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OBJECTIVE: The Impact of Event Scale-Revised (IES-R) is a widely used self-report for assessing posttraumatic stress disorder (PTSD), originally aligned with Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV diagnostic criteria. This study aimed to evaluate the applicability of the IES-R under the DSM-5 guidelines and establish a cutoff point for DSM-5 PTSD diagnosis. METHODS: A total of 238 participants recruited from multiple psychiatric centers, including 67 patients with PTSD, 72 patients with psychiatric controls, and 99 healthy controls, were included in the study. All participants completed the Korean version of the Structured Clinical Interview for the DSM-5 research version to confirm the presence of PTSD, the Korean version of PTSD Checklist for DSM-5 (PCL-5), the Beck Depression Inventory-II, the Beck Anxiety Inventory, and the Spielberger State Trait Anxiety Inventory. RESULTS: The IES-R demonstrated good internal consistency and a high correlation with the PCL-5. Through factor analysis, 5 distinct dimensions emerged within the IES-R: sleep disturbance, intrusion, hyperarousal, avoidance, and numbness-dissociation. A proposed cutoff score of 25 on the IES-R was suggested for identifying patients with PTSD. CONCLUSION: These findings underscore the scale's concurrent validity with the DSM-5 PTSD criteria and its effectiveness as a screening tool. Implementing a cutoff score of 25 on the IES-R can enhance its utility in identifying DSM-5 PTSD cases.
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Recently, volatile organic compounds (VOCs) have been shown to act as precursors of secondary organic particles that react with ultraviolet rays in the atmosphere and contribute to photochemical smog, global warming, odor, and human health risks, highlighting the importance of VOC management. In this study, we measured VOC concentrations in various contexts including industrial and residential areas of Bucheon, Korea, through mobile laboratory and proton-transfer-reaction time-of-flight mass spectrometry methods to determine winter VOC concentrations and visualized the data based on spatial information. Regional characteristics, temperature/humidity, atmospheric conditions, wind speed, traffic volume, etc., during the measurement period of the study site were comprehensively reviewed. For this purpose, global information system (GIS)-based air quality data and various environmental variables were comprehensively reviewed to assess spatial and temporal concentrations in three dimensions rather than in tables and graphs. Among VOCs, the levels of toluene, methanol, and n + i-butene were relatively high, with average concentrations of 48.3 ± 67.2, 34.4 ± 102.7, and 32.6 ± 57.7 ppb, respectively, at the end of the working day. The highest concentrations occurred near the Ojeong Industrial Complex. Mobile pollution sources are also a major driver of VOCs, highlighting the necessity of comprehensively reviewing traffic variables such as road level, estimated traffic volume, and average speed when identifying hotspots of air pollution. GIS-based visualization analysis techniques will improve the efficiency of air quality management.
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Importance: The Centers for Medicare & Medicaid Services' mandatory End-Stage Renal Disease Treatment Choices (ETC) model, launched on January 1, 2021, randomly assigned approximately 30% of US dialysis facilities and managing clinicians to financial incentives to increase the use of home dialysis and kidney transplant. Objective: To assess the ETC's association with use of home dialysis and kidney transplant during the model's first 2 years and examine changes in these outcomes by race, ethnicity, and socioeconomic status. Design, Setting, and Participants: This retrospective cross-sectional study used claims and enrollment data for traditional Medicare beneficiaries with kidney failure from 2017 to 2022 linked to same-period transplant data from the United Network for Organ Sharing. The study data span 4 years (2017-2020) before the implementation of the ETC model on January 1, 2021, and 2 years (2021-2022) following the model's implementation. Exposure: Receiving dialysis treatment in a region randomly assigned to the ETC model. Main Outcomes and Measures: Primary outcomes were use of home dialysis and kidney transplant. A difference-in-differences (DiD) approach was used to estimate changes in outcomes among patients treated in regions randomly selected for ETC participation compared with concurrent changes among patients treated in control regions. Results: The study population included 724â¯406 persons with kidney failure (mean [IQR] age, 62.2 [53-72] years; 42.5% female). The proportion of patients receiving home dialysis increased from 12.1% to 14.3% in ETC regions and from 12.9% to 15.1% in control regions, yielding an adjusted DiD estimate of -0.2 percentage points (pp; 95% CI, -0.7 to 0.3 pp). Similar analysis for transplant yielded an adjusted DiD estimate of 0.02 pp (95% CI, -0.01 to 0.04 pp). When further stratified by sociodemographic measures, including age, sex, race and ethnicity, dual Medicare and Medicaid enrollment, and poverty quartile, there was not a statistically significant difference in home dialysis use across joint strata of characteristics and ETC participation. Conclusions and Relevance: In this cross-sectional study, the first 2 years of the ETC model were not associated with increased use of home dialysis or kidney transplant, nor changes in racial, ethnic, and socioeconomic disparities in these outcomes.
