Association of Nonprofit Hospitals' Charitable Activities With Unreimbursed Medicaid Care After Medicaid Expansion.

Importance: In the United States, nonprofit hospitals receive tax-exempt status with the expectation that they provide a high level of benefit to local communities. Prior work has shown that Medicaid expansion reduced hospital spending on uncompensated care. Objective: To measure the association of tax-exempt hospital spending with community benefit and changes in uncompensated care after Medicaid expansion. Design, Setting, and Participants: This cohort study was performed using a difference-in-differences analysis (ie, a pre-post treatment-control design) to estimate changes in reported charitable categories associated with Medicaid expansion. Data from Internal Revenue Service form 990, Schedule H, tax filings for 2253 tax-exempt hospitals in the United States from 2012 to 2016 were used. Data were analyzed from June to November 2019. Exposure: The proportion of the hospital's tax filing that spanned the period after Medicaid expansion. Main Outcomes and Measures: Hospital-reported spending on uncompensated care, unreimbursed Medicaid expenses, and other community benefit spending categories. Results: Across 2253 hospitals, mean (SD) uncompensated care costs between 2012 and 2016 were $4.20 million ($8.80 million) and unreimbursed Medicaid expenses were $7.60 million ($18.62 million). Compared with tax-exempt hospitals in states that did not expand Medicaid, those in states that did expand Medicaid reported mean reductions in their provision of uncompensated care of $1.11 million (95% CI, $0.35 million to $1.87 million; P < .001), representing a mean change of -2% (95% CI, -6% to 2%; P < .001). These reductions have been offset by mean reported increases in the provision of unreimbursed Medicaid expenses of $1.63 million (95% CI, $0.31 million to $2.94 million; P = .02), representing a mean increase of 2% (95% CI, 1% to 4%; P = .01). Tax-exempt hospitals in states that expanded Medicaid reported no statistically significant mean increase in spending on other community benefit activities. Conclusions and Relevance: In this study, large decreases in uncompensated care among tax-exempt hospitals associated with Medicaid expansion were not accompanied by increases in other reportable categories of community health benefit spending. Instead, they were accompanied by increased spending on unreimbursed Medicaid expenses.

Experimental Protocol for Using Drosophila As an Invertebrate Model System for Toxicity Testing in the Laboratory.

Emergent properties and external factors (population-level and ecosystem-level interactions, in particular) play important roles in mediating ecologically-important endpoints, though they are rarely considered in toxicological studies. D. melanogaster is emerging as a toxicology model for the behavioral, neurological, and genetic impacts of toxicants, to name a few. More importantly, species in the genus Drosophila can be utilized as a model system for an integrative framework approach to incorporate emergent properties and answer ecologically-relevant questions in toxicology research. The aim of this paper is to provide a protocol for exposing species in the genus Drosophila to pollutants to be used as a model system for a range of phenotypic outputs and ecologically-relevant questions. More specifically, this protocol can be used to 1) link multiple biological levels of organization and understand the impact of toxicants on both individual- and population-level fitness; 2) test the impact of toxicants at different stages of developmental exposure; 3) test multigenerational and evolutionary implications of pollutants; and 4) test multiple contaminants and stressors simultaneously.

Concurrent zero-dimensional and one-dimensional biomineralization of gold from a solution of Au3+ and bovine serum albumin.

A technique was developed for preparing a novel material that consists of gold nanoparticles trapped within a fiber of unfolded proteins. These fibers are made in an aqueous solution that contains HAuCl4 and the protein, bovine serum albumin (BSA). By changing the ratio of gold to BSA in solution, two different types of outcomes are observed. At lower gold to BSA ratios (30-120), a purple solution results after heating the mixture at 80 °C for 4 h. At higher gold to BSA ratios (130-170), a clear solution containing purple fibers results after heating the mixture at 80 °C for 4 h. UV-Vis spectroscopy and light scattering techniques show growth in nanocolloid size as gold to BSA ratio rises above 100. Data indicate that, for the higher gold to BSA ratios, the gold is sequestered within the solid material. The material mass, visible by eye, appears to be an aggregation of smaller individual fibers. Scanning electron microscopy and transmission electron microscopy indicate that these fibers are primarily one-dimensional aggregates, which can display some branching, and can be as narrow as 400 nm in size. The likely mechanism for the synthesis of the novel material is discussed.

