The impact of terminating cost-sharing reductions payments on health insurance plan choices.

The Trump administration terminated cost-sharing reductions (CSRs) payments to health insurers in 2017, while still required insurers to provide CSRs to eligible enrollees in the Marketplace. Marketplace administration data reveals that, in response to this termination, insurers raised premiums to compensate for their loss. Consequently, premium increases led to more advanced premium tax credits for enrollees in the Marketplace. To investigate the impact of CSRs payment termination on low-income consumer insurance plan choices, I leverage variations in state price regulations and employed a difference-in-differences design. In a robustness analysis, I utilized differences in county income distributions to examine the effects of the termination on insurance choices. The results indicate that after the termination, more low-income enrollees opted for cheaper bronze plans, and fewer chose silver plans. These results suggest that alterations in subsidy channels may inadvertently encourage low-income individuals to purchase less expensive health insurance plans, highlighting an unintended consequence of the termination of cost-sharing subsidies.

Performance evaluation of plastic optical fiber communication using micro-lens coupling and computational temporal ghost imaging algorithm.

Plastic optical fiber communication (POFC) systems are particularly sensitive to signal performance and power budget. In this paper, we propose what we belive to be a novel scheme to jointly enhance the bit-error-ratio (BER) performance and coupling efficiency for multi-level pulse amplitude modulation (PAM-M) based POFC systems. The computational temporal ghost imaging (CTGI) algorithm is developed for PAM4 modulation for the first time to resist the system distortion. The simulation results reveal that enhanced BER performance and clear eye diagrams are acquired by using CTGI algorithm with an optimized modulation basis. Experimental results also investigate and show, with CTGI algorithm, the BER performance for 180 Mb/s PAM4 signals is enhanced from 2.2 × 10-2 to 8.4 × 10-4 over 10 m POF by using a 40 MHz photodetector. The POF link is equipped with micro-lenses at its end faces by using a ball-burning technique, which helps to increase the coupling efficiency from 28.64% to 70.61%. Both simulation and experimental results show that the proposed scheme is feasible to achieve a cost-effective and high-speed POFC system with short reach.

Effects of soluble Antarctic krill protein-curcumin complex combined with photodynamic inactivation on the storage quality of shrimp.

A new protein complex (SAKP-Cur) was successfully prepared by combining soluble Antarctic krill protein with curcumin through hydrophobic action. The potency of photodynamic inactivation (PDI) mediated by the complex on preserving the storage quality of shrimp at 4 °C was investigated by microbiological, chemical, physical and histological methods. Results showed that the SAKP-Cur significantly improved the stability of curcumin, and greatly inactivated the native bacteria in shrimp driven by PDI. Meanwhile, the complex-mediated PDI effectively reduced the endogenous enzyme activity, the production of total volatile basic nitrogen (TVB-N) and malondialdehyde (MDA) in shrimp. Moreover, it obviously maintained the integrity and elasticity of the muscle fibers, thereby reducing the loss of water in myofibrils. Notably, the SAKP-Cur enhanced the PDI potency to preserve the freshness of shrimp during 4 °C storage or freeze-thaw cycles treatment. Therefore, the SAKP-Cur coupled with PDI is an effective fresh-keeping technology for aquatic products.

Cutoff Point of Mini-Balance Evaluation Systems Test Scores for Elderly Estimated by Center of Pressure Measurements by Linear Regression and Decision Tree Classification.

BACKGROUND: Understanding balance ability and assessing the risk of possible falls are very important for elderly rehabilitation. The Mini-Balanced Evaluation System Test (Mini-BESTest) is an important survey for older adults to evaluate subject balance, but it is not easy to complete due to various limitations of physical activities, including occasional fear of injury. A center of pressure (CoP) signal can be extracted from a force pressure plate with a short recording time, and it is relatively achievable to ask subjects to stand on a force pressure plate in a clinical environment. The goal of this study is to estimate the cutoff score of Mini-BESTest scores from CoP data. METHODS: CoP signals from a human balance evaluation database with data from 75 people were used. Time domain, frequency domain, and nonlinear domain parameters of 60 s CoP signals were extracted to classify different cutoff point scores for both linear regression and a decision tree algorithm. Classification performances were evaluated by accuracy and area under a receiver operating characteristic curve. RESULTS: The correlation coefficient between real and estimated Mini-BESTest scores by linear regression is 0.16. Instead of linear regression, binary classification accuracy above or below a cutoff point score was developed to examine the CoP classification performance for Mini-BESTest scores. The decision tree algorithm is superior to regression analysis among scores from 16 to 20. The highest area under the curve is 0.76 at a cutoff point score of 21 for the CoP measurement condition of eyes opened on the foam, and the corresponding classification accuracy is 76.15%. CONCLUSIONS: CoP measurement is a potential tool to estimate corresponding balance and fall survey scores for elderly rehabilitation and is useful for clinical users.