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Hemodiálisis en el Domicilio , Fallo Renal Crónico , Trasplante de Riñón , Reembolso de Incentivo , Humanos , Femenino , Masculino , Estudios Transversales , Hemodiálisis en el Domicilio/estadística & datos numéricos , Hemodiálisis en el Domicilio/economía , Estados Unidos , Estudios Retrospectivos , Fallo Renal Crónico/terapia , Fallo Renal Crónico/cirugía , Anciano , Persona de Mediana Edad , MedicareRESUMEN
Enrollment in Medicare Advantage (MA) has been rapidly growing. We examined whether MA enrollment affects the outcomes of post-acute nursing home care among patients with Alzheimer's disease and related dementias (ADRD). We exploited year-to-year changes in MA penetration rates within counties from 2012 through 2019. After adjusting for patient-level characteristics and county fixed effects, we found that MA enrollment was not associated with days spent at home, nursing home days, likelihood of becoming a long-stay resident, hospital days, hospital readmission, or 1-year mortality. There was a modest increase in successful discharge to the community by 0.73 percentage points (relative increase of 2.4%) associated with a 10-percentage-point increase in MA enrollment. The results are consistent among racial/ethnic subgroups and dual-eligible patients. These findings suggest an imperative need to monitor and improve quality of managed care among enrollees with ADRD.
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Background/Objectives: to evaluate the association between androgen deprivation therapy (ADT) and newly developed neovascular age-related macular degeneration (AMD) in patients with prostate cancer. Methods: We identified 228,803 men from the nationwide claims database in the Republic of Korea diagnosed with prostate cancer between 1 August 2009 and 31 December 2018 and followed until April 2021. Cases were defined as those newly diagnosed with neovascular AMD during follow-up. Cases were matched with controls based on age, index date, and follow-up duration, at a case-to-control ratio of 1:4. Adjusted odds ratios (aORs) of incident neovascular AMD associated with ADT were estimated using conditional logistic regression. Results: The main analysis included 1700 cases and 6800 controls, with a median follow-up of 3.42 years. ADT was associated with a reduced risk of incident neovascular AMD in patients with prostate cancer (aOR = 0.840; 95% confidence interval [CI], 0.743-0.951; p = 0.0058) in the multivariable analysis. A cumulative ADT duration less than 1 year was associated with a reduced risk of neovascular AMD (aOR = 0.727; 95% CI, 0.610-0.866; p = 0.0004); however, no association was observed when the duration of ADT was between 1 and 2 years (aOR = 0.862; 95% CI, 0.693-1.074; p = 0.1854) or more than 2 years (aOR = 1.009; 95% CI, 0.830-1.226; p = 0.9304). Conclusions: In patients with prostate cancer, medical castration for less than a year is associated with a reduced risk of incident neovascular AMD. These results suggest that androgens are involved in the pathogenesis of neovascular AMD.
