Adults with diabetes residing in "food swamps" have higher hospitalization rates.

ObjectiveTo examine the relationship between food swamps and hospitalization rates among adults with diabetes.Data sourcesBlue Cross Blue Shield Association Community Health Management Hub® 2014, AHRQ Health Care Cost and Utilization Project state inpatient databases 2014, and HHS Area Health Resources File 2010-2014.Study designCross-sectional analysis of 784 counties across 15 states. Food swamps were measured using a ratio of fast food outlets to grocers. Multivariate linear regression estimated the association of food swamp severity and hospitalization rates. Population-weighted models were controlled for comorbidities; Medicaid; emergency room utilization; percentage of population that is female, Black, Hispanic, and over age 65; and state fixed effects. Analyses were stratified by rural-urban category.Principal findingsAdults with diabetes residing in more severe food swamps had higher hospitalization rates. In adjusted analyses, a one unit higher food swamp score was significantly associated with 49.79 (95 percent confidence interval (CI) = 19.28, 80.29) additional all-cause hospitalizations and 19.12 (95 percent CI = 11.09, 27.15) additional ambulatory care-sensitive hospitalizations per 1000 adults with diabetes. The food swamp/all-cause hospitalization rate relationship was stronger in rural counties than urban counties.ConclusionsFood swamps are significantly associated with higher hospitalization rates among adults with diabetes. Improving the local food environment may help reduce this disparity

SNR-calibrated Type Ia supernova models

Current Type Ia supernova (SN Ia) models can reproduce most visible+IR + UV observations. In the X-ray band, the determination of elemental abundance ratios in supernova remnants (SNRs) through their spectra has reached enough precision to constrain SN Ia models. Martínez-Rodríguez et al have shown that the Ca/S mass ratio in SNRs cannot be reproduced with the standard nuclear reaction rates for a wide variety of SN Ia models, and suggested that the 12C+16O reaction rate could be overestimated by a factor as high as ten. We show that the same Ca/S ratio can be obtained by simultaneously varying the rates of the reactions 12C + 16O, 12C + 12C, 16O + 16O, and 16O(¿, a)12C within the reported uncertainties. We also show that the yields of the main products of SN Ia nucleosynthesis do not depend on the details of which rates are modified, but can be parametrized by an observational quantity such as Ca/S. Using this SNR-calibrated approach, we then proceed to compute a new set of SN Ia models and nucleosynthesis for both Chandrasekhar and sub-Chandrasekhar mass progenitors with a 1D hydrodynamics and nucleosynthesis code. We discuss the nucleosynthesis of the models as a function of progenitor metallicity, mass, and deflagration-to-detonation transition density. The yields of each model are almost independent on the reaction rates modified for a common Ca/S ratio.Peer ReviewedPostprint (author's final draft

Linking Structural Capabilities and Workplace Climate in Community Health Centers.

Many strategies to improve health care quality focus on improving the structural capabilities of primary care practices, including quality infrastructure and registry use, which are critical to managing chronic diseases. However, improving structural capabilities requires practices to expend significant resources and can be especially disruptive to community health centers (CHCs) serving high proportions of socioeconomically vulnerable patients. We explore the relationship between the structural capabilities and workplace climate in CHCs. The final sample for this analysis includes 25 CHC sites that could be matched across CHC site director surveys of structural capabilities and CHC adult primary care clinicians and staff (n = 446). To estimate the association between structural capabilities and dimensions of workplace climate, we estimated multivariate linear regression models that included the climate scales as dependent variables and the 5 structural capability scales as the main independent variables, with the 3 clinic-level and 2 staff-level covariates. More manageable clinic workload was associated with lower electronic record functionality (β = -0.47, P = .007), but positively associated with quality infrastructure (β = 0.92, P = .007). Staff relationships and quality improvement orientation were positively associated with quality infrastructure (β = 1.09, P = .006 and β = 0.87, P = .005). Manager readiness was associated with more robust quality infrastructure (β = 1.35, P = .016), but lower electronic record functionality (β = -0.48, P = .015) and less proactive patient outreach (β = -1.32, P = .025). Complex relationships between structural capabilities and workplace climate were found in CHCs. Further clarification of these complex connections may enable policy makers and practitioners to design and implement nuanced strategies to improve quality of care in CHCs

Central galaxies in different environments: Do they have similar properties?

We perform an exhaustive comparison among central galaxies from SDSS catalogs in different local environments at 0.01<=z<=0.08. The central galaxies are separated into two categories: group centrals (host halos containing satellites) and field centrals (host halos without satellites). From the latter, we select other two subsamples: isolated centrals and bright field centrals, both with the same magnitude limit. The stellar mass (Ms) distributions of the field and group central galaxies are different, which explains why in general the field central galaxies are mainly located in the blue cloud/star forming regions, whereas the group central galaxies are strongly biased to the red sequence/passive regions. The isolated centrals occupy the same regions as the bright field centrals since both populations have similar Ms distributions. At parity of Ms, the color and specific star formation rate (sSFR) distributions of the samples are similar, specially between field and group centrals. Furthermore, we find that the stellar-to-halo mass (Ms-Mh) relation of isolated galaxies does not depend on the color, sSFR and morphological type. For systems without satellites, the Ms-Mh relation steepens at high halo masses compared to group centrals, which is a consequence of assuming a one-to-one relation between group total stellar mass and halo mass. Under the same assumption, the scatter around the Ms-Mh relation of centrals with satellites increases with halo mass. Our results suggest that the mass growth of central galaxies is mostly driven by the halo mass, with environment and mergers playing a secondary role.Comment: 17 pages, 11 figures after last Referee's report. Accepted for publication in Ap

Alzheimer's disease and HIV associated dementia related genes: I. location and function.

