Type Of Coverage Research Articles

Fatigue performance of endodontically treated premolars restored with direct and indirect cuspal coverage restorations utilizing fiber-reinforced cores

ObjectivesThe aim of this in vitro study was to investigate the fatigue survival and fracture behavior of endodontically treated (ET) premolars restored with different types of post-core and cuspal coverage restorations.Materials and methodsMOD cavities were prepared on 108 extracted maxillary premolars. During the endodontic treatment, all teeth were instrumented with rotary files (ProTaper Universal) to the same apical enlargement (F2) and were obturated with a matched single cone obturation. After the endodontic procedure, the cavities were restored with different post-core and overlay restorations (n = 12/group). Three groups (A1–A3) were restored with either conventional composite core (PFC; control) or flowable short-fiber-reinforced composite (SFRC) core with/without custom-made fiber posts and without overlays. Six groups had similar post-core foundations as described above but with either direct PFC (B1–B3) or indirect CAD/CAM (C1–C3) overlays. Fatigue survival was tested for all restorations using a cyclic loading machine until fracture occurred or 50,000 cycles were completed. Kaplan-Meyer survival analysis was conducted, followed by pairwise post hoc comparisons.ResultsNone of the restored teeth survived all 50,000. Application of flowable SFRC as luting-core material with fiber post and CAD/CAD overlays (Group C3) showed superior performance regarding fatigue survival (p < 0.05) to all the other groups. Flowable SFRC with fiber post and direct overlay (Group B3) showed superior survival compared to all other direct techniques (p < 0.05), except for the same post-core foundation but without cuspal coverage (Group A3).ConclusionsCustom-made fiber post and SFRC as post luting core material with or without cuspal coverage performed well in terms of fatigue resistance and survival when used for the restoration of ET premolars.Clinical relevanceThe fatigue survival of direct and indirect cuspal coverage restorations in ET MOD premolars is highly dependent on whether the core build-up is fiber-reinforced or not. The combination of short and long fibers in the form of individualized post-cores seems to offer a favorable solution in this situation.

Photodynamic therapy in treatment of trophic ulcers in patients, suffering chronic venous insufficiency

Objective. Elaboration of complex approach to treatment of trophic ulcers of venous etiology, using photodynamical tissue therapy and modern types of the wound coverage.&#x0D; Materials and methods. Into the investigation 24 patients were included, suffering venous ulcers on background of postthrombophlebitic disease and ageing from 31 to 79 yrs old. Into the comparison group there were included 14 patients, in whom a standard treatment (venotonic preparations, elastic compression, local application of multicomponent ointments depending on the wound phase present) was used. Into the main group10 patients were included, in whom the elaborated procedure of photodynamical therapy was applied. In treatment of the patients the Korobov’s photonic matrix «Barva Flex», owing spectral diapason 700-630 nm, corresponding to red light, was applied. Gel «Levuderm» (6% gel 5-aminolevulinic acid phosphate, which constitutes a natural predecessor of endogenous photosensitizer protoporphyrin IX) was applied.&#x0D; Results. Transition of the wound process to the second stage in the comparison group was durable, in 50% of patients epithelization did not complete up to 45th day of treatment. In the main group, under the impact of the treatment method proposed, the term of granulations appearance have had shortened as well as filling in of the wound by mature granulation tissue, and epithelization have accelerated by 29.8%, comparing with standard therapy.&#x0D; Conclusion. This investigation owes a shortage because of insufficient volume of sampling. Thus, it is necessary to perform further controlled investigations to discover the mechanisms of basic impact of the 5-aminolevulinic acid photodynamical therapy on the wound healing process.

Intersectional Stereotyping in Media Coverage: The Case of Stacey Abrams Versus Stacey Evans in Georgia

ABSTRACT Research on race and gender in the media finds that stereotypes often influence the type of coverage that women and minority candidates receive during campaigns. However, much less is known about the specific stereotypes that women candidates of color face in the media. To understand the challenges and opportunities that women candidates of color encounter, political scientists must take a closer look at the way they are portrayed in the news. As a first step, I conduct a content analysis of Georgia’s 2018 Democratic gubernatorial primary, comparing the stereotypes used in campaign coverage of the two candidates – Stacey Abrams and Stacey Evans. I find that newspaper coverage of Stacey Abrams contained many more references to agentic stereotypes, like assertiveness, than coverage of Stacey Evans. Moreover, I find that agentic traits are more likely to be negative when applied to Stacey Abrams than to Stacey Evans.

