011 ED visits by those enrolled in traditional Medicare, the weighted median total (and % out-of-pocket) costs were $881.95 (13.3%) for the 30 days prior to the ED visit, $419.70 (10.1%) for the ED visit, and $809.00 (13.8%) for the 30 days after the ED visit. For the 2,595 ED visits by those enrolled in Medicare Advantage, the weighted median total (and % out-of-pocket) costs were $484.92 (24.0%) for the 30 days prior to the ED visit, $216.66 (21.9%) for the ED visit, and $439.13 (22.4%) for the 30 days after the ED visit. CONCLUSION: Older adults insured by Medicare Advantage incur lower total health care costs and face similar overall out-of-pocket expenses in the time period surrounding emergency care. However, a higher proportion of expenses are out-of-pocket compared with those insured by traditional Medicare, providing evidence of greater cost sharing for Medicare Advantage plan enrollees.

sRNA-Effector: A tool to expedite discovery of small RNA regulators.

microRNAs (miRNAs) are small regulatory RNAs that repress target mRNA transcripts through base pairing. Although the mechanisms of miRNA production and function are clearly established, new insights into miRNA regulation or miRNA-mediated gene silencing are still emerging. In order to facilitate the discovery of miRNA regulators or effectors, we have developed sRNA-Effector, a machine learning algorithm trained on enhanced crosslinking and immunoprecipitation sequencing and RNA sequencing data following knockdown of specific genes. sRNA-Effector can accurately identify known miRNA biogenesis and effector proteins and identifies 9 putative regulators of miRNA function, including serine/threonine kinase STK33, splicing factor SFPQ, and proto-oncogene BMI1. We validated the role of STK33, SFPQ, and BMI1 in miRNA regulation, showing that sRNA-Effector is useful for identifying new players in small RNA biology. sRNA-Effector will be a web tool available for all researchers to identify potential miRNA regulators in any cell line of interest.

Performance of FIB4 and APRI scores for the prediction of fibrosis in patients with chronic hepatitis B virus infection.

BACKGROUND: The evaluation of hepatic fibrosis is essential in the therapeutic management of chronic hepatitis B virus infection. The development of non-invasive tests for liver fibrosis assessement has allowed to avoid liver biops in some cases. AIM: To assess the performance of the scores APRI and FIB-4 in the assessment of significant fibrosis in chronic hepatitis B virus infection. METHODS: Evaluation study, including patients with chronic hepatitis B virus infection who had a liver biopsy. The accuracy of APRI and FIB4  for the detection of significant fibrosis was compared with  the liver biopsy data. RESULTS: One hundred and one patients were included. Significant fibrosis was found in 10.9% of patients. For a cut-off value of 0.49, the APRI score predicted significant fibrosis with a sensitivity of 54%, a specificity of 93% and a negative predictive value of 94%. For a cut-off value of 1.01, the FIB-4 score predicted significant fibrosis with a sensitivity of 64%, a specificity of 84% and a negative predictive value of 95%. Performance of both scores was influenced by age, the body mass index, and cytolysis. CONCLUSION: The APRI and FIB-4 scores had a good accuracy to exclude significant fibrosis in chronic hepatitis B virus infection.