Telmisartan Therapy Does Not Improve Lymph Node or Adipose Tissue Fibrosis More Than Continued Antiretroviral Therapy Alone.

PubMed

Utay, Netanya S; Kitch, Douglas W; Yeh, Eunice; Fichtenbaum, Carl J; Lederman, Michael M; Estes, Jacob D; Deleage, Claire; Magyar, Clara; Nelson, Scott D; Klingman, Karen L; Bastow, Barbara; Luque, Amneris E; McComsey, Grace A; Douek, Daniel C; Currier, Judith S; Lake, Jordan E

2018-05-05

Fibrosis in lymph nodes may limit CD4+ T-cell recovery, and lymph node and adipose tissue fibrosis may contribute to inflammation and comorbidities despite antiretroviral therapy (ART). We hypothesized that the angiotensin receptor blocker and peroxisome proliferator-activated receptor γ agonist telmisartan would decrease lymph node or adipose tissue fibrosis in treated human immunodeficiency virus type 1 (HIV) infection. In this 48-week, randomized, controlled trial, adults continued HIV-suppressive ART and received telmisartan or no drug. Collagen I, fibronectin, and phosphorylated SMAD3 (pSMAD3) deposition in lymph nodes, as well as collagen I, collagen VI, and fibronectin deposition in adipose tissue, were quantified by immunohistochemical analysis at weeks 0 and 48. Two-sided rank sum and signed rank tests compared changes over 48 weeks. Forty-four participants enrolled; 35 had paired adipose tissue specimens, and 29 had paired lymph node specimens. The median change overall in the percentage of the area throughout which collagen I was deposited was -2.6 percentage points (P = 0.08) in lymph node specimens and -1.3 percentage points (P = .001) in adipose tissue specimens, with no between-arm differences. In lymph node specimens, pSMAD3 deposition changed by -0.5 percentage points overall (P = .04), with no between-arm differences. Telmisartan attenuated increases in fibronectin deposition (P = .06). In adipose tissue, changes in collagen VI deposition (-1.0 percentage point; P = .001) and fibronectin deposition (-2.4 percentage points; P < .001) were observed, with no between-arm differences. In adults with treated HIV infection, lymph node and adipose tissue fibrosis decreased with continued ART alone, with no additional fibrosis reduction with telmisartan therapy.

Friction behavior and other material properties of nickel-titanium and titanium-molybdenum archwires following electrochemical surface refinement.

PubMed

Meier, Miriam Julia; Bourauel, Christoph; Roehlike, Jan; Reimann, Susanne; Keilig, Ludger; Braumann, Bert

2014-07-01

The aim of this work was to investigate whether electrochemical surface treatment of nickel-titanium (NiTi) and titanium-molybdenum (TiMo) archwires (OptoTherm and BetaTitan; Ortho-Dent Specials, Kisdorf, Germany) reduces friction inside the bracket-archwire complex. We also evaluated further material properties and compared these to untreated wires. The material properties of the surface-treated wires (Optotherm/LoFrix and BetaTitan/LoFrix) were compared to untreated wires made by the same manufacturer (see above) and by another manufacturer (Neo Sentalloy; GAC, Bohemia, NY, USA). We carried out a three-point bending test, leveling test, and friction test using an orthodontic measurement and simulation system (OMSS). In addition, a pure bending test was conducted at a special test station, and scanning electron micrographs were obtained to analyze the various wire types for surface characteristics. Finally, edge beveling and cross-sectional dimensions were assessed. Force losses due to friction were reduced by 10 percentage points (from 36 to 26%) in the NiTi and by 12 percentage points (from 59 to 47%) in the TiMo wire specimens. Most of the other material properties exhibited no significant changes after surface treatment. While the three-point bending tests revealed mildly reduced force levels in the TiMo specimens due to diameter losses of roughly 2%, these force levels remained almost unchanged in the NiTi specimens. Compared to untreated NiTi and TiMo archwire specimens, the surface-treated specimens demonstrated reductions in friction loss by 10 and 12 percentage points, respectively.

US Adult Illicit Cannabis Use, Cannabis Use Disorder, and Medical Marijuana Laws: 1991-1992 to 2012-2013.

PubMed

Hasin, Deborah S; Sarvet, Aaron L; Cerdá, Magdalena; Keyes, Katherine M; Stohl, Malka; Galea, Sandro; Wall, Melanie M

2017-06-01

Over the last 25 years, illicit cannabis use and cannabis use disorders have increased among US adults, and 28 states have passed medical marijuana laws (MML). Little is known about MML and adult illicit cannabis use or cannabis use disorders considered over time. To present national data on state MML and degree of change in the prevalence of cannabis use and disorders. Differences in the degree of change between those living in MML states and other states were examined using 3 cross-sectional US adult surveys: the National Longitudinal Alcohol Epidemiologic Survey (NLAES; 1991-1992), the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002), and the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III; 2012-2013). Early-MML states passed MML between NLAES and NESARC ("earlier period"). Late-MML states passed MML between NESARC and NESARC-III ("later period"). Past-year illicit cannabis use and DSM-IV cannabis use disorder. Overall, from 1991-1992 to 2012-2013, illicit cannabis use increased significantly more in states that passed MML than in other states (1.4-percentage point more; SE, 0.5; P = .004), as did cannabis use disorders (0.7-percentage point more; SE, 0.3; P = .03). In the earlier period, illicit cannabis use and disorders decreased similarly in non-MML states and in California (where prevalence was much higher to start with). In contrast, in remaining early-MML states, the prevalence of use and disorders increased. Remaining early-MML and non-MML states differed significantly for use (by 2.5 percentage points; SE, 0.9; P = .004) and disorder (1.1 percentage points; SE, 0.5; P = .02). In the later period, illicit use increased by the following percentage points: never-MML states, 3.5 (SE, 0.5); California, 5.3 (SE, 1.0); Colorado, 7.0 (SE, 1.6); other early-MML states, 2.6 (SE, 0.9); and late-MML states, 5.1 (SE, 0.8). Compared with never-MML states, increases in use were significantly greater in late-MML states (1.6-percentage point more; SE, 0.6; P = .01), California (1.8-percentage point more; SE, 0.9; P = .04), and Colorado (3.5-percentage point more; SE, 1.5; P = .03). Increases in cannabis use disorder, which was less prevalent, were smaller but followed similar patterns descriptively, with change greater than never-MML states in California (1.0-percentage point more; SE, 0.5; P = .06) and Colorado (1.6-percentage point more; SE, 0.8; P = .04). Medical marijuana laws appear to have contributed to increased prevalence of illicit cannabis use and cannabis use disorders. State-specific policy changes may also have played a role. While medical marijuana may help some, cannabis-related health consequences associated with changes in state marijuana laws should receive consideration by health care professionals and the public.

Cost-effectiveness of exercise and diet in overweight and obese adults with knee osteoarthritis.

PubMed

Sevick, Mary A; Miller, Gary D; Loeser, Richard F; Williamson, Jeff D; Messier, Stephen P

2009-06-01

The purpose of this study was to compare the cost-effectiveness of dietary and exercise interventions in overweight or obese elderly patients with knee osteoarthritis (OA) enrolled in the Arthritis, Diet, and Physical Activity Promotion Trial (ADAPT). ADAPT was a single-blinded, controlled trial of 316 adults with knee OA, randomized to one of four groups: Healthy Lifestyle Control group, Diet group, Exercise group, or Exercise and Diet group. A cost analysis was performed from a payer perspective, incorporating those costs and benefits that would be realized by a managed care organization interested in maintaining the health and satisfaction of its enrollees while reducing unnecessary utilization of health care services. The Diet intervention was most cost-effective for reducing weight, at $35 for each percentage point reduction in baseline body weight. The Exercise intervention was most cost-effective for improving mobility, costing $10 for each percentage point improvement in a 6-min walking distance and $9 for each percentage point improvement in the timed stair climbing task. The Exercise and Diet intervention was most cost-effective for improving self-reported function and symptoms of arthritis, costing $24 for each percentage point improvement in subjective function, $20 for each percentage point improvement in self-reported pain, and $56 for each percentage point improvement in self-reported stiffness. The Exercise and Diet intervention consistently yielded the greatest improvements in weight, physical performance, and symptoms of knee OA. However, it was also the most expensive and was the most cost-effective approach only for the subjective outcomes of knee OA (self-reported function, pain, and stiffness). Perceived function and symptoms of knee OA are likely to be stronger drivers of downstream health service utilization than weight, or objective performance measures and may be the most cost-effective in the long term.

Association of Admission to Veterans Affairs Hospitals Versus non-Veterans Affairs Hospitals with Mortality and Readmission Rates Among Older Men Hospitalized with Acute Myocardial Infarction, Heart Failure, and Pneumonia

PubMed Central

Nuti, Sudhakar V.; Qin, Li; Rumsfeld, John S.; Ross, Joseph S.; Masoudi, Frederick A.; Normand, Sharon-Lise T.; Murugiah, Karthik; Bernheim, Susannah M.; Suter, Lisa G.; Krumholz, Harlan M.

2017-01-01

Importance Little contemporary information is available about comparative performance between Veterans Affairs (VA) and non-VA hospitals, particularly related to mortality and readmission rates, 2 important outcomes of care. Objective To assess and compare mortality and readmission rates among men in VA and non-VA hospitals. To avoid confounding geographic effects with health care system effects, we studied VA and non-VA hospitals within the same metropolitan statistical area (MSA). Design Cross-sectional analysis between 2010 and 2013 Setting Medicare Standard Analytic Files and Enrollment Database Participants Male Medicare Fee-for-Service beneficiaries aged 65 or older hospitalized between 2010 and 2013 in VA and non-VA acute care hospitals for acute myocardial infarction (AMI), heart failure (HF), or pneumonia. Exposures Hospitalization in a VA or non-VA hospital in urban MSAs that contained at least 1 VA and non-VA hospital Main Outcomes and Measures For each condition, 30-day risk-standardized mortality rates and risk-standardized readmission rates for VA and non-VA hospitals. Mean-aggregated within-MSA differences in mortality and readmission rates were also assessed. Results We studied 104 VA and 1,513 non-VA hospitals, with each condition-outcome analysis cohort for VA and non-VA hospitals containing at least 7,900 patients, in 92 MSAs. Mortality rates were lower in VA hospitals than non-VA hospitals for AMI (13.5% vs. 13.7%, p=0.02; −0.2 percentage point difference) and HF (11.4% vs. 11.9%, p=0.008; −0.5 percentage point difference), but higher for pneumonia (12.6% vs. 12.2%, p<0.05; 0.4 percentage point difference). In contrast, readmission rates were higher in VA hospitals for all 3 conditions (AMI: 17.8% vs. 17.2%, 0.6 percentage point difference; HF: 24.7% vs. 23.5%, 1.2 percentage point difference; pneumonia: 19.4% vs. 18.7%, 0.7 percentage point difference, all p<0.001). In within-MSA comparisons, VA hospitals had lower mortality rates for AMI (percentage point difference: −0.22, 95% CI: −0.40 to −0.04) and HF (−0.63, 95% CI: −0.95 to −0.31), and mortality rates for pneumonia were not significantly different (−0.03, 95% CI: −0.46 to 0.40); however, VA hospitals had higher readmission rates (AMI: 0.62, 95% CI: 0.48 to 0.75; HF: 0.97, 95% CI: 0.59 to 1.34; pneumonia: 0.66, 95% CI: 0.41 to 0.91). Conclusion and Relevance Among older men with AMI, HF, and pneumonia, hospitalization at VA hospitals, compared with hospitalization at non-VA hospitals, was associated with lower risk-standardized 30-day all-cause mortality rates for AMI and HF, and higher risk-standardized 30 day all-cause readmission rates for all 3 conditions, both nationally and within similar geographic areas, although absolute differences between these outcomes at VA and non-VA hospitals were small. PMID:26864412

US Adult Illicit Cannabis Use, Cannabis Use Disorder, and Medical Marijuana Laws

PubMed Central

Sarvet, Aaron L.; Cerdá, Magdalena; Keyes, Katherine M.; Stohl, Malka; Galea, Sandro; Wall, Melanie M.

