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Families of children born with CHD face added stress owing to uncertainty about the magnitude of the financial burden for medical costs they will face. This study seeks to assess the family responsibility for healthcare bills during the first 12 months of life for commercially insured children undergoing surgery for severe CHD.
The MarketScan® database from Truven was used to identify commercially insured infants in 39 states from 2010 to 2012 with an ICD-9 diagnosis code for transposition of the great arteries, tetralogy of Fallot, or truncus arteriosus, as well as the corresponding procedure code for complete repair. Data extraction identified payment responsibilities of the patients’ families in the form of co-payments, deductibles, and co-insurance during the 1st year of life.
There were 481 infants identified who met the criteria. Average family responsibility for healthcare bills during the 1st year of life was $2928, with no difference between the three groups. The range of out-of-pocket costs was $50–$18,167. Initial hospitalisation and outpatient care accounted for the majority of these responsibilities.
Families of commercially insured children with severe CHD requiring corrective surgery face an average of ~$3000 in out-of-pocket costs for healthcare bills during the first 12 months of their child’s life, although the amount varied considerably. This information provides a framework to alleviate some of the uncertainty surrounding healthcare financial responsibilities, and further examination of the origination of these expenditures may be useful in informing future healthcare policy discussion.
Congenital genitourinary tract anomalies are some of the most commonly identified prenatal abnormalities, being identified in between 1 in 250 and 1 in 1000 pregnancies. They consist of a wide spectrum of heterogeneous malformations. Obstructive uropathies account for the majority of these abnormalities. the second-trimester detailed scan (often at 18+0–21+6 weeks) is the examination in which the majority of genitourinary abnormalities are diagnosed. However, with the widespread use of first-trimester ultrasound screening, severe renal anomalies and “megacystis” are being noted between 11+0 and 13+6 weeks. Additionally, third-trimester ultrasound may reveal late-onset uropathies, often associated with changes in liquor volume.
High-resolution optical spectra were taken of the carbon star V Hydrae at 10 different epochs spanning two stellar periods using the Hamilton Echelle Spectrograph at Lick Observatory. Velocities were determined at each epoch by performing a cross-correlation analysis against the spectra of standard stars with previously-determined velocities. The velocities of individual atomic absorption and emission lines, and their variations with phase, were also determined. The rising and falling of the photosphere is clearly in evidence, with an amplitude about the mean of ± 5 km s−1 and a phase consistent with the expectation that maximum light occurs at minimum radius. In addition, the spectra were subjected to a rotational broadening analysis, in which we determined V sin(i), where V is the presumed equatorial rotation velocity, by minimizing the differences between the spectra of V Hya and a number of artificially broadened comparison stars showing no evidence for broadening. Mechanisms other than stellar rotation, including both turbulence and opacity, were found to be unlikely contributors to the broadening. The very unusual rotation velocity (for a red giant) was found to vary between about 10 and 18 km s−1, with an average of ≈ 14 km s−1. The relative phase of the rotation velocity curve is consistent with the hypothesis that the pulsation leads to a periodically varying moment of inertia. The assumption of angular momentum conservation, coupled with the radial velocity and V sin(i) curves, permits a deduction of the equilibrium stellar radius: The similar magnitudes of the rotation and pulsation velocities imply that they are dynamically coupled, leading to a latitude–dependent circulation which probably affects the mass loss. This interaction should also have a strong effect on the convective structure of the envelope. The angular momentum implied for the V Hya atmosphere leads us to the conclusion that it is a common-envelope binary, and that it is a precursor of a binary nucleus in a bipolar planetary nebula.
One of the most exciting challenge facing theories of post-main sequence evolution today is to understand how Asymptotic Giant Branch (AGB) stars transform themselves into aspherical planetary nebulae (PNe). Recently, high-resolution imaging surveys of young planetary nebulae and protoplanetary nebulae (PPNe: objects in transition between the AGB and PN phases) have revealed that the majority of these objects are characterised by multipolar bubbles distributed roughly point-symmetrically around the central star. These data strongly suggest that the current model for the shaping of PNe is no longer adequate. High angular-resolution kinematic information is sorely needed to complement the imaging data in order to test new hypotheses, such as our proposal that episodic high-speed jet-like outflows, operating during the protoplanetary or very late-AGB phase, are the primary agent.