Extraction of Interface-Trap Densities of the Stacked Bonding Structure in 3D Integration Using High-Frequency Capacitance-Voltage Technique.

An extraction method of the interface-trap densities (Dit) of the stacked bonding structure in 3D integration using high-frequency capacitance-voltage technique is proposed. First, an accurate high-frequency capacitance-voltage model is derived. Next, by numerically solving the charge-balance equation and charge conservation equation, Dit is extracted by fitting the measured and calculated capacitance-voltage curves based on the derived model. Subsequently, the accuracy of the derived model is verified by the agreements between the analytical results and TCAD simulation results. The average extraction error proves the precision and efficiency of the extraction method. Finally, the stacked bonding structure has been fabricated, and Dit at the interface between silicon and insulator is extracted to diagnose and calibrate the fabrication processes.

Aldo-Keto Reductase 1C3 Mediates Chemotherapy Resistance in Esophageal Adenocarcinoma via ROS Detoxification.

Esophageal adenocarcinoma (EAC) is one of the most lethal malignancies, and limits promising treatments. AKR1C3 represents a therapeutic target to combat the resistance in many cancers. However, the molecular mechanism of AKR1C3 in the chemotherapy resistance of EAC is still unclear. We found that the mRNA level of AKR1C3 was higher in EAC tumor tissues, and that high AKR1C3 expression might be associated with poor overall survival of EAC patients. AKR1C3 overexpression decreased cell death induced by chemotherapeutics, while knockdown of AKR1C3 attenuated the effect. Furthermore, we found AKR1C3 was inversely correlated with ROS production. Antioxidant NAC rescued chemotherapy-induced apoptosis in AKR1C3 knockdown cells, while the GSH biosynthesis inhibitor BSO reversed a protective effect of AKR1C3 against chemotherapy. AKT phosphorylation was regulated by AKR1C3 and might be responsible for eliminating over-produced ROS in EAC cells. Intracellular GSH levels were modulated by AKR1C3 and the inhibition of AKT could reduce GSH level in EAC cells. Here, we reported for the first time that AKR1C3 renders chemotherapy resistance through controlling ROS levels via AKT signaling in EAC cells. Targeting AKR1C3 may represent a novel strategy to sensitize EAC cells to conventional chemotherapy.

Method for controlling temperature sensitivity of the fiber intermodal sensor and its application in the torsion sensor.

Temperature crosstalk has always been a critical problem for fiber intermodal sensors. In this work, we have proposed a novel method based on the special temperature response of photosensitive fiber to control the temperature sensitivity of the fiber intermodal sensor. The control of temperature sensitivity has been realized via adjusting the proportion of photosensitive fiber to single-mode fiber in the sensing part. The temperature sensitivity as high as -192 pm/°C, and as low as -2.6 pm/°C can be obtained, satisfying the demand in both research and application. The torsion sensor is taken as an example to illustrate feasibility of this method, showing no evident interference in the measurement of torsion parameters. The proposed method outstrips the conventional one by simple structure, facile manufacture, multiple use and low cost, which brings great promise for further employment in laboratory and industry.

Targeting Glutaminolysis: New Perspectives to Understand Cancer Development and Novel Strategies for Potential Target Therapies.

Metabolism rewiring is an important hallmark of cancers. Being one of the most abundant free amino acids in the human blood, glutamine supports bioenergetics and biosynthesis, tumor growth, and the production of antioxidants through glutaminolysis in cancers. In glutamine dependent cancer cells, more than half of the tricarboxylic/critic acid (TCA) metabolites are derived from glutamine. Glutaminolysis controls the process of converting glutamine into TCA cycle metabolites through the regulation of multiple enzymes, among which the glutaminase shows the importance as the very first step in this process. Targeting glutaminolysis via glutaminase inhibition emerges as a promising strategy to disrupt cancer metabolism and tumor progression. Here, we review the regulation of glutaminase and the role of glutaminase in cancer metabolism and metastasis. Furthermore, we highlight the glutaminase inhibitor based metabolic therapy strategy and their potential applications in clinical scenarios.

Linking Cancer Stem Cell Plasticity to Therapeutic Resistance-Mechanism and Novel Therapeutic Strategies in Esophageal Cancer.