Disparities in Care Experienced by Older Hispanic Medicare Beneficiaries in Urban and Rural Areas.

Hispanic older adults face substantial health disparities compared with non-Hispanic-White (hereafter "White") older adults. To the extent that these disparities stem from cultural and language barriers faced by Hispanic people, they may be compounded by residence in rural areas. The objective of this study was to investigate possible interactions between Hispanic ethnicity and rural residence in predicting the health care experiences of older adults in the United States, and whether disparities in care for rural Hispanic older adults differ in Medicare Advantage versus Medicare Fee-for-Service. Medicare beneficiaries age 65 years and older who responded to the 2017-2018 nationally representative Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. We fit a series of linear, case-mix-adjusted models predicting Medicare CAHPS measures of patient experience (rescaled to a 0-100 scale) from ethnicity, place of residence, and Medicare coverage type. In all residential areas, Hispanic beneficiaries reported worse experiences with getting needed care (-3 points), getting care quickly (-4 points), and care coordination (-1 point) than White beneficiaries (all P's<0.001). In rural areas only, Hispanic beneficiaries reported significantly worse experiences than White beneficiaries on doctor communication and customer services (-3 and -9 points, respectively, P<0.05). Tests of a 3-way interaction between ethnicity, rural residence, and coverage type were nonsignificant. There is a need to improve access to care and care coordination for Hispanic beneficiaries overall and doctor-patient communication and customer service for rural Hispanic beneficiaries. Strategies for addressing deficits faced by rural Hispanics may involve cultural competency training and provision of language-appropriate services for beneficiaries (perhaps as telehealth services).

Improving Urban Land Cover Classification in Cloud-Prone Areas with Polarimetric SAR Images

Urban land cover (ULC) serves as fundamental environmental information for urban studies, while accurate and timely ULC mapping remains challenging due to cloud contamination in tropical and subtropical areas. Synthetic aperture radar (SAR) has excellent all-weather working capability to overcome the challenge, while optical SAR data fusion is often required due to the limited land surface information provided by SAR. However, the mechanism by which SAR can compensate optical images, given the occurrence of clouds, in order to improve the ULC mapping, remains unexplored. To address the issue, this study proposes a framework, through various sampling strategies and three typical supervised classification methods, to quantify the ULC classification accuracy using optical and SAR data with various cloud levels. The land cover confusions were investigated in detail to understand the role of SAR in distinguishing land cover under different types of cloud coverage. Several interesting experimental results were found. First, 50% cloud coverage over the optical images decreased the overall accuracy by 10–20%, while the incorporation of SAR images was able to improve the overall accuracy by approximately 4%, by increasing the recognition of cloud-covered ULC information, particularly the water bodies. Second, if all the training samples were not contaminated by clouds, the cloud coverage had a higher impact with a reduction of 35% in the overall accuracy, whereas the incorporation of SAR data contributed to an increase of approximately 5%. Third, the thickness of clouds also brought about different impacts on the results, with an approximately 10% higher reduction from thick clouds compared with that from thin clouds, indicating that certain spectral information might still be available in the areas covered by thin clouds. These findings provide useful references for the accurate monitoring of ULC over cloud-prone areas, such as tropical and subtropical cities, where cloud contamination is often unavoidable.

Connectivity and coverage constrained wireless sensor nodes deployment using steepest descent and genetic algorithms

Connectivity and different coverage types including target, area, and barrier coverages are among the most critical challenges of wireless sensor networks (WSN). This paper investigates node deployment for the challenges of target coverage, area coverage, and connectivity over randomly distributed homogeneous and heterogeneous WSNs, and suggests a new method in both centralized and distributed modes which (i) covers all targets by the required number of sensors, (ii) provides maximum area coverage and connectivity over the network, and (iii) manages sensors' movement from the initial locations to the final ones. Specifically, in the case of target coverage, a new analytical deployment method using the steepest descend (SD) algorithm with Armijo and Wolf rules is proposed instead of evolutionary methods. The results demonstrate this method outperforms over Genetic algorithm (GA) in managing sensors' movement towards targets, guaranteeing 100% coverage in targets, and providing a significant reduction- more than 40% in the worst condition-in algorithm complexity. However, when area coverage and connectivity are also considered, a new hybrid deployment method, which first uses GA to extract the optimal sensors' coordinates via analyzing these challenges simultaneously and then employs SD algorithm to move sensors towards these locations, is suggested. Numerical results confirm the complexity of this two-step method is approximately identical to the GA method of existing research; however, it provides sensors' trajectory and more accuracy for network coverage and connectivity.

