Mean Total Ratio Research Articles

Increasing medicare charge-to-payment ratios for dermatologists from 2012 to 2017.

Government-backed medical insurance plans have undergone significant changes in the last decade, but more information is needed to understand reimbursement trends, particularly for specialist medical services. The objective of this study was to identify the ratios of submitted dermatology service charges to allowed Medicare payments over the years. Further variables studied include regional or state variations, gender of provider, hierarchical condition category (HCC) risk scores of patient complexity, and number of services. Data were collected from publicly available Medicare Part B Provider Utilization and Payment Data: Physician and Other Supplier 2012-2017 datasets. All data analysis was performed on SAS 9.4 Statistical Software.Total dermatology related medicare charges-to-payment ratios steadily increased over the years (1.77 [in 2012], 1.82 [2013], 1.87 [2014], 1.95 [2015], 2.02 [2016], and 2.06 [2017]). This suggests that for every $2.06 charged in 2017, dermatology providers could expect $1 of actual payment. When further stratified into medical services vs. drug services, this upward trend remained for medical charges but drug service ratios have remained constant. There was also significant geographic variation in total medicare charges-to-payment ratios as states in the Midwest (mean total ratio: 2.48) had higher charges to payment gaps than states in the Northeast (2.26), West (2.16), and South (1.99; p = 0.01).This study identifies trends and variables associated with dermatology medicare payments. Providers may use this information to better understand changing payment structures in their own practices and hopefully these results can be valuable in future policy discussions.

Hybrid Airship Fuel Optimization for Various Cruise Modes

Hybrid airships are new-age air transportation vehicles that consume lesser fuel than conventional airplanes and take lesser flight time than conventional airships. In the present study, hybrid airship fuel consumption during cruise is minimized by optimizing volume and lift apportionment through optimization. In literature, cruise mode 1 (varying cruise speed), cruise mode 2 (varying lift coefficient), and combination of cruise modes 1 and 2 are detailed. This paper introduces two novel cruise modes, namely, cruise mode 4 (varying atmospheric density cruise) and cruise mode 5 (constant dynamics pressure cruise). All five cruise modes are investigated and formulated by posing as optimization problems considering fuel weight minimization as the objective function. Fuel weight minimization has been carried out for two time constraints (24 and 36 h). The optimization problems were solved using MATLAB optimization toolbox. From the results, it is found that cruise modes 4 and 5, which are having the highest mean total ratio and highest mean buoyancy ratio, provide least fuel consumption. The results indicated that cruise modes 1, 2, and 3 require 5–7% more fuel than cruise modes 4 and 5.

26307 Trends and factors associated with dermatology Medicare charges to payment ratios, 2012-2017

Government-backed medical insurance plans have undergone significant changes in the last decade, but more information is needed to understand reimbursement trends, particularly for specialist medical services. The objective of this study was to identify the ratios of submitted dermatology service charges to allowed Medicare payments over the years. Further variables studied include regional or state variations, gender of provider, hierarchical condition category (HCC) risk scores of patient complexity, and number of services. Data were collected from publicly available Medicare Part B Provider Utilization and Payment Data: Physician and Other Supplier 2012-2017 datasets. All data analysis was performed on SAS 9.4 Statistical Software. Total dermatology related Medicare charges to payment ratios steadily increased over the years (1.77 [in 2012], 1.82 [2013], 1.87 [2014], 1.95 [2015], 2.02 [2016], and 2.06 [2017]). This suggests that for every $2.06 charged in 2017, dermatology providers could expect $1 of actual payment. When further stratified into medical services vs drug services, this upward trend remained for medical charges but drug service ratios have remained constant. There was also significant geographic variation in total Medicare charges to payment ratios as states in the Midwest (mean total ratio: 2.48) had higher charges to payment gaps than states in the Northeast (2.26), West (2.16), and South (1.99; P = .01). This study identifies trends and variables associated with dermatology Medicare payments. Providers may use this information to better understand changing payment structures in their own practices and hopefully these results can be valuable in future policy discussions.

Measurement of Nutrition Environments in Grocery Stores, Convenience Stores, and Restaurants in the Lower Mississippi Delta.

IntroductionThe Lower Mississippi Delta is characterized by several factors associated with poor diet quality. Our objective was to measure local nutrition environments of pregnant women and their infants who participated in a nutrition and physical activity intervention to assess environmental exposures potentially influencing their dietary habits.MethodsWe measured the nutrition environments of 5 towns in which participants resided by using the Nutrition Environment Measures Survey for grocery stores, convenience stores, full-service restaurants, and fast food restaurants. We used general linear models to test for differences in ratio scores, calculated by dividing each food outlet score by the maximum score possible, among food outlet classes and subclasses.ResultsMean total ratio scores (expressed as percentages) for the Nutrition Environment Measures Survey among 4 classes of food outlets were significantly different from one another except for convenience stores and full-service restaurants. On average, grocery stores (n = 11) had 54% of maximum points possible, followed by full-service restaurants (21%; n = 50), convenience stores (16%; n = 86), and fast food restaurants (8%; n = 119). We found no significant differences in mean total ratio scores among convenience store subclasses. For fast food restaurant subclasses, stand-alone restaurants (n = 81) had 19% of maximum points possible, significantly higher than grocery store delicatessens (6%; n = 8), corner stores that sold fast food (3%; n = 5), and gas stations that sold fast food (4%; n = 25).ConclusionThese 5 Lower Mississippi Delta towns scored low on nutrition environment measures associated with healthful eating. Behavioral interventions designed to bring about positive changes in dietary habits of rural residents are needed; however, effects may be minimal if environmental factors supportive of healthful eating are not available.