Alzheimer's disease (AD), the most common cause of dementia, has few clinical similarities to HIV-1-associated dementia (HAD). However, genes were identified related among these dementias. Discovering correlations between gene function, expression, and structure in the human genome continues to aid in understanding the similarities between pathogenesis of these two dementing disorders. The current work attempts to identify relationships between these dementias in spite of their clinical differences, based on genomic structure, function, and expression. In this comparative study, the NCBI Entrez Genome Database is used to detect these relationships. This approach serves as a model for future diagnosis and treatment in the clinical arena as well as suggesting parallel pathways of disease mechanisms. Identifying a correlation among expression, structure, and function of genes involved in pathogenesis of these dementing disorders, may assist to understand better their interaction with each other and the human genome

Cost and benefits of using best management practices to control non-point sources of pollution under environmental and economic uncertainty

The economy of northwest Arkansas, including the Lincoln Lake watershed (a sub-watershed of the Illinois River), relies greatly upon livestock and poultry production. The supply of production by-products is increasingly under scrutiny as one of the potential sources of water pollution in the region. In light of the recent economic crisis, methodologies that help producers to evaluate the environmental and economic impacts of several practices before implementing them may be a cost-effective means of increasing BMP adoption. This study uses stochastic dominance techniques to evaluate, environmentally and economically, ten best management practices (BMPs) combinations to lessen water pollution in the Lincoln Lake watershed. All BMP combinations analyzed were effective in reducing total phosphorous (TP) losses. However, six combinations also decreased net returns (NR) when compared to a baseline. This suggests that including BMPs in the bermudagrass production systems may lead to increased NR risk. Without additional incentives, producers will not likely implement these BMP combinations regardless of their TP reduction benefits. Although, as expected, rankings of BMP combinations in terms of TP or NR differed from each other, four scenarios established that environmental and economic goals are not necessarily conflicting; they may be complementary. Additionally, this analysis revealed that producers’ risk preferences did not matter when selecting among the top-four BMP combinations but it could be a factor for other less preferred scenarios.nonpoint pollution, watershed, best management practices, risk analysis, stochastic dominance, Environmental Economics and Policy, Risk and Uncertainty, Q25, Q53,

Nariai--Bertotti--Robinson spacetimes as a building material for one-way wormholes with horizons, but without singularity

We discuss the problem of wormholes from the viewpoint of gluing together two Reissner--Nordstr\"om-type universes while putting between them a segment of the Nariai-type world (in both cases there are also present electromagnetic fields as well as the cosmological constant). Such a toy wormhole represents an example of one-way topological communication free from causal paradoxes, though involving a travel to next spacetime sheet since one has to cross at least a pair of horizons through which the spacetimes' junction occurs. We also consider the use of thin shells in these constructions. Such a ``material'' for wormholes we choose taking into account specific properties of the Nariai--Bertotti--Robinson spacetimes.Comment: 5 pages, a talk delivered at the 11th Marcel Grossmann Meeting (2006

How do healthcare professionals working in accountable care organisations understand patient activation and engagement? Qualitative interviews across two time points.

ObjectiveIf patient engagement is the new 'blockbuster drug' why are we not seeing spectacular effects? Studies have shown that activated patients have improved health outcomes, and patient engagement has become an integral component of value-based payment and delivery models, including accountable care organisations (ACO). Yet the extent to which clinicians and managers at ACOs understand and reliably execute patient engagement in clinical encounters remains unknown. We assessed the use and understanding of patient engagement approaches among frontline clinicians and managers at ACO-affiliated practices.DesignQualitative study; 103 in-depth, semi-structured interviews.ParticipantsSixty clinicians and eight managers were interviewed at two established ACOs.ApproachWe interviewed healthcare professionals about their awareness, attitudes, understanding and experiences of implementing three key approaches to patient engagement and activation: 1) goal-setting, 2) motivational interviewing and 3) shared decision making. Of the 60 clinicians, 33 were interviewed twice leading to 93 clinician interviews. Of the 8 managers, 2 were interviewed twice leading to 10 manager interviews. We used a thematic analysis approach to the data.Key resultsInterviewees recognised the term 'patient activation and engagement' and had favourable attitudes about the utility of the associated skills. However, in-depth probing revealed that although interviewees reported that they used these patient activation and engagement approaches, they have limited understanding of these approaches.ConclusionsWithout understanding the concept of patient activation and the associated approaches of shared decision making and motivational interviewing, effective implementation in routine care seems like a distant goal. Clinical teams in the ACO model would benefit from specificity defining key terms pertaining to the principles of patient activation and engagement. Measuring the degree of understanding with reward that are better-aligned for behaviour change will minimise the notion that these techniques are already being used and help fulfil the potential of patient-centred care