The past and present of System-Theoretic Accident Model And Processes (STAMP) and its associated techniques: A scoping review

Targeting the analysis of socio-technical complexity, the System-Theoretic Accident Model and Processes (STAMP) was developed to engineer safer systems. Since its inception in the early 2000s, STAMP and its associated techniques, namely the System-Theoretic Process Analysis (STPA) and the Causal Analysis based on System Theory (CAST), have attracted increasing interest as suitable approaches for safety studies. Nonetheless, a literature review on their applications is lacking. This paper fills this gap via a scoping literature survey on contributions indexed in academic journals and conference proceedings. Through a systematic analysis of 321 eligible documents, this research presents a comprehensive examination of relevant features for STAMP, STPA and CAST since 2003, such as the system type and domain of analysis, coverage and completeness of the analytical and methodological steps, respectively, as well as alterations and/or enrichments of their original versions. The bibliometric findings from primary, secondary and non-empirical research contributions are discussed to critically reflect on the past and present of STAMP and its associated techniques, and possible future directions are highlighted.

Retrospective Study Evaluating Effect of Voxelotor Treatment on Acute Care Utilization during the Peak of COVID-19

IntroductionIn sickle cell disease (SCD), the polymerization of deoxygenated HbS fundamentally alters the structure of the erythrocyte, producing the sickle cell that is characteristic of the disease. Clinical manifestations often perceived in patients suffering from SCD include vaso-occlusion, anemia, and hemolysis. Due to these sequelae, patients frequent the emergency room (ER), urgent care clinic, and hospital. Voxelotor, an oral medication approved by the Food and Drug Administration (FDA) in 2019 for the treatment of SCD, directly targets the pathophysiology of SCD by inhibiting deoxygenated HbS polymerization. Results of the Phase III HOPE trial indicate that the drug can increase hemoglobin levels and reduce markers of hemolysis as well as the incidence of worsening anemia in patients with SCD (Vichinsky et al. N Engl J Med 2019).The COVID-19 pandemic has posed several challenges for patients with SCD in 2020. Amid the pandemic, patients continued to seek out acute medical care, including care in the ER, urgent care clinics, and hospital. The aim of this study was to determine whether utilization of acute medical care differed for patients who received voxelotor before and after therapy in 2020. We also evaluated the utilization of healthcare through telemedicine platforms to facilitate access to novel therapies such as voxelotor for patients with SCD.Methods13 patients (≥18 years of age as of January 1, 2020) with SCD who had begun treatment with voxelotor between January 1, 2020 and December 31, 2020 were included in the initial analysis. Six patients were excluded from final analysis: three discontinued treatment due to side effects, one was noncompliant with treatment, and two were lost to follow-up. Acute care utilization, measured by the number of times each patient visited the ER, urgent care clinic, and hospital was compared for each patient in the period six months prior to their first dose of voxelotor and in the period six months after their last dose of the drug in 2020 using paired t-tests and Wilcoxon matched-pairs signed rank tests. Demographic information and the type of visit at which patients agreed to proceed with voxeletor was recorded for each patient. Simple linear regressions and multiple regressions controlled for covariates, defined as sex, BMI, age, type of insurance coverage, and duration of treatment.ResultsAll seven (100%) patients discussed voxelotor treatment with their provider during a telehealth video visit. In the period before initiating treatment, patients frequented the ER an average of 2.71 (SD=6.75) times. In the six months after their last dose, patients visited the ER less than they had in the period prior to treatment, on average 0.57 (SD=0.79) times. This difference did not achieve statistical significance (p>0.9999). The mean number of visits to the urgent care clinic in the six months before treatment was 2.71 (SD=6.75) compared to 2 (SD=4) in the period after patients' last dose in 2020. This finding was not statistically significant (p>0.9999). Hospitalizations, on average, decreased significantly from 5.14 (SD=2.34) in the six months before starting treatment to 1.57 (SD=0.98) after ending therapy for 2020 (p=0.0015). Covariates did not have an effect on the differences in acute care utilization before treatment and after last treatment in 2020.ConclusionsThe findings of this study imply that treatment with voxelotor was associated with a decrease in the frequency of hospitalizations for the seven patients analyzed. This finding can potentially be attributed to the efficacy of voxelotor in improving anemia and reducing complications associated with SCD. While the difference between ER visits and urgent care visits before treatment and after the last dose in 2020 did not achieve statistical significance, likely due to small sample size, the data does suggest a reduction in both outcomes. In addition, the observation that all visits in which patient and provider discussed and initiated treatment were virtual support the use of telemedicine technology to improve access to multidisciplinary care and novel therapies for SCD patients. The impact of voxelotor treatment will continue to be assessed in SCD patients at our institution, and more data from clinical encounters will lead to a greater understanding of the efficacy of voxelotor. [Display omitted] DisclosuresJain: GBT: Speakers Bureau; Novartis: Speakers Bureau; Sanofi: Other: advisory board; Argenx: Other: advisory board; DOVA: Other: advisory board.