A real options approach to clinical faculty salary structure.

One can use the option theory model originally developed to price financial opportunities in security markets to analyze many other economic arrangements such as the salary structures of clinical faculty in an academic medical center practice plan. If one views the underlying asset to be the portion (labeled "salary") of the economic value of the collections made for the care provided patients by the physician, then a salary guarantee can be considered a put option provided the physician, the guarantee having value to the physician only when the actual salary earned is less than the salary guarantee. Similarly, within an incentive plan, a salary cap can be thought of as a call option provided to the practice plan since a salary cap only has value to the practice plan when a physician's earnings exceed the cap. Further, based on analysis of prior earnings, the Black-Scholes options pricing model can be used both to price each option and to determine a financially neutral balance between a salary guarantee and a salary cap by equating the prices of the implied put and call options. We suggest that such analysis is superior to empirical methods for setting clinical faculty salary structure in the academic practice plan setting.

Crystal structure of the ionic liquid EtNH3NO3-insights into the thermal phase behavior of protic ionic liquids.

The crystal structure of the salt ethylammonium nitrate (EtNH(3)NO(3)) has been determined. EtNH(3)NO(3) is one of the most widely studied protic ionic liquids (PILs)-ILs formed by proton transfer from a Brønsted acid to a Brønsted base. The structural features from the crystal structure, in concert with a Raman spectroscopic analysis of the ions, provide direct insight as to why EtNH(3)NO(3) melts below ambient temperature, while other related salts (such as EtNH(3)Cl) do not.

Fluorescence monitoring of ionic liquid-facilitated biopolymer mobilization and reorganization.

Ionic liquid-facilitated mobilization and reorganization of biopolymers in natural fibrous materials is visualized by confocal fluorescent spectromicroscopy. Ionic liquid-based processes controllably fuse adjacent fibres while simultaneously leaving selected amounts of biopolymers in their native states. These processes generate congealed materials with extended intermolecular hydrogen bonding networks and enhanced properties.

3-(1-Methyl-3-imidazolio)propane-sulfonate: a precursor to a Brønsted acid ionic liquid.

The title compound, C(7)H(12)N(2)O(3)S, is a zwitterion precursor to a Brønsted acid ionic liquid with potential as an acid catalyst. The C-N-C-C torsion angle of 100.05 (8)° allows the positively charged imidazolium head group and the negatively charged sulfonate group to inter-act with neighboring zwitterions, forming a C-H⋯O hydrogen-bonding network; the shortest among these inter-actions is 2.9512 (9) Å. The C-H⋯O inter-actions can be described by graph-set notation as two R(2) (2)(16) and one R(2) (2)(5) hydrogen-bonded rings.

Use of a polyhedral oligomeric silsesquioxane (POSS)-imidazolium cation as an organic modifier for montmorillonite.

Recent studies on organically modified clays (OMCs) have reported enhanced thermal stabilities when using imidazolium-based surfactants over the typical ammonium-based surfactants. Other studies have shown that polyhedral oligomeric silsesquioxanes (POSS) also improve the thermal properties of composites containing these macromers. In an attempt to utilize the beneficial properties of both imidazolium surfactants and POSS macromers, a dual nanocomposite approach to prepare OMCs was used. In this study, the preparation of a new POSS-imidazolium surfactant and its use as an organic modifier for montmorillonite are reported. The purity, solubility, and thermal characteristics of the POSS-imidazolium chloride were evaluated. In addition, several OMCs were prepared by exchanging the Na+ with POSS imidazolium cations equivalent to 100%, 95%, 40%, 20%, and 5% of the cation exchange capacity of the clay. The subsequent OMCs were characterized using thermal analysis techniques (DSC, SDT, and TGA) as well as 29Si NMR to determine the POSS content in the clay interlayer both before and after thermal oxidation degradation. Results indicate the following: (1) the solvent choice changes the efficiency of the ion-exchange reaction of the clay; (2) self-assembled crystalline POSS domains are present in the clay interlayer; (3) the d-spacing of the exchanged clay is large (3.6 nm), accommodating a bilayer structure of the POSS-imidazolium; and (4) the prepared POSS-imidazolium exchanged clays exhibit higher thermal stabilities than any previously prepared imidazolium or ammonium exchanged montmorillonite.