Angiogenesis in CD5-positive Diffuse Large B Cell Lymphoma: A Morphometric Analysis.

CD5-positive diffuse large B cell lymphoma (DLBCL) is the least frequent immunohistochemical subgroup of DLBCL. The relatively little available data suggests a worse outcome in this population, resulting from a resistance to chemotherapy. The aim was the comparative assessment of angiogenesis in both CD5-positive and CD5-negative DLBCL, as well as in lymphatic tissues without lymphoproliferative diseases. The analysis included 36 cases of CD5-positive DLBCL (19 females and 17 males) aged 29-87 years (mean age 69), diagnosed and treated in the Maria Sklodowska-Curie Institute and Oncology Center and Medical University of Warsaw in 2002-2013. The control group comprised 28 cases of CD5-negative DLBCL (14 females and 14 males) aged 24-82 years (mean age 58.5). The secondary control group (13 cases) consisted of normal lymphatic tissue obtained from patients without lymphoproliferative diseases. The level of angiogenesis was assessed on the basis of immunohistochemical CD34, vWF and HIF1α expression measured using morphometric methods. CD5-positive DLBCL, in comparison to CD5-negative DLBCL, was characterized by: (1) higher mean of total blood vessel area, (2) higher mean total ratio of blood vessel area and staining intensity, (3) higher mean of total blood vessel area in regions defined as hot spots, (4) higher mean of total ratio of blood vessel area and staining intensity in hot spots. The measurements in lymph nodes without lymphoproliferative diseases lay between the values obtained in both DLBCL subgroups. We observed a significant exacerbation of angiogenesis in CD5-positive DLBCL in comparison to the CD5-negative subgroup, possibly explaining its more aggressive clinical course. Our data does not substantiate the hypothesis that angiogenesis is more pronounced in frequent CD5-negative DLBCL subgroup in comparison to benign lymphatic tissue.

Transplantation of Mesenchymal Cells Improves Peripheral Limb Ischemia in Diabetic Rats

Adipose tissue-derived mesenchymal stromal cells (ADSCs) are a prominent cellular source for regenerative medicine. We tested whether transplantation of ADSCs into the ischemic muscular tissue of diabetic animals would attenuate impaired cell metabolism and microcirculatory function. We induced unilateral hind limb ischemia in male streptozotocin-treated rats and nondiabetic controls. One day after femoral artery ligation, six rats per group were intramuscularly injected allogeneic ADSCs (10(6)-10(7)-10(8) cells/mL); or conditioned media from ADSC cultures (CM); or saline; or allogeneic fibroblasts (10(7) cells/mL); or nonconditioned medium. Rats underwent magnetic resonance angiography; short time inversion recovery (STIR) edema-weighed imaging; proton MR spectroscopy ((1)H-MRS); immunoblotting and immunofluorescence on both hind limbs for 4 weeks. T1-weighted and STIR images showed tissue swelling and signal hyperintensity, respectively, in the ischemic tissue. The mean total ratio of creatine/water for the occluded limbs was significantly lower than for the nonoccluded limbs in both nondiabetic and diabetic rats. ADSC and CM groups had greater recovery of tCr/water in ischemic limbs in both diabetic and nondiabetic rats, with increased expression of α-sarcomeric actinin, vascular endothelial growth factor and hepatocyte growth factor, as well as increased vessel density. ADSCs improve ischemic muscle metabolism and increase neovasculogenesis in diabetic rats.

Magnetic resonance spectroscopy to detect functional improvement by adipose tissue-derived stromal cell transplantation in the ischemic hind limb in diabetic rats