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With Medicare Advantage (MA) enrollment surpassing 50 percent of Medicare beneficiaries, accurate risk-adjusted plan payment rates are essential. However, artificially exaggerated coding intensity, where plans seek to enhance measured health risk through the addition or inflation of diagnoses, may threaten payment rate integrity. One factor that may play a role in escalating coding intensity is health risk assessments (HRAs)-typically in-home reviews of enrollees' health status-that enable plans to capture information about their enrollees. In this study, we evaluated the impact of HRAs on Hierarchical Condition Categories (HCC) risk scores, variation in this impact across contracts, and the aggregate payment impact of HRAs, using 2019 MA encounter data. We found that 44.4 percent of MA beneficiaries had at least one HRA. Among those with at least one HRA, HCC scores increased by 12.8 percent, on average, as a result of HRAs. More than one in five enrollees had at least one additional HRA-captured diagnosis, which raised their HCC score. Potential scenarios restricting the risk-score impact of HRAs correspond with $4.5-$12.3 billion in reduced Medicare spending in 2020. Addressing increased coding intensity due to HRAs will improve the value of Medicare spending and ensure appropriate payment in the MA program.
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Medicare Part C , Ajuste de Riesgo , Humanos , Estados Unidos , Medicare Part C/economía , Medición de Riesgo , Anciano , Masculino , Femenino , Gastos en Salud/estadística & datos numéricos , Estado de Salud , Anciano de 80 o más AñosRESUMEN
Importance: The End-Stage Renal Disease Treatment Choices (ETC) model randomly selected 30% of US dialysis facilities to receive financial incentives based on their use of home dialysis, kidney transplant waitlisting, or transplant receipt. Facilities that disproportionately serve populations with high social risk have a lower use of home dialysis and kidney transplant raising concerns that these sites may fare poorly in the payment model. Objective: To examine first-year ETC model performance scores and financial penalties across dialysis facilities, stratified by their incident patients' social risk. Design, Setting, and Participants: A cross-sectional study of 2191 US dialysis facilities that participated in the ETC model from January 1 through December 31, 2021. Exposure: Composition of incident patient population, characterized by the proportion of patients who were non-Hispanic Black, Hispanic, living in a highly disadvantaged neighborhood, uninsured, or covered by Medicaid at dialysis initiation. A facility-level composite social risk score assessed whether each facility was in the highest quintile of having 0, 1, or at least 2 of these characteristics. Main Outcomes and Measures: Use of home dialysis, waitlisting, or transplant; model performance score; and financial penalization. Results: Using data from 125â¯984 incident patients (median age, 65 years [IQR, 54-74]; 41.8% female; 28.6% Black; 11.7% Hispanic), 1071 dialysis facilities (48.9%) had no social risk features, and 491 (22.4%) had 2 or more. In the first year of the ETC model, compared with those with no social risk features, dialysis facilities with 2 or more had lower mean performance scores (3.4 vs 3.6, P = .002) and lower use of home dialysis (14.1% vs 16.0%, P < .001). These facilities had higher receipt of financial penalties (18.5% vs 11.5%, P < .001), more frequently had the highest payment cut of 5% (2.4% vs 0.7%; P = .003), and were less likely to achieve the highest bonus of 4% (0% vs 2.7%; P < .001). Compared with all other facilities, those in the highest quintile of treating uninsured patients or those covered by Medicaid experienced more financial penalties (17.4% vs 12.9%, P = .01) as did those in the highest quintile in the proportion of patients who were Black (18.5% vs 12.6%, P = .001). Conclusions: In the first year of the Centers for Medicare & Medicaid Services' ETC model, dialysis facilities serving higher proportions of patients with social risk features had lower performance scores and experienced markedly higher receipt of financial penalties.
