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Objective: The aim of this study was to evaluate an adult home palliative care (HPC) program for multiple insurance product lines using multiple vendors to determine if the annual costs of health care decreased for those enrolled in HPC. Study Design: Of the 506 members who were referred to and qualified for palliative care in 2019, a retroactive review was done comparing annual health care costs between the 396 members in the enrolled group and the 110 members in the group receiving usual care. Methods: The total health care costs for the calendar year 2019 were compared between the group enrolled in HPC and those who received usual care. Cost savings were further evaluated based on whether the member was enrolled in the palliative care program for 1-5 versus 6-12 months. Results: Overall medical costs for these 396 enrollees for the calendar year 2019 showed a gross savings of $24,643 per member (16.7% decrease in cost). For members enrolled for 1-5 months, annual gross savings were $23,314 per member (15.8% decrease from the comparison group), and for members enrolled for 6-12 months, annual gross savings were $26,409 per member (17.9% decrease). The savings were most prominent for the commercial insurance product with a 51% decrease in annual costs. Conclusions: Adult home-based palliative care delivered by multiple vendors (consisting of multiple insurance product lines) to a population is effective in decreasing total medical costs by 16.7% during a calendar year compared with a control group. The gross savings for those enrolled for 6-12 months (17.9%) were greater than the gross savings for those enrolled for 1-5 months (15.8%). The savings were most prominent for the commercial insurance product, while an increase in cost was seen for the Medicaid product.

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Directly growing perovskite single crystals on charge carrier transport layers will unravel a promising route for the development of emerging optoelectronic devices. Herein, in situ growth of high-quality all-inorganic perovskite (CsPbBr3) single crystal arrays (PeSCAs) on cubic zinc oxide (c-ZnO) is reported, which is used as an inorganic electron transport layer in optoelectronic devices, via a facile spin-coating method. The PeSCAs consist of rectangular thin microplatelets of 6-10 µm in length and 2-3 µm in width. The deposited c-ZnO enables the formation of phase-pure and highly crystallized cubic perovskites via an epitaxial lattice coherence of (100)CsPbBr3∥(100)c-ZnO, which is further confirmed by grazing incidence wide-angle X-ray scattering. The PeSCAs demonstrate a significant structural stability of 26 days with a 9 days excellent photoluminescence stability in ambient environment, which is much superior to the perovskite nanocrystals (PeNCs). The high crystallinity of the PeSCAs allows for a lower density of trap states, longer carrier lifetimes, and narrower energetic disorder for excitons, which leads to a faster diffusion rate than PeNCs. These results unravel the possibility of creating the interface toward c-ZnO heterogeneous layer, which is a major step for the realization of a better integration of perovskites and charge carrier transport layers.

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Printable perovskite quantum dot (QD) ink is very important for achieving high quality coffee ring-free fluorescent microarrays for different kinds of emerging perovskite optoelectronic applications using inkjet printing. In this work, we prepared a printable CsPbBr3 perovskite QD ink by mixing high-boiling point dodecane with low-boiling point toluene as a solvent. The evaporation rate, viscosity and surface tension of the ink were carefully optimized by tuning the volume ratio of these two solvents for forming appropriate Marangoni flow, so as to balance the capillary flow and eliminate the coffee ring effect further. Successfully, CsPbBr3 perovskite microarrays with uniform surface, low roughness and no coffee rings were achieved by inkjet printing the optimized perovskite QD ink on a PVK (poly-(9-vinylcarbazole)) layer. Furthermore, we patterned the CsPbBr3 perovskite QD ink, and the printed patterns were only visible under ultraviolet (UV) light, which can be applied in invisible anti-counterfeiting labels and encryption in the future.