2017-01-01

Importance Over the last 25 years, illicit cannabis use and cannabis use disorders have increased among US adults, and 28 states have passed medical marijuana laws (MML). Little is known about MML and adult illicit cannabis use or cannabis use disorders considered over time. Objective To present national data on state MML and degree of change in the prevalence of cannabis use and disorders. Design, Participants, and Setting Differences in the degree of change between those living in MML states and other states were examined using 3 cross-sectional US adult surveys: the National Longitudinal Alcohol Epidemiologic Survey (NLAES; 1991-1992), the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002), and the National Epidemiologic Survey on Alcohol and Related Conditions–III (NESARC-III; 2012-2013). Early-MML states passed MML between NLAES and NESARC (“earlier period”). Late-MML states passed MML between NESARC and NESARC-III (“later period”). Main Outcomes and Measures Past-year illicit cannabis use and DSM-IV cannabis use disorder. Results Overall, from 1991-1992 to 2012-2013, illicit cannabis use increased significantly more in states that passed MML than in other states (1.4–percentage point more; SE, 0.5; P = .004), as did cannabis use disorders (0.7–percentage point more; SE, 0.3; P = .03). In the earlier period, illicit cannabis use and disorders decreased similarly in non-MML states and in California (where prevalence was much higher to start with). In contrast, in remaining early-MML states, the prevalence of use and disorders increased. Remaining early-MML and non-MML states differed significantly for use (by 2.5 percentage points; SE, 0.9; P = .004) and disorder (1.1 percentage points; SE, 0.5; P = .02). In the later period, illicit use increased by the following percentage points: never-MML states, 3.5 (SE, 0.5); California, 5.3 (SE, 1.0); Colorado, 7.0 (SE, 1.6); other early-MML states, 2.6 (SE, 0.9); and late-MML states, 5.1 (SE, 0.8). Compared with never-MML states, increases in use were significantly greater in late-MML states (1.6–percentage point more; SE, 0.6; P = .01), California (1.8–percentage point more; SE, 0.9; P = .04), and Colorado (3.5–percentage point more; SE, 1.5; P = .03). Increases in cannabis use disorder, which was less prevalent, were smaller but followed similar patterns descriptively, with change greater than never-MML states in California (1.0–percentage point more; SE, 0.5; P = .06) and Colorado (1.6–percentage point more; SE, 0.8; P = .04). Conclusions and Relevance Medical marijuana laws appear to have contributed to increased prevalence of illicit cannabis use and cannabis use disorders. State-specific policy changes may also have played a role. While medical marijuana may help some, cannabis-related health consequences associated with changes in state marijuana laws should receive consideration by health care professionals and the public. PMID:28445557

The Association of Health Insurance with institutional delivery and access to skilled birth attendants: evidence from the Kenya Demographic and health survey 2008-09.

PubMed

Were, Lawrence P O; Were, Edwin; Wamai, Richard; Hogan, Joseph; Galarraga, Omar

2017-07-03

Healthcare financing through health insurance is gaining traction as developing countries strive to achieve universal health coverage and address the limited access to critical health services for specific populations including pregnant women and their children. However, these reforms are taking place despite limited evaluation of impact of health insurance on maternal health in developing countries including Kenya. In this study we evaluate the association of health insurance with access and utilization of obstetric delivery health services for pregnant women in Kenya. Nationally representative data from the Kenya Demographic and Health Survey 2008-09 was used in this study. 4082 pregnant women with outcomes of interest - Institutional delivery (Yes/No - delivery at hospital, dispensary, maternity home, and clinic) and access to skilled birth attendants (help by a nurse, doctor, or trained midwife at delivery) were selected from 8444 women ages 15-49 years. Linear and logistic regression, and propensity score adjustment are used to estimate the causal association of enrollment in insurance on obstetric health outcomes. Mothers with insurance are 23 percentage points (p < 0.01) more likely to deliver at an institution and 20 percentages points (p < 0.01) more likely have access to skilled birth attendants compared to those not insured. In addition mothers of lower socio-economic status benefit more from enrollment in insurance compared to mothers of higher socio-economic status. For both institutional delivery and access to skilled birth attendants, the average difference of the association of insurance enrollment compared to not enrolling for those of low SES is 23 percentage points (p < 0.01), and 6 percentage points (p < 0.01) for those of higher SES. Enrolling in health insurance is associated with increased access and utilization of obstetric delivery health services for pregnant women. Notably, those of lower socio-economic status seem to benefit the most from enrollment in insurance.

Tier 3 multidisciplinary medical weight management improves outcome of Roux-en-Y gastric bypass surgery.

PubMed

Patel, P; Hartland, A; Hollis, A; Ali, R; Elshaw, A; Jain, S; Khan, A; Mirza, S

2015-04-01

In 2013 the Department of Health specified eligibility for bariatric surgery funded by the National Health Service. This included a mandatory specification that patients first complete a Tier 3 medical weight management programme. The clinical effectiveness of this recommendation has not been evaluated previously. Our bariatric centre has provided a Tier 3 programme six months prior to bariatric surgery since 2009. The aim of our retrospective study was to compare weight loss in two cohorts: Roux-en-Y gastric bypass only (RYGB only cohort) versus Tier 3 weight management followed by RYGB (Tier 3 cohort). A total of 110 patients were selected for the study: 66 in the RYGB only cohort and 44 in the Tier 3 cohort. Patients in both cohorts were matched for age, sex, preoperative body mass index and pre-existing co-morbidities. The principal variable was therefore whether they undertook the weight management programme prior to RYGB. Patients from both cohorts were followed up at 6 and 12 months to assess weight loss. The mean weight loss at 6 months for the Tier 3 cohort was 31% (range: 18-69%, standard deviation [SD]: 0.10 percentage points) compared with 23% (range: 4-93%, SD: 0.12 percentage points) for the RYGB only cohort (p=0.0002). The mean weight loss at 12 months for the Tier 3 cohort was 34% (range: 17-51%, SD: 0.09 percentage points) compared with 27% (range: 14-48%, SD: 0.87 percentage points) in the RYGB only cohort (p=0.0037). Our study revealed that in our matched cohorts, patients receiving Tier 3 specialist medical weight management input prior to RYGB lost significantly more weight at 6 and 12 months than RYGB only patients. This confirms the clinical efficacy of such a weight management programme prior to gastric bypass surgery and supports its inclusion in eligibility criteria for bariatric surgery.

Registered Replication Report: Rand, Greene, and Nowak (2012).

PubMed

Bouwmeester, S; Verkoeijen, P P J L; Aczel, B; Barbosa, F; Bègue, L; Brañas-Garza, P; Chmura, T G H; Cornelissen, G; Døssing, F S; Espín, A M; Evans, A M; Ferreira-Santos, F; Fiedler, S; Flegr, J; Ghaffari, M; Glöckner, A; Goeschl, T; Guo, L; Hauser, O P; Hernan-Gonzalez, R; Herrero, A; Horne, Z; Houdek, P; Johannesson, M; Koppel, L; Kujal, P; Laine, T; Lohse, J; Martins, E C; Mauro, C; Mischkowski, D; Mukherjee, S; Myrseth, K O R; Navarro-Martínez, D; Neal, T M S; Novakova, J; Pagà, R; Paiva, T O; Palfi, B; Piovesan, M; Rahal, R-M; Salomon, E; Srinivasan, N; Srivastava, A; Szaszi, B; Szollosi, A; Thor, K Ø; Tinghög, G; Trueblood, J S; Van Bavel, J J; van 't Veer, A E; Västfjäll, D; Warner, M; Wengström, E; Wills, J; Wollbrant, C E

2017-05-01

In an anonymous 4-person economic game, participants contributed more money to a common project (i.e., cooperated) when required to decide quickly than when forced to delay their decision (Rand, Greene & Nowak, 2012), a pattern consistent with the social heuristics hypothesis proposed by Rand and colleagues. The results of studies using time pressure have been mixed, with some replication attempts observing similar patterns (e.g., Rand et al., 2014) and others observing null effects (e.g., Tinghög et al., 2013; Verkoeijen & Bouwmeester, 2014). This Registered Replication Report (RRR) assessed the size and variability of the effect of time pressure on cooperative decisions by combining 21 separate, preregistered replications of the critical conditions from Study 7 of the original article (Rand et al., 2012). The primary planned analysis used data from all participants who were randomly assigned to conditions and who met the protocol inclusion criteria (an intent-to-treat approach that included the 65.9% of participants in the time-pressure condition and 7.5% in the forced-delay condition who did not adhere to the time constraints), and we observed a difference in contributions of -0.37 percentage points compared with an 8.6 percentage point difference calculated from the original data. Analyzing the data as the original article did, including data only for participants who complied with the time constraints, the RRR observed a 10.37 percentage point difference in contributions compared with a 15.31 percentage point difference in the original study. In combination, the results of the intent-to-treat analysis and the compliant-only analysis are consistent with the presence of selection biases and the absence of a causal effect of time pressure on cooperation.

Registered Replication Report: Rand, Greene, and Nowak (2012)

PubMed Central

Bouwmeester, S.; Verkoeijen, P. P. J. L.; Aczel, B.; Barbosa, F.; Bègue, L.; Brañas-Garza, P.; Chmura, T. G. H.; Cornelissen, G.; Døssing, F. S.; Espín, A. M.; Evans, A. M.; Ferreira-Santos, F.; Fiedler, S.; Flegr, J.; Ghaffari, M.; Glöckner, A.; Goeschl, T.; Guo, L.; Hauser, O. P.; Hernan-Gonzalez, R.; Herrero, A.; Horne, Z.; Houdek, P.; Johannesson, M.; Koppel, L.; Kujal, P.; Laine, T.; Lohse, J.; Martins, E. C.; Mauro, C.; Mischkowski, D.; Mukherjee, S.; Myrseth, K. O. R.; Navarro-Martínez, D.; Neal, T. M. S.; Novakova, J.; Pagà, R.; Paiva, T. O.; Palfi, B.; Piovesan, M.; Rahal, R.-M.; Salomon, E.; Srinivasan, N.; Srivastava, A.; Szaszi, B.; Szollosi, A.; Thor, K. Ø.; Tinghög, G.; Trueblood, J. S.; Van Bavel, J. J.; van ‘t Veer, A. E.; Västfjäll, D.; Warner, M.; Wengström, E.; Wills, J.; Wollbrant, C. E.

2017-01-01

In an anonymous 4-person economic game, participants contributed more money to a common project (i.e., cooperated) when required to decide quickly than when forced to delay their decision (Rand, Greene & Nowak, 2012), a pattern consistent with the social heuristics hypothesis proposed by Rand and colleagues. The results of studies using time pressure have been mixed, with some replication attempts observing similar patterns (e.g., Rand et al., 2014) and others observing null effects (e.g., Tinghög et al., 2013; Verkoeijen & Bouwmeester, 2014). This Registered Replication Report (RRR) assessed the size and variability of the effect of time pressure on cooperative decisions by combining 21 separate, preregistered replications of the critical conditions from Study 7 of the original article (Rand et al., 2012). The primary planned analysis used data from all participants who were randomly assigned to conditions and who met the protocol inclusion criteria (an intent-to-treat approach that included the 65.9% of participants in the time-pressure condition and 7.5% in the forced-delay condition who did not adhere to the time constraints), and we observed a difference in contributions of −0.37 percentage points compared with an 8.6 percentage point difference calculated from the original data. Analyzing the data as the original article did, including data only for participants who complied with the time constraints, the RRR observed a 10.37 percentage point difference in contributions compared with a 15.31 percentage point difference in the original study. In combination, the results of the intent-to-treat analysis and the compliant-only analysis are consistent with the presence of selection biases and the absence of a causal effect of time pressure on cooperation. PMID:28475467

Insurance Coverage and Treatment Use Under the Affordable Care Act Among Adults With Mental and Substance Use Disorders.

PubMed

Saloner, Brendan; Bandara, Sachini; Bachhuber, Marcus; Barry, Colleen L

2017-06-01

Many adults who have mental or substance use disorders or both experience insurance-related barriers to care, contributing to low treatment utilization. Expanded insurance under the Affordable Care Act (ACA) could improve coverage and access. The study identified changes in coverage and treatment use following 2014 ACA insurance expansions. Data from the National Survey on Drug Use and Health were used to identify individuals ages 18-64 screening positive for any mental disorder (N=29,962) or substance use disorder (N=19,243) for two periods: 2011-2013 and 2014. Regression-adjusted means were calculated for insurance rates and treatment used in each period overall and among individuals with household incomes ≤200% of the federal poverty level (FPL). Compared with 2011-2013, in 2014 significant reductions were seen in the uninsured rate for individuals with mental disorders (-5.4 percentage points, p<.01) and substance use disorders (-5.1 percentage points, p<.01). Increases in insurance coverage occurred mostly through Medicaid. Insurance gains were larger for adults with incomes ≤200% of FPL compared with the overall sample. Use of mental health treatment increased by 2.1 percentage points (p=.04), but use of substance use disorder treatment did not change. No significant changes were noted in treatment settings for mental and substance use disorder treatments. Payment by Medicaid for substance use disorder treatment increased by 7.4 percentage points (p=.05). Sizable increases in coverage for adults with mental disorders and adults with substance use disorders were identified in the year following the 2014 ACA expansions; however, low treatment rates among this population remain a concern. Initiatives to engage the newly insured in treatment are needed.

Greater involvement of HIV-infected peer-mothers in provision of reproductive health services as "family planning champions" increases referrals and uptake of family planning among HIV-infected mothers.

