bluuebunny/crossref_metadata_2025_split huggingface dataset:
Beyond Health Insurance: Remaining Disparities in US Health Care in the Post‐ACA Era
Authors: SOMMERS BENJAMIN D. , McMURTRY CAITLIN L. , BLENDON ROBERT J. , BENSON JOHN M. , SAYDE JUSTIN M. 
Published: March 2017

Policy Points:
In a national survey of approximately 8,000 adults in 2015, we found large income‐ and race‐based disparities in perceived health care quality, affordability, and use of emergency departments.
Lack of health insurance is one factor that contributes to worse health care experiences among lower‐income Americans and racial/ethnic minorities, but it only explains a small to moderate portion of these disparities.
While the Affordable Care Act has led to significant improvements in health care access and affordability, large gaps remain. Repeal of the law would undo much of this progress, but even if the law remains in effect, policymakers need to address other social determinants that contribute to ongoing income‐ and race‐based disparities in health care.
ContextThe Affordable Care Act (ACA) has reduced the US uninsured rate to a historic low. But coverage is only one of many factors contributing to race‐ and income‐based disparities in health care access, affordability, and quality.MethodsUsing a novel 2015 national survey of more than 8,000 Americans, we examined disparities between low‐income and high‐income adults and between racial/ethnic minorities and whites. We conducted a series of regression analyses, starting with models that only took into account income or race, and then sequentially adjusted for health insurance, state of residence, demographics, and health status. We examined self‐reported quality of care, cost‐related delays in care, and emergency department (ED) use due to lack of available appointments. Then we used multivariate regression to assess respondents’ views of whether quality and affordability had improved over the past 2 years and whether the ACA was helping them.FindingsQuality of care ratings were significantly worse among lower‐income adults than higher‐income adults. Only 10%‐25% of this gap was explained by health insurance coverage. Cost‐related delays in care and ED use due to lack of available appointments were nearly twice as common in the lowest‐income group, and less than 40% of these disparities was explained by insurance. There were significant racial/ethnic gaps: reported quality of care was worse among blacks and Latinos than whites, with 16%‐70% explained by insurance. In contrast to these disparities, lower‐income and minority groups were generally more likely than whites or higher‐income adults to say that the ACA was helping them and that the quality and/or affordability of care had improved in recent years.ConclusionsOur post–health reform survey shows ongoing stark income and racial disparities in the health care experiences of Americans. While the ACA has narrowed these gaps, insurance expansion alone will not be enough to achieve health care equity.
Information Blocking: Is It Occurring and What Policy Strategies Can Address It?
Authors: ADLER‐MILSTEIN JULIA , PFEIFER ERIC 
Published: March 2017

Policy Points:
Congress has expressed concern about electronic health record (EHR) vendors and health care providers knowingly interfering with the electronic exchange of patient health information. These “information blocking” practices would privately benefit vendors and providers but limit the societal quality and efficiency benefits from EHR adoption.
We found that information blocking is reported to frequently occur among EHR vendors as well as hospitals and health systems, and that it is perceived to be motivated by opportunities for revenue gain.
Because information blocking is largely legal today, the most effective policy response likely involves a combination of direct enforcement and the altering of market conditions that promote information blocking.
ContextCongress has raised concerns about providers and electronic health record (EHR) vendors knowingly engaging in business practices that interfere with electronic health information exchange (HIE). Such “information blocking” is presumed to occur because providers and vendors reap financial benefits, but these practices harm public good and substantially limit the value to be gained from EHR adoption. Crafting a policy response has been difficult because, beyond anecdotes, there is no data that captures the extent of information blocking.MethodsWe conducted a national survey of leaders of HIE efforts who work to enable HIE across provider organizations. We asked them about the frequency of information blocking, its specific forms, and the effectiveness of various policy strategies to address it. We received responses from 60 individuals (57% response rate). We calculated descriptive statistics across responses.FindingsHalf of respondents reported that EHR vendors routinely engage in information blocking, and 25% of respondents reported that hospitals and health systems routinely do so. Among EHR vendors, the most common form of information blocking was deploying products with limited interoperability. Among hospitals and health systems, the most common form was coercing providers to adopt particular EHR or HIE technology. Increasing transparency of EHR vendor business practices and product performance, stronger financial incentives for providers to share information, and making information blocking illegal were perceived as the most effective policy remedies.ConclusionsInformation blocking appears to be real and fairly widespread. Policymakers have some existing levers that can be used to curb information blocking and help information flow to where it is needed to improve patient care. However, because information blocking is largely legal today, a strong response will involve new legislation and associated enforcement actions.
Value‐Based Physician Payment in Oncology: Public and Private Insurer Initiatives
Authors: ROBINSON JAMES C. 
Published: March 2017