Typology of Human Mobility and Immobility for Disaster Risk Reduction: Exploratory Case Study in Hillsborough County, Florida

Disaster induced and climate related migration and displacement are a crucial issue in the era of climate change. Particularly, human mobility, immobility, and trapped populations are forms of proactive or inactive responses to those negative disturbances. The authors hypothesize that human immobility is deeply rooted in socio-geographical factors such as income, home rental or ownership, insurance coverage, how long one has lived in the area, and previous disaster experiences. This comparative case study was administered at the neighborhood level in Hillsborough County, Florida, which was impacted by Hurricane Irma. The results indicate that new residents who lived in their homes for less than five years were more likely to be non-insurance holders whether they were renters or homeowners. Long term residents, who lived in the same home for more than 13 years, tended to be immobile while holding several types of home insurance coverage. Those who indicated that they do not have home insurance and answered “no idea” when asked whether they will stay in one place or move in years to come have a higher potential to become “trapped” when disaster strikes.

Cyber-insurance in EU policy-making: Regulatory options, the market's challenges and the US example

Over the last decades digital technologies have penetrated our daily lives affecting all aspects of our societal and economic activities. Even though the benefits of relying on information systems to run everyday tasks, organise one's business, interact with each other or enjoy public services are undisputable, the increasing use of digital technologies comes with a price: the growing exposure to cyber risks. This new type of threat has been in the center of the EU agenda for over 15 years during which a solid legislative framework for the protection S of network and information systems against cyber incidents has been developed. However, security and resilience of infrastructures and networks is one parameter of the challenge. Dealing with the financial risk emerging from a cyber incident, is another, equally important one. The need to mitigate these risks led to the emergence of a new insurance market, the cyber insurance market. Despite though the constantly growing demand for this type of insurance coverage, the market is still under development. The fast-evolving nature of cyber threats, the lack of a common language as regards risks, losses and coverages and the lack of historical data on cyber incidents are listed among the factors that slow down the market's growth. Currently, all involved stakeholders in the insurance field are considering specific initiatives that would accelerate the process of turning the EU market more competitive and efficient against its many challenges. The example of the US cyber insurance market, with its shortcomings and know-how, could also contribute to this effort, as an example of a market that has been intensively facing these challenges for almost twenty years.

Evaluation of the safety and effectiveness of a sealant hemostatic patch for preventing cerebrospinal fluid leaks in cranial surgery

ABSTRACT Background Cerebrospinal fluid (CSF) leak remains a significant source of morbidity after neurosurgical procedures. The objective is to evaluate the effectiveness and safety of a polyethylene glycol-coated collagen patch (PCC) in different neurosurgical procedures. Methods A retrospective, single-center cohort study in patients who underwent a cranial neurosurgical procedure. After collecting multiple data variables, patients were divided into two groups depending on the use of PCC as sealant on dural closure following procedures. Results Data from 230 patients were collected (PCC, 128; control group, 102). Incidence of CSF leakage was significantly lower in the PCC group (p < .001). Complications that were significantly lower in PCC than the control group included surgical infection (p = .022), and hydrocephalus (p = .017), as well as reduced rates of reintervention (p < .001) and shorter hospital stays (p = .028). Factors associated with a higher incidence of CSF leakage included posterior fossa procedures, reinterventions, and the need for CSF drainage placement. PCC reduced the risk of suffering CSF leakage by more than 75% (p = .002) once adjusted for age, surgical approach, type of cranial opening, reintervention, CSF drainage, dural substitute, and dural defect coverage. Conclusions Our findings confirm PCC as an effective means of preventing CSF leakage following cranial neurosurgery with fewer associated complications.

