Churn in Supplemental Nutrition Assistance Program: Changes in Medicaid Expenditure and Acute Care Utilization.

BACKGROUND: The Supplemental Nutrition Assistance Program (SNAP) provides financial assistance to low-income individuals and families to help them purchase food. However, when participants experience short-term disenrollment from the program, known as churn, it can disrupt their health care usage patterns or result in acute health care needs due to the loss of financial benefits and time burden required to reapply for SNAP. OBJECTIVE: The objective of this study was to examine the changes in health care expenditures and acute care utilization during periods of SNAP churn compared with nonchurn periods among those who churn during the study period. RESEARCH DESIGN: Longitudinal analysis of Pennsylvania Medicaid claims data for enrollees participating in SNAP between 2016 and 2018 using individual fixed-effects models. We add to the literature by estimating whether these changes varied based on the amount of SNAP benefit lost, or differed between adults and children. RESULTS: We found that SNAP churn was associated with reductions in pharmacy and primary care spending across all SNAP benefit levels and age groups. Specifically, our findings indicate a reduction of 4%-6% in pharmacy expenditures for adults and 2%-4% for children. Moreover, there was a 3%-4% decrease in primary care expenditures for adults and a 4%-6% decrease for children. Acute care utilization did not significantly change during a SNAP churn period. CONCLUSION: Our findings of decreases in pharmacy and primary care spending suggest that preventing SNAP churn may help reduce instances where adult and child participants forgo necessary care.

Intelligent Fault Diagnosis of Rolling Bearing Based on Gramian Angular Difference Field and Improved Dual Attention Residual Network.

With the rapid development of smart manufacturing, data-driven deep learning (DL) methods are widely used for bearing fault diagnosis. Aiming at the problem of model training crashes when data are imbalanced and the difficulty of traditional signal analysis methods in effectively extracting fault features, this paper proposes an intelligent fault diagnosis method of rolling bearings based on Gramian Angular Difference Field (GADF) and Improved Dual Attention Residual Network (IDARN). The original vibration signals are encoded as 2D-GADF feature images for network input; the residual structures will incorporate dual attention mechanism to enhance the integration ability of the features, while the group normalization (GN) method is introduced to overcome the bias caused by data discrepancies; and then the model is trained to complete the classification of faults. In order to verify the superiority of the proposed method, the data obtained from Case Western Reserve University (CWRU) bearing data and bearing fault experimental equipment were compared with other popular DL methods, and the proposed model performed optimally. The method eventually achieved an average identification accuracy of 99.2% and 97.9% on two different types of datasets, respectively.

Maryland's Global Budget Revenue Program: Impact on Neonatal Intensive Care Unit Admissions and Infant Mortality.

BACKGROUND: In 2014, Maryland implemented the Global Budget Revenue (GBR) program to reduce unnecessary hospital utilization and contain spending. Little is known about its impact on pediatric health outcomes and high-cost services that are primarily financed by payers other than Medicare. OBJECTIVE: The aim was to examine the impact of the GBR program on neonatal intensive care unit (NICU) admission and infant mortality. RESEARCH DESIGN: We conducted a difference-in-differences analysis comparing changes of NICU admissions and infant mortality in Maryland with changes in 20 comparison states (including DC), before and after implementation of the GBR program. Effects were estimated for all infants and for risk groups defined by birthweight and gestation. SUBJECTS: A total of 11,965,997 newborns in Maryland and the comparison states was identified using US birth certificate data from 2011 to 2017. MEASURES: NICU admissions, the infant mortality rate, and the neonatal mortality rate. RESULTS: The GBR program was associated with a 1.26 percentage points (-16.8%, P=0.03) decline in NICU admissions over three full years of implementation. Reductions were driven by fewer admissions among moderately low to normal birthweight (1500-3999 g) and moderately preterm to term (32-41 wk) infants. The effects for very-low birthweight and very preterm infants were small and not statistically precise. There was no significant change in infant or neonatal mortality rates. CONCLUSIONS: Maryland's hospitals reacted to the GBR program by reducing NICU services for infants that did not have clear observed clinical need. Our results suggest that GBR constrained high-cost services, without adversely affecting infant mortality.

Changes to Contraceptive Method Use at Title X Clinics Following Delaware Contraceptive Access Now, 2008-2017.