We have therefore begun a program of using interferometric mapping of OH (and H2O, when feasible) maser emission in order to trace the kinematics of the structures discovered in protoplanetary nebulae with HST. These masers provide a unique and crucial probe of the kinematics of the circumstellar material in PPNe, because of the lack of other emission-line diagnostics. Although our work is still in its infancy (only two objects have been studied in detail), we find that the OH masers indicate the presence of multiple low-latitude outflows and an increase of outflow velocity with latitude. This paper summarises our progress so far, the state of current studies, and future prospects.
When Gabriele Brandstetter published Tanz-Lektüren: Körperbilder und Raumfiguren der Avantgarde in 1995, German dance studies hardly existed. The book was a pioneering effort that exerted considerable influence on dance studies in Germany as it developed over the next decades. Now, twenty years later, Tanz-Lektüren has been translated into English, and its appearance is most welcome. The book's importance is not merely historical; on the contrary, it has much to offer today's anglophone reader, particularly in Brandstetter's use of Aby Warburg's theories to analyze dance imagery and movement patterns. Important, too, is her inclusion of numerous writers and artists whose views on dance are little known, or at least little analyzed, in English.
Epidemiology formed the basis of ‘the Barker hypothesis’, the concept of ‘developmental programming’ and today’s discipline of the Developmental Origins of Health and Disease (DOHaD). Animal experimentation provided proof of the underlying concepts, and continues to generate knowledge of underlying mechanisms. Interventions in humans, based on DOHaD principles, will be informed by experiments in animals. As knowledge in this discipline has accumulated, from studies of humans and other animals, the complexity of interactions between genome, environment and epigenetics, has been revealed. The vast nature of programming stimuli and breadth of effects is becoming known. As a result of our accumulating knowledge we now appreciate the impact of many variables that contribute to programmed outcomes. To guide further animal research in this field, the Australia and New Zealand DOHaD society (ANZ DOHaD) Animals Models of DOHaD Research Working Group convened at the 2nd Annual ANZ DOHaD Congress in Melbourne, Australia in April 2015. This review summarizes the contributions of animal research to the understanding of DOHaD, and makes recommendations for the design and conduct of animal experiments to maximize relevance, reproducibility and translation of knowledge into improving health and well-being.
Sub-arcsecond (down to 0.1″ × 0.2″) radio continuum observations using the VLA2 in a number of configurations have been carried out in order to investigate the fine-scale morphological details of the ionized gas and the distribution of spectral index along the triskelian-shaped figure of Sgr A West. In addition to finding a number of isolated patches of thermally-emitting gas and an absorbing feature at λ6cm within three arcminutes of the Galactic center, we have observed:
1) radio continuum emission from IRS-7, implying that the stellar wind from this supergiant is externally ionized. An improved position for this object was obtained.
2) the circular mini-cavity located along the east-west bar of Sgr A West. This feature has a diameter of 2-arcseconds and may have been created by a spherical wind, the source of which is yet to be identified; the seemingly most plausible candidate, IRS-16, is offset by 3″ from the center of the cavity.
Spectral index maps having a resolution of 0.7″ × 0.3″ were made from scaled array observations at λ2cm and 6cm. They show that the eastern arm has a spectral index near −0.1, while the northern arm and the bar have positive spectral indices, indicating perhaps a partial opacity effect. The spectral index of IRS-7 is +0.6, consistent with that expected from a completely ionized stellar wind.
The ionization of interstellar gas and the heating of dust near the galactic center are usually assumed to be dominated overall by the radiation emanating from young, massive stars. This paper questions that assumption by pointing to the paucity of direct evidence for current star formation and by considering alternative sources of ionization and luminosity. It is suggested that star formation can be inhibited by the strong, poloidal magnetic fields observed in the galactic center. The presence of some red supergiants (e.g., IRS7) can be understood if massive star formation occurs episodically.