Structural-Functional Analysis of a Pension as an Object of Pension Legal Relations

The pension system of the Russian Federation has undergone three fundamental reforms. In 1992, the first law on pensions began to operate in Russia, which significantly differed from the Union legislation. In 2002, insurance principles were introduced into the pension system, which led to a change in the entire system of pension coverage for persons working under an employment contract, including new types of pension coverage. In 2015, there was a significant reform of the existing insurance pension system, which in its significance is no less significant than all the previous changes in the pension legislation. Each pension reform changed the procedure for calculating pensions, legislatively establishing a new pension formula for determining the amount of a pension. Along with this, the structural elements of pensions also changed. At the same time, it is possible to identify similar features in the structural elements of pensions assigned in different periods, but at the functional level. The totality of similar functions of pension elements allows us to talk about certain patterns in the development of the pension provision of the Russian Federation. So, despite the change in the nature of pensions from state to insurance, the essence of pensions, in general, remained the same. Moreover, the essence and functions of the elements of state and insurance pensions are largely the same. The pension is a social security payment with a complex structure. The presence of a structure, the presence of elements and connections between them, indicates a complex function performed by a pension. This function cannot be reduced to a compensatory function, a function of assistance or a function of substitution of earnings. There is an element in the pension structure that reflects past employment. In pensions of different nature, this happens in different ways: wages are taken into account (in state pensions) or insurance contributions (in compulsory pension insurance pensions). In addition, the pension should include an element that increases the amount of the pension in the presence of special circumstances of a subjective nature: disabled dependents, the need for constant outside care. In pensions for state pension provision, such an element is supplements to pensions; in compulsory pension insurance, this function is performed by a fixed payment. Social pensions and funded pension are one-component payments, which raises questions not only about the nature of these pensions, but also about their essence.

Peculiarities of Preoperative Planning of Total Hip Arthroplasty in Patients with Hip-Lumbar Syndrome

Summary. At present, no scheme of approach to surgical treatment of patients with hip-lumbar syndrome (HLS) depending on the type of vertical posture and the type of bone formation and progression of coxarthrosis is developed. The decision of these questions, interesting from the scientific and practical point of view, is an actual task of modern orthopedics and defines features of preoperative planning of total hip arthroplasty (THA) in patients with HLS.&#x0D; Objective: to determine the features of preoperative planning of total hip arthroplasty in patients with hip-lumbar syndrome.&#x0D; Materials and Methods. The basis for the development of recommendations for preoperative planning of THA in patients with HLS was the data of retrospective analysis of medical histories of 138 patients who underwent hip arthroplasty in the Department of Orthopedics and Traumatology of Adults of SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine”. The data of the clinical study of 506 patients with idiopathic, dysplastic and post-traumatic coxarthrosis conducted earlier were also taken into account, and the tactics of treatment in cementless hip arthroplasty was developed.&#x0D; Results. It was determined that the vertical posture affects the progression of coxarthrosis and the nature of the lesion of the lumbar spine in patients with HLS. Patients with a certain hypolordotic posture and a rapid course of coxarthrosis are recommended to undergo primary decompression of the spinal roots and THA at the second stage. In other cases, the initial implementation of THA is recommended. Recommendations for the use of the type and method of fixation and coverage of the leg of the endoprosthesis depending on the type of bone formation in the HLS of the examined patients are developed.&#x0D; Conclusions. Taking into account the features of preoperative planning of THA in patients with HLS will reduce the number of negative results and complications of this category of orthopedic patients.

