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Hazel and Wally want to be big and tall so they start rolling, picking up mud and goo that makes them seem bigger but leads to a series of problems they can avoid only if they keep rolling.

Groovy Joe is a guitar-playing dog who loves to sing and dance, and when many other dogs come and join him his home gets a little crowded, but the party's fun, and Joe is definitely a guitar hero.

Prescription opioid misuse (POM) among people living with HIV (PLWH) is a serious concern due to risks related to dependence and overdose, and PLWH may be at higher risk for POM due to psychosocial stressors including psychological distress. However, scant POM research has examined the role of HIV-related stigma (e.g., internalized stigma, enacted stigma) in POM among PLWH. Guided by minority stress theory, this study examined a hypothesized serial mediation among enacted stigma, internalized stigma, psychological distress, and POM within a sample of Chinese PLWH with pain symptoms enrolled in a wave (between November 2017 and February 2018) of a longitudinal cohort study in Guangxi (n = 116). Models were tested individually for six enacted stigma experiences, controlling for key demographic and health-related variables (e.g., CD4 + count). Results showed HIV-related workplace discrimination was the most common stigma experience (12%,) and 10.3% of PLWH reported POM. Indirect effect analyses showed that internalized stigma was indirectly associated with POM through psychological distress. Internalized stigma and psychological distress mediated the association between workplace discrimination and POM. Family discrimination, gossip, and healthcare discrimination were directly associated with POM. This study suggests that Chinese PLWH may engage in POM to cope with psychological distress that is rooted in HIV-related stigma and highlights the important context of workplace discrimination for PLWH. Implications for interventions to reduce POM among PLWH are discussed.

Groovy Joe is a fun-loving dog with a tub full of ice cream--which he shares with his unexpected dinosaur guests.

Quality of life and satisfaction with outcome of treatment were ascertained by questionnaires in men with prostate cancer and their spouses or partners after prostatectomy, brachytherapy, or external-beam radiotherapy (with or without adjuvant hormonal treatment). Each treatment had it own pattern of effects on the quality of life, and in each case, residual effects of treatment caused distress in the patients' partners. Quality of life and satisfaction with outcome of treatment were ascertained by questionnaires in men with prostate cancer and their spouses or partners after prostatectomy, brachytherapy, or external-beam radiotherapy (with or without adjuvant hormonal treatment). Assessment of the outcome of prostate-cancer treatment entails measuring not only the duration of survival but also the health-related quality of life. 1 , 2 Early studies of patient-reported outcomes of prostatectomy or conventional radiotherapy found concern about urinary incontinence, bowel function, and sexual activity. 3 – 5 However, little is known about the quality of life after newer treatments such as brachytherapy and androgen-suppression therapy as an adjunct to radiotherapy. 6 – 8 Single-institution studies and one retrospective analysis of a longitudinal, multicenter cohort used instruments that had been developed for assessment of standard external-beam radiotherapy and prostatectomy to probe the quality of life after . . .

\"Mama Nut says it's bedtime, but Hazel Nut and Wally Nut just aren't quite ready to stop the fun and go to bed\"-- Provided by publisher.

Health systems and provider groups currently lack a systematic mechanism to evaluate the financial implications of value-based alternative payments. We sought to develop a method to prospectively quantify the financial implications, including risk and uncertainty of (1) transitioning from a fee-for-service to an episode-based payment model and (2) modifying episode-specific clinical cost drivers. Finally, we highlight practical applications for the model to help facilitate stakeholder engagement in the transition to value-based payment models.OBJECTIVESHealth systems and provider groups currently lack a systematic mechanism to evaluate the financial implications of value-based alternative payments. We sought to develop a method to prospectively quantify the financial implications, including risk and uncertainty of (1) transitioning from a fee-for-service to an episode-based payment model and (2) modifying episode-specific clinical cost drivers. Finally, we highlight practical applications for the model to help facilitate stakeholder engagement in the transition to value-based payment models.We created a financial simulation from empirical data to demonstrate the feasibility and potential use cases within the context of a hypothetical episode-based payment model for prostate cancer surgery (prostatectomy).STUDY DESIGNWe created a financial simulation from empirical data to demonstrate the feasibility and potential use cases within the context of a hypothetical episode-based payment model for prostate cancer surgery (prostatectomy).We used Monte Carlo simulation methods to predict financial outcomes under various clinical and payment model scenarios for our pilot prostatectomy episode use case. We input patient-level empirical cost, reimbursement, and clinical data for a cohort of 157 patients at our institution into our model to quantify expected financial outcomes (payments, financial margins) and financial risk for stakeholders (payer, hospital, providers) under an episode-based payment model.METHODSWe used Monte Carlo simulation methods to predict financial outcomes under various clinical and payment model scenarios for our pilot prostatectomy episode use case. We input patient-level empirical cost, reimbursement, and clinical data for a cohort of 157 patients at our institution into our model to quantify expected financial outcomes (payments, financial margins) and financial risk for stakeholders (payer, hospital, providers) under an episode-based payment model.Compared with the status quo, there is a range of expected financial outcomes for various stakeholders depending on the financial parameters (episode price, shared savings, downside risk, stop-loss) in an episode-based payment model. Modifying clinical cost drivers has a profound impact on these outcomes. Uncertainty is high due to the small number of episodes.RESULTSCompared with the status quo, there is a range of expected financial outcomes for various stakeholders depending on the financial parameters (episode price, shared savings, downside risk, stop-loss) in an episode-based payment model. Modifying clinical cost drivers has a profound impact on these outcomes. Uncertainty is high due to the small number of episodes.The simulation demonstrates that both financial parameters and clinical cost drivers significantly affect the expected financial outcomes for stakeholders in value-based payment models.CONCLUSIONSThe simulation demonstrates that both financial parameters and clinical cost drivers significantly affect the expected financial outcomes for stakeholders in value-based payment models.

Hazel Nut wants to sing and dance, but Mama, Papa, and Wally Nut are too busy, so Hazel calls in a special family member to get everyone moving.

We report on the growth of epitaxial Sc x Al 1− x N ( x  = 0.3–0.4) on (111) Si substrates via molecular beam epitaxy. Growth of an AlN nucleation layer (NL) is sensitive to the III/V flux ratio, with more N-rich growth conditions leading to evidence of grain tilt and a degradation in the structural quality of subsequently grown ScAlN. Utilizing the optimized AlN NL III/V of 0.9, Sc x Al 1− x N films were grown with x  = 0.3–0.4 having an x-ray diffraction 0002 reflection rocking curve full width at half maximum (FWHM) of 0.69°–1.14°. Incorporation of a graded ScAlN initiation layer is shown to reduce the FWHM and tensile stress magnitude, while yielding a film with rms roughness as low as 0.57 nm and no detectable anomalously oriented grains on the sample surface.