Adipose tissue-derived stromal cells (ADSCs) are a prominent cellular source in regenerative medicine. We tested whether transplantation of ADSCs into ischemic muscular tissue of diabetic animals would attenuate the impairment in cell metabolism and microcirculatory with a combination of techniques including magnetic resonance imaging and spectroscopy (1H-MRS). Methods: We induced unilateral hind limb ischemia in male streptozotocin-treated rats and non-diabetic controls. One day after femoral artery ligation, 6 rats per group were randomly injected intramuscularly allogeneic ADSCs (C1: 106, C2: 107, C3: 108 cells/mL); or conditioned media from ADSC cultures (CM); or saline (control). Rats underwent magnetic resonance angiography (MRA); short time inversion recovery (STIR) edema-weighed imaging; 1H-MRS; immunoblotting and immunofluorescence on both hind limbs for 4 weeks. Results: T1-weighted and STIR images showed the presence of tissue swelling and signal hyperintensity respectively in tissue affected by occlusion. Mean total ratio of tissue creatine/water (tCr/water) for the occluded limb was significantly lower than for the non-occluded limbs in both non-diabetic and diabetic rats. At 4 weeks, ADSC and CM groups had greater recovery of tCr/water in ischemic limbs compared with controls in both diabetic- and non-diabetic rats (**p<0.01; *p<0.05) (Figure 1, panel A), with less tissue swelling (panel B), increased expression of α-sarcomeric actinin, vascular endothelial growth factor (VEGF) and hepatocyte growth factor (HGF) (Table 1), as well as increased vessel density (panel C) and suppression of the up-regulation of water channel aquaporin (AQP)-1 and pro-inflammatory early response gene such as cycloxygenase (COX)-2 (panel D). Figure 1 Figure 1 Table 1. VEGF and HGF expression in diabetic rat ischemic tissues after femoral artery ligation and treatments with ADSCs conditioned medium and controls Values (pg/mL) are mean ± SD from 3 independent experiments of vascular endothelial growth factor (VEGF) and hepatocyte growth factor (HGF) in frozen tissues from limbs with femoral artery ligation treated with multiple injections of PBS (1 mL), FB (107 cells/mL), ADSCs (at concentration C1 = 106 cells/mL, C2 = 107 cells/mL, C3 = 108 cells/mL) or supernatants obtained from primary ADSCs (conditioned medium. CM, 1 mL) or non-conditioned medium (1 mL). N=6 rats per each treatment group. **P<0.01 vs non-diabetic non-occluded PBS-treated; °°P<0.01 vs diabetic non-occluded PBS-treated; #P<0.05 vs diabetic occluded PBS treated, ##P<0.01 vs diabetic occluded PBS-treated. Legend: PBS, phosphate buffer saline; ADSCs, adipose tissue-derived stromal cells; CM, conditioned medium; NCM, non-conditioned medium; FB, fibroblasts; VEGF, vascular endothelial growth factor; HGF, hepatocyte growth factor. Conclusions: ADSCs improve ischemic muscle metabolism and increase neovasculogenesis in diabetic rats with hind limb ischemia. 1H-MRS is a useful tool to monitor attempts at salvaging the ischemic tissues with cell-derived novel therapies.

Clinical implications of incorporating heterogeneity corrections in mantle field irradiation

Purpose: Patient dose calculations for mantle-field irradiation have traditionally been performed using homogeneous, water phantom data. The advent of computed tomography (CT)-based treatment planning now permits dose calculations to be corrected for actual patient density. Incorporation of full heterogeneity corrections is desirable, because calculations performed in this fashion more closely represent the actual dose delivered to the patient. In preparation for full clinical implementation of heterogeneity corrections in mantle irradiation, an evaluation of possible changes in dosimetry when transitioning from treatment plans generated without heterogeneity corrections to treatment plans that incorporated full heterogeneity corrections is presented. Methods and materials: A retrospective analysis was performed of treatment plans with and without heterogeneity corrections for 15 consecutive patients who had undergone full mantle-field irradiation. Comparisons were made of the absolute delivered doses (in cGy per monitor unit) and the absolute volume (in cubic centimeters) enclosed by the isodose surface of the 30.6 Gy prescription line and the surface representing 90% of the prescribed dose. Dose–volume histograms (DVHs) were generated and studied to evaluate differences in the doses received by the lungs, heart, and spinal cord between corrected and uncorrected plans. Comparisons were made of the volumes of lung receiving at least 20 Gy, the volumes of heart receiving at least 25.2 Gy, and the maximum cord dose. Results: Dosimetric differences between heterogeneity-corrected and heterogeneity-uncorrected calculations were small. The mean total ratio of corrected-to-uncorrected dose per monitor unit was 1.01, with a standard deviation (SD) of 0.02. The mean corrected-to-uncorrected treated volume ratio (30.6 Gy) was 0.97, SD 0.14, and the mean corrected-to-uncorrected volume ratio of the 90% isodose surface was 0.99, SD 0.02. The ratio of the volume of lung receiving at least 20 Gy was 1.03, SD 0.02; the ratio of the volume of heart receiving at least 25.2 Gy was 1.01, SD 0.03; and the maximum spinal cord dose ratio was 1.02, SD 0.02. Conclusions: In all patient treatment plans evaluated, no significant dosimetric differences were observed between heterogeneity-corrected and heterogeneity-uncorrected treatment plans. However, unpredictable differences in the prescription isodose (30.6 Gy) were observed. The differences in coverage at the 90% isodose volume were negligible. The dose administered to lung in heterogeneity-corrected plans demonstrates a higher dose overall, with the greatest increase occurring at volumes receiving at least 20 Gy. In light of these small dosimetric differences, we believe that heterogeneity corrections can be incorporated into full mantle-field treatment planning.