PubMed

Mudiope, Peter; Musingye, Ezra; Makumbi, Carolyne Onyango; Bagenda, Danstan; Homsy, Jaco; Nakitende, Mai; Mubiru, Mike; Mosha, Linda Barlow; Kagawa, Mike; Namukwaya, Zikulah; Fowler, Mary Glenn

2017-06-27

In 2012, Makerere University Johns - Hopkins University, and Mulago National Referral Hospital, with support from the National Institute of Health (under Grant number: NOT AI-01-023) undertook operational research at Mulago National Hospital PMTCT/PNC clinics. The study employed Peer Family Planning Champions to offer health education, counselling, and triage aimed at increasing the identification, referral and family planning (FP) uptake among HIV positive mothers attending the clinic. The Peer Champion Intervention to improve FP uptake was introduced into Mulago Hospital PMTCT/PNC clinic, Kampala Uganda. During the intervention period, peers provided additional FP counselling and education; assisted in identification and referral of HIV Positive mothers in need of FP services; and accompanied referred mothers to FP clinics. We compiled and compared the average proportions of mothers in need that were referred and took up FP in the pre-intervention (3 months), intervention (6 months), and post-intervention(3 months) periods using interrupted time series with segmented regression models with an autoregressive term of one. Overall, during the intervention, the proportion of referred mothers in need of FP increased by 30.4 percentage points (P < 0.001), from 52.7 to 83.2 percentage points. FP uptake among mothers in need increased by over 31 percentage points (P < 0.001) from 47.2 to 78.5 percentage points during the intervention. There was a positive non-significant change in the weekly trend of referral β 3  = 2.9 percentage points (P = 0.077) and uptake β 3  = 1.9 percentage points (P = 0.176) during the intervention as compared to the pre-intervention but this was reversed during the post intervention. Over 57% (2494) mothers took up Depo-Provera injectable-FP method during the study. To support overstrained health care work force in post-natal clinics, peers in trained effective family planning can be a valuable addition to clinic staff in limited-resource settings. The study provides additional evidence on the utilization of peer mothers in HIV care, improves health services uptake including family planning which is a common practice in many donor supported programs. It also provides evidence that may be used to advocate for policy revisions in low-income countries to include peers as support staff especially in busy clinic settings with poor services uptake.

The impact of the African Youth Alliance program on the sexual behavior of young people in Uganda.

PubMed

Karim, Ali Mehryar; Williams, Timothy; Patykewich, Leslie; Ali, Disha; Colvin, Charlotte E; Posner, Jessica; Rutaremwa, Gideon

2009-12-01

This study evaluates the impact of the African Youth Alliance (AYA) program on the sexual behavior of young people aged 17-22 in Uganda. Between 2000 and 2005, the comprehensive multicomponent AYA program implemented behavior-change communication and youth-friendly clinical services, and it coordinated policy and advocacy. The program provided institutional capacity building and established coordination mechanisms between agencies that implemented programs for young people. The analysis of findings from both a self-reported exposure design and a static group comparison design indicated that AYA had a positive impact on sexual behavior among young females but not among young males. AYA-exposed girls were at least 13 percentage points more likely to report having used a condom at last sex, at least 10 percentage points more likely to report that they had consistently used condoms with their current partner, at least 10 percentage points more likely to have used contraceptives at last sex, and 13 percentage points more likely to have had fewer sex partners during the past 12 months, compared with girls who were not exposed to the AYA program. Scaling up the AYA program in Uganda could, therefore, be expected to improve significantly the sexual and reproductive health of young women. Effective strategies for promoting safer sexual behaviors among boys and young men must be identified, however.

12 CFR 226.22 - Determination of annual percentage rate.

Code of Federal Regulations, 2010 CFR

2010-01-01

... annual percentage rate shall be considered accurate if it is not more than 1/8 of 1 percentage point... more than 1/4 of 1 percentage point above or below the annual percentage rate determined in accordance... transaction. (d) Certain transactions involving ranges of balances. For purposes of disclosing the annual...

The Affordable Care Act Appears to Have Narrowed Racial and Ethnic Disparities in Insurance Coverage and Access to Care Among Young Adults.

PubMed

Lipton, Brandy J; Decker, Sandra L; Sommers, Benjamin D

2017-04-01

Prior to the Affordable Care Act, one in three young adults aged 19 to 25 years were uninsured, with substantial racial/ethnic disparities in coverage. We analyzed the separate and cumulative changes in racial/ethnic disparities in coverage and access to care among young adults after implementation of the Affordable Care Act's 2010 dependent coverage provision and 2014 Medicaid and Marketplace expansions. We find that the dependent coverage provision was associated with similar gains across racial/ethnic groups, but the 2014 expansion was associated with larger gains in coverage among Hispanics and Blacks relative to Whites. After the 2014 expansion, coverage increased by 11.0 and 10.1 percentage points among Hispanics and Blacks, respectively, compared with a 5.6 percentage point increase among Whites. The percentage with a usual source of care and a recent doctor's visit also increased more for Blacks relative to Whites. Increases in coverage were larger in Medicaid expansion compared with nonexpansion states for most racial/ethnic groups.

Elimination of Cost Sharing for Screening Mammography in Medicare Advantage Plans.

PubMed

Trivedi, Amal N; Leyva, Bryan; Lee, Yoojin; Panagiotou, Orestis A; Dahabreh, Issa J

2018-01-18

The Affordable Care Act (ACA) required most insurers and the Medicare program to eliminate cost sharing for screening mammography. We conducted a difference-in-differences study of biennial screening mammography among 15,085 women 65 to 74 years of age in 24 Medicare Advantage plans that eliminated cost sharing to provide full coverage for screening mammography, as compared with 52,035 women in 48 matched control plans that had and maintained full coverage. In plans that eliminated cost sharing, adjusted rates of biennial screening mammography increased from 59.9% (95% confidence interval [CI], 54.9 to 65.0) in the 2-year period before cost-sharing elimination to 65.4% (95% CI, 61.8 to 69.0) in the 2-year period thereafter. In control plans, the rates of biennial mammography were 73.1% (95% CI, 69.2 to 77.0) and 72.8% (95% CI, 69.7 to 76.0) during the same periods, yielding a difference in differences of 5.7 percentage points (95% CI, 3.0 to 8.4). The difference in differences was 9.8 percentage points (95% CI, 4.5 to 15.2) among women living in the areas with the highest quartile of educational attainment versus 4.3 percentage points (95% CI, 0.2 to 8.4) among women in the lowest quartile. As indicated by the difference-in-differences estimates, after the elimination of cost sharing, the rate of biennial mammography increased by 6.5 percentage points (95% CI, 3.7 to 9.4) for white women and 8.4 percentage points (95% CI, 2.5 to 14.4) for black women but was almost unchanged for Hispanic women (0.4 percentage points; 95% CI, -7.3 to 8.1). The elimination of cost sharing for screening mammography under the ACA was associated with an increase in rates of use of this service among older women for whom screening is recommended. The effect was attenuated among women living in areas with lower educational attainment and was negligible among Hispanic women. (Funded by the National Institute on Aging.).

Female access to non-primary occupations: the Indonesian case.

PubMed

Moir, H V

1980-12-01

Focus in this discussion is on the range of nonprimary occupations open to women in Indonesia compared to those open to men. Particular attention is directed to the question of whether given occupations (particularly those that are important sources of employment) are more or less open to women in urban compared to rural areas. Whether an occupation is open to women or not is defined on the basis of the proportion female in that occupation. Where the proportion female is high, it is evident that women have a substantial degree of access to that occupation. In contrast, where the proportion female is very low, it is obviously unusual for women to enter that occupation and female access to such occupations is relatively restricted. The data presented refer to the employed population, i.e., the economically active population excluding the unemployed. The 1971 Population Census is used to maintain seasonal comparability with other analyses of the Indonesian workforce and to allow for seasonal comparability with the data from the 1980 Population Census. Out of 75 nonprimary occupation groups, 39 are excluded from the analysis because in most provinces they employ less than 0.1% of the labor force. The percentage of the male workforce in rural areas that is engaged in the remaining 36 occupations is less than the percentage of the female rural workforce engaged in these same occupations (95.0 compared to 98.2% in Java-Bali and 94.1 compared to 97.4% in the Outer Islands). In urban areas, male-female differences in the percentage concentrated in these 36 occupations are slightly larger (4.4 percentage points in urban compared to 3.2 percentage points in rural Java-Bali and 5.6 and 3.3 percentage points for urban and rural areas in the Outer Islands). A negative association was found between the degree of occupational segregation by sex and the relative modernness of an area, i.e., occupational segregation by sex is greatest in the least modern area of the country, the rural areas of the other islands, and is lowest in the metropolitan area of Jakarta. Although occupational segregation is lower in Jakarta than elsewhere in Indonesia, it is still quite high with an Index value of 51.2. Women were found to be underrepresented in the upper level occupations in all areas of Indonesia. The degree of underrepresentation was considerably greater in rural than in urban areas. Women are over-represented in sales and service occupations, and within these broad categories are most dominant in the more traditional sector of the economy than is the male labor force.

Comparing Matchplay Characteristics and Physical Demands of Junior and Professional Tennis Athletes in the Era of Big Data.

PubMed

Kovalchik, Stephanie A; Reid, Machar

2017-12-01

Differences in the competitive performance characteristics of junior and professional tennis players are not well understood. The present study provides a comprehensive comparative analysis of junior and professional matchplay. The study utilized multiple large-scale datasets covering match, point, and shot outcomes over multiple years of competition. Regression analysis was used to identify differences between junior and professional matchplay. Top professional men and women were found to play significantly more matches, sets, and games compared to junior players of an equivalent ranking. Professional players had a greater serve advantage, men winning 4 and women winning 2 additional percentage points on serve compared to juniors. Clutch ability in break point conversion was 6 to 8 percentage points greater for junior players. In general, shots were more powerful and more accurate at the professional level with the largest differences observed for male players on serve. Serving to the center of the court was more than two times more common for junior players on first serve. While male professionals performed 50% more total work in a Grand Slam match than juniors, junior girls performed 50% more work than professional women. Understanding how competitiveness, play demands, and the physical characteristics of shots differ between junior and professional tennis players can help set realistic expectations and developmentally appropriate training for transitioning players.

Reinforced cementitous composite with in situ shrinking microfibers

NASA Astrophysics Data System (ADS)

Kim, Eric S.; Lee, Jason K.; Lee, Patrick C.; Huston, Dryver R.; Tan, Ting; Al-Ghamdi, Saleh

2017-03-01

This paper describes an innovative fiber reinforcement technology for cementitious composite structures that employs in situ shrinking microfibers to provide supplemental strength-enhancing compressive stresses. Reinforced concrete is one of the most commonly used structural materials in construction industry, primarily due to its cost, durability, ability to be easily fabricated into a variety of shapes on site, and locally abundant raw material availability almost everywhere. Unlike incumbent passive reinforcing microfiber technology, in situ shrinking microfibers that respond to an in situ stimulus such as heat, pH, or moisture variations can induce pre-compression to matrix and create additional resistance from external loads, creating stronger composite structures. In this paper, heat-activated-shrinking (HAS) microfibers made from polyolefin, and pH-activated-shrinking (pHAS) microfibers made from chitosan powder were used to study effects of shrinking microfiber reinforcing in concrete. Shrinking ratios and tensile strengths of both microfibers were measured. Cementitious specimens with active shrinking microfibers, passive non shrinking fibers, as well as control samples were made. Mechanical properties of the samples were compared with compression and three-point bending tests. The optimum microfiber weight percentages for HAS microfibers were 0.5 wt% in compression tests, and 1.0 wt% in three-point bending tests. For pHAS microfibers, the optimum weight percentages were 0.5 wt% in three-point bending tests. Compared to heat passive microfibers specimens, 45% increase in the maximum compression strengths, and 124% increase in the maximum bending strengths were achieved at the optimum weight percentages of HAS microfibers. In addition, with 0.5 wt% of pHAS microfibers, 145% increase in the maximum bending strengths of three-point bending tests resulted compared to pH passive microfibers specimens.

Association Between Loss of Hospital-Based Obstetric Services and Birth Outcomes in Rural Counties in the United States.

PubMed

Kozhimannil, Katy B; Hung, Peiyin; Henning-Smith, Carrie; Casey, Michelle M; Prasad, Shailendra

2018-03-27

Hospital-based obstetric services have decreased in rural US counties, but whether this has been associated with changes in birth location and outcomes is unknown. To examine the relationship between loss of hospital-based obstetric services and location of childbirth and birth outcomes in rural counties. A retrospective cohort study, using county-level regression models in an annual interrupted time series approach. Births occurring from 2004 to 2014 in rural US counties were identified using birth certificates linked to American Hospital Association Annual Surveys. Participants included 4 941 387 births in all 1086 rural counties with hospital-based obstetric services in 2004. Loss of hospital-based obstetric services in the county of maternal residence, stratified by adjacency to urban areas. Primary outcomes were county rates of (1) out-of-hospital births; (2) births in hospitals without obstetric units; and (3) preterm births (<37 weeks' gestation). Between 2004 and 2014, 179 rural counties lost hospital-based obstetric services. Of the 4 941 387 births studied, the mean (SD) maternal age was 26.2 (5.8) years. A mean (SD) of 75.9% (23.2%) of women who gave birth were non-Hispanic white, and 49.7% (15.6%) were college graduates. Rural counties not adjacent to urban areas that lost hospital-based obstetric services had significant increases in out-of-hospital births (0.70 percentage points [95% CI, 0.30 to 1.10]); births in a hospital without an obstetric unit (3.06 percentage points [95% CI, 2.66 to 3.46]); and preterm births (0.67 percentage points [95% CI, 0.02 to 1.33]), in the year after loss of services, compared with those with continual obstetric services. Rural counties adjacent to urban areas that lost hospital-based obstetric services also had significant increases in births in a hospital without obstetric services (1.80 percentage points [95% CI, 1.55 to 2.05]) in the year after loss of services, compared with those with continual obstetric services, and this was followed by a decreasing trend (-0.19 percentage points per year [95% CI, -0.25 to -0.14]). In rural US counties not adjacent to urban areas, loss of hospital-based obstetric services, compared with counties with continual services, was associated with increases in out-of-hospital and preterm births and births in hospitals without obstetric units in the following year; the latter also occurred in urban-adjacent counties. These findings may inform planning and policy regarding rural obstetric services.