The Master of Medical Management (MMM) degree: an analysis of alumni perceptions.

Innovation in health administration education stimulates administrators and faculty to identify unmet educational needs within the health sector. In 1997, the inaugural class of the Master of Medical Management (MMM) at Tulane University graduated, signaling an individual achievement for all graduates and an accomplishment in innovation and collaboration in health administration education. Tulane University, in partnership with The American College of Physician Executives (ACPE), designed a unique health administration degree to meet the distinctive needs of physicians serving in executive and managerial roles or seeking to serve in such roles in the future. Since 1997, there are nearly 700 MMM graduates who hail from Carnegie Mellon, Tulane University, and the University of Southern California. ACPE administered a survey to 500 MMM alumni in the fall of 2005. The response rate was 47% (235 of 500). The findings from this survey describe the reasons why physicians decided to enroll in the MMM, their experiences as MMM students, and their perceptions of how the MMM had an impact on their careers. Moreover, in this article, recommendations are offered related to the design and delivery of innovative educational programs for emerging disciplines within the health sector.

Complementary and alternative medicine: opportunities and challenges.

Complementary and alternative medicine (CAM) has emerged as a significant sector within the health care industry as patient demand has increased, as the number and diversity of providers has grown, and as more providers deliver evidence-based CAM modalities to patients. The challenges confronting health care organizations that offer CAM are both similar and dissimilar to organizations that do not offer CAM. The unique challenges will be described in a way to provide academics and health care finance practitioners with a plan to address these challenges which range from lack of third-party coverage to lack of knowledge about financing CAM among patients and providers. Not only will the unique challenges be described but the distinctive opportunities to finance CAM will be highlighted. These opportunities will be discussed from both a financial perspective and innovation perspective with the aim of providing academics and health care financial practitioners with a rationale to offer CAM to patients and get compensated for providing these services.

Alkyl vs. alkoxy chains on ionic liquid cations.

The crystal structures and thermal behavior of the 1-(2-methoxyethyl)-2,3-dimethylimidazolium chloride and hexa-fluorophosphate salts are compared with the analogous 1-butyl-2,3-dimethylimidazolium salts to examine the influence of the ether oxygen on salt thermal properties for a typical constituent cation used in the preparation of ionic liquids.

New disordering mode for TFSI- anions: the nonequilibrium, plastic crystalline structure of Et4NTFSI.

A new TFSI- anion disordering mode has been discovered in a supercooled plastic crystalline phase of Et4NTFSI, which may, in part, account for the low melting points of TFSI- salts with organic cations, thereby forming ionic liquids, and the intriguing properties of LiTFSI for lithium battery applications.

Dissolution and regeneration of Bombyx mori silk fibroin using ionic liquids.

In this work, the suitability of imidazolium-based ionic liquid solvents is investigated for the dissolution and regeneration of silkworm (Bombyx mori) silk. Within an ionic liquid the anion plays a larger role in dictating the ultimate solubility of the silk. The dissolution of the silk in the ionic liquid is confirmed using wide-angle X-ray scattering. The dissolved silk is also processed into 100 mum-thick, two-dimensional films, and the structure of these films is examined. The rinse solvent, acetonitrile or methanol, has a profound impact on both the topography of the films and the secondary structure of the silk protein. The image depicts a silkworm cocoon dissolved in 1-butyl-3-methylimidazolium chloride and then regenerated as a film with birefringence.