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Disparidades en Atención de Salud , Fallo Renal Crónico , Reembolso de Incentivo , Diálisis Renal , Autocuidado , Determinantes Sociales de la Salud , Anciano , Femenino , Humanos , Masculino , Negro o Afroamericano/estadística & datos numéricos , Población Negra/estadística & datos numéricos , Estudios Transversales , Disparidades en Atención de Salud/economía , Disparidades en Atención de Salud/etnología , Disparidades en Atención de Salud/estadística & datos numéricos , Hispánicos o Latinos/estadística & datos numéricos , Fallo Renal Crónico/economía , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/etnología , Fallo Renal Crónico/terapia , Trasplante de Riñón/estadística & datos numéricos , Medicaid/economía , Medicaid/estadística & datos numéricos , Pacientes no Asegurados/estadística & datos numéricos , Modelos Económicos , Reembolso de Incentivo/economía , Reembolso de Incentivo/estadística & datos numéricos , Diálisis Renal/economía , Diálisis Renal/métodos , Diálisis Renal/estadística & datos numéricos , Determinantes Sociales de la Salud/economía , Determinantes Sociales de la Salud/etnología , Determinantes Sociales de la Salud/estadística & datos numéricos , Estados Unidos/epidemiología , Poblaciones Vulnerables/estadística & datos numéricos , Listas de Espera , Autocuidado/economía , Autocuidado/métodos , Autocuidado/estadística & datos numéricosRESUMEN
Switchable tribological properties of ferroelectrics offer an alternative route to visualize and control ferroelectric domains. Here, we observe the switchable friction and wear behavior of ferroelectrics using a nanoscale scanning probe-down domains have lower friction coefficients and show slower wear rates than up domains and can be used as smart masks. This asymmetry is enabled by flexoelectrically coupled polarization in the up and down domains under a sufficiently high contact force. Moreover, we determine that this polarization-sensitive tribological asymmetry is widely applicable across various ferroelectrics with different chemical compositions and crystalline symmetry. Finally, using this switchable tribology and multi-pass patterning with a domain-based dynamic smart mask, we demonstrate three-dimensional nanostructuring exploiting the asymmetric wear rates of up and down domains, which can, furthermore, be scaled up to technologically relevant (mm-cm) size. These findings demonstrate that ferroelectrics are electrically tunable tribological materials at the nanoscale for versatile applications.
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The synergistic catalytic performances of bimetallic catalysts are often attributed to the reaction mechanism associated with the alloying process of the catalytic metals. Chemically induced hot electron flux is strongly correlated with catalytic activity, and the interference between two metals at the atomic level can have a huge impact on the hot electron generation on the bimetallic catalysts. In this study, we investigate the correlation between catalytic synergy and hot electron chemistry driven by the electron coupling effect using a model system of Au-Pd bimetallic nanoparticles. We show that the bimetallic nanocatalysts exhibit enhanced catalytic activity under the hydrogen oxidation reaction compared with that of monometallic Pd nanocatalysts. Analysis of the hot electron flux generated in each system revealed the formation of Au/PdOx interfaces, resulting in high reactivity on the bimetallic catalyst. In further experiments with engineering the Au@Pd core-shell structures, we reveal that the hot electron flux, when the topmost surface Pd atoms were less affected by inner Au, due to the concrete shell, was smaller than the alloyed one. The alloyed bimetallic catalyst forming the metal-oxide interfaces has a more direct effect on the hot electron chemistry, as well as on the catalytic reactivity. The great significance of this study is in the confirmation that the change in the hot electron formation rate with the metal-oxide interfaces can be observed by shell engineering of nanocatalysts.
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Driven by industrialization and urbanization, urban air pollution can increase respiratory, heart, and cerebrovascular diseases, and thus mortality rates; as such, it is necessary to improve air quality through the consideration of individual pollutants and emission sources. In Republic of Korea, national and local governments have installed urban and roadside air quality monitoring systems. However, stations are lacking outside metropolitan regions, and roadside stations are sparsely distributed, limiting comparisons of pollutant concentrations with vehicle traffic and floating population levels. Local governments have begun using mobile laboratories (MLs) to supplement the fixed measurement network and investigate road pollution source characteristics based on their spatiotemporal distribution; however, the collected data cannot be used effectively if they are not visualized. Here, we propose a method to collect and visualize global information system (GIS)-based air quality data overlayed with environmental variables to support air quality management measures. Spatiotemporal analyses of ML-derived data from Bucheon, Korea, confirmed that particulate and gaseous pollutant concentrations were high during typical commuting hours, at intersections, and at a specially managed road. During commuting hours, the maximum PM10 concentration reached 200.7 µg/m3 in the Nae-dong, Gyeongin-ro, and Ojeong-dong ready-mix concrete complex areas, and the maximum PM2.5 concentration was 161.7 µg/m3. The maximum NOx, NO2, and NO levels of 1.34 ppm, 0.18 ppm, and 1.18 ppm, respectively, were also detected during commuting hours. These findings support the need for targeted management of air pollution in this region, and highlight the benefit of comprehensively comparing road levels, driving speed, and traffic levels when identifying hotspots of air pollution. Such analyses will contribute to the development of air quality management measures customized to regional characteristics.