Use of the Dual-Antiplatelet Therapy Score to Guide Treatment Duration After Percutaneous Coronary Intervention.

PubMed

Piccolo, Raffaele; Gargiulo, Giuseppe; Franzone, Anna; Santucci, Andrea; Ariotti, Sara; Baldo, Andrea; Tumscitz, Carlo; Moschovitis, Aris; Windecker, Stephan; Valgimigli, Marco

2017-07-04

The dual-antiplatelet therapy (DAPT) score was developed to identify patients more likely to derive harm (score <2) or benefit (score ≥2) from prolonged DAPT after percutaneous coronary intervention (PCI). To evaluate the safety and efficacy of DAPT duration according to DAPT score. Retrospective assessment of DAPT score-guided treatment duration in a randomized clinical trial. (ClinicalTrials.gov: NCT00611286). PCI patients. 1970 patients undergoing PCI. DAPT (aspirin and clopidogrel) for 24 versus 6 months. Primary efficacy outcomes were death, myocardial infarction, or cerebrovascular accident. The primary safety outcome was type 3 or 5 bleeding according to the Bleeding Academic Research Consortium definition. Outcomes were assessed between 6 and 24 months. 884 patients (44.9%) had a DAPT score of at least 2, and 1086 (55.1%) had a score less than 2. The reduction in the primary efficacy outcome with 24- versus 6-month DAPT was greater in patients with high scores (risk difference [RD] for score ≥2, -2.05 percentage points [95% CI, -5.04 to 0.95 percentage points]; RD for score <2, 2.91 percentage points [CI, -0.43 to 6.25 percentage points]; P = 0.030). However, the difference by score for the primary efficacy outcome varied by stent type; prolonged DAPT with high scores was effective only in patients receiving paclitaxel-eluting stents (RD, -7.55 percentage points [CI, -12.85 to -2.25 percentage points]). The increase in the primary safety outcome with 24- versus 6-month DAPT was greater in patients with low scores (RD for score ≥2, 0.20 percentage point [CI, -1.20 to 1.60 percentage points]; RD for score <2, 2.58 percentage points [CI, 0.71 to 4.46 percentage points]; P = 0.046). Retrospective calculation of the DAPT score. Prolonged DAPT resulted in harm in patients with low DAPT scores undergoing PCI but reduced risk for ischemic events in patients with high scores receiving paclitaxel-eluting stents. Whether prolonged DAPT benefits patients with high scores treated with contemporary drug-eluting stents requires further study. None.

Protease-modulating polyacrylate-based hydrogel stimulates wound bed preparation in venous leg ulcers – a randomized controlled trial

PubMed Central

Humbert, P; Faivre, B; Véran, Y; Debure, C; Truchetet, F; Bécherel, P-A; Plantin, P; Kerihuel, J-C; Eming, SA; Dissemond, J; Weyandt, G; Kaspar, D; Smola, H; Zöllner, P

2014-01-01

Background Stringent control of proteolytic activity represents a major therapeutic approach for wound-bed preparation. Objectives We tested whether a protease-modulating polyacrylate- (PA-) containing hydrogel resulted in a more efficient wound-bed preparation of venous leg ulcers when compared to an amorphous hydrogel without known protease-modulating properties. Methods Patients were randomized to the polyacrylate-based hydrogel (n = 34) or to an amorphous hydrogel (n = 41). Wound beds were evaluated by three blinded experts using photographs taken on days 0, 7 and 14. Results After 14 days of treatment there was an absolute decrease in fibrin and necrotic tissue of 37.6 ± 29.9 percentage points in the PA-based hydrogel group and by 16.8 ± 23.0 percentage points in the amorphous hydrogel group. The absolute increase in the proportion of ulcer area covered by granulation tissue was 36.0 ± 27.4 percentage points in the PA-based hydrogel group and 14.5 ± 22.0 percentage points in the control group. The differences between the groups were significant (decrease in fibrin and necrotic tissue P = 0.004 and increase in granulation tissue P = 0.0005, respectively). Conclusion In particular, long-standing wounds profited from the treatment with the PA-based hydrogel. These data suggest that PA-based hydrogel dressings can stimulate normalization of the wound environment, particularly in hard-to-heal ulcers. PMID:24612304

Two-stage, low noise advanced technology fan. 4: Aerodynamic final report

NASA Technical Reports Server (NTRS)

Harley, K. G.; Keenan, M. J.

1975-01-01

A two-stage research fan was tested to provide technology for designing a turbofan engine for an advanced, long range commercial transport having a cruise Mach number of 0.85 -0.9 and a noise level 20 EPNdB below current requirements. The fan design tip speed was 365.8m/sec (1200ft/sec);the hub/tip ratio was 0.4; the design pressure ratio was 1.9; and the design specific flow was 209.2 kg/sec/sq m(42.85lbm/sec/sq ft). Two fan-versions were tested: a baseline configuration, and an acoustically treated configuration with a sonic inlet device. The baseline version was tested with uniform inlet flow and with tip-radial and hub-radial inlet flow distortions. The baseline fan with uniform inlet flow attained an efficiency of 86.4% at design speed, but the stall margin was low. Tip-radial distortion increased stall margin 4 percentage points at design speed and reduced peak efficiency one percentage point. Hub-radial distortion decreased stall margin 4 percentage points at all speeds and reduced peak efficiency at design speed 8 percentage points. At design speed, the sonic inlet in the cruise position reduced stall margin one percentage point and efficiency 1.5 to 4.5 percentage points. The sonic inlet in the approach position reduced stall margin 2 percentage points.

Quality of Care for White and Hispanic Medicare Advantage Enrollees in the United States and Puerto Rico.

PubMed

Rivera-Hernandez, Maricruz; Leyva, Bryan; Keohane, Laura M; Trivedi, Amal N

2016-06-01

Geographic, racial, and ethnic variations in quality of care and outcomes have been well documented among the Medicare population. Few data exist on beneficiaries living in Puerto Rico, three-quarters of whom enroll in Medicare Advantage (MA). To determine the quality of care provided to white and Hispanic MA enrollees in the United States and Puerto Rico. A cross-sectional study of MA enrollees in 2011 was conducted, including white enrollees in the United States (n = 6 289 374), Hispanic enrollees in the United States (n = 795 039), and Hispanic enrollees in Puerto Rico (n = 267 016). The study was conducted from January 1, 2011, to December 31, 2011; data analysis took place from January 19, 2015, to January 2, 2016. Seventeen performance measures related to diabetes mellitus (including hemoglobin A1c control, retinal eye examination, low-density lipoprotein cholesterol control, nephropathy screening, and blood pressure control), cardiovascular disease (including low-density lipoprotein cholesterol control, blood pressure control, and use of a β-blocker after myocardial infarction), cancer screening (colorectal and breast), and appropriate medications (including systemic corticosteroids and bronchodilators for chronic obstructive pulmonary disease [COPD] and disease-modifying antirheumatic drugs). Of the 7.35 million MA enrollees in the United States and Puerto Rico in our study, 1.06 million (14.4%) were Hispanic. Approximately 25.1% of all Hispanic MA enrollees resided in Puerto Rico, which was more than those residing in any state. For 15 of the 17 measures assessed, Hispanic MA enrollees in Puerto Rico received worse care compared with Hispanics in the United States, with absolute differences in performance rates ranging from 2.2 percentage points for blood pressure control in diabetes mellitus (P = .03) to 31.3 percentage points for use of disease-modifying antirheumatic drug therapy (P < .01). Adjusted performance differences between Hispanic MA enrollees in Puerto Rico and Hispanic MA enrollees in the United States exceeded 20 percentage points for 3 measures: use of disease-modifying antirheumatic drug therapy (-23.8 percentage points [95% CI, -30.9 to -16.8]), use of systemic corticosteroid in COPD exacerbation (-21.3 percentage points [95% CI, -27.5 to -15.1]), and use of bronchodilator therapy in COPD exacerbation (-22.7 percentage points [95% CI, -27.7 to -17.6]). We found modest differences in care between white and Hispanic MA enrollees in the United States but substantially worse care for enrollees in Puerto Rico compared with their US counterparts. Major efforts are needed to improve care delivery on the island to a level equivalent to the United States.

Quality of Care for White and Hispanic Medicare Advantage Enrollees in the United States and Puerto Rico

PubMed Central

Rivera-Hernandez, Maricruz; Leyva, Bryan; Keohane, Laura M.; Trivedi, Amal N.

2016-01-01

IMPORTANCE Geographic, racial, and ethnic variations in quality of care and outcomes have been well documented among the Medicare population. Few data exist on beneficiaries living in Puerto Rico, three-quarters of whom enroll in Medicare Advantage (MA). OBJECTIVE To determine the quality of care provided to white and Hispanic MA enrollees in the United States and Puerto Rico. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study of MA enrollees in 2011 was conducted, including white enrollees in the United States (n = 6 289 374), Hispanic enrollees in the United States (n = 795 039), and Hispanic enrollees in Puerto Rico (n = 267 016). The study was conducted from January 1, 2011, to December 31, 2011; data analysis took place from January 19, 2015, to January 2, 2016. MAIN OUTCOMES AND MEASURES Seventeen performance measures related to diabetes mellitus (including hemoglobin A1c control, retinal eye examination, low-density lipoprotein cholesterol control, nephropathy screening, and blood pressure control), cardiovascular disease (including low-density lipoprotein cholesterol control, blood pressure control, and use of a β-blocker after myocardial infarction), cancer screening (colorectal and breast), and appropriate medications (including systemic corticosteroids and bronchodilators for chronic obstructive pulmonary disease [COPD] and disease-modifying antirheumatic drugs). RESULTS Of the 7.35 million MA enrollees in the United States and Puerto Rico in our study, 1.06 million (14.4%) were Hispanic. Approximately 25.1% of all Hispanic MA enrollees resided in Puerto Rico, which was more than those residing in any state. For 15 of the 17 measures assessed, Hispanic MA enrollees in Puerto Rico received worse care compared with Hispanics in the United States, with absolute differences in performance rates ranging from 2.2 percentage points for blood pressure control in diabetes mellitus (P = .03) to 31.3 percentage points for use of disease-modifying antirheumatic drug therapy (P < .01). Adjusted performance differences between Hispanic MA enrollees in Puerto Rico and Hispanic MA enrollees in the United States exceeded 20 percentage points for 3 measures: use of disease-modifying antirheumatic drug therapy (−23.8 percentage points [95% CI, −30.9 to −16.8]), use of systemic corticosteroid in COPD exacerbation (−21.3 percentage points [95% CI, −27.5 to −15.1]), and use of bronchodilator therapy in COPD exacerbation (−22.7 percentage points [95% CI, −27.7 to −17.6]). CONCLUSIONS AND RELEVANCE We found modest differences in care between white and Hispanic MA enrollees in the United States but substantially worse care for enrollees in Puerto Rico compared with their US counterparts. Major efforts are needed to improve care delivery on the island to a level equivalent to the United States. PMID:27111865

Effects of Guideline and Formulary Changes on Statin Prescribing in the Veterans Affairs.

PubMed

Markovitz, Adam A; Holleman, Rob G; Hofer, Timothy P; Kerr, Eve A; Klamerus, Mandi L; Sussman, Jeremy B

2017-12-01

To compare the effects of two sequential policy changes-the addition of a high-potency statin to the Department of Veterans Affairs (VA) formulary and the release of the American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines-on VA provider prescribing. Retrospective analysis of 1,100,682 VA patients, 2011-2016. Interrupted time-series analysis of changes in prescribing of moderate-to-high-intensity statins among high-risk patients and across high-risk subgroups. We also assessed changes in prescribing of atorvastatin and other statin drugs. We estimated marginal effects (ME) of formulary and guideline changes by comparing predicted and observed statin use. Data from VA Corporate Data Warehouse. The use of moderate-to-high-intensity statins increased by 2 percentage points following the formulary change (ME, 2.4, 95% confidence interval [CI], 2.2 to 2.6) and less than 1 percentage point following the guideline change (ME, 0.8, 95% CI, 0.6 to 0.9). The formulary change led to approximately a 12 percentage-point increase in the use of moderate-to-high-intensity atorvastatin (ME, 11.5, 95% CI, 11.3 to 11.6). The relatively greater provider response to the formulary change occurred across all patient subgroups. Addition of a high-potency statin to formulary affected provider prescribing more than the ACC/AHA guidelines. © Health Research and Educational Trust.

Comparative cost-effectiveness of metformin-based dual therapies associated with risk of cardiovascular diseases among Chinese patients with type 2 diabetes: Evidence from a population-based national cohort in Taiwan.