Policy Points:
Public and private insurers are implementing payment mechanisms to improve coordination and reduce the cost of drug, hospital, and ancillary services for cancer patients. Some target unnecessary hospitalization, while others create incentives for prescribing lower‐cost chemotherapies and biologics.
Physician payment methods in oncology require a balance between incentives for cost control and incentives for patient access to expensive specialty drugs.
None of the initiatives adopt bundled methods out of concern for shifting excessive financial risk onto physicians in the context of rapid pharmaceutical innovation.
ContextHigh‐value oncology requires physicians to monitor and coordinate all aspects of care, educate and engage their patients, and adopt cost‐effective drug treatments. However, oncology practices in the United States traditionally have been reimbursed based on the number of office visits performed and through cost‐plus margins from prescription of expensive drugs. Public and private payers now are experimenting with methods of payment that include monthly care management fees, annual bonuses, and incentives for conservative choice among alternative drug regimens.MethodsThis paper uses case study methods to examine oncology payment initiatives at Medicare, Anthem, Aetna, and UnitedHealthcare, the nation's largest public and private health insurance plans.FindingsThe 4 insurers supplement traditional fee‐for‐service payment with payment methods designed to promote coordination of care and conservative use of health care resources. Medicare, Aetna, and UnitedHealthcare reward oncology practices that reduce per‐patient spending, targeting unnecessary patient visits to emergency departments and hospitals. Anthem offers monthly payments to practices that adhere to lower‐cost drug treatment pathways; Aetna increases the percentage markup on low‐cost generic chemotherapies but not on high‐cost biologics; and UnitedHealthcare removes the linkage between physician payment and spending on office‐infused drugs. As a condition for receiving the new payments, each of the initiatives requires participating practices to report and, in some cases, improve performance on quality metrics. None of the initiatives bundles payment for oncology drugs together with payment for other oncology services, out of concern for shifting financial risk onto physicians and creating access barriers for patients.ConclusionsThe emerging “value‐based” methods of oncology payment supplement fee‐for‐service and cost‐based reimbursements with per‐month and per‐episode payments, but none of the payers bundle spending on cancer drugs with payments for other services. Payers recognize that bundled payment could create access barriers for patients and undermine innovation in effective but expensive new pharmaceuticals.
Angiotensin converting enzyme‐inhibitory activity and antimicrobial effect of fermented camel milk (Camelus dromedarius)
Authors: Alhaj Omar A , Metwalli Ali A , Ismail Elsayed A , Ali Hatem S , Al‐Khalifa Abdulrahman S , Kanekanian Ara D 
Published: March 2017

This study aimed to determine the angiotensin converting enzyme‐inhibitory activity and antimicrobial effect of fermented camel milk. Samples were prepared either using Lactobacillus acidophilus and Streptococcus thermophilus or Lactobacillus helveticus and Str. thermophilus and labelled as S1 and S2, respectively. The IC50 values of S1 and S2 samples ranged between 113–200 and 70–133 μg/mL, respectively. The antimicrobial effects of S1 and S2 samples against Bacillus cereus, Salmonella Typhimurium and Staphylococcus aureus were apparent after 12 h of incubation and continued until 15 days of storage, whereas unfermented camel milk exhibited no antimicrobial effects against any of the tested pathogens.
Mindfulness and job performance: a study of Australian leaders
Authors: King Elizabeth , Haar Jarrod M 
Published: March 2017