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PM10 is known to have a great adverse effect on the human body. However, there is a lack of research analyzing the impact of PM10 on the occurrence of accidents. Accordingly, the purpose of this study is to analyze the correlation between PM10 and accidents in the construction industry and to present a new concentration group to manage accidents caused by PM10 in the construction industry. This study was conducted in the following four stages. (i) collection of data, (ii) classification of data, (iii) relative probability analysis, and (iv) modified PM10 group classification. The main results of this study are as follows. When the frequency analysis of the traditional method was conducted, 3,721 accidents occurred at a PM10 concentration of 32 µg/m3. However, as a result of the relative probability analysis presented in this study, it was confirmed that the relative accident probability increased as the PM10 concentration increased. In addition, the current PM10 concentration is presented by the WHO in six groups from a health perspective. However, in this study, the newly proposed PM10 group was classified into three groups from the perspective of the probability of construction accidents. The group proposed in this study is not from a health perspective but a group for managing construction site accidents. The contribution of this study was to confirm that PM10 also affects accidents occurring at construction sites, and the impact of PM10 on accidents was quantitatively analyzed through the relative probability analysis presented in this study.
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BACKGROUND: Fibrosis plays an important role in both normal physiological and pathological phenomena as fibroblasts differentiate to myofibroblasts. The activation of fibroblasts is determined through interactions with the surrounding extracellular matrix (ECM). However, how this fibroblast-to-myofibroblast transition (FMT) is regulated and affected by elastin concentration in a three-dimensional (3D) microenvironment has not been investigated. METHODS: We developed an insoluble elastin-gradient 3D hydrogel system for long-lasting cell culture and studied the molecular mechanisms of the FMT in embedded cells by nanoflow LC-MS/MS analysis along with validation through real-time PCR and immunofluorescence staining. RESULTS: By optimizing pH and temperature, four 3D hydrogels containing fibroblasts were successfully fabricated having elastin concentrations of 0, 20, 50, and 80% in collagen. At the low elastin level (20%), fibroblast proliferation was significantly increased compared to others, and in particular, the FMT was clearly observed in this condition. Moreover, through mass spectrometry of the hydrogel environment, it was confirmed that differentiation proceeded in two stages. In the early stage, calcium-dependent proteins including calmodulin and S100A4 were highly associated. On the other hand, in the late stage after several passages of cells, distinct markers of myofibroblasts were presented such as morphological changes, increased production of ECM, and increased α-SMA expression. We also demonstrated that the low level of elastin concentration induced some cancer-associated fibroblast (CAF) markers, including PDGFR-ß, and fibrosis-related disease markers, including THY-1. CONCLUSION: Using our developed 3D elastin-gradient hydrogel system, we evaluated the effect of different elastin concentrations on the FMT. The FMT was induced even at a low concentration of elastin with increasing CAF level via calcium signaling. With this system, we were able to analyze varying protein expressions in the overall FMT process over several cellular passages. Our results suggest that the elastin-gradient system employing nonlinear optics imaging provides a good platform to study activated fibroblasts interacting with the microenvironment, where the ECM plays a pivotal role.
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The metal-support interaction plays a crucial role in determining the catalytic activity of supported metal catalysts. Changing the facet of the support is a promising strategy for catalytic control via constructing a well-defined metal-support nanostructure. Herein, we developed cubic and octahedral Cu2O supports with (100) and (111) facets terminated, respectively, and Pt nanoparticles (NPs) were introduced. The in situ characterizations revealed the facet-dependent encapsulation of the Pt NPs by a CuO layer due to the oxidation of the Cu2O support during the CO oxidation reaction. The CuO layer on Pt at cubic Cu2O (Pt/c-Cu2O) significantly enhanced catalytic performance, while the thicker CuO layer on Pt at octahedral Cu2O suppressed CO conversion. The formation of a thin CuO layer is attributed to the dominant Pt-O-Cu bond at the Pt/c-Cu2O interface, which suppresses the adsorption of oxygen molecules. This investigation provides insight into designing high-performance catalysts via engineering the interface interaction.