The H92α recombination line was observed at 8 GHz toward the “pistol-shaped” HII region G0.15–0.05 using the VLA2 in its most compact configuration. The line profiles of individual components of this source peak at VLSR=123 km/s and have total line widths of ~90 km/s. The kinematical structure of the “pistol” is unusual in that much of the neutral and ionized gas in this region is seen predominantly at either +50 or +20 km/s. The line width and radial velocity are the largest found in the Galactic center region with the exception of Sgr A West. We also found gas at VLSR=140 km/s associated with G0.18–0.04: the sickle-shaped feature which surrounds G0.15–0.05. The kinematic properties of G0.18–0.04 and G0.15–0.05 suggest that these two features are components of a single, but complex thermal system interacting with the nonthermal filaments of the radio Arc. In this regard, the width of the broad recombination line from G0.15–0.05, and its large radial velocity, might be explained as the interaction of streaming relativistic particles in the nonthermal filaments of the Arc impacting upon ambient gas clouds lying in the Galactic plane.
Existing radiofrequency data on the center of the Galaxy are used to defend the hypothesis that the magnetic field within a radius of at least 70 pc of the nucleus has a poloidal geometry, is relatively uniform in strength, and is very strong relative to extended fields measured elsewhere in the Galaxy, having a flux density greater than or about a milligauss. The implications of this strong, pervasive field are: 1) that a strong ring current is present at radii beyond 70 pc, and 2) that the dynamics of molecular clouds in the Galactic center are significantly affected by, though probably not dominated by, the magnetic field. At radii within 5 pc, far-IR polarization data suggest a substantial deviation of the magnetic field from a poloidal geometry, at least within the gas and dust layer. There, the coupling of the field to the rapidly orbiting gas near the nucleus is presumably responsible for this local distortion of the larger-scale field geometry.
Continuum observations of the southern extension of the radio Arc located near 1~0.2° have been carried out at λ20 and 6cm using the VLA in its hybrid B/C and C/D array configurations. A number of long and narrow filaments have been identified on the negative latitude side of the plane. Some of the filaments appear to extend continuously into the radio continuum Arc and suggesting strongly that they are associated physically with the Arc. Other filaments appear isolated and thus have characteristics similar to those of the radio “threads” which have been seen near the Galactic center. These new threads and filaments are highly polarized at λ6cm and show rotation measures which vary between 300 and 3000 rad m−2. The details present in the high-resolution images of this region strengthen the hypotheses that the large field strength is dynamically important and that the large-scale geometry of the magnetic field is poloidal near the Galactic center.
We provide detailed contextual information on 25 14C dates for unusually well-preserved archaeological and paleontological remains from Daisy Cave. Paleontological materials, including faunal and floral remains, have been recovered from deposits spanning roughly the past 16,000 yr, while archaeological materials date back to ca. 10,500 BP. Multidisciplinary investigations at the site provide a detailed record of environmental and cultural changes on San Miguel Island during this time period. This record includes evidence for the local or regional extinction of a number of animal species, as well as some of the earliest evidence for the human use of boats and other maritime activities in the Americas. Data from Daisy Cave contribute to a growing body of evidence that Paleoindians had adapted to a wide variety of New World environments prior to 10,000 PB. Analysis of shell-charcoal pairs, along with isotopic analysis of associated marine shells, supports the general validity of marine shell dating, but also provides evidence for temporal fluctuations in the reservoir effect within the Santa Barbara Channel region.
