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  • Pruitt Lindegaard posted an update 3 days, 19 hours ago

    Hospital readmission within 30 days is undesirable and costly. Most programs and studies have focused on the Medicare population and readmission prevention through discharge planning; less is understood about how Medicaid might reduce readmissions to improve outcomes and control program costs. The objective of this study was to estimate the relationship between the Colorado Medicaid Accountable Care Collaborative (ACC) and 30-day hospital readmission rates. A difference-in-differences design was used to compare 30-day readmissions before and after Medicaid members were enrolled in the ACC program using 2 different control groups Medicaid members not enrolled and commercially insured. The authors used Probit regressions at the hospital level, controlling for patient characteristics, and clustered errors at the provider level. The study sample included Colorado adults ages 19-64 with qualifying hospital discharge. Analysis data included Medicaid and commercial payer administrative claims data (2009-2015) from Colorado’s All-Payer Claims Database. The ACC program significantly reduced 30-day readmissions among Colorado Medicaid patients. Participation in the ACC program reduced the probability of a 30-day readmission by 1.4% (P  less then  0.001), with the largest effect among maternity and delivery patients. CFI-400945 Because the majority of Medicaid members are female, even after Medicaid expansion, and Medicaid covers a disproportionate share of complex births, maternity and delivery readmissions are a fruitful area for reducing Medicaid expenditures. To reduce readmissions, Medicaid programs will need to develop interventions specific to their populations.Inconsistent contraceptive use and risky sexual behaviour perpetuate the burden of sexually transmitted diseases, especially in low- and middle-income countries (LMIC). Psychosocial interventions (PSI) can contribute to change sexual behaviour, however, their overall effectiveness is unclear. We thus conducted a meta-analysis of the effectiveness of PSIs to increase condom and contraceptive use in LMICs. Seven databases were searched systematically for randomised trials comparing a PSI with a control condition. Risk ratios of 31 eligible studies were pooled in random-effects analyses for condom and contraceptive use and unprotected sex, using sensitivity analyses to further investigate the results. Risk of bias was assessed using the Cochrane tool, and heterogeneity and publication bias were assessed. PSIs increased condom use by about 6% at post-test and 8% at follow-up as compared to control conditions. Contraceptive use was increased by about 14% at post-test. There were no effects on unprotected sex. Results suggest that PSIs have the potential to increase contraceptive and, to a smaller degree, condom use in LMICs. The reliability of these results is partly limited by heterogeneity and the risk of publication bias. PSIs were further found to provide substantial benefits to the exposed populations beyond the targeted outcomes.Inflammatory cytokines have been suggested to play important roles in radiation-induced lung injury (RILI). Identifying significantly changed circulating and tissue cytokines after thoracic irradiation will aid in deciphering the mechanism of RILI and identifying potential biomarkers to predict clinical outcome. Herein, the levels of 24 cytokines were measured in serial plasma samples and lung tissue samples collected from a pilot study where nonhuman primates (NHPs) received 11.5 Gy whole thoracic lung irradiation (WTLI) and were then treated with or without a medical countermeasure, AEOL 10150 [a superoxide dismutase (SOD) mimetic]. Seven plasma cytokines (i.e., IP-10, MCP-1, IL-12, IL-15, IL-16, IL-7 and IL-6) were found to be significantly changed at different time points due to WTLI. Plasma IP-10 and MDC were significantly changed between the vehicle group and the drug group. The levels of IP-10, MCP-1, MIP-1α, TARC, IL-17, TNF-β and IL-6 were significantly elevated in the lung tissue lysates of NHPs that received WTLI versus radiation-naïve NHPs. The terminal plasma concentrations of IP-10, MDC, TARC, IL-12, IL-15 and IL-6 were significantly correlated with their levels in the lung tissue. The levels of four cytokines (MCP-4, IL-17, TNF-β and IL-2) at early time points (≤8 weeks postirradiation) were significantly correlated with their terminal plasma levels, respectively. Statistical analysis indicated that circulating cytokines could be discriminatory predictors of AEOL 10150 treatment. Taken together, our data suggested that the cytokine profiles were significantly changed after WTLI as well as mitigator treatment, and that the plasma cytokine profiles could potentially be used to distinguish vehicle or mitigator treatment after WTLI in a NHP model.To investigate the effects of low-dose γ irradiation on apoptosis and development of the brain in zebrafish embryos, cumulative 15 mGy doses of γ rays from a 137Cs source were used to irradiate zebrafish embryos at 2 h post-fertilization (hpf) for 120 h. Apoptosis of the brain, brain morphological development, cell submicroscopic structure and mRNA expression were analyzed, respectively. Results indicate that after 15 mGy exposure, the apoptosis of zebrafish brain increased, vacuoles appeared in brain tissue, some organelles were damaged and vacuoles appeared locally in brain cells. The mRNA expression level of axin2 was significantly upregulated, and those of frizzled, β-catenin, camk2, TCF/LEF and bcl9 were significantly downregulated in brain tissue. These genes are involved in the Wnt signaling pathway. The findings of this work suggest that low-dose radiation may influence the apoptosis and development of the brain in the zebrafish embryo by inhibiting the Wnt signaling pathway.Numerous studies have shown that exosomes play important roles in tumor biology development. However, the function of exosomal protein in cancer progression under different oxygen condition after irradiation is poorly understood. In this study, non-small cell lung cancer (NSCLC) A549 cells were γ-ray irradiated under normoxic or hypoxic conditions, then the exosomes released from the irradiated cells were collected and co-cultured with nonirradiated A549 cells or human umbilical vein endothelial cells (HUVECs). It was found that the exosomes significantly promoted the proliferation, migration and invasion of A549 cells as well as the proliferation and angiogenesis of HUVECs. Moreover, the exosomes released from hypoxic cells and/or irradiated cells had more powerful driving force in tumor progression compared to that generated from normoxia cells. Meanwhile, the proteins contained in the exosomes derived from A549 cells under different conditions were detected using tandem mass tag (TMT), and their expression profiles were analyzed.

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