Esophageal cancer (EC) is an aggressive form of cancer, including squamous cell carcinoma (ESCC) and adenocarcinoma (EAC) as two predominant histological subtypes. Accumulating evidence supports the existence of cancer stem cells (CSCs) able to initiate and maintain EAC or ESCC. In this review, we aim to collect the current evidence on CSCs in esophageal cancer, including the biomarkers/characterization strategies of CSCs, heterogeneity of CSCs, and the key signaling pathways (Wnt/ß-catenin, Notch, Hedgehog, YAP, JAK/STAT3) in modulating CSCs during esophageal cancer progression. Exploring the molecular mechanisms of therapy resistance in EC highlights DNA damage response (DDR), metabolic reprogramming, epithelial mesenchymal transition (EMT), and the role of the crosstalk of CSCs and their niche in the tumor progression. According to these molecular findings, potential therapeutic implications of targeting esophageal CSCs may provide novel strategies for the clinical management of esophageal cancer.

[Analysis of dyslipidemia among patients with diabetes mellitus in Jilin Province communities].

OBJECTIVE: To investigate the pattern of dyslipidemia in patients with diabetes mellitus in Jilin province communities, and to provide a theoretical basis for the management of dyslipidemia among patients with diabetes. METHOD: Based on the prevalence and risk factors of chronic diseases survey among adults in Jilin Province 2012 used multistage stratified random sampling design, a total of 1825 community residents aged 18 -79 years-old with diabetes mellitus in 9 districts of Jilin Province undergo the survey with questionnaire(age, gender, history of chronic disease in the past one year), blood index detection (blood glucose, total cholesterol high density lipoprotein cholesterol, low density lipoprotein cholesterol and triglycerides), and anthropometric (height and weight). RESULT: Among 1825 patients with diabetes, 883 males (48.4%), 942 females (51. 6%); the mean age was (55.73 + 10. 27) years old. The mean values of TG,TC,LDL-C and HDL-C were 2. 17,5.17,3.10 and 1.20 mmol/L,the mean values of TC,LDL-C and HDL-C of female were higher than male(P <0. 001). The prevalence of dyslipidenmia. was 66.9% (69.0% in, male and 65.0% in female). The prevalence of dyslipidemia in male was decreased with increasing age(P <0. 001) , the prevalence of dyslipidemia in female was increased with age (P <0. 001). In age groups of 18- , 35 - and 45 - years, the prevalence of dyslipidemia in male was higher than female (P <0. 05,P <0. 001 ,P <0. 001)', however, it was lower than female in 55 - and 65 - 79 years old grouips (P < 0.: 05). The prevalence of dyslipidemia of overweight '(71. 8%) and obesity (75. 8%) was higher than normal subjects. Among patients with diabetes, 19. 2% had high total cholesterol, 47. 8% had high triglyceride, 14. 5% had high levels of low-density lipoprotein cholesterol, 29. 2% had low high-density lipoprotein cholesterol. The proportion of diabetic patients two serum lipid values outside of clinical target were 27. 1% , the most prevalent dyslipidemia pattern among diabetic patients was a combination of TG above goal with HDL-C below target, which was observed in 17. 4 % of the patients. The second most common pattern of dyslipidemia was isolated TG increase, which was observed in 15, 9% of the patients. CONCLUSION: The mean values of TG,TC, LDL-C and HDL-C among community residents with diabetes mellitus in Jilin province were higher than the general population. The prevalence of dyslipidemia in male aged 18 -54 years, female aged 55 years and above and overweight or obesity was high; the most prevalent dyslipidemia pattern among diabetic patients was a combination of TG above goal with HDL_C below target.

[Investigation on rates of awareness, treatment and control of diabetes mellitus and the influence factors in rural areas of Jilin province].

OBJECTIVE: Assess the rates of awareness, treatment and control of diabetes mellitus and the influence factors in rural areas of Jilin province. METHODS: Multistage stratified random cluster sampling design was used to select participants that carried out with questionnaire interview and physical examination. The analysis was based on a representative sample of 923 diabetes mellitus. Multiple logistic regressions were used to examine socio-demographic factors associated with the levels of awareness, treatment and control of diabetes. RESULTS: Diabetes awareness, treatment, control and control among treated were 68. 9% ,57. 7% ,23. 9% and 41. 5% , respectively in rural area of Jilin province. Multivariable logistic regression analysis showed that the main effect factors on the rates of awareness were gender, family history of diabetes, smoke, drink and exercise. The rates of treatment were associated with age, occupation, family history of diabetes, drink and exercise, and the rates of control were associated gender. CONCLUSIONS: The rates of awareness, treatment and control of diabetes mellitus were expected to be improved in rural areas of Jilin province. The effective preventive strategies which concentrate on the influence factors should be taken to control their blood glucose level.