A radio survey of red giant SiO sources in the inner Galaxy and bulge is not hindered by extinction. Accurate stellar velocities (<1 km/s) are obtained with minimal observing time (<1 min) per source. Detecting over 20,000 SiO maser sources yields data comparable to optical surveys with the additional strength of a much more thorough coverage of the highly obscured inner Galaxy. Modeling of such a large sample would reveal dynamical structures and minority populations; the velocity structure can be compared to kinematic structures seen in molecular gas, complex orbit structure in the bar, or stellar streams resulting from recently infallen systems. Our Bulge Asymmetries and Dynamic Evolution (BAaDE) survey yields bright SiO masers suitable for follow-up Galactic orbit and parallax determination using VLBI.
Here we outline our early VLA observations at 43 GHz in the northern bulge and Galactic plane (0<l°<250), and ALMA observations at 86 GHz in the southern bulge (250<l°<360). We report a preliminary overall 70% detection rate in our color-selected MSX sources.
The history of supermassive black holes’ activity can be partly constrained by monitoring the diffuse X-ray emission possibly created by the echoes of past events propagating through the molecular clouds of their respective environments. In particular, using this method we have demonstrated that our Galaxy’s supermassive black hole, Sgr A⋆, has experienced multiple periods of higher activity in the last centuries, likely due to several short but very energetic events, and we now investigate the possibility of studying the past activity of other supermassive black holes by applying the same method to M31⋆. We set strong constraints on putative phase transitions of this more distant galactic nucleus but the existence of short events such as the ones observed in the Galactic center cannot be assessed with the upper limits we derived.
We summarize work on the central parsec of the Galactic center based on imaging and spectroscopic observations at the Keck and Gemini telescopes. These observations include stellar positions in two dimension and the velocity in three dimensions. Spectroscopic observations also enables measurements of the physical properties of individual stars, such as the spectral type and in some cases the effective temperature, metallicity, and surface gravity. These observations show a complex stellar population with a young (4-6 Myr) compact star cluster in the central 0.5 pc embedded in in an older and much more massive nuclear star cluster. Surprisingly, the old late-type giants do not show a cusp profile as long been expected from theoretical work. The majority of the stars have higher than solar metallicity, with only about 6% of the stars having [M/Fe] < −0.5, which is consistent with an origin from the MW disk.
We present constraints on the variability and binarity of young stars in the central 10 arcseconds (~ 0.4 pc) of the Milky Way Galactic Center (GC) using Keck Adaptive Optics data over a 12 year baseline. Given our experiment’s photometric uncertainties, at least 36% of our sample’s known early-type stars are variable. We identified eclipsing binary systems by searching for periodic variability. In our sample of spectroscopically confirmed and likely early-type stars, we detected the two previously discovered GC eclipsing binary systems. We derived the likely binary fraction of main sequence, early-type stars at the GC via Monte Carlo simulations of eclipsing binary systems, and find that it is at least 32% with 90% confidence.
Recently, high-resolution imaging surveys of young planetary nebulae (PNe) and protoplanetary nebulae (PPNe) have revealed that the majority of these objects are characterised by multipolar bubbles distributed roughly point-symmetrically around the central star (e.g. Sahai & Trauger 1998, Sahai 2000). Sahai & Trauger (1998) have proposed that episodic high-speed jet-like outflows, operating during the protoplanetary or very late-AGB phase, are the primary agent for shaping PNe. OH and H2O masers provide a unique and crucial probe of the kinematics of the circumstellar material in PPNe, because of the general lack of other emission-line diagnostics. Here we present new results from our ongoing study of PPNe using HST images with interferometric OH & H2O maser-line data to unravel their detailed spatio-kinematic structure (e.g. Sahai et al. 1999a, Sahai, Claussen, & Morris 2002).
Galactic H2O masers are associated either with the circumstellar shells of late-type stars or with star-forming regions (SFRs). Previous surveys for H2O masers had revealed relatively few near the Galactic Center (GC). We report on the continuation of a survey using the VLA to make 22.2 GHz observations of IRAS point sources which lie within 2° of the GC and which have either 12 μm or 25 μm flux > 8 Jy. Taylor, Morris and Schulman (TMS, 1992, AJ, 106, 1978) previously observed 97 of 342 candidate sources. We have observed 160 more and plan to complete the survey in early 1995.