PubMed

Ou, Huang-Tz; Chen, Yen-Ting; Liu, Ya-Ming; Wu, Jin-Shang

2016-06-01

To assess the cost-effectiveness of metformin-based dual therapies associated with cardiovascular disease (CVD) risk in a Chinese population with type 2 diabetes. We utilized Taiwan's National Health Insurance Research Database (NHIRD) 1997-2011, which is derived from the claims of National Health Insurance, a mandatory-enrollment single-payer system that covers over 99% of Taiwan's population. Four metformin-based dual therapy cohorts were used, namely a reference group of metformin plus sulfonylureas (Metformin-SU) and metformin plus acarbose, metformin plus thiazolidinediones (Metformin-TZD), and metformin plus glinides (Metformin-glinides). Using propensity scores, each subject in a comparison cohort was 1:1 matched to a referent. The effectiveness outcome was CVD risk. Only direct medical costs were included. The Markov chain model was applied to project lifetime outcomes, discounted at 3% per annum. The bootstrapping technique was performed to assess uncertainty in analysis. Metformin-glinides was most cost-effective in the base-case analysis; Metformin-glinides saved $194 USD for one percentage point of reduction in CVD risk, as compared to Metformin-SU. However, for the elderly or those with severe diabetic complications, Metformin-TZD, especially pioglitazone, was more suitable; as compared to Metformin-SU, Metformin-TZD saved $840.1 USD per percentage point of reduction in CVD risk. Among TZDs, Metformin-pioglitazone saved $1831.5 USD per percentage point of associated CVD risk reduction, as compared to Metformin-rosiglitazone. When CVD is considered an important clinical outcome, Metformin-pioglitazone is cost-effective, in particular for the elderly and those with severe diabetic complications. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Vaccinating Girls and Boys with Different Human Papillomavirus Vaccines: Can It Optimise Population-Level Effectiveness?

PubMed Central

Drolet, Mélanie; Boily, Marie-Claude; Van de Velde, Nicolas; Franco, Eduardo L.; Brisson, Marc

2013-01-01

Background Decision-makers may consider vaccinating girls and boys with different HPV vaccines to benefit from their respective strengths; the quadrivalent (HPV4) prevents anogenital warts (AGW) whilst the bivalent (HPV2) may confer greater cross-protection. We compared, to a girls-only vaccination program with HPV4, the impact of vaccinating: 1) both genders with HPV4, and 2) boys with HPV4 and girls with HPV2. Methods We used an individual-based transmission-dynamic model of heterosexual HPV infection and diseases. Our base-case scenario assumed lifelong efficacy of 100% against vaccine types, and 46,29,8,18,6% and 77,43,79,8,0% efficacy against HPV-31,-33,-45,-52,-58 for HPV4 and HPV2, respectively. Results Assuming 70% vaccination coverage and lifelong cross-protection, vaccinating boys has little additional benefit on AGW prevention, irrespective of the vaccine used for girls. Furthermore, using HPV4 for boys and HPV2 for girls produces greater incremental reductions in SCC incidence than using HPV4 for both genders (12 vs 7 percentage points). At 50% vaccination coverage, vaccinating boys produces incremental reductions in AGW of 17 percentage points if both genders are vaccinated with HPV4, but increases female incidence by 16 percentage points if girls are switched to HPV2 (heterosexual male incidence is incrementally reduced by 24 percentage points in both scenarios). Higher incremental reductions in SCC incidence are predicted when vaccinating boys with HPV4 and girls with HPV2 versus vaccinating both genders with HPV4 (16 vs 12 percentage points). Results are sensitive to vaccination coverage and the relative duration of protection of the vaccines. Conclusion Vaccinating girls with HPV2 and boys with HPV4 can optimize SCC prevention if HPV2 has higher/longer cross-protection, but can increase AGW incidence if vaccination coverage is low among boys. PMID:23840589

Vaccinating Girls and Boys with Different Human Papillomavirus Vaccines: Can It Optimise Population-Level Effectiveness?

PubMed

Drolet, Mélanie; Boily, Marie-Claude; Van de Velde, Nicolas; Franco, Eduardo L; Brisson, Marc

2013-01-01

Decision-makers may consider vaccinating girls and boys with different HPV vaccines to benefit from their respective strengths; the quadrivalent (HPV4) prevents anogenital warts (AGW) whilst the bivalent (HPV2) may confer greater cross-protection. We compared, to a girls-only vaccination program with HPV4, the impact of vaccinating: 1) both genders with HPV4, and 2) boys with HPV4 and girls with HPV2. We used an individual-based transmission-dynamic model of heterosexual HPV infection and diseases. Our base-case scenario assumed lifelong efficacy of 100% against vaccine types, and 46,29,8,18,6% and 77,43,79,8,0% efficacy against HPV-31,-33,-45,-52,-58 for HPV4 and HPV2, respectively. Assuming 70% vaccination coverage and lifelong cross-protection, vaccinating boys has little additional benefit on AGW prevention, irrespective of the vaccine used for girls. Furthermore, using HPV4 for boys and HPV2 for girls produces greater incremental reductions in SCC incidence than using HPV4 for both genders (12 vs 7 percentage points). At 50% vaccination coverage, vaccinating boys produces incremental reductions in AGW of 17 percentage points if both genders are vaccinated with HPV4, but increases female incidence by 16 percentage points if girls are switched to HPV2 (heterosexual male incidence is incrementally reduced by 24 percentage points in both scenarios). Higher incremental reductions in SCC incidence are predicted when vaccinating boys with HPV4 and girls with HPV2 versus vaccinating both genders with HPV4 (16 vs 12 percentage points). Results are sensitive to vaccination coverage and the relative duration of protection of the vaccines. Vaccinating girls with HPV2 and boys with HPV4 can optimize SCC prevention if HPV2 has higher/longer cross-protection, but can increase AGW incidence if vaccination coverage is low among boys.

Does Winning a Pay-for-Performance Bonus Improve Subsequent Quality Performance? Evidence from the Hospital Quality Incentive Demonstration

PubMed Central

Ryan, Andrew; Sutton, Matthew; Doran, Tim

2014-01-01

Objective To test whether receiving a financial bonus for quality in the Premier Hospital Quality Incentive Demonstration (HQID) stimulated subsequent quality improvement. Data Hospital-level data on process-of-care quality from Hospital Compare for the treatment of acute myocardial infarction (AMI), heart failure, and pneumonia for 260 hospitals participating in the HQID from 2004 to 2006; receipt of quality bonuses in the first 3 years of HQID from the Premier Inc. website; and hospital characteristics from the 2005 American Hospital Association Annual Survey. Study Design Under the HQID, hospitals received a 1 percent bonus on Medicare payments for scoring between the 80th and 90th percentiles on a composite quality measure, and a 2 percent bonus for scoring at the 90th percentile or above. We used a regression discontinuity design to evaluate whether hospitals with quality scores just above these payment thresholds improved more in the subsequent year than hospitals with quality scores just below the thresholds. In alternative specifications, we examined samples of hospitals scoring within 3, 5, and 10 percentage point “bandwidths” of the thresholds. We used a Generalized Linear Model to estimate whether the relationship between quality and lagged quality was discontinuous at the lagged thresholds required for quality bonuses. Principal Findings There were no statistically significant associations between receipt of a bonus and subsequent quality performance, with the exception of the 2 percent bonus for AMI in 2006 using the 5 percentage point bandwidth (0.8 percentage point increase, p < .01), and the 1 percent bonus for pneumonia in 2005 using all bandwidths (3.7 percentage point increase using the 3 percentage point bandwidth, p < .05). Conclusions We found little evidence that hospitals' receipt of quality bonuses was associated with subsequent improvement in performance. This raises questions about whether winning in pay-for-performance programs, such as Hospital Value-Based Purchasing, will lead to subsequent quality improvement. PMID:23909992

34 CFR 685.202 - Charges for which Direct Loan Program borrowers are responsible.

Code of Federal Regulations, 2010 CFR

2010-07-01

... held prior to that June 1 plus 3.1 percentage points, but does not exceed 8.25 percent. (ii) Loans... plus 2.5 percentage points, but does not exceed 8.25 percent. (B) During all other periods. The...-day Treasury bills auctioned at the final auction held prior to that June 1 plus 3.1 percentage points...

Antibiotic Prescribing for Nonbacterial Acute Upper Respiratory Infections in Elderly Persons.

PubMed

Silverman, Michael; Povitz, Marcus; Sontrop, Jessica M; Li, Lihua; Richard, Lucie; Cejic, Sonny; Shariff, Salimah Z

2017-06-06

Reducing inappropriate antibiotic prescribing for acute upper respiratory tract infections (AURIs) requires a better understanding of the factors associated with this practice. To determine the prevalence of antibiotic prescribing for nonbacterial AURIs and whether prescribing rates varied by physician characteristics. Retrospective analysis of linked administrative health care data. Primary care physician practices in Ontario, Canada (January-December 2012). Patients aged 66 years or older with nonbacterial AURIs. Patients with cancer or immunosuppressive conditions and residents of long-term care homes were excluded. Antibiotic prescriptions for physician-diagnosed AURIs. A multivariable logistic regression model with generalized estimating equations was used to examine whether prescribing rates varied by physician characteristics, accounting for clustering of patients among physicians and adjusting for patient-level covariates. The cohort included 8990 primary care physicians and 185 014 patients who presented with a nonbacterial AURI, including the common cold (53.4%), acute bronchitis (31.3%), acute sinusitis (13.6%), or acute laryngitis (1.6%). Forty-six percent of patients received an antibiotic prescription; most prescriptions were for broad-spectrum agents (69.9% [95% CI, 69.6% to 70.2%]). Patients were more likely to receive prescriptions from mid- and late-career physicians than early-career physicians (rate difference, 5.1 percentage points [CI, 3.9 to 6.4 percentage points] and 4.6 percentage points [CI, 3.3 to 5.8 percentage points], respectively), from physicians trained outside of Canada or the United States (3.6 percentage points [CI, 2.5 to 4.6 percentage points]), and from physicians who saw 25 to 44 patients per day or 45 or more patients per day than those who saw fewer than 25 patients per day (3.1 percentage points [CI, 2.1 to 4.0 percentage points] and 4.1 percentage points [CI, 2.7 to 5.5 percentage points], respectively). Physician rationale for prescribing was unknown. In this low-risk elderly cohort, 46% of patients with a nonbacterial AURI were prescribed antibiotics. Patients were more likely to receive prescriptions from mid- or late-career physicians with high patient volumes and from physicians who were trained outside of Canada or the United States. Ontario Ministry of Health and Long-term Care, Academic Medical Organization of Southwestern Ontario, Schulich School of Medicine and Dentistry, Western University, and Lawson Health Research Institute.

Characterization of different biological types of steers (cycle IV): wholesale, subprimal, and retail product yields.

PubMed

Wheeler, T L; Cundiff, L V; Koch, R M; Dikeman, M E; Crouse, J D

1997-09-01

Carcass cut-out yields of 888 steers obtained from mating Hereford and Angus cows to Hereford or Angus (HA), Charolais (Ch), Gelbvieh (Gb), Pinzgauer (Pz), Shorthorn (Sh), Galloway (Gw), Longhorn (Lh), Nellore (Ne), Piedmontese (Pm), and Salers (Sa) sires were compared. Data were evaluated at constant age (426 d), carcass weight (324 kg), fat thickness (1.2 cm), fat trim percentage (23%), and marbling (Small(00)) end points. Piedmontese-sired steers excelled in total retail product and fat trim percentages at all slaughter end points except at the 23% fat trim end point. At an age end point, percentage of retail product was greater in steers sired by Continental European breeds (Gb, Ch, Sa, Pz; 63.3 to 65.5% at 0 cm trim) than in steers sired by British breeds (Sh, HA; 60.1 to 61.0%). Piedmontese-sired steers, which were expected to carry one copy of a major gene for muscle hypertrophy, had the highest (P < .05) retail product yields at an age end point (69.7%). At an age end point, although carcass weights were significantly heavier (P < .05) for Charolais-sired steers than for Piedmontese-sired steers, lean growth rate, as reflected by totally trimmed retail product at 426 d, was similar (P > .05) for Piedmontese and Charolais-sired steers. Differences among sire breeds were small for retail product percentage at marbling, fat thickness, and fat trim end points. Ranking of sire breeds for age-constant weight of retail product was as follows: Ch, Pm, Gb, Sa, Ne, Pz, HA, Sh, Gw, and Lh. Sire breed differences in wholesale and subprimal cut yields were similar to total retail product differences. Piedmontese-sired steers produced the most muscular, leanest, and highest-yielding carcasses, and HA- and Sh-sired steers produced the fattest, lowest-yielding carcasses.

The Effects of Antipsychotic Quality Reporting on Antipsychotic and Psychoactive Medication Use.

PubMed

Bowblis, John R; Lucas, Judith A; Brunt, Christopher S

2015-08-01

The objective of this study is to examine how nursing homes changed their use of antipsychotic and other psychoactive medications in response to Nursing Home Compare's initiation of publicly reporting antipsychotic use in July 2012. The study includes all state recertification surveys (n = 40,415) for facilities six quarters prior and post the initiation of public reporting. Using a difference-in-difference framework, the change in use of antipsychotics and other psychoactive medications is compared for facilities subject to public reporting and facilities not subject to reporting. The percentage of residents using antipsychotics, hypnotics, or any psychoactive medication is found to decline after public reporting. Facilities subject to reporting experienced an additional decline in antipsychotic use (-1.94 vs. -1.40 percentage points) but did not decline as much for hypnotics (-0.60 vs. -1.21 percentage points). Any psychoactive use did not vary with reporting status, and the use of antidepressants and anxiolytics did not change. Public reporting of an antipsychotic quality measure can be an effective policy tool for reducing the use of antipsychotic medications--though the effect many only exist in the short run. © Health Research and Educational Trust.

