The health effects of nursing home specialization in post-acute care.

Nursing homes serve both long-term care and post-acute care (PAC) patients, two groups with distinct financing mechanisms and requirements for care. We examine empirically the effect of nursing home specialization in PAC using 2011-2018 data for Medicare patients admitted to nursing homes following a hospital stay. To address patient selection into specialized nursing homes, we use an instrumental variables approach that exploits variation over time in the distance from the patient's residential ZIP code to the closest nursing home with different levels of PAC specialization. We find that patients admitted to nursing homes more specialized in PAC have lower hospital readmissions and mortality, longer nursing home stays, and higher Medicare spending for the episode of care, suggesting that specialization improves patient outcomes but at higher costs.

Comparing demographic and health characteristics of new and existing SNAP recipients: application of a machine learning algorithm.

BACKGROUND: The Supplemental Nutrition Assistance Program (SNAP) expanded significantly after the Great Recession of 2008-2009, but no studies have characterized this new group of recipients. Few data sets provide details on whether an individual is a new or established recipient of SNAP. OBJECTIVE: We sought to identify new and existing SNAP recipients, and to examine differences in sociodemographic characteristics, health, nutritional status, and food purchasing behavior between new and existing recipients of SNAP after the recession. METHODS: We created a probabilistic algorithm to identify new and existing SNAP recipients using the 1999-2013 waves of the Panel Study of Income Dynamics. We applied this algorithm to the National Household Food Acquisition and Purchase Survey (FoodAPS), fielded during 2012-2013, to predict which individuals were likely to be new SNAP recipients. We then compared health and nutrition characteristics between new, existing, and never recipients of SNAP in FoodAPS. RESULTS: New adult SNAP recipients had higher socioeconomic status, better self-reported health, and greater food security relative to existing recipients, and were more likely to smoke relative to never recipients. New child SNAP recipients were less likely to eat all meals and had lower BMI relative to existing recipients. New SNAP households exhibited differences in food access and expenditures, although dietary quality was similar to that of existing SNAP households. CONCLUSION: We developed a novel algorithm for predicting new and existing SNAP recipiency that can be applied to other data sets, and subsequently demonstrated differences in health characteristics between new and existing recipients. The expansion of SNAP since the Great Recession enrolled a population that differed from the existing SNAP population and that may benefit from different types of nutritional and health services than those traditionally offered.

Methods for culturing human femur tissue explants to study breast cancer cell colonization of the metastatic niche.

Bone is the most common site of breast cancer metastasis. Although it is widely accepted that the microenvironment influences cancer cell behavior, little is known about breast cancer cell properties and behaviors within the native microenvironment of human bone tissue.We have developed approaches to track, quantify and modulate human breast cancer cells within the microenvironment of cultured human bone tissue fragments isolated from discarded femoral heads following total hip replacement surgeries. Using breast cancer cells engineered for luciferase and enhanced green fluorescent protein (EGFP) expression, we are able to reproducibly quantitate migration and proliferation patterns using bioluminescence imaging (BLI), track cell interactions within the bone fragments using fluorescence microscopy, and evaluate breast cells after colonization with flow cytometry. The key advantages of this model include: 1) a native, architecturally intact tissue microenvironment that includes relevant human cell types, and 2) direct access to the microenvironment, which facilitates rapid quantitative and qualitative monitoring and perturbation of breast and bone cell properties, behaviors and interactions. A primary limitation, at present, is the finite viability of the tissue fragments, which confines the window of study to short-term culture. Applications of the model system include studying the basic biology of breast cancer and other bone-seeking malignancies within the metastatic niche, and developing therapeutic strategies to effectively target breast cancer cells in bone tissues.