Bivariate Mixed Poisson Regression Models with Varying Dispersion

The main purpose of this article is to present a new class of bivariate mixed Poisson regression models with varying dispersion that offers sufficient flexibility for accommodating overdispersion and accounting for the positive correlation between the number of claims from third-party liability bodily injury and property damage. Maximum likelihood estimation for this family of models is achieved through an expectation-maximization algorithm that is shown to have a satisfactory performance when three members of this family, namely, the bivariate negative binomial, bivariate Poisson–inverse Gaussian, and bivariate Poisson–Lognormal distributions with regression specifications on every parameter are fitted on two-dimensional motor insurance data from a European motor insurer. The a posteriori, or bonus-malus, premium rates that are determined by these models are calculated via the expected value and variance principles and are compared to those based only on the a posteriori criteria. Finally, we present an extension of the proposed approach with varying dispersion by developing a bivariate Normal copula-based mixed Poisson regression model with varying dispersion and dependence parameters. This approach allows us to consider the influence of individual and coverage-specific risk factors on the mean, dispersion, and copula parameters when modeling different types of claims from different types of coverage. For expository purposes, the Normal copula paired with negative binomial distributions for marginals and regressors on the mean, dispersion, and copula parameters is fitted on a simulated dataset via maximum likelihood.

Pension systems and the current account: An empirical exploration

This paper empirically investigates the role of pension systems in driving current account balances. We construct three indicators—a system’s type of funding, generosity, and coverage—to measure pension systems. Using a panel of 49 countries that spans over 30 years, we find that the presence of a fully-funded system is associated with a higher current account balance. Further, we find that this effect increases with the system’s generosity and coverage. In contrast, we find no significant correlation between pay-as-you-go systems and current account balances. By accounting for pension indicators, we are able to explain a significant share of the increase in current account surpluses in advanced economies over the past two decades.

Health Insurance Literacy and Medical Debt in Middle-Age Americans.

Background:Health insurance literacy (HIL) may influence medical financial burden among people who are sick and the most vulnerable.Objective:This study examined the relationships between HIL, health insurance factors, and medical debt among middle-age Americans, a population with an increasing prevalence of illnesses.Methods:Linear and generalized linear regression analyses were conducted on data drawn from the 2015–2016 waves of the Health Reform Monitoring Survey, a national, internet-based sample of Americans age 18 to 64 years. The analytical sample included 8,042 people age 50 to 64 years.Key Results:Adjusted mean HIL scores did not differ by private versus public insurance or by out-of-pocket costs. Mean HIL scores were lower with higher deductibles; however, differences in mean scores were small. Higher HIL was associated with lower medical debt (odds ratio = 0.97; 95% confidence interval [0.96, 0.98]), but at the highest HIL score, the risk of having medical debt was still 13.8%. Public coverage, higher annual deductibles, and out-of-pocket costs were associated with higher risks of having medical debt.Conclusions:The findings suggest that HIL plays an important role in medical debt burden. However, with the shift toward high cost-sharing insurance plans, addressing health care affordability issues along with HIL are critical to eliminate medical debt problems. [HLRP: Health Literacy Research and Practice. 2021;5(4):e319–e332.]Plain Language Summary:Understanding and using health insurance (also defined as health insurance literacy) may influence the ability to pay medical bills among people who are sick and vulnerable. This study examined the relationships among health insurance literacy, health insurance factors, and difficulty paying medical bills (i.e., medical debt) in Americans age 50 to 64 years using data from the Health Reform Monitoring Survey. People with higher health insurance literacy reported lower medical debt. Type of insurance coverage did not influence medical debt. Those with annual deductibles and out-of-pocket health care costs were more likely to report having medical debt.

Do Adult Medicaid Benefits for Oral Health Reduce ED Visits?