The long-term effect of premier pay for performance on patient outcomes.

PubMed

Jha, Ashish K; Joynt, Karen E; Orav, E John; Epstein, Arnold M

2012-04-26

Pay for performance has become a central strategy in the drive to improve health care. We assessed the long-term effect of the Medicare Premier Hospital Quality Incentive Demonstration (HQID) on patient outcomes. We used Medicare data to compare outcomes between the 252 hospitals participating in the Premier HQID and 3363 control hospitals participating in public reporting alone. We examined 30-day mortality among more than 6 million patients who had acute myocardial infarction, congestive heart failure, or pneumonia or who underwent coronary-artery bypass grafting (CABG) between 2003 and 2009. At baseline, the composite 30-day mortality was similar for Premier and non-Premier hospitals (12.33% and 12.40%, respectively; difference, -0.07 percentage points; 95% confidence interval [CI], -0.40 to 0.26). The rates of decline in mortality per quarter at the two types of hospitals were also similar (0.04% and 0.04%, respectively; difference, -0.01 percentage points; 95% CI, -0.02 to 0.01), and mortality remained similar after 6 years under the pay-for-performance system (11.82% for Premier hospitals and 11.74% for non-Premier hospitals; difference, 0.08 percentage points; 95% CI, -0.30 to 0.46). We found that the effects of pay for performance on mortality did not differ significantly among conditions for which outcomes were explicitly linked to incentives (acute myocardial infarction and CABG) and among conditions not linked to incentives (congestive heart failure and pneumonia) (P=0.36 for interaction). Among hospitals that were poor performers at baseline, mortality was similar in the two groups of hospitals at the start of the study (15.12% and 14.73%; difference, 0.39 percentage points; 95% CI, -0.36 to 1.15), with similar rates of improvement per quarter (0.10% and 0.07%; difference, -0.03 percentage points; 95% CI, -0.08 to 0.02) and similar mortality rates at the end of the study (13.37% and 13.21%; difference, 0.15 percentage points; 95% CI, -0.70 to 1.01). We found no evidence that the largest hospital-based pay-for-performance program led to a decrease in 30-day mortality. Expectations of improved outcomes for programs modeled after Premier HQID should therefore remain modest.

Engaging with community-based public and private mid-level providers for promoting the use of modern contraceptive methods in rural Pakistan: results from two innovative birth spacing interventions.

PubMed

Azmat, Syed Khurram; Hameed, Waqas; Hamza, Hasan Bin; Mustafa, Ghulam; Ishaque, Muhammad; Abbas, Ghazunfer; Khan, Omar Farooq; Asghar, Jamshaid; Munroe, Erik; Ali, Safdar; Hussain, Wajahat; Ali, Sajid; Ahmed, Aftab; Ali, Moazzam; Temmerman, Marleen

2016-03-17

Family planning (FP) interventions aimed at reducing population growth have negligible during the last two decades in Pakistan. Innovative FP interventions that help reduce the growing population burden are the need of the hour. Marie Stopes Society--Pakistan implemented an operational research project--'Evidence for Innovating to Save Lives', to explore effective and viable intervention models that can promote healthy timing and spacing of pregnancy in rural and under-served communities of Sindh, Punjab and Khyber Pakhtunkhwa provinces of Pakistan. We conducted a quasi-experimental (pre- and post-intervention with control arm) study to assess the effectiveness of each of the two intervention models, (1) Suraj model (meaning 'Sun' in English), which uses social franchises (SF) along with a demand-side financing (DSF) approach using free vouchers, and (2) Community Midwife (CMW) model, in promoting the use of modern contraceptive methods compared to respective controls. Baseline and endline cross-sectional household surveys were conducted, 24 months apart, by recruiting 5566 and 6316 married women of reproductive age (MWRA) respectively. We used Stata version 8 to report the net effect of interventions on outcome indicators using difference-in-differences analysis. Multivariate Cox proportional hazard regression analysis was used to assess the net effect of the intervention on current contraceptive use, keeping time constant and adjusting for other variables in the model. The Suraj model was effective in significantly increasing awareness about FP methods among MWRA by 14% percentage points, current contraceptive use by 5% percentage points and long term modern method--intrauterine device (IUD) use by 6% percentage points. The CMW model significantly increased contraceptive awareness by 28% percentage points, ever use of contraceptives by 7% percentage points and, IUD use by 3% percentage points. Additionally the Suraj intervention led to a 35% greater prevalence (prevalence ratio: 1.35, 95% CI: 1.22-1.50) of contraceptive use among MWRA. Suraj intervention highlights the importance of embedding subsidized FP services within the communities of the beneficiaries. The outcomes of the CMW intervention also improved the use of long-term contraceptives. These findings indicate the necessity of designing and implementing FP initiatives involving local mid-level providers to expand contraceptive coverage in under-served areas.

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Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-20

..., shrinks to the greater of: (a) 4 percentage points, or, (b) one-quarter the applicable percentage... national best offer, as appropriate, shrinks to the greater of: (a) 4 percentage points, or, (b) one...

Prevalence and Characteristics of Chinese Patients With Duchenne and Becker Muscular Dystrophy: A Territory Wide Collaborative Study in Hong Kong.

PubMed

Chan, Sophelia H S; Lo, Ivan F M; Cherk, Sharon W W; Cheng, Wai Wai; Fung, Eva L W; Yeung, Wai Lan; Ngan, Mary; Lee, Wing Cheong; Kwong, Ling; Wong, Suet Na; Ma, Che Kwan; Tai, Shuk Mui; Ng, Grace S F; Wu, Shun Ping; Wong, Virginia C N

2015-01-01

The aim of this collaborative study on Duchenne muscular dystrophy and Becker muscular dystrophy is to determine the prevalence and to develop data on such patients as a prelude to the development of registry in Hong Kong. Information on clinical and molecular findings, and patient care, was systematically collected in 2011 and 2012 from all Pediatric Neurology Units in Hong Kong. Ninety patients with dystrophinopathy were identified, and 83% has Duchenne muscular dystrophy. The overall prevalence of dystrophinopathy in Hong Kong in 2010 is 1.03 per 10 000 males aged 0 to 24 years. Among the Duchenne group, we observed a higher percentage (40.6%) of point mutations with a lower percentage (45.3%) of exon deletions in our patients when compared with overseas studies. Although we observed similar percentage of Duchenne group received scoliosis surgery, ventilation support, and cardiac treatment when compared with other countries, the percentage (25%) of steroid use is lower.

Prevalence and Characteristics of Chinese Patients With Duchenne and Becker Muscular Dystrophy

PubMed Central

Lo, Ivan F. M.; Cherk, Sharon W. W.; Cheng, Wai Wai; Fung, Eva L. W.; Yeung, Wai Lan; Ngan, Mary; Lee, Wing Cheong; Kwong, Ling; Wong, Suet Na; Ma, Che Kwan; Tai, Shuk Mui; Ng, Grace S. F.; Wu, Shun Ping; Wong, Virginia C. N.

2015-01-01

The aim of this collaborative study on Duchenne muscular dystrophy and Becker muscular dystrophy is to determine the prevalence and to develop data on such patients as a prelude to the development of registry in Hong Kong. Information on clinical and molecular findings, and patient care, was systematically collected in 2011 and 2012 from all Pediatric Neurology Units in Hong Kong. Ninety patients with dystrophinopathy were identified, and 83% has Duchenne muscular dystrophy. The overall prevalence of dystrophinopathy in Hong Kong in 2010 is 1.03 per 10 000 males aged 0 to 24 years. Among the Duchenne group, we observed a higher percentage (40.6%) of point mutations with a lower percentage (45.3%) of exon deletions in our patients when compared with overseas studies. Although we observed similar percentage of Duchenne group received scoliosis surgery, ventilation support, and cardiac treatment when compared with other countries, the percentage (25%) of steroid use is lower. PMID:28503591

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Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-27

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Monte Carlo Simulations Comparing Fisher Exact Test and Unequal Variances t Test for Analysis of Differences Between Groups in Brief Hospital Lengths of Stay.

PubMed

Dexter, Franklin; Bayman, Emine O; Dexter, Elisabeth U

2017-12-01

We examined type I and II error rates for analysis of (1) mean hospital length of stay (LOS) versus (2) percentage of hospital LOS that are overnight. These 2 end points are suitable for when LOS is treated as a secondary economic end point. We repeatedly resampled LOS for 5052 discharges of thoracoscopic wedge resections and lung lobectomy at 26 hospitals. Unequal variances t test (Welch method) and Fisher exact test both were conservative (ie, type I error rate less than nominal level). The Wilcoxon rank sum test was included as a comparator; the type I error rates did not differ from the nominal level of 0.05 or 0.01. Fisher exact test was more powerful than the unequal variances t test at detecting differences among hospitals; estimated odds ratio for obtaining P < .05 with Fisher exact test versus unequal variances t test = 1.94, with 95% confidence interval, 1.31-3.01. Fisher exact test and Wilcoxon-Mann-Whitney had comparable statistical power in terms of differentiating LOS between hospitals. For studies with LOS to be used as a secondary end point of economic interest, there is currently considerable interest in the planned analysis being for the percentage of patients suitable for ambulatory surgery (ie, hospital LOS equals 0 or 1 midnight). Our results show that there need not be a loss of statistical power when groups are compared using this binary end point, as compared with either Welch method or Wilcoxon rank sum test.

Prostate Cancer Screening In Men Ages 75 And Older Fell By 8 Percentage Points After Task Force Recommendation

PubMed Central

Howard, David H.; Tangka, Florence K.; Guy, Gery P.; Ekwueme, Donatus U.; Lipscomb, Joseph

2016-01-01

In 2008 the US Preventive Services Task Force recommended against screening men ages 75 and older for prostate cancer. Using Medicare Current Beneficiary Survey Access to Care files and linked claims, we compared trends in prostate-specific antigen (PSA) testing rates between men ages 75 and older and men ages 65–74. We estimate that the revised recommendation led to a 7.9-percentage-point decline in annual PSA testing rates over two years among men ages 75 and older. Although 42 percent of men in this age group continue to receive PSA tests, our results highlight the potential of guidelines with negative recommendations to reduce the use of low-value medical care. PMID:23459740

DOE Office of Scientific and Technical Information (OSTI.GOV)

Diaz-Cruz, J. L.

We discuss several aspects of the flavor problem in the Supersymmetry. First, in order to quantify the SUSY flavor problem, we generate randomly the entries of the sfermion mass matrices and determine which percentage of the points are consistent with current bounds on the flavor violating transitions, for which we take as an illustration the lepton flavor violating (LFV) decays li {yields} lj{gamma}. In the first instance we apply the mass-insertion method, and study how this percentage changes as one varies the parameters of the model. It is found that for 105 points about 10% of points pass current LFVmore » bounds on {mu} {yields} e{gamma} provided the sleptons masses are {approx} 10 TeV. While bounds on {tau} {yields} {mu}{gamma}, e{gamma} are satisfied for almost 100% of points even for sleptons masses as low as 360 GeV. Then, we consider an ansatz for sfermion masses that can be diagonalized exactly, and compare the results obtained previously for {tau} {yields} {mu}{gamma}. Now, we get that 100% of points satisfy the experimental bounds but with sleptons masses larger than 460 GeV.« less

A Comparison of Self-reported Medication Adherence to Concordance Between Part D Claims and Medication Possession.

PubMed

Savitz, Samuel T; Stearns, Sally C; Zhou, Lei; Thudium, Emily; Alburikan, Khalid A; Tran, Richard; Rodgers, Jo E

2017-05-01

Medicare Part D claims indicate medication purchased, but people who are not fully adherent may extend prescription use beyond the interval prescribed. This study assessed concordance between Part D claims and medication possession at a study visit in relation to self-reported medication adherence. We matched Part D claims for 6 common medications to medications brought to a study visit in 2011-2013 for the Atherosclerosis Risk in Communities study. The combined data consisted of 3027 medication events (claims, medications possessed, or both) for 2099 Atherosclerosis Risk in Communities study participants. Multinomial logistic regression estimated the association of concordance (visit only, Part D only, or both) with self-reported medication adherence while controlling for sociodemographic characteristics, veteran status, and availability under Generic Drug Discount Programs. Relative to participants with high adherence, medication events for participants with low adherence were approximately 25 percentage points less likely to match and more likely to be visit only (P<0.001). The results were similar but smaller in magnitude (approximately 2-3 percentage points) for participants with medium adherence. Compared with females, medication events for male veterans were approximately 11 percentage points less likely to match and more likely to be visit only. Events for medications available through Generic Drug Discount Programs were 3 percentage points more likely to be visit only. Part D claims were substantially less likely to be concordant with medications possessed at study visit for participants with low self-reported adherence. This result supports the construction of adherence proxies such as proportion days covered using Part D claims.

Is there a successful business case for telepharmacy?