Objectives. To measure changes in the contraceptive methods used by Title X clients after implementation of Delaware Contraceptive Access Now, a public-private initiative that aims to increase access to contraceptives, particularly long-acting reversible contraceptives (LARCs).Methods. Using administrative data from the 2008-2017 Family Planning Annual Reports and a difference-in-differences design, we compared changes in contraceptive method use among adult female Title X family planning clients in Delaware with changes in a set of comparison states. We considered permanent methods, LARCs, moderately effective methods, less effective methods, and no method use.Results. Results suggest a 3.2-percentage-point increase in LARC use relative to changes in other states (a 40% increase from baseline). We were unable to make definitive conclusions about other contraceptive method types.Conclusions. Delaware Contraceptive Access Now increased LARC use among Title X clients. Our results have implications for states considering comprehensive family planning initiatives.

Medicaid Expansion at Title X Clinics: Client Volume, Payer Mix, and Contraceptive Method Type.

BACKGROUND: Title X supports access to family planning and preventive care services. Given its focus on low-income clients, Title X clinics may have been particularly affected by the Affordable Care Act's Medicaid expansion. OBJECTIVES: To examine the impact of the Affordable Care Act's Medicaid expansion on Title X client volumes, health insurance coverage, and contraceptive method mix. RESEARCH DESIGN: A difference-in-differences design compared changes in the outcomes of interest before and after expansion, for expansion versus nonexpansion states. SUBJECTS: Administrative data from Family Planning Annual Reports that describe Title X clients who sought services. MEASURES: Female client volume was measured using a participation ratio defined as the number of female clients per 100 women aged 15-44 with incomes <250% of the federal poverty line. We also examined the share of clients by insurance type and contraceptive method type. RESULTS: We did not find evidence that expansion was related to changes in client volume. We did find a significant 9.9 percentage point increase in the share of clients with Medicaid and a significant 10.0 percentage point decrease in the share of clients without coverage. We found suggestive evidence that expansion was associated with increased use of long-acting reversible contraceptives, but those results were somewhat sensitive to model specification. CONCLUSIONS: Expansion was associated with meaningful increases in Medicaid coverage at Title X clinics and declines in uninsurance. Our results have important implications for the financial stability of Title X clinics in light of historical declines in Title X grant revenues.

The association of late-life depression with all-cause and cardiovascular mortality among community-dwelling older adults: systematic review and meta-analysis.

BACKGROUND: Late-life depression has become an important public health problem. Available evidence suggests that late-life depression is associated with all-cause and cardiovascular mortality among older adults living in the community, although the associations have not been comprehensively reviewed and quantified.AimTo estimate the pooled association of late-life depression with all-cause and cardiovascular mortality among community-dwelling older adults. METHOD: We conducted a systematic review and meta-analysis of prospective cohort studies that examine the associations of late-life depression with all-cause and cardiovascular mortality in community settings. RESULTS: A total of 61 prospective cohort studies from 53 cohorts with 198 589 participants were included in the systematic review and meta-analysis. A total of 49 cohorts reported all-cause mortality and 15 cohorts reported cardiovascular mortality. Late-life depression was associated with increased risk of all-cause (risk ratio 1.34; 95% CI 1.27, 1.42) and cardiovascular mortality (risk ratio 1.31; 95% CI 1.20, 1.43). There was heterogeneity in results across studies and the magnitude of associations differed by age, gender, study location, follow-up duration and methods used to assess depression. The associations existed in different subgroups by age, gender, regions of studies, follow-up periods and assessment methods of late-life depression. CONCLUSION: Late-life depression is associated with higher risk of both all-cause and cardiovascular mortality among community-dwelling elderly people. Future studies need to test the effectiveness of preventing depression among older adults as a way of reducing mortality in this population. Optimal treatment of late-life depression and its impact on mortality require further investigation.Declaration of interestNone.

Cloning and expression analysis of betalain biosynthesis genes in Amaranthus tricolor.