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Small molecule degraders of small ubiquitin-related modifier 1 (SUMO1) induce SUMO1 degradation in colon cancer cells and inhibits the cancer cell growth; however, it is unclear how SUMO1 degradation leads to the anticancer activity of the degraders. Genome-wide CRISPR-Cas9 knockout screen has identified StAR-related lipid transfer domain containing 7 (StarD7) as a critical gene for the degrader's anticancer activity. Here, we show that both StarD7 mRNA and protein are overexpressed in human colon cancer and its knockout significantly reduces colon cancer cell growth and xenograft progression. The treatment with the SUMO1 degrader lead compound HB007 reduces StarD7 mRNA and protein levels and increases endoplasmic reticulum (ER) stress and reactive oxygen species (ROS) production in colon cancer cells and three-dimensional (3D) organoids. The study further provides a novel mechanism of the compound anticancer activity that SUMO1 degrader-induced decrease of StarD7 occur through degradation of SUMO1, deSUMOylation and degradation of T cell-specific transcription 4 (TCF4) and thereby inhibition of its transcription of StarD7 in colon cancer cells, 3D organoids and patient-derived xenografts (PDX).
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Proteínas Portadoras , Neoplasias del Colon , Humanos , Proteínas Portadoras/genética , Especies Reactivas de Oxígeno/metabolismo , Neoplasias del Colon/tratamiento farmacológico , Neoplasias del Colon/genética , ARN Mensajero , Estrés del Retículo Endoplásmico , Proteína SUMO-1/genética , Proteína SUMO-1/metabolismo , Factor de Transcripción 4/metabolismoRESUMEN
We investigate the capacity-achieving symbol distributions for directly modulated laser (DML) and direct-detection (DD) systems utilizing probabilistic constellation shaped pulse amplitude modulation formats. DML-DD systems utilize a bias tee to feed the DC bias current and AC-coupled modulation signals. Also, an electrical amplifier is commonly utilized to drive the laser. Thus, most DML-DD systems are subject to the constraints of the average optical power and peak electrical amplitude. We compute the channel capacity of the DML-DD systems under these constraints by using the Blahut-Arimoto algorithm to obtain the capacity-achieving symbol distributions. We also carry out experimental demonstration to verify our computation results. We show that the probabilistic constellation shaping (PCS) technique marginally increases the capacity of DML-DD system when the optical modulation index (OMI) is less than 1. However, the PCS technique allows us to increase the OMI larger than 1 without clipping distortions. As a result, we can increase the capacity of DML-DD system by using the PCS technique in comparison with the uniformly distributed signals.
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Importance: Before 2021, most Medicare beneficiaries with end-stage renal disease (ESRD) were unable to enroll in private Medicare Advantage (MA) plans. The 21st Century Cures Act permitted these beneficiaries to enroll in MA plans effective January 2021. Objective: To examine changes in MA enrollment among Medicare beneficiaries with ESRD after enactment of the 21st Century Cures Act overall and by race or ethnicity and dual-eligible status. Design, Setting, and Participants: This cross-sectional time-trend study used data from Medicare beneficiaries with ESRD (both kidney transplant recipients and those undergoing dialysis) between January 2019 and December 2021. Data were analyzed between June and October 2022. Exposures: 21st Century Cures Act. Main Outcomes and Measures: Primary outcomes were the proportion of Medicare beneficiaries with prevalent ESRD who switched from traditional Medicare to MA between 2020 and 2021 and those with incident ESRD who newly enrolled in MA in 2021. Individuals who stayed in traditional Medicare were enrolled in 2020 and 2021 and those who switched to MA were enrolled in traditional Medicare in 2020 and MA in 2021. Results: Among 575â¯797 beneficiaries with ESRD in 2020 or 2021 (mean [SD] age, 64.7 [14.2] years, 42.2% female, 34.0% Black, and 7.7% Hispanic or Latino), the proportion of beneficiaries enrolled in MA increased from 24.8% (December 2020) to 37.4% (December 2021), a relative change of 50.8%. The largest relative increases in MA enrollment were among Black (72.8% relative increase), Hispanic (44.8%), and dual-eligible beneficiaries with ESRD (73.6%). Among 359â¯617 beneficiaries with TM and prevalent ESRD in 2020, 17.6% switched to MA in 2021. Compared with individuals who stayed in traditional Medicare, those who switched to MA had modestly more chronic conditions (6.3 vs 6.1; difference, 0.12 conditions [95% CI, 0.10-0.16]) and similar nondrug spending in 2020 (difference, $509 [95% CI, -$58 to $1075]) but were more likely to be Black (difference, 19.5 percentage points [95% CI, 19.1-19.9]) and have dual Medicare-Medicaid eligibility (difference, 20.8 percentage points [95% CI, 20.4-21.2]). Among beneficiaries who were newly eligible for Medicare ESRD benefits in 2021, 35.2% enrolled in MA. Conclusions and Relevance: Results suggest that increases in MA enrollment among Medicare beneficiaries with ESRD were substantial the first year after the 21st Century Cures Act, particularly among Black, Hispanic, and dual-eligible individuals. Policy makers and MA plans may need to assess network adequacy, disenrollment, and equity of care for beneficiaries who enrolled in MA.
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Fallo Renal Crónico , Medicare Part C , Anciano , Humanos , Femenino , Estados Unidos , Persona de Mediana Edad , Masculino , Estudios Transversales , Fallo Renal Crónico/terapiaRESUMEN
Tuning the selectivity of CO2 hydrogenation is of significant scientific interest, especially using nickel-based catalysts. Fundamental insights into CO2 hydrogenation on Ni-based catalysts demonstrate that CO is a primary intermediate, and product selectivity is strongly dependent on the oxidation state of Ni. Therefore, modifying the electronic structure of the nickel surface is a compelling strategy for tuning product selectivity. Herein, we synthesized well dispersed Cu-Ni bimetallic nanoparticles (NPs) using a simple hydrothermal method for CO selective CO2 hydrogenation. A detailed study on the monometallic (Ni and Cu) and bimetallic (CuxNi1-x) catalysts supported on γ-Al2O3 was performed to increase CO selectivity while maintaining the high reaction rate. The Cu0.5Ni0.5/γ-Al2O3 catalyst shows a high CO2 conversion and more CO product selectivity than its monometallic counterparts. The surface electronic and geometric structure of Cu0.5Ni0.5 bimetallic NPs was studied using ambient pressure X-ray photoelectron spectroscopy (AP-XPS) and in situ diffuse reflectance infrared Fourier-transform spectroscopy under reaction conditions. The Cu core atoms migrate toward the surface, resulting in the restructuring of the Cu@Ni core-shell structure to a Cu-Ni alloy during the reaction and functioning as the active site by enhancing CO desorption. A systematic correlation is obtained between catalytic activity from a continuous fixed-bed flow reactor and the surface electronic structural details derived from AP-XPS results, establishing the structure-activity relationship. This investigation contributes to providing a strategy for controlling CO2 hydrogenation selectivity by modifying the surface structure of bimetallic NP catalysts.
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Athletes need to maintain the necessary physical conditioning for sports performance while wearing face masks to reduce the risk of virus transmission during training and competition during the COVID-19 situation. The quantitative and physiological effects of face masks on exercise capacity needs to be reported. The purpose of this study was to evaluate elite athletes to quantify, in detail, the effect of a KF94 face mask on changes in lactic acid during recovery after high-intensity aerobic exercise. Thirteen elite soft tennis athletes were recruited. A crossover design was used to examine the effects of using a disposable KF94 face mask compared with not masking during exercise. The participants completed a shuttle run test experiment two times during a 3-day period, including 5−10 min of warmup according to their personal preferences. The lactic acid concentration at 20 min of recovery after maximum exercise was 5.98 ± 1.53 mM/L without a mask and 7.61 ± 1.85 mM/L with a KF94 mask (p < 0.001). The maximum laps of shuttle run tests were 101.5 ± 22.5 laps without a mask and 94.2 ± 20.2 laps with a KF94 mask (p < 0.001). Intense exercise after wearing quarantine masks reduces the maximum aerobic exercise ability and decreases the ability to recover lactic acid.