PubMed

Khan, Shamima; Snyder, Herbert W; Rathke, Ann M; Scott, David M; Peterson, Charles D

2008-04-01

The purpose of this study was to assess the financial operation of a Single Business Unit (SBU), consisting of one central retail pharmacy and two remote retail telepharmacies. Analyses of income statements and balance sheets for three consecutive years (2002-2004) were conducted. Several items from these statements were compared to the industry average. Gross profit increased from $260,093 in 2002 to $502,262 in 2004. The net operating income percent was 2.9 percentage points below the industry average in 2002, 3.9 percentage points below in 2003, and 1.3 percentage points above in 2004. The inventory turnover ratio remained consistently below the industry average, but it also increased over the period. This is an area of concern, given the high cost of pharmaceuticals and a higher likelihood of obsolescence that exists with a time-sensitive inventory. Despite these concerns, the overall trend for the SBU is positive. The rate of growth between 2002 and 2004 shows that it is getting close to median sales as reported in the NCPA Digest. The results of this study indicate that multiple locations become profitable when a sufficient volume of patients (sales) is reached, combined with efficient use of the pharmacist's time.

The impact of diabetes on employment and work productivity.

PubMed

Tunceli, Kaan; Bradley, Cathy J; Nerenz, David; Williams, L Keoki; Pladevall, Manel; Elston Lafata, Jennifer

2005-11-01

The purpose of this study was to longitudinally examine the effect of diabetes on labor market outcomes. Using secondary data from the first two waves (1992 and 1994) of the Health and Retirement Study, we identified 7,055 employed respondents (51-61 years of age), 490 of whom reported having diabetes in wave 1. We estimated the effect of diabetes in wave 1 on the probability of working in wave 2 using probit regression. For those working in wave 2, we modeled the relationships between diabetic status in wave 1 and the change in hours worked and work-loss days using ordinary least-squares regressions and modeled the presence of health-related work limitations using probit regression. All models control for health status and job characteristics and are estimated separately by sex. Among individuals with diabetes, the absolute probability of working was 4.4 percentage points less for women and 7.1 percentage points less for men relative to that of their counterparts without diabetes. Change in weekly hours worked was not statistically significantly associated with diabetes. Women with diabetes had 2 more work-loss days per year compared with women without diabetes. Compared with individuals without diabetes, men and women with diabetes were 5.4 and 6 percentage points (absolute increase), respectively, more likely to have work limitations. This article provides evidence that diabetes affects patients, employers, and society not only by reducing employment but also by contributing to work loss and health-related work limitations for those who remain employed.

Characteristics of individuals with integrated pensions.

PubMed

Bender, K A

1999-01-01

Employer pensions that integrate benefits with Social Security have been the focus of relatively little research. Since changes in Social Security benefit levels and other program characteristics can affect the benefit levels and other features of integrated pension plans, it is important to know who is covered by these plans. This article examines the characteristics of workers covered by integrated pension plans, compared to those with nonintegrated plans and those with no pension coverage. Integrated pension plans are those that explicitly adjust their benefit structure to help compensate for the employer's contributions to the Social Security program. There are two basic integration methods used by defined benefit (DB) plans. The offset method causes a reduction in employer pension benefits by up to half of the Social Security retirement benefit; the excess rate method is characterized by an accrual rate that is lower for earnings below the Social Security taxable maximum than above it. Defined contribution (DC) pension plans can be integrated along the lines of the excess rate method. To date, research on integrated pensions has focused on plan characteristics, as reported to the Bureau of Labor Statistics (BLS) through its Employee Benefits Survey (EBS). This research has examined the prevalence of integration among full-time, private sector workers by industry, firm size, and broad occupational categories. However, because the EBS provides virtually no data on worker characteristics, analyses of the effects of pension integration on retirement benefits have used hypothetical workers, varying according to assumed levels of earnings and job tenure. This kind of analysis is not particularly helpful in examining the potential effects of changes in the Social Security program on workers' pension benefits. However, data on pension integration at the individual level are available, most recently from the Health and Retirement Study (HRS), a nationally representative survey of individuals aged 51-61 in 1992. This dataset provides the basis for the analysis presented here. The following are some of the major findings from this analysis. The incidence of pension integration in the HRS sample is 32 percent of all workers with a pension (14 percent of all workers). The HRS can also identify integrated DC plans, a statistic that is not available from BLS data. The rate of integration for workers with only DC plans is 8 percent. After controlling for other variables, several socio-demographic characteristics are significantly related to the incidence of integration. The probability of having an integrated pension is 4.6 percentage points less for men compared to women. Non-Hispanic blacks are 6.4 percentage points less likely than non-Hispanic whites to have integrated pensions. Union members are 14 percentage points less likely to have integrated pensions, while workers with less than a graduate level education are at least 15 percentage points more likely to have a pension that is integrated. Some earnings and pension characteristics are also significantly correlated with pension integration. Earnings are positively related, with the probability of having an integrated pension increasing by 2 percentage points for an increase of $1,000 in annual pay. An even larger effect comes from earning at or above the Social Security taxable maximum. Workers at or above this income level are 10 percentage points more likely to have an integrated plan, but for those with more than one plan the probability of pension integration goes up by 13 percentage points.

Contributions of Two-Year Institutions to Four-Year Completions. Snapshot™ Report, Spring 2015

ERIC Educational Resources Information Center

National Student Clearinghouse, 2015

2015-01-01

In the 2013-14 academic year, 46 percent of students who completed a degree at a four-year institution were enrolled at a two-year institution at some point in the previous 10 years. This is a one percentage point increase over the comparable figure for degrees awarded in 2010-11. The prior two-year enrollment may have been brief (as little as a…

STAR 3 randomized controlled trial to compare sensor-augmented insulin pump therapy with multiple daily injections in the treatment of type 1 diabetes: research design, methods, and baseline characteristics of enrolled subjects.

PubMed

Davis, Stephen N; Horton, Edward S; Battelino, Tadej; Rubin, Richard R; Schulman, Kevin A; Tamborlane, William V

2010-04-01

Sensor-augmented pump therapy (SAPT) integrates real-time continuous glucose monitoring (RT-CGM) with continuous subcutaneous insulin infusion (CSII) and offers an alternative to multiple daily injections (MDI). Previous studies provide evidence that SAPT may improve clinical outcomes among people with type 1 diabetes. Sensor-Augmented Pump Therapy for A1c Reduction (STAR) 3 is a multicenter randomized controlled trial comparing the efficacy of SAPT to that of MDI in subjects with type 1 diabetes. Subjects were randomized to either continue with MDI or transition to SAPT for 1 year. Subjects in the MDI cohort were allowed to transition to SAPT for 6 months after completion of the study. SAPT subjects who completed the study were also allowed to continue for 6 months. The primary end point was the difference between treatment groups in change in hemoglobin A1c (HbA1c) percentage from baseline to 1 year of treatment. Secondary end points included percentage of subjects with HbA1c < or =7% and without severe hypoglycemia, as well as area under the curve of time spent in normal glycemic ranges. Tertiary end points include percentage of subjects with HbA1c < or =7%, key safety end points, user satisfaction, and responses on standardized assessments. A total of 495 subjects were enrolled, and the baseline characteristics similar between the SAPT and MDI groups. Study completion is anticipated in June 2010. Results of this randomized controlled trial should help establish whether an integrated RT-CGM and CSII system benefits patients with type 1 diabetes more than MDI.

Association Between the 2014 Medicaid Expansion and US Hospital Finances.

PubMed

Blavin, Fredric

2016-10-11

The Affordable Care Act expanded Medicaid eligibility for millions of low-income adults. The choice for states to expand Medicaid could affect the financial health of hospitals by decreasing the proportion of patient volume and unreimbursed expenses attributable to uninsured patients while increasing revenue from newly covered patients. To estimate the association between the Medicaid expansion in 2014 and hospital finances by assessing differences between hospitals in states that expanded Medicaid and in those states that did not expand Medicaid. Observational study with analysis of data for nonfederal general medical or surgical hospitals in fiscal years 2011 through 2014, using data from the American Hospital Association Annual Survey and the Health Care Cost Report Information System from the US Centers for Medicare & Medicaid Services. Multivariable difference-in-difference regression analyses were used to compare states with Medicaid expansion with states without Medicaid expansion. Hospitals in states that expanded Medicaid eligibility before January 2014 were excluded. Medicaid expansion in 2014, accounting for variation in fiscal year start dates. Hospital-reported information on uncompensated care, uncompensated care as a percentage of total hospital expenses, Medicaid revenue, Medicaid as a percentage of total revenue, operating margins, and excess margins. The sample included between 1200 and 1400 hospitals per fiscal year in 19 states with Medicaid expansion and between 2200 and 2400 hospitals per fiscal year in 25 states without Medicaid expansion (with sample size varying depending on the outcome measured). Expansion of Medicaid was associated with a decline of $2.8 million (95% CI, -$4.1 to -$1.6 million; P < .001) in mean annual uncompensated care costs per hospital. Hospitals in states with Medicaid expansion experienced a $3.2 million increase (95% CI, $0.9 to $5.6 million; P = .008) in mean annual Medicaid revenue per hospital, relative to hospitals in states without Medicaid expansion. Medicaid expansion was also significantly associated with improved excess margins (1.1 percentage points [95% CI, 0.1 to 2.0 percentage points]; P = .04), but not improved operating margins (1.1 percentage points [95% CI, -0.1 to 2.3 percentage points]; P = .06). The hospitals located in the 19 states that implemented the Medicaid expansion had significantly increased Medicaid revenue, decreased uncompensated care costs, and improvements in profit margins compared with hospitals located in the 25 states that did not expand Medicaid. Further study is needed to assess longer-term implications of this policy change on hospitals' overall finances.

Outcomes after out-of-hospital cardiac arrest treated by basic vs advanced life support.

PubMed

Sanghavi, Prachi; Jena, Anupam B; Newhouse, Joseph P; Zaslavsky, Alan M

2015-02-01

Most out-of-hospital cardiac arrests receiving emergency medical services in the United States are treated by ambulance service providers trained in advanced life support (ALS), but supporting evidence for the use of ALS over basic life support (BLS) is limited. To compare the effects of BLS and ALS on outcomes after out-of-hospital cardiac arrest. Observational cohort study of a nationally representative sample of traditional Medicare beneficiaries from nonrural counties who experienced out-of-hospital cardiac arrest between January 1, 2009, and October 2, 2011, and for whom ALS or BLS ambulance services were billed to Medicare (31,292 ALS cases and 1643 BLS cases). Propensity score methods were used to compare the effects of ALS and BLS on patient survival, neurological performance, and medical spending after cardiac arrest. Survival to hospital discharge, to 30 days, and to 90 days; neurological performance; and incremental medical spending per additional survivor to 1 year. Survival to hospital discharge was greater among patients receiving BLS (13.1% vs 9.2% for ALS; 4.0 [95% CI, 2.3-5.7] percentage point difference), as was survival to 90 days (8.0% vs 5.4% for ALS; 2.6 [95% CI, 1.2-4.0] percentage point difference). Basic life support was associated with better neurological functioning among hospitalized patients (21.8% vs 44.8% with poor neurological functioning for ALS; 23.0 [95% CI, 18.6-27.4] percentage point difference). Incremental medical spending per additional survivor to 1 year for BLS relative to ALS was $154,333. Patients with out-of-hospital cardiac arrest who received BLS had higher survival at hospital discharge and at 90 days compared with those who received ALS and were less likely to experience poor neurological functioning.

Association of the Affordable Care Act Dependent Coverage Provision With Prenatal Care Use and Birth Outcomes.

PubMed

Daw, Jamie R; Sommers, Benjamin D

2018-02-13

The effect of the Affordable Care Act (ACA) dependent coverage provision on pregnancy-related health care and health outcomes is unknown. To determine whether the dependent coverage provision was associated with changes in payment for birth, prenatal care, and birth outcomes. Retrospective cohort study, using a differences-in-differences analysis of individual-level birth certificate data comparing live births among US women aged 24 to 25 years (exposure group) and women aged 27 to 28 years (control group) before (2009) and after (2011-2013) enactment of the dependent coverage provision. Results were stratified by marital status. The dependent coverage provision of the ACA, which allowed young adults to stay on their parent's health insurance until age 26 years. Primary outcomes were payment source for birth, early prenatal care (first visit in first trimester), and adequate prenatal care (a first trimester visit and 80% of expected visits). Secondary outcomes were cesarean delivery, premature birth, low birth weight, and infant neonatal intensive care unit (NICU) admission. The study population included 1 379 005 births among women aged 24-25 years (exposure group; 299 024 in 2009; 1 079 981 in 2011-2013), and 1 551 192 births among women aged 27-28 years (control group; 325 564 in 2009; 1 225 628 in 2011-2013). From 2011-2013, compared with 2009, private insurance payment for births increased in the exposure group (36.9% to 35.9% [difference, -1.0%]) compared with the control group (52.4% to 51.1% [difference, -1.3%]), adjusted difference-in-differences, 1.9 percentage points (95% CI, 1.6 to 2.1). Medicaid payment decreased in the exposure group (51.6% to 53.6% [difference, 2.0%]) compared with the control group (37.4% to 39.4% [difference, 1.9%]), adjusted difference-in-differences, -1.4 percentage points (95% CI, -1.7 to -1.2). Self-payment for births decreased in the exposure group (5.2% to 4.3% [difference, -0.9%]) compared with the control group (4.9% to 4.3% [difference, -0.5%]), adjusted difference-in-differences, -0.3 percentage points (95% CI, -0.4 to -0.1). Early prenatal care increased from 70% to 71.6% (difference, 1.6%) in the exposure group and from 75.7% to 76.8% (difference, 0.6%) in the control group (adjusted difference-in-differences, 0.6 percentage points [95% CI, 0.3 to 0.8]). Adequate prenatal care increased from 73.5% to 74.8% (difference, 1.3%) in the exposure group and from 77.5% to 78.8% (difference, 1.3%) in the control group (adjusted difference-in-differences, 0.4 percentage points [95% CI, 0.2 to 0.6]). Preterm birth decreased from 9.4% to 9.1% in the exposure group (difference, -0.3%) and from 9.1% to 8.9% in the control group (difference, -0.2%) (adjusted difference-in-differences, -0.2 percentage points (95% CI, -0.3 to -0.03). Overall, there were no significant changes in low birth weight, NICU admission, or cesarean delivery. In stratified analyses, changes in payment for birth, prenatal care, and preterm birth were concentrated among unmarried women. In this study of nearly 3 million births among women aged 24 to 25 years vs those aged 27 to 28 years, the Affordable Care Act dependent coverage provision was associated with increased private insurance payment for birth, increased use of prenatal care, and modest reduction in preterm births, but was not associated with changes in cesarean delivery rates, low birth weight, or NICU admission.