OBJECTIVES: To clone genes involved in the betalain biosynthesis pathway and to assess the effects of phytohormones on betalain biosynthesis in Amaranthus tricolor. RESULTS: Five betalain biosynthesis genes were cloned by reverse transcription PCR and rapid amplification of cDNA ends. Betacyanin analyses revealed that pigments accumulated differently in various tissues and under different phytohormone treatments. Quantitative RT-PCR analysis indicated that gene expression levels did not correlate with pigment accumulation. Notably, gene expression and pigment accumulation were negatively regulated by 2,4-dichlorophenoxyacetic acid. The expression of AmaDOPA5-GT, AmaDODA, and AmaB5-GT was induced by pigmentation-promoting 6-benzyl aminopurine (6-BA). and pigmentation-inhibiting gibberellin A3 while AmaTyDC expression was suppressed. AmaTyDC expression was also suppressed by pigmentation-promoting kinetin. Additionally, the expression of AmaB6-GT was suppressed by 6-BA. CONCLUSIONS: The changes in betacyanin levels among various tissues and following phytohormone treatments were related to the differences in betalain biosynthesis gene expression levels.

Maize catalases are recruited by a virus to modulate viral multiplication and infection.

Given the detrimental effects of excessive reactive oxygen species (ROS) accumulation in plant cells, various antioxidant mechanisms have evolved to maintain cellular redox homeostasis, encompassing both enzymatic components (e.g., catalase, superoxide dismutase) and non-enzymatic ones. Despite extensive research on the role of antioxidant systems in plant physiology and responses to abiotic stresses, the potential exploitation of antioxidant enzymes by plant viruses to facilitate viral infection remains insufficiently addressed. Herein, we demonstrate that maize catalases (ZmCATs) exhibited up-regulated enzymatic activities upon sugarcane mosaic virus (SCMV) infection. ZmCATs played crucial roles in SCMV multiplication and infection by catalysing the decomposition of excess cellular H2 O2 and promoting the accumulation of viral replication-related cylindrical inclusion (CI) protein through interaction. Peroxisome-localized ZmCATs were found to be distributed around SCMV replication vesicles in Nicotiana benthamiana leaves. Additionally, the helper component-protease (HC-Pro) of SCMV interacted with ZmCATs and enhanced catalase activities to promote viral accumulation. This study unveils a significant involvement of maize catalases in modulating SCMV multiplication and infection through interaction with two viral factors, thereby enhancing our understanding regarding viral strategies for manipulating host antioxidant mechanisms towards robust viral accumulation.

The Effect Of Next Generation Accountable Care Organizations On Medicare Expenditures.

The Next Generation Accountable Care Organization (NGACO) model (active during 2016-21) tested the effects of high financial risk, payment mechanisms, and flexible care delivery on health care spending and value for fee-for-service Medicare beneficiaries. We used quasi-experimental methods to examine the model's effects on Medicare Parts A and B spending. Sixty-two ACOs with more than 4.2 million beneficiaries and more than 91,000 practitioners participated in the model. The model was associated with a $270 per beneficiary per year, or approximately $1.7 billion, decline in Medicare spending. After shared savings payments to ACOs were included, the model increased net Medicare spending by $56 per beneficiary per year, or $96.7 million. Annual declines in spending for the model grew over time, reflecting exit by poorer-performing NGACOs, improvement among the remaining NGACOs, and the COVID-19 pandemic. Larger declines in spending occurred among physician practice ACOs and ACOs that elected population-based payments and risk caps greater than 5 percent.

Reliability evaluation based on different distributions of random load.

The reliability models of the components under the nonstationary random load are developed in this paper. Through the definition of the distribution of the random load, it can be seen that the conventional load-strength interference model is suitable for the calculation of the static reliability of the components, which does not reflect the dynamic change in the reliability and cannot be used to evaluate the dynamic reliability. Therefore, by developing an approach to converting the nonstationary random load into the random load whose pdf is the same at each moment when the random load applies, the reliability model based on the longitudinal distribution is derived. Moreover, through the definition of the transverse standard load and the transverse standard load coefficient, the reliability model based on the transverse distribution is derived. When the occurrence of the random load follows the Poisson process, the dynamic reliability models considering the strength degradation are derived. These models take the correlation between the random load and the strength into consideration. The result shows that the dispersion of the initial strength and that of the transverse standard load coefficient have great influences on the reliability and the hazard rate of the components.

Effect of Welding Defects on Fatigue Properties of SWA490BW Steel Cruciform Welded Joints.

Welding is prone to several defects. To test the fatigue properties of the welded defective joints of high-speed rail bogies, SMA490BW steel cruciform welded joints were employed with artificial defects treatment. Consequently, fatigue tests were conducted on the specimens. Fatigue fracture morphology was studied via scanning electron microscopy. The ABAQUS (version 2022) finite element software was used to calculate the stress distribution and concentration factor of cruciform welded joints with defects. The results show that the fatigue limits of 1 and 2.4 mm defect specimens were approximately 57.2 and 53.75 Mpa, respectively. Furthermore, the stress concentration factor of no, 1 mm, and 2.4 mm defects were 2.246, 4.441, and 6.684, respectively, indicating that the stress concentration factor of 1 and 2.4 mm defects increased by 98 and 198%, respectively, with respect to the no-defect case.

Discovery of a cis-regulatory element SaeM involved in dynamic regulation of synergid-specific MYB98.

MYB98 is a key regulator of the genetic network behind pollen tube attraction toward the female gametophyte. MYB98 is specifically expressed in the synergid cells (SCs), a female gametophyte component cells specialized for pollen tube attraction. However, it had not been clear how exactly MYB98 achieves this specific expression pattern. In the current study, we have determined that a normal SC-specific expression of MYB98 is dependent on a 16-bp-long cis-regulatory element, CATTTACACATTAAAA, freshly named as the "S ynergid-specific A ctivation E lement of M YB98" (SaeM). An 84 bp fragment harboring SaeM in the middle was sufficient to drive exclusively SC-specific expression. The element was present in a significantly large proportion of SC-specific gene promoters and in the promoter of MYB98 homologous genes in the Brassicaceae (pMYB98s). Significance of such family-wide SaeM-like element conservation in exclusive SC-specific expression was confirmed by the Arabidopsis-like activation feature of Brassica oleracea-derived pMYB98 and absence of such feature of pMYB98 derived from a non-Brassicaceae member Prunus persica. Additionally, the yeast-one-hybrid assay showed that the SaeM can be recognized by ANTHOCYANINLESS2 (ANL2) and DAP-seq data further suggested for additional three ANL2 homologs targeting the similar cis-element. Overall, our study has concluded that SaeM plays a crucial role in driving exclusively SC-specific expression of MYB98 and strongly suggests for the involvement of ANL2 and its homologs in its dynamic regulation in planta. Future study on the transcription factors is expected to shed more light on the mechanism behind the process.

Blueberry anthocyanins: protection against ageing and light-induced damage in retinal pigment epithelial cells.

Retinal pigment epithelium (RPE) cells are vital for retinal health. However, they are susceptible to injury with ageing and exposure to excessive light, including UV (100-380 nm) and visible (380-760 nm) radiation. To evaluate the protective effect of blueberry anthocyanins on RPE cells, in vitro cell models of replicative senescent and light-induced damage were established in the present study. After purification and fractionation, blueberry anthocyanin extracts (BAE) were yielded with total anthocyanin contents of 31·0 (SD 0·5) % and were used in this study. Replicative senescence of RPE cells was induced by repeatedly passaging cells from the fourth passage to the tenth. From the fifth passage, cultured RPE cells began to enter a replicative senescence, exhibiting reduced cell proliferation along with an increase in the number of ß-galactosidase-positive cells. RPE cells maintained high cell viability (P < 0·01) and a low (P < 0·01) percentage of ß-galactosidase-positive cells when treated with 0·1 µg/ml BAE. In contrast, after exposure to 2500 (SD 500) lx light (420-800 nm) for 12 h, RPE cells in the positive control (light exposure, no BAE treatment) exhibited premature senescence, low (P < 0·01) cell viability and increased (P < 0·01) vascular endothelial growth factor (VEGF) release compared with negative control cells, which were not subjected to light irradiation and BAE exposure. Correspondingly, BAE is beneficial to RPE cells by protecting these cells against light-induced damage through the suppression of ageing and apoptosis as well as the down-regulation of the over-expressed VEGF to normal level. These results demonstrate that BAE is efficacious against senescence and light-induced damage of RPE cells.

The Impact of the COVID-19 Pandemic on Depressive Symptoms in China: A Longitudinal, Population-Based Study.

Objectives: We aimed to examine how COVID-19 incidence is associated with depressive symptoms in China, whether the association is transient, and whether the association differs across groups. Methods: We used a longitudinal sample from 2018 to 2020 waves of the China Family Panel Study. We constructed COVID-19 incidence rates as the number of new cases per 100,000 population in respondents' resident provinces in the past 7, 14, and 28 days when a respondent was surveyed. We performed linear or logistic regressions to examine the associations, and performed stratified analyses to explore the heterogeneity of the associations. Results: Our sample included 13,655 adults. The 7-day incidence rate was positively associated with the CES-D score (coef. = 2.551, 95% CI: 1.959-3.142), and likelihood of being more depressed (adjusted odds ratio = 6.916, 95% CI: 4.715-10.144). The associations were larger among those with less education, pre-existing depression, or chronic conditions. We did not find any significant association between the 14- or 28-day local incidence rates and depressive symptoms. Conclusion: The impact of COVID-19 incidence on mental health in China's general population was statistically significant and moderate in magnitude and transient. Disadvantaged groups experienced higher increases in depressive symptoms.

Experimental Study on Vibration Fatigue Behavior of Aircraft Aluminum Alloy 7050.

It has been previously noted that the development of aerospace material technology and breakthroughs are inseparable when obtaining great achievements in the aerospace industry. Materials are the basis and precursor of modern high technology and industry. As one of the most powerful aluminium alloys, 7050 is widely used in the aerospace field. In this manuscript, the vibration fatigue behaviour of aircraft aluminium alloy 7050 is studied based on experiments. A vibration fatigue experiment and the traditional fatigue testing of aluminium alloy 7050 were performed. We found that there was an extreme difference between the vibration fatigue and the traditional fatigue curves. In addition, the experimental end criteria for the vibration fatigue experiment of aluminium alloy 7050 was obtained from the acceleration reduction and the frequency reduction value. For the acceleration experimental end criterion, 2% was the acceleration reduction value for the vibration fatigue experimental end criteria of aluminium alloy 7050. For the frequency experimental end criterion, 2% was the frequency reduction value for the vibration fatigue experimental end criteria of aluminium alloy 7050.

An effective method for remaining useful life estimation of bearings with elbow point detection and adaptive regression models.

Bearing is one of the critical components in rotating equipment. Therefore, accurate estimation of the remaining useful life (RUL) of bearings plays a vital role in reducing the costly unplanned maintenance and increasing the reliability of machines. This paper proposes a method for bearing prognostics that uses iteratively updated degradation regression models to capture the degradation trend in bearing's health indicator (HI), and the models are utilized to predict the degradation trajectory of HI and to estimate the RUL of bearings. The importance of determining the time to start prediction by elbow point is explained, which is often overlooked in prognostics. To improve the prognostic performance, an adaptive approach for elbow point detection is designed based on the gradient change of HIs, and a new smooth approach is applied to reduce spurious fluctuations in degradation trajectory. The effectiveness of the proposed method is validated on two publicly available data sets, i.e., IMS and FEMTO bearing prognostics data set, and its prognostic performance is compared with that of three state-of-the-art methods. The obtained results demonstrate that the proposed method can effectively detect elbow point and determine the time to start prediction, and can calibrate the degradation regression model dynamically according to the evolving degradation trend in the HI, which validates its superior prognostic performance.

Simulation Analysis and Experimental Study of the Strength of Aluminum Alloy Suspension Structure.

High-speed trains have a large amount of ancillary equipment, which is suspended from the underside of the train by means of a suspension structure. Due to the large mass of the ancillary equipment, the suspension structure is subjected to various loads during train operation and there is a risk of fatigue failure. In this paper, the stress distribution at the suspension point and the lo-cation of the maximum stress point under load are investigated in detail based on actual test loads at the suspension point and finite element simulation analysis. In order to further investigate the fracture failure of the suspension points, experimental studies were carried out. Firstly, static strength tests were carried out to obtain the load-displacement curves of the structural members and to determine the fracture strength of the structure based on the displacement sensors, and secondly, fatigue tests at different stress levels were carried out to obtain the load-life curves of the structural members and to investigate the probabilistic load-life curves at different reliability levels. The test results show that the structural component has a high fracture strength of 65kN, while the conditional fatigue strength is relatively low, corresponding to a load level of 12.5kN at a median life of 106 cycles. The above research work provides the necessary basis for the design, optimization and reliability assessment of the suspension structures of high-speed trains.

