Twelve pumpkin cultivars (Cucurbita maxima D.), cultivated in Iowa, were studied for their seed oil content, fatty acid composition, and tocopherol content. Oil content ranged from 10.9 to 30.9%. Total unsaturated fatty acid content ranged from 73.1 to 80.5%. The predominant fatty acids present were linoleic, oleic, palmitic, and stearic. Significant differences were observed among the cultivars for stearic, oleic, linoleic, and gadoleic acid content of oil. Low linolenic acid levels were observed (<1%). The tocopherol content of the oils ranged from 27.1 to 75.1 μg/g of oil for α-tocopherol, from 74.9 to 492.8 μg/g for γ-tocopherol, and from 35.3 to 1109.7 μg/g for δ-tocopherol. The study showed potential for pumpkin seed oil from all 12 cultivars to have high oxidative stability that would be suitable for food and industrial applications, as well as high unsaturation and tocopherol content that could potentially improve the nutrition of human diets. Keywords: Pumpkin seed oil; pumpkin seed; oilseed; winter squash; Cucurbitaceae; fatty acid; tocopherol

We describe the key policy and educational opportunities in the United States to address and potentially overcome the barriers to greater integration of palliative care into the healthcare of Americans with serious illness.

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IMPORTANCEPostacute care is thought to be a major source of wasteful spending. The extent to which accountable care organizations (ACOs) can limit postacute care spending has implications for the importance and design of other payment models that include postacute care. OBJECTIVE To assess changes in postacute care spending and use of postacute care associated with provider participation as ACOs in the Medicare Shared Savings Program (MSSP) and the pathways by which they occurred. DESIGN, SETTING, AND PARTICIPANTS With the use of fee-for-service Medicare claims from a random 20% sample of beneficiaries with 25 544 650 patient-years, 8 395 426 hospital admissions, and 1 595 352 stays in skilled nursing facilities (SNFs) from January 1, 2009, to December 31, 2014, difference-in-difference comparisons of beneficiaries served by ACOs with beneficiaries served by local non-ACO health care professionals (control group) were performed before vs after entry into the MSSP. Differential changes were estimated separately for cohorts of ACOs entering the MSSP in 2012, 2013, and 2014. EXPOSURES Patient attribution to an ACO in the MSSP. MAIN OUTCOMES AND MEASURES Postacute spending, discharge to a facility, length of SNF stays, readmissions, use of highly rated SNFs, and mortality, adjusted for patient characteristics. RESULTS For the 2012 cohort of 114 ACOs, participation in the MSSP was associated with an overall reduction in postacute spending (differential change in 2014 for ACOs vs control

Assisted living serves as a potential substitute for nursing home care for some healthier individuals with greater financial resources, suggesting implications for policy makers, providers, and consumers.

No abstract

Objectives To document the extent and appropriateness of use of antipsychotics and benzodiazepines among nursing home residents using a nationally representative survey. Methods Cross-sectional analysis of the 2004 National Nursing Home Survey. Bivariate and multivariate analyses examined relationships between resident and facility characteristics and antipsychotic and benzodiazepine use by appropriateness classification among residents aged 60 years and older (N = 12,090). Resident diagnoses and information about behavioral problems were used to categorize antipsychotic and benzodiazepine use as appropriate, potentially appropriate, or having no appropriate indication. Results More than one quarter (26%) of nursing home residents used an antipsychotic medication, 40% of whom had no appropriate indication for such use. Among the 13% of residents who took benzodiazepines, 42% had no appropriate indication. In adjusted analyses, the odds of residents taking an antipsychotic without an appropriate indication were highest for residents with diagnoses of depression (odds ratio [OR] = 1.31; 95% confidence interval [CI]: 1.12–1.53), dementia (OR = 1.82; 95% CI: 1.52–2.18), and with behavioral symptoms (OR = 1.97, 95% CI: 1.56–2.50). The odds of potentially inappropriate antipsychotic use increased as the percentage of Medicaid residents in a facility increased (OR = 1.08, 95% CI: 1.02–1.15) and decreased as the percentage of Medicare residents increased (OR = 0.46, 95% CI: 0.25–0.83). The odds of taking a benzodiazepine without an appropriate indication were highest among residents who were female (OR = 1.44; 95% CI: 1.18–1.75), white (OR = 1.95; 95% CI: 1.47–2.60), and had behavioral symptoms (OR = 1.69; 95% CI: 1.41–2.01). Conclusion Antipsychotics and benzodiazepines seem to be commonly prescribed to residents lacking an appropriate indication for their use.

Private equity investors have recently targeted nursing home chains as investment opportunities. Media attention has raised quality-of-care concerns, but little has been published in the research literature on the topic. Using a multivariate framework, we assessed how private equity purchases of nursing homes affected a range of outcomes. Although some transactions are quite recent, we found little evidence to suggest that nursing home quality worsens significantly following purchase by private equity companies. Nonetheless, recent nursing home ownership trends raise important questions about oversight and accountability, whose answers extend beyond private equity ownership.