The previous ChristianaCare Health System (CCHS) study that examined the financial burden of dental-related Emergency Department (ED) visits within the ChristianaCare Health System between June 1, 2013, and June 22, 2018, provided evidence to support the claim that a large percentage of patients utilizing the ED for dental-related disease were uninsured, as well as the fact that the treatment the patients received was more costly and less effective than definitive dental care in a dental/oral surgery office. On October 1, 2020, adults (19-65) living in Delaware who were eligible for medical Medicaid coverage were enrolled in dental Medicaid coverage as part of their plans. This study aims to compare the previous study's results to the same population between the dates of October 1, 2020, and March 1, 2021, following the approval of adult Medicaid dental coverage and to determine if there was an increased utilization of dental benefits and a subsequent reduction in ED-related dental visits, as patients opted to seek care at dental/oral surgery offices.Data were retrospectively collected on all non-traumatic, dental-related problems presenting to the Wilmington and Christiana Emergency Departments between October 1, 2020, and March 1, 2021. Patients were categorized by the diagnostic code (ICD-10) used during their ED visits. Patient demographics and insurance coverage were obtained. The data were analyzed, and the treatment provided was determined for each visit based on the CPT code used. These results were then extrapolated and compared to the previous study's statistics to determine: 1) if the insurance coverage types and 2) subsequent volume of ED visits had significantly changed as compared to the pre-Medicaid dental coverage time period.After extrapolating the results of the 6-month time period (October 1, 2020, to March 1, 2021), it was determined that the overall distribution of insurance coverage types of those patients presenting to the ED did not significantly change when compared to the previous study (June 1, 2013, to June 22, 2018). Overall, the percentage of patients utilizing Medicaid insurance for ED-related dental visits was 56% before and after the institution of the dental benefits through Medicaid. However, the volume of patients presenting to the ED for dental-related concerns decreased following the addition of dental benefits within adult Medicaid.Based on the results exhibited in this study, since the addition of dental benefits to adult Medicaid in Delaware, the number of dental-related ED visits appears to have decreased as compared to those exhibited in the previous study, while the overall distribution of insurance coverage types did not appear to significantly change. This reduction in total volume of dental-related ED visits is suspected to be related to improved access to care with the addition of dental benefits to adult Medicaid. It is believed that with this improved access to care, along with continued community outreach and dental education, the volume of future dental-related ED visits can effectively continue to be reduced, and the shift toward the use of dental/oral surgery offices for more effective and definitive dental care can be promoted. Furthermore, this trend is suspected to lead to improved oral health throughout the community and a decrease in the total cost of care.

ДОСЛІДЖЕННЯ АКУСТИЧНОГО НАВАНТАЖЕННЯ ВІД ТРАНСПОРТНОГО ПОТОКУ НА ПРИКЛАДІ МІСТА ХМЕЛЬНИЦЬКОГО

Introduction. Urbanization, intensification of road transport, development of urban infrastructure contributes to increased noise pollution. As traffic flows increase, so do acoustic discomfort zones, and the problem of traffic noise is becoming increasingly environmentally and socially important. Problem statement. The traffic flow significantly exacerbates the environmental problems of cities. One of the most negative factors is the increasing acoustic load. Noise pollution is currently becoming one of the most important environmental stressors. Noise levels depend on the intensity, speed, nature of traffic, type and quality of coverage, land use planning (longitudinal and transverse street profiles, building architecture, traffic lights) and the presence of greenery. Noise leads to an imbalance of auditory adaptation, regulatory processes of the central nervous system, gastrointestinal tract, hemodynamic disorders, the development of noise sickness. At long influence mechanisms of reflex and neurohumoral reactions are broken, there is a nervous pathology, attention decreases by 12-16%. Physiological and biochemical adaptation of a person to noise is impossible, in addition, noise has an inherent consuming effect. Acoustic load has a negative impact on flora and fauna. The main ones are reduced adaptive and reproductive capacity, changes in trophic nets, increased risk of predation, growth retardation, accelerated transpiration, death of leaves and flowers. This problem is most acute for urban ecosystems, as urbanization is one of the main factors in reducing biodiversity due to the loss of natural habitats, their fragmentation or drastic change. In urban conditions, many anthropogenic (industrial, transport noise) is added to the natural noise, which significantly changes the acoustic background. Currently, the noise load in megacities has increased by 12-15 dB, and the volume by three to four times. In cities with heavy traffic, the noise level is approaching 80 dB. Cartographic methods are widely used to visualize and predict noise load. Mapping the noise load of cities is relevant for Ukraine. Currently, acoustic maps have been developed only for certain districts of Kyiv. The creation of acoustic maps will help improve the ecological condition of urban areas. Purpose. Investigate and assess the level of noise load created by traffic flows on the main highways of the city of Khmelnytsky, create an acoustic map and determine the main directions of noise pollution. Research methods. general scientific (generalization, comparison, analysis and synthesis, theoretical and methodological substantiation); mathematical statistics; field (full-scale measurements of noise on the territory); cartographic (construction of a map-scheme) Results. The article highlights the problem of urban ecosystem acoustic load. It is evaluated the noise pollution of Khmelnytskyi city in Ukraine. The noise contamination model is constructed using GIS technologies within modern software package. It is shown that simulation and visualization of noise load using software makes it possible to objectively and detail estimate the acoustic situation and to propose managerial decisions development to protect the population from noise. Conclusion. The intensity of traffic noise depends on the condition and width of roads, the distance of residential buildings from the axis of the roadway. Depending on the capacity of roads, the presence of intersections changes the acoustic load. Reduction of urban traffic noise is associated with absorbing, reflecting, shielding and insulating acoustic ability. Optimization of noise protection of the urban ecosystem depends on a set of architectural and planning solutions. When introducing technical and economic characteristics of noise protection measures, it is necessary to take into account their features (practical limitations and opportunities).

Enrollment in Supplemental Insurance Coverage Among Medicare Beneficiaries by Race/Ethnicity.

The objective of this study was to examine racial/ethnic differences in enrollment trends for supplemental insurance coverage among traditional Medicare (TM) and Medicare Advantage (MA) beneficiaries. We employed a retrospective cohort study design using the 2010-2016 Medicare Current Beneficiary Survey. We included two types of outcomes: 1) seven exclusive types of insurance coverage in a given year and 2) changes in insurance coverage in the next year for those with each of the seven exclusive types of insurance coverage. Our primary independent variable was race/ethnicity. We conducted regression while controlling for demographic, socioeconomic, and health characteristics. We calculated the adjusted value of the outcome by race/ethnicity after adjusting for demographic, socioeconomic, and health status characteristics. We found substantial racial/ethnic differences in supplemental insurance coverage among TM and MA beneficiaries. Compared to White beneficiaries, racial/ethnic minority beneficiaries had lower adjusted rates of enrollment in Medigap among TM beneficiaries and higher enrollment in Medicaid among both TM and MA beneficiaries. Trends in enrollment differed by supplemental insurance coverage, but an increasing trend in enrollment among MA beneficiaries without supplemental insurance coverage and MA beneficiaries with Medicaid was notable. Overall trends were consistent across all racial/ethnic groups. Finally, most beneficiaries were less likely to change insurance coverage in the next year, but a distinct phenomenon was observed among Black beneficiaries with the lowest rates of remaining in Medigap or MA only. Our findings indicate the minority Medicare beneficiaries may not have equitable access to supplemental insurance coverage.

Characteristics and variation law of wind-blown sand delivered to the Ningxia–Inner Mongolia reach of the Yellow River under a changing environment

Wind-blown sand is one of the key factors affecting the evolution of sediment transport, erosion, and deposition in rivers crossing desert areas. However, the differences and complex variations in the spatial and temporal distribution of the underlying surface conditions are seldom considered in research on the river inflow of wind-blown sand over a long time period. The Yellow River contains a large amount of sediment. The Ningxia–Inner Mongolia reach of the Yellow River was selected as the research area of the current study. The reach flows out of Heishanxia and then flows through the Tengger, Hedong, Ulan Buh, and Kubuqi Deserts. In the current study, the wind speed, vegetation coverage, and sand matter on the river basin's surface were analyzed from the perspectives of the river basin surface and riverbank line. The vegetation coverage of the river basin's surface was calculated using the normalized difference vegetation index. Based on the types of sand matter, vegetation coverage, and other underlying surface conditions, the loose particle sediment transport efficiency was determined, the Lettau and Lettau formula for the sediment transport rate was modified, a surface wind-erosion sand flux model was established, and the amount of wind-blown sand transported into the Ningxia–Inner Mongolia reach was calculated. The results show that, from 1981 to 2014, the annual average amount of wind-blown sand transported into the main stream and tributaries of the Ningxia–Inner Mongolia reach of the Yellow River were 7,310,000 and 13,190,000 t, respectively. The Shizuishan–Bayangole reach received 51% of the total wind-blown sand that transported into the main stream, while the tributaries in the Shidakongdui area were the most important source wind-blown sand, providing 74% of the total wind-blown sand inflow from the tributaries. In recent years, the amount of sand transported into the river of the mainstream and tributaries of the Ningxia–Inner Mongolia reach of the Yellow River has significantly decreased from 1981 to 2002, particularly in 1993–2002, which is mainly the result of the weakening wind speed, increasing vegetation coverage, and embankment construction. More specifically, environmental protection policies led by the government, such as “returning farmland to forest”, have played an important and positive role. Therefore, when regulating the water and sediment in the Ningxia–Inner Mongolia reach of the Yellow River, the issue of wind-blown sand deposition into the river should be fully considered in water and sediment regulation.