Integrated Metabolo-transcriptomics Reveals the Defense Response of Homogentisic Acid in Wheat against Puccinia striiformis f. sp. tritici.

Stripe rust is a widespread and harmful wheat disease caused by Puccinia striiformis f. sp. tritici (Pst) worldwide. Targeted metabolome and transcriptomics analyses of CYR23 infected leaves were performed to identify the differential metabolites and differentially expressed genes related to wheat disease resistance. We observed upregulation of 33 metabolites involved in the primary and secondary metabolism, especially for homogentisic acid (HGA), p-coumaroylagmatine, and saccharopine. These three metabolites were mainly involved in the phenylpropanoid metabolic pathway, hydroxycinnamic acid amides pathway, and saccharopine pathway. Combined with transcriptome data on non-compatible interaction, the synthesis-related genes of these three differential metabolites were all upregulated significantly. The gene regulatory network involved in response to Pst infection was constructed, which revealed that several transcription factor families including WRKYs, MYBs, and bZIPs were identified as potentially hubs in wheat resistance response against Pst. An in vitro test showed that HGA effectively inhibited the germination of stripe rust fungus urediniospores and reduced the occurrence of wheat stripe rust. The results of gene silencing and overexpression of HGA synthesis-related gene 4-hydroxyphenylpyruvate dioxygenase proved that HGA was involved in wheat disease resistance. These results provided a further understanding of the disease resistance of wheat and indicated that HGA can be developed as a potential agent against Pst.

Motion error analysis of a shield machine tool-changing robot based on a screw-vector method.

Industrial robots are widely used in various industrial fields, such as handling and welding, due to their good repeat positioning accuracy. The motion error determines the absolute accuracy. For robot design, dimensional parameter errors and drive parameter errors, a mathematical model of a kinematic exponential product with error screws was proposed. The influence of different rod lengths and transmission errors on the accuracy of the end motion was analysed. A composite analysis method based on screw theory and vector method is proposed for the spatial deflection error of robot rotating joints with clearance. By using screw theory, a mathematical error model of the axial movement and spatial deflection of the joint gap was established. A mathematical model of joint space radial movement was established by using the three-dimensional vector method. Through numerical simulation, the position distribution law of the random error of the robot terminal in the workspace and the distribution of the plane projection density were obtained. By solving the attitude matrix, the distribution of each Euler angle error was obtained. A simulation test was carried out to verify the model's correctness. The calculation showed that the method is simple and correct, and the obtained error distribution characteristics are of great significance to improving robotic kinematic calibration accuracy and optimising the spatial position error distribution.

An evaluation of the Be Your Own Baby public awareness campaign.

OBJECTIVE: Assess the impact of the Be Your Own Baby (BYOB) public awareness campaign including population-level exposure, the effectiveness of ad platforms, and the effect of the campaign on family planning clinic attendance, the campaign's primary goal. DATA SOURCES: The study relied on administrative data on traffic and engagement from the campaign's website, population survey data measuring campaign exposure, and clinic attendance volumes from state-by-year restricted-use versions of the Office of Population Affairs' Family Planning Annual Reports (2006-2018). STUDY DESIGN: Bivariate analyses were used to assess website traffic and engagement and population-level exposure across key subgroups. We then used the synthetic control method to examine the impact of the BYOB campaign on per capita Title X clinic attendance among the target demographic, women 18-29 years of age. DATA COLLECTION/EXTRACTION METHODS: Not applicable. We relied on secondary sources. PRINCIPAL FINDINGS: Primary media platforms used by the campaign included social media, digital display, streaming audio, YouTube, and search. Website traffic was driven primarily by digital display ads, but engagement was highest for search. Our results suggest nearly 12% of Delaware women 18-29 years of age were exposed to the campaign. However, exposure was measured at the end of the campaign and was likely much larger during its peak. Our results indicated that the campaign was associated with between 13 and 23 additional Title X clinic visits per 1000 women compared with 110 users per 1000 at baseline in 2014. CONCLUSIONS: Our findings suggest the BYOB campaign was successful at increasing clinic attendance among the target demographic. These results have important implications for other programs seeking to use public awareness messaging to increase participation in the health care system and are especially important for Title X administrators who have faced declining patient volumes for over 10 years.