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Throughout life neurons are continuously generated in the subgranular zone of the hippocampus. The subsequent integration of newly generated neurons alters patterns of dentate gyrus input and output connectivity, potentially rendering memories already stored in those circuits harder to access. Consistent with this prediction, we previously showed that increasing hippocampal neurogenesis after training induces forgetting of hippocampus-dependent memories, including contextual fear memory. However, the brain regions supporting contextual fear memories change with time, and this time-dependent memory reorganization might regulate the sensitivity of contextual fear memories to fluctuations in hippocampal neurogenesis. By virally expressing the inhibitory designer receptor exclusively activated by designer drugs, hM4Di, we first confirmed that chemogenetic inhibition of dorsal hippocampal neurons impairs retrieval of recent (day-old) but not remote (month-old) contextual fear memories in male mice. We then contrasted the effects of increasing hippocampal neurogenesis at recent versus remote time points after contextual fear conditioning in male and female mice. Increasing hippocampal neurogenesis immediately following training reduced conditioned freezing when mice were replaced in the context 1 month later. In contrast, when hippocampal neurogenesis was increased time points remote to training, conditioned freezing levels were unaltered when mice were subsequently tested. These temporally graded forgetting effects were observed using both environmental and genetic interventions to increase hippocampal neurogenesis. Our experiments identify memory age as a boundary condition for neurogenesis-mediated forgetting and suggest that, as contextual fear memories mature, they become less sensitive to changes in hippocampal neurogenesis levels because they no longer depend on the hippocampus for their expression.SIGNIFICANCE STATEMENT New neurons are generated in the hippocampus throughout life. As they integrate into the hippocampus, they remodel neural circuitry, potentially making information stored in those circuits harder to access. Consistent with this, increasing hippocampal neurogenesis after learning induces forgetting of the learnt information. The current study in mice asks whether these forgetting effects depend on the age of the memory. We found that post-training increases in hippocampal neurogenesis only impacted recently acquired, and not remotely acquired, hippocampal memories. These experiments identify memory age as a boundary condition for neurogenesis-mediated forgetting, and suggest remote memories are less sensitive to changes in hippocampal neurogenesis levels because they no longer depend critically on the hippocampus for their expression.

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Importance: Data from electronic health records (EHRs) are increasingly used for risk prediction. However, EHRs do not reliably collect sociodemographic and neighborhood information, which has been shown to be associated with health. The added contribution of neighborhood socioeconomic status (nSES) in predicting health events is unknown and may help inform population-level risk reduction strategies. Objective: To quantify the association of nSES with adverse outcomes and the value of nSES in predicting the risk of adverse outcomes in EHR-based risk models. Design, Setting, and Participants: Cohort study in which data from 90 097 patients 18 years or older in the Duke University Health System and Lincoln Community Health Center EHR from January 1, 2009, to December 31, 2015, with at least 1 health care encounter and residence in Durham County, North Carolina, in the year prior to the index date were linked with census tract data to quantify the association between nSES and the risk of adverse outcomes. Machine learning methods were used to develop risk models and determine how adding nSES to EHR data affects risk prediction. Neighborhood socioeconomic status was defined using the Agency for Healthcare Research and Quality SES index, a weighted measure of multiple indicators of neighborhood deprivation. Main Outcomes and Measures: Outcomes included use of health care services (emergency department and inpatient and outpatient encounters) and hospitalizations due to accidents, asthma, influenza, myocardial infarction, and stroke. Results: Among the 90 097 patients in the training set of the study (57 507 women and 32 590 men; mean [SD] age, 47.2 [17.7] years) and the 122 812 patients in the testing set of the study (75 517 women and 47 295 men; mean [SD] age, 46.2 [17.9] years), those living in neighborhoods with lower nSES had a shorter time to use of emergency department services and inpatient encounters, as well as a shorter time to hospitalizations due to accidents, asthma, influenza, myocardial infarction, and stroke. The predictive value of nSES varied by outcome of interest (C statistic ranged from 0.50 to 0.63). When added to EHR variables, nSES did not improve predictive performance for any health outcome. Conclusions and Relevance: Social determinants of health, including nSES, are associated with the health of a patient. However, the results of this study suggest that information on nSES may not contribute much more to risk prediction above and beyond what is already provided by EHR data. Although this result does not mean that integrating social determinants of health into the EHR has no benefit, researchers may be able to use EHR data alone for population risk assessment.

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Difficulties in realizing persistent neurogenesis, inabilities in modeling pathogenesis of most cases, and a shortage of disease material for screening therapeutic agents restrict our progress to overcome challenges presented by neurodegenerative diseases. We propose that reprogramming primary somatic cells of patients into induced pluripotent stem cells (iPSCs) provides a new avenue to overcome these impediments. Their abilities in self-renewal and differentiation into various cell types will enable disease investigation and drug development. In this review, we introduce efficient approaches to generate iPSCs and distinct iPSCs differentiation stages, and critically discuss paradigms of iPSCs technology application to investigate neurodegenerative diseases such as Alzheimer's disease (AD), Parkinson's disease (PD), and Huntington's disease (HD). Although iPSCs technology is in its infancy and faces many obstacles, it has great potential in helping to identify therapeutic targets for treating neurodegenerative diseases.

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