Effects of the EQUIP quasi-experimental study testing a collaborative quality improvement approach for maternal and newborn health care in Tanzania and Uganda.

PubMed

Waiswa, P; Manzi, F; Mbaruku, G; Rowe, A K; Marx, M; Tomson, G; Marchant, T; Willey, B A; Schellenberg, J; Peterson, S; Hanson, C

2017-07-18

Quality improvement is a recommended strategy to improve implementation levels for evidence-based essential interventions, but experience of and evidence for its effects in low-resource settings are limited. We hypothesised that a systemic and collaborative quality improvement approach covering district, facility and community levels, supported by report cards generated through continuous household and health facility surveys, could improve the implementation levels and have a measurable population-level impact on coverage and quality of essential services. Collaborative quality improvement teams tested self-identified strategies (change ideas) to support the implementation of essential maternal and newborn interventions recommended by the World Health Organization. In Tanzania and Uganda, we used a plausibility design to compare the changes over time in one intervention district with those in a comparison district in each country. Evaluation included indicators of process, coverage and implementation practice analysed with a difference-of-differences and a time-series approach, using data from independent continuous household and health facility surveys from 2011 to 2014. Primary outcomes for both countries were birth in health facilities, breastfeeding within 1 h after birth, oxytocin administration after birth and knowledge of danger signs for mothers and babies. Interpretation of the results considered contextual factors. The intervention was associated with improvements on one of four primary outcomes. We observed a 26-percentage-point increase (95% CI 25-28%) in the proportion of live births where mothers received uterotonics within 1 min after birth in the intervention compared to the comparison district in Tanzania and an 8-percentage-point increase (95% CI 6-9%) in Uganda. The other primary indicators showed no evidence of improvement. In Tanzania, we saw positive changes for two other outcomes reflecting locally identified improvement topics. The intervention was associated with an increase in preparation of clean birth kits for home deliveries (31 percentage points, 95% CI 2-60%) and an increase in health facility supervision by district staff (14 percentage points, 95% CI 0-28%). The systemic quality improvement approach was associated with improvements of only one of four primary outcomes, as well as two Tanzania-specific secondary outcomes. Reasons for the lack of effects included limited implementation strength as well a relatively short follow-up period in combination with a 1-year recall period for population-based estimates and a limited power of the study to detect changes smaller than 10 percentage points. Pan African Clinical Trials Registry: PACTR201311000681314.

Presenting Cost and Efficiency Measures That Support Consumers to Make High-Value Health Care Choices.

PubMed

Greene, Jessica; Sacks, Rebecca M

2018-02-25

To identify approaches to presenting cost and resource use measures that support consumers in selecting high-value hospitals. Survey data were collected from U.S. employees of Analog Devices (n = 420). In two online experiments, participants viewed comparative data on four hospitals. In one experiment, participants were randomized to view one of five versions of the same comparative cost data, and in the other experiment they viewed different versions of the same readmissions data. Bivariate and multivariate analyses examined whether presentation approach was related to selecting the high-value hospital. Consumers were approximately 16 percentage points more likely to select a high-value hospital when cost data were presented using actual dollar amounts or using the word "affordable" to describe low-cost hospitals, compared to when the Hospital Compare spending ratio was used. Consumers were 33 points more likely to select the highest performing hospital when readmission performance was shown using word icons rather than percentages. Presenting cost and resource use measures effectively to consumers is challenging. This study suggests using actual dollar amounts for cost, but presenting performance on readmissions using evaluative symbols. © Health Research and Educational Trust.

Improving performance in thermodynamics: Integrating learning by teaching pedagogy

NASA Astrophysics Data System (ADS)

Campagni, Jamie Anthony

Historically, Thermo is perceived to be the most challenging course in the MET Curriculum at UNC Charlotte. The complexity and difficulties of this course have contributed to the some of the highest DFW rates compared to any other courses offered within the MET program. One hypothesis contributing to high DFW rates is the pedagogy in which Thermo is taught, which is the foundation of this study. Implementation of LBT in the spring 2014 offering of Thermo was deemed a success. The DFW rate in spring 2014 was reduced by 19 percentage points compared to the DFW rate in spring 2013, which exceeded the target of 10 percentage points. However, only cumulative GPA was a significant predictor of whether a student passed or failed the course. The semester in which students took Thermo was not a significant predictor. Students in the spring 2014 semester also exhibited statistically significant higher final exam averages compared to the 2012 and 2013 semesters. In general, students felt that LBT activities enhanced their learning and application of Thermodynamic concepts. Students had a very positive perception of LBT compared to traditional lecture in that 100% of students would recommend this teaching style to other students.

The effectiveness of intervention on the behavior of individuals with autism: a meta-analysis using percentage of data points exceeding the median of baseline phase (PEM).

PubMed

Ma, Hsen-Hsing

2009-05-01

The aim of the present study is to demonstrate the percentage of data points exceeding the median of baseline phase (PEM) approach using data on autism treatment for illustrative purposes to compare the effectiveness of different interventions on the problem behaviors of individuals with autism. Electronic databases such as The ProQuest and Google were searched. A total of 163 articles were located, producing 1,502 effect sizes. The results demonstrate that five highly effective intervention strategies were priming, self-control, training, positive reinforcement and punishment, and presenting preferential activities. The least effective strategy was to teach perspective-taking skills. The PEM approach is recommended for use in meta-analysis for single-case experimental designs.

Science and Engineering Degree Completion by Gender. Snapshot™ Report, Spring 2017

ERIC Educational Resources Information Center

National Student Clearinghouse, 2017

2017-01-01

From 2006 to 2016, degree completion in the so-called "hard sciences" increased in prevalence for both genders. Excluding social sciences and psychology, the percentage of bachelor's degrees accounted for by science and engineering disciplines increased five percentage points for men, and two percentage points for women. This brief…

Population increase, economic growth, educational inequality, and income distribution: some recent evidence.

PubMed

Ram, R

1984-04-01

The relationship between population increase, economic growth, education and income inequality was examined in a cross-section study based on data from 26 developing and 2 developed countries. As other studies have noted, high population growth is associated with a less equal income distribution. A 1 percentage point reduction in the rate of population growth tends to raise the income share of the poorest 80% in the less developed world by almost 5 percentage points and is associated with a 1.7 percentage point increase in the income share of the poorest 40%. The relationship between short-run income growth and equality, on the other hand, is strong and positive. Estimates suggest that a 1 percentage point increase in the short-run rate of growth of the gross domestic product (GDP) increases the income share of the bottom 80% by about 2 percentage points and that of the poorest 40% by almost 1 percentage point. Although higher mean schooling appears to be a mild equalizer, educational inequality does not appear to have an adverse effect on income distribution. Overall, these results challenge the widely held belief that there must be a growth-equity trade-off. Moreover, they suggest that the impact of educational inequality on income distribution may be different from that observed in earlier studies, implying a need for caution in using these earlier results as a basis for educational policy development.

Trends in contraceptive use among female adolescents in Ghana.

PubMed

Abdul-Rahman, Lutuf; Marrone, Gaetano; Johansson, Annika

2011-06-01

Within the past one and half decades many efforts have been made to improve the availability and access to adolescent sexual and reproductive health services. Despite these efforts, adolescents still face a number of sexual and reproductive health problems. This paper uses data from the 2003 and 2008 Ghana Demographic and Health Surveys to examine changes in contraceptive use among sexually active female adolescents (15-19 years old). The results show that between 2003 and 2008 there was a significant increase in the current use of any contraceptive method (from 23.7% to 35.1%, p = 0.03). It also indicates a shift from modern to traditional contraceptive methods. Traditional methods recorded about 60% (7.8 percentage points) increase as compared to 5.5% (2.6 percentage points) for modern methods. Also ever use of any traditional method recorded a higher increase as compared to any modem method. There was a slight decline 7% (4.4 parentage points) in the number of non-users who intended to use contraceptives in the future. On the whole the findings indicate increasing unmet need for modern contraception due to barriers such as limited access, cost and misconceptions about the effects of contraceptives.

Quantitative trait loci markers derived from whole genome sequence data increases the reliability of genomic prediction.

PubMed

Brøndum, R F; Su, G; Janss, L; Sahana, G; Guldbrandtsen, B; Boichard, D; Lund, M S

2015-06-01

This study investigated the effect on the reliability of genomic prediction when a small number of significant variants from single marker analysis based on whole genome sequence data were added to the regular 54k single nucleotide polymorphism (SNP) array data. The extra markers were selected with the aim of augmenting the custom low-density Illumina BovineLD SNP chip (San Diego, CA) used in the Nordic countries. The single-marker analysis was done breed-wise on all 16 index traits included in the breeding goals for Nordic Holstein, Danish Jersey, and Nordic Red cattle plus the total merit index itself. Depending on the trait's economic weight, 15, 10, or 5 quantitative trait loci (QTL) were selected per trait per breed and 3 to 5 markers were selected to tag each QTL. After removing duplicate markers (same marker selected for more than one trait or breed) and filtering for high pairwise linkage disequilibrium and assaying performance on the array, a total of 1,623 QTL markers were selected for inclusion on the custom chip. Genomic prediction analyses were performed for Nordic and French Holstein and Nordic Red animals using either a genomic BLUP or a Bayesian variable selection model. When using the genomic BLUP model including the QTL markers in the analysis, reliability was increased by up to 4 percentage points for production traits in Nordic Holstein animals, up to 3 percentage points for Nordic Reds, and up to 5 percentage points for French Holstein. Smaller gains of up to 1 percentage point was observed for mastitis, but only a 0.5 percentage point increase was seen for fertility. When using a Bayesian model accuracies were generally higher with only 54k data compared with the genomic BLUP approach, but increases in reliability were relatively smaller when QTL markers were included. Results from this study indicate that the reliability of genomic prediction can be increased by including markers significant in genome-wide association studies on whole genome sequence data alongside the 54k SNP set. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Cocoa Flavanol Supplementation Influences Skin Conditions of Photo-Aged Women: A 24-Week Double-Blind, Randomized, Controlled Trial.

PubMed

Yoon, Hyun-Sun; Kim, Jong Rhan; Park, Gyeong Yul; Kim, Jong-Eun; Lee, Dong Hun; Lee, Ki Won; Chung, Jin Ho

2016-01-01

The consumption of dietary antioxidants is considered to be a good strategy against photo-aging. However, the results of previous clinical trials that investigated the effects of oral consumption of high-flavanol cocoa products on skin photo-aging have been contradictory. The aim of this study was to investigate whether high-flavanol cocoa supplementation would improve the moderately photo-aged facial skin of female participants, by assessing skin wrinkles and elasticity. We performed a 24-wk, randomized, double-blind, placebo-controlled study to evaluate the effects of oral supplementation of cocoa flavanols on cutaneous photo-aging. All participants were moderately photo-aged Korean women with visible facial wrinkles (age range: 43-86 y). Participants were randomly assigned to receive a placebo beverage or cocoa beverage that contained 320 mg total cocoa flavanols/d. We measured wrinkles, skin elasticity, and hydration at baseline and at 12 and 24 wk. The primary endpoint was the mean percentage change in the average roughness value (Rz) at 24 wk. At 24 wk, the mean percentage change in Rz (primary endpoint) was significantly lower in the cocoa group than in the placebo group (-8.7 percentage points; 95% CI: -16.1, -1.3 percentage points; P = 0.023). The mean percentage changes in gross elasticity, as determined by a cutometer, also differed between the groups at 12 wk (9.1 percentage points; 95% CI: 1.5, 16.7 percentage points; P = 0.020) and 24 wk (8.6 percentage points; 95% CI: 1.0, 16.2 percentage points; P = 0.027). However, there were no significant differences in skin hydration and barrier integrity between the 2 groups. In moderately photo-aged women, regular cocoa flavanol consumption had positive effects on facial wrinkles and elasticity. Cocoa flavanol supplementation may contribute to the prevention of the progression of photo-aging. This trial was registered at clinicaltrials.gov as NCT02060097. © 2016 American Society for Nutrition.

E-waste collection in Italy: Results from an exploