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Frailty regarding neurologists: a functional manual.
Moreover, the copolymer can serve as a controlled release matrix for antifoulant 4,5-dichloro-2-octylisothiazolone (DCOIT), and the release rate increases with the contents of degradable fragments. The marine field tests confirmed that these copolymer-based coatings exhibited excellent antibiofouling ability for more than 3 months. The current copolymer is derived from commonly used monomers and an easily conducted polymerization method. Hence, we believe this method may offer innovative insights into marine antifouling applications.Hybrid inorganic-organic materials such as quantum dots (QDs) coupled with organic semiconductors have a wide range of optoelectronic applications, taking advantage of the respective materials' strengths. A key area of investigation in such systems is the transfer of triplet exciton states to and from QDs, which has potential applications in the luminescent harvesting of triplet excitons generated by singlet fission, in photocatalysis and photochemical upconversion. While the transfer of energy from QDs to the triplet state of organic semiconductors has been intensely studied in recent years, the mechanism and materials parameters controlling the reverse process, triplet transfer to QDs, have not been well investigated. Here, through a combination of steady-state and time-resolved optical spectroscopy we study the mechanism and energetic dependence of triplet energy transfer from an organic ligand (TIPS-tetracene carboxylic acid) to PbS QDs. Over an energetic range spanning from exothermic (-0.3 eV) to endothermic (+0.1 eV) triplet energy transfer we find that the triplet energy transfer to the QD occurs through a single step process with a clear energy dependence that is consistent with an electron exchange mechanism as described by Marcus-Hush theory. In contrast, the reverse process, energy transfer from the QD to the triplet state of the ligand, does not show any energy dependence in the studied energy range; interestingly, a delayed formation of the triplet state occurs relative to the quantum dots' decay. Based on the energetic dependence of triplet energy transfer we also suggest design criteria for future materials systems where triplet excitons from organic semiconductors are harvested via QDs, for instance in light emitting structures or the harvesting of triplet excitons generated via singlet fission.One-dimensional nanostructures with controllable aspect ratios are essential for a wide range of applications. An approach for magnetic superparticle (SP) assembly over large areas (55 mm × 25 mm) is introduced via co-assistance of electrostatic and magnetic fields, so-called magnetic layer-by-layer assembly, on an arbitrary hydrophilic substrate within minutes. The SP structures [diameter (d) = 120-350 nm] of Fe3O4 or Ag@Fe3O4 composites composed of hundreds of magnetite nanocrystals (d = 10-20 nm) are used as colloidal monomers to fabricate arrays of high aspect ratio (up to 102) linear nanochains, viz. colloidal polymers, where thermal disturbances were minimized. The arrays of colloidal polymers exhibit strong optical polarization effects owing to their geometrical anisotropy, which can be used as a simple optical filter. Furthermore, by using the binary colloidal mixture of different magnetic colloids, including different sized Fe3O4 and magnetoplasmonic Ag@Fe3O4, low aspect ratio (2-15) colloidal chains, viz. magnetic/plasmonic oligomers, with tunable lengths were fabricated, affording a facile but an effective approach to modulate the optical properties of the chains. The scalable fabrication of well-aligned, linear colloidal polymers and oligomers opens up appealing opportunities for the development of sensors, subwavelength waveguides, optical tweezers, and enhanced solar harvesting devices.Objective Immune thrombocytopenia (ITP) is a rare autoimmune disease and hematologic disorder characterized by reduced platelet counts that can result in significant symptoms, such as bleeding, bruising, epistaxis or petechiae. The thrombopoietin receptor agonist, eltrombopag is second-line agents used to treat chronic immune thrombocytopenia purpura in adults and children. Methods The aim of the present study was to evaluate the efficacy, safety and side effects, especially iron deficiency of eltrombopag treatment in pediatric patients with acute refractory and chronic immune thrombocytopenia. Results The diagnosis was chronic ITP in 89 patients and acute refractory ITP in 16 patients. The mean age of patients was 9.5 ± 4.5 years (1.2-18 years) at the beginning of EPAG treatment. Overall response rate was 74.3 %( n78). selleck chemicals The mean time for Plt count ≥50×109/L was 11.6 ±8 weeks (range 1-34 weeks). The treatment was stopped in 27 patients (25.7%) on an average of 6.8±9 months (range 1-38 months). The reason for discontinuation was lack of response in 18 patients, nonadherence in 4 patients, and hepatotoxicity in 2 patients. Response to treatment continued for average of 4 months after cessation of EPAG in 3 patients. Conclusion Results of the current study imply that eltrombopag is an effective therapeutic option in pediatric patients with acute refractory and chronic ITP. However, patients must be closely monitored for response and side effects especially iron deficiency during treatment.Correction to the Original Research article "Impact of Complex Care Management on Spending and Utilization for High-Need, High-Cost Medicaid Patients" published in the February 2020 issue of The American Journal of Managed Care.OBJECTIVES In 2012, the Ohio Department of Medicaid introduced requirements for enhanced care management to be delivered by Medicaid managed care organizations (MCOs). This study evaluated the impact of care management on reducing infant mortality in the largest Medicaid MCO in Ohio. STUDY DESIGN Observational study using infant and maternal individual-level enrollment and claims data (2009-2015), which used a quasi-experimental research design built on a sibling-comparison approach that controls for within-family confounders. METHODS Using individual-level data from the largest MCO in Ohio, we estimated linear probability models to examine the effect of infant engagement in care management on infant mortality. We used a within-family fixed-effects research design to determine if care management reduced infant mortality and estimated models separately for healthy infants and nonhealthy infants. RESULTS Infant engagement in care management was associated with a reduction of 7.4 percentage points (95% CI, -10.7 to -4.1; P less then .001) in infant mortality among the most vulnerable infants, those identified as not well at birth. This effect was larger in recent years and likely driven by new statewide enhanced care management requirements. Infant mortality was unchanged for healthy infants engaged in care management (coefficient = 0.03; 95% CI, -0.01 to 0.08). CONCLUSIONS This study provides evidence that care management can be effective in reducing infant mortality among Medicaid MCO enrollees, a population at high risk of mortality. Few infants were engaged in care management, suggesting to policy makers that there is room for many additional infants to benefit from this intervention.OBJECTIVES Analyses of emergency department (ED) use require visit classification algorithms based on administrative data. Our objectives were to present an expanded and revised version of an existing algorithm and to use this tool to characterize patterns of ED use across US hospitals and within a large sample of health plan enrollees. STUDY DESIGN Observational study using National Hospital Ambulatory Medical Care Survey ED public use files and hospital billing data for a health plan cohort. METHODS Our Johns Hopkins University (JHU) team classified many uncategorized diagnosis codes into existing New York University Emergency Department Algorithm (NYU-EDA) categories and added 3 severity levels to the injury category. We termed this new algorithm the NYU/JHU-EDA. We then compared visit distributions across these 2 algorithms and 2 other previous revised versions of the NYU-EDA using our 2 data sources. RESULTS Applying the newly developed NYU/JHU-EDA, we classified 99% of visits. Based on our analyses, it is evident that an even greater number of US ED visits than categorized by the NYU-EDA are nonemergent. For the first time, we provide a more complete picture of the level of severity among patients treated for injuries within US hospital EDs, with about 86% of such visits being nonsevere. Also, both the original and updated classification tools suggest that, of the 38% of ED visits that are clinically emergent, the majority either do not require ED resources or could have been avoided with better primary care. CONCLUSIONS The updated NYU/JHU-EDA taxonomy appears to offer cogent retrospective inferences about population-level ED utilization.OBJECTIVES To examine differences in the out-of-pocket costs for common generic drugs used to treat chronic conditions when individuals used their Medicare prescription drug plan (PDP) or when purchased through Walmart's generic drug discount programs (GDDPs) from 2009 to 2017. STUDY DESIGN A retrospective analysis of Medicare PDP Formulary files and Walmart's GDDP retail drug lists from 2009 to 2017. METHODS We identified all generic drugs used to treat chronic conditions that were on Walmart's GDDP retail drug list from 2009 to 2017. We then determined the out-of-pocket costs for each drug for each Medicare PDP and compared those costs with Walmart's GDDP cash price. RESULTS There were 62 and 43 generic medications used to treat common chronic diseases available through Walmart's GDDP in 2009 and 2017, respectively. Across all PDPs, the median beneficiary out-of-pocket expenditure for a 30-day supply of the GDDP-available medications for chronic diseases decreased from $5.70 (interquartile range [IQR], $2.55-$7.98) in 2009 to $2.00 (IQR, $0.00-$4.00) in 2017 (P less then .001) Approximately three-fifths (60.2%) of PDPs required beneficiaries to pay out-of-pocket costs higher than those of Walmart's GDDP in 2009, but only one-third (33.4%) did so in 2017. CONCLUSIONS Although Medicare beneficiary out-of-pocket costs for commonly used generic drug prescriptions generally decreased over time, Medicare beneficiaries may still be paying more for the same drugs than they would through Walmart's GDDP. Increased generic drug price transparency, including enforcing bans on gag clauses, is needed to ensure that Medicare beneficiaries obtain drugs using the most affordable options.OBJECTIVES Empirical evaluation of market power that hospitals gain over health plans through hospitals' ability to cancel their contracts with plans while keeping large shares of plans' emergency patients and getting paid for them at above-market rates. STUDY DESIGN Case-study analysis of 5 California hospitals that initially had contracts with most commercial health plans and then cancelled all those contracts at the same time. METHODS We conducted a before-and-after case-study analysis comparing volume, price, and net revenues for the 5 study hospitals 3 years before and up to 4 years after the cancellation of their commercial contracts. The volume and price trends in study hospitals were compared with data on control hospitals in the same geographic area over the matching study period. RESULTS Despite substantially increasing their prices on a noncontracted basis, the 5 study hospitals collectively retained 50% of their commercial health plan volume in first 2 years after the cancellation and 41% of their commercial volume in years 3 and 4, with net commercial revenues increasing as a result.
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