Mindfulness relates to being aware of the present reality and living in the moment, and, while linked to well‐being, it has only recently been tested on specific leader samples. Despite attention, the links between mindfulness and job performance are scarce, with the performance of leaders especially so. The present study tests self‐reported mindfulness from 84 Australian leaders towards two forms of leadership performance as rated by their immediate manager. Using structural equation modelling, we find mindfulness is positively related to leadership self‐mastery and leadership organizational‐transformation. The best fit for the data was a full mediation model: mindfulness predicting leadership self‐mastery, predicting leadership organizational‐transformation. Furthermore, we tested for the moderating effects of tenure duration and found that mindfulness was especially beneficial for leadership self‐mastery at low tenure duration. Findings suggest that leadership performance may ultimately be enhanced by having leaders who are more mindful and present at work.
Effects of dipeptidyl peptidase‐4 inhibitors in type 2 diabetes patients with moderate to severe chronic kidney disease: Meta‐analysis of randomized controlled trials using unadjusted data
Authors: Yang Man , Wang Ling , Gu Lijie , Yuan Weijie 
Published: March 2017

AbstractBackgroundThree meta‐analyses recently evaluated the effects of dipeptidyl peptidase (DPP)‐4 inhibitors in type 2 diabetes (T2D) patients with chronic kidney disease (CKD). However, the combination of adjusted and unadjusted data in these meta‐analyses may be questionable. The present study performed a meta‐analysis of the effects of DPP‐4 inhibitors in T2D patients with moderate to severe CKD using unadjusted data from randomized controlled trials (RCTs).MethodsThe PubMed, Embase (via Ovid), and Cochrane Central databases were searched for papers regarding the effects of DPP‐4 inhibitors in CKD patients published before 1 August 2016. Data were independently extracted by two authors. A pooled analysis of unadjusted data was performed using random‐effects models.ResultsTwelve studies representing 10 RCTs were included in the present analysis. Comparing mean HbA1c change between placebo and treatment, DPP‐4 inhibitors significantly improved HbA1c levels at 12 weeks (mean difference [MD] –0.42; 95% confidence interval [CI] –0.54, −0.29), but improvements in HbA1c were seen only in dialysis patients at 24 weeks (MD –0.52; 95% CI –0.72, –0.32)*. Improvements in HbA1c were equivalent between DPP‐4 inhibitors and sulfonylureas at 52 or 54 weeks. There were no significant differences in the incidence of severe or any hypoglycemic events between DPP‐4 inhibitors and control (placebo or sulfonylureas) at 12, 24, and 52 or 54 weeks. However, DPP‐4 inhibitors induced fewer symptomatic hypoglycemic events compared with sulfonylureas at 52 or 54 weeks. *[Correction added on 30 October 2017, after first online publication: The value ‘0.32’ has been corrected to ‘−0.32’.]ConclusionsThe present analysis shows that DPP‐4 inhibitors are effective and comparable with sulfonylureas in T2D patients with moderate to severe CKD.
Intertwining phylogenetic trees and networks
Authors: Schliep Klaus , Potts Alastair J. , Morrison David A. , Grimm Guido W. 
Published: March 2017

Summary

The fields of phylogenetic tree and network inference have dramatically advanced in the past decade, but independently with few attempts to bridge them.

Here we provide a framework, implemented in the phangorn library in R, to transfer information between trees and networks.

This includes: (i) identifying and labelling equivalent tree branches and network edges, (ii) transferring tree branch support to network edges, and (iii) mapping bipartition support from a sample of trees (e.g. from bootstrapping or Bayesian inference) onto network edges.

The ability to readily combine tree and network information should lead to more comprehensive evolutionary comparisons and inferences.
The Right to the World
Authors: Nevins Joseph 
Published: March 2017

AbstractThe global number of refugees, asylum seekers, and those displaced within their countries are at record levels in the post‐World War II era. Meanwhile, efforts by relatively wealthy and powerful nation‐states to exclude unwanted migrants through enhanced territorial control have reached unprecedented heights, producing great harm–most notably premature death–for many. The factors driving out‐migration from homelands made unviable, coupled with multiple forms of violence experienced by migrants, demonstrate the need for an expansion of rights–conceived of as both entitlements and sites of struggle. So, herein, I assert the need for “the right to the world”–specifically a right to mobility and a just share of the Earth's resources–to help realize the promise of a dignified life for all. In making the case for such, the article offers a critical analysis of the contemporary human rights regime and of the “right to the city”.
Phase 1 study of OCV‐C02, a peptide vaccine consisting of two peptide epitopes for refractory metastatic colorectal cancer
Authors: Taniguchi Hiroya , Iwasa Satoru , Yamazaki Kentaro , Yoshino Takayuki , Kiryu Chika , Naka Yoshiharu , Liew Ei Leen , Sakata Yuh 
Published: March 2017

SummaryOCV‐C02 is a peptide vaccine consisting of two peptide epitopes derived from ring finger protein 43 (RNF43) and translocase of outer mitochondrial membrane 34 (TOMM34). This Phase 1 study assessed the safety, preliminary efficacy and immunological responses following OCV‐C02 administration in patients with advanced or relapsed colorectal cancer who were intolerant or refractory to standard chemotherapy. Primary endpoint was any occurrence of dose‐limiting toxicity (DLT) during cycle 1. Secondary endpoints were treatment‐emergent adverse events, efficacy and immunological responses. Efficacy was evaluated based on overall response rate, disease control rate, time to treatment failure and overall survival. Immunological responses were evaluated by measuring CTL, delayed‐type hypersensitivity (DTH) and regulatory T cells (Tregs). Twenty‐four patients who were HLA‐A*24:02‐positive were enrolled and grouped into four cohorts of six patients each: cohorts 1, 2, 3, and 4 which received s.c. OCV‐C02 (emulsifying agent: Montanide™ ISA 51 VG) 0.3, 1, 3, and 6 mg/body, respectively. After cycle 1, patients who were eligible and willing to continue vaccination proceeded to the extended treatment period. No DLT occurred in cycle 1 and no major safety problems were reported throughout the trial. One patient in cohort 2, three patients in cohort 3 and two patients in cohort 4 achieved stable disease. CTL and DTH responses following vaccination were also observed across the four cohorts. OCV‐C02 at 0.3 to 6 mg/body was found to be safe and well tolerated. Trial registrations: JAPIC clinical trials registry (ID: JapicCTI‐132075) and ClinicalTrials.Gov (ID: NCT01801930).
Overall survival of first‐line axitinib in metastatic renal cell carcinoma: Japanese subgroup analysis from phase II study
Authors: Oya Mototsugu , Tomita Yoshihiko , Fukasawa Satoshi , Shinohara Nobuo , Habuchi Tomonori , Rini Brian I. , Fujii Yosuke , Kamei Yoichi , Umeyama Yoshiko , Bair Angel H. , Uemura Hirotsugu 
Published: March 2017

Subgroup analyses of a randomized global phase II study of axitinib showed objective response rate of 66% and median progression‐free survival of 27.6 months in treatment‐naïve Japanese patients with metastatic renal cell carcinoma (RCC). This analysis evaluated overall survival (OS) and safety in 44 Japanese patients and compared the results with 169 non‐Japanese patients. In addition, baseline characteristics for predictive factors that may influence OS in first‐line metastatic RCC were explored in all patients using a Cox proportional hazard model. With median follow‐up of 33 months, fewer than half (16 of 44) of the Japanese patients had died and median OS was not reached (95% confidence interval [CI], 38.8 months–not estimable), whereas 107 of 169 (63%) non‐Japanese patients had died and median OS was 33.9 months (95% CI, 28.9–42.7). Estimated 1‐year, 2‐year and 3‐year survival probability (95% CI) was 86.4% (76.2–96.5), 75.0% (62.2–87.8) and 68.2% (54.4–81.9), respectively, in Japanese patients, and was higher than that in non‐Japanese patients (75.1% [68.4–81.8], 62.1% [54.5–69.7] and 47.2% [39.3–55.1], respectively). The updated safety analysis did not reveal any new adverse events of concern among Japanese or non‐Japanese patients. The multivariate analysis identified that lower baseline Eastern Cooperative Oncology Group performance status, lower baseline tumor burden, and longer time from histopathological diagnosis to treatment were significant positive predictors of OS. The current analysis confirmed the clinical activity of axitinib in treatment‐naïve Japanese patients with metastatic RCC, with an acceptable toxicity profile.
Locus on chromosome 16 is significantly associated with increased tendency to lose pups in females of the RR/Sgn inbred mouse strain
Authors: Suto Jun‐ichi 
Published: March 2017

AbstractFemales of the inbred mouse strain RR/Sgn have an apparent tendency to lose pups during rearing. To identify genes underlying this abnormal maternal phenotype, we performed quantitative trait loci (QTL) mapping in 349 (C57BL/6 J × RR/Sgn) F1 × RR/Sgn backcross mice and identified one significant and one suggestive QTL on chromosomes 16 and 4, respectively. We assigned the gene symbol nurturing ability QTL 3 (Naq3) to the QTL on chromosome 16. Twenty of the 21 mothers who lost entire litters were homozygous for RR/Sgn allele at Naq3; i.e., the significant association of Naq3 with pup loss was further confirmed by binomial tests. We tentatively propose that Mapk1, Kalrn, and Vps8 are potential candidate genes for Naq3.
A Narrative Analysis of the Political Economy Shaping Policy on Child Undernutrition in India
Authors: Nisbett Nicholas 
Published: March 2017

ABSTRACTThis article examines two narratives on the subject of child undernutrition in India espoused by competing sides of the policy elite. It argues that undertaking narrative policy analysis in a structured fashion helps to elucidate a clearer sense of the underlying positions within this important area of development discourse. India's high rates of child undernutrition have become a battleground of positions on the country's growth trajectory, revealing of the wider assumptions, ideologies and manifestations of power of the various actors espousing particular positions. Recent debates have brought into focus not only the contestation of various causalities and remedies, but also the politics of measurement, data and their interpretation. The results of this analysis are relevant elsewhere in their illumination of the politically public nature of technocratic debates on nutrition and the way in which this public discourse extends beyond the immediate topic to wider ideological divisions and assumptions on growth, equity and recent history.
Effects of short‐term N addition on plant biomass allocation and C and N pools of the Sibiraea angustata scrub ecosystem
Authors: Wang D. , He H. L. , Gao Q. , Zhao C. Z. , Zhao W. Q. , Yin C. Y. , Chen X. L. , Ma Z. L. , Li D. D. , Sun D. D. , Cheng X. Y. , Liu Q. 
Published: March 2017

SummaryTo explain the effects of short‐term N addition on plant biomass allocation and on carbon (C) and nitrogen (N) pools in an alpine scrub ecosystem, we carried out a field experiment in Sibiraea angustata scrubland on the eastern margin of the Qinghai‐Tibetan Plateau of China. After one and a half years of N addition at four rates (N0, control; N20, 20; N50, 50; N100, 100 kg N ha−1 year−1), we investigated the amount and allocation of biomass and the C and N pools in several parts of the ecosystem, including shrubs (leaves, shoots and branches, coarse roots and fine roots), grass (above‐ and below‐ground) and litter (wood and leaf debris) components, and seven depth intervals within the soil (0–5, 5–10, 10–20, 20–30, 30–50, 50–70 and 70–100 cm). The results were as follows: (i) total vegetation biomass showed a linear increase with the increase in N (P < 0.05), mainly from the increased root biomass in both shrubs and grasses, (ii) the ecosystem C and N storage were 36 and 3.26 kg m−2, respectively, of which the shrub, grass, litter and soil components contributed 11.08, 0.47, 0.25 and 88%, respectively, to the C pool and 3.07, 0.16, 0.08 and 97%, respectively, to the N pool, (iii) the ecosystem N pool did not change in response to the addition of N, whereas the ecosystem C pool responded linearly to increasing N (P < 0.05). These results suggest that the alpine scrub ecosystem functions as a net C sink under increasing atmospheric N deposition, mainly by promoting belowground C sequestration.Highlights

Effects of short‐term N addition on biomass allocation and C and N pools in alpine scrub.
Response to N addition in C pool of components of the ecosystem and soil at depth (0–100 cm).
Root:shoot ratio of vegetation and ecosystem C pool increased linearly with increasing N.
Alpine scrub ecosystem may function as a net C sink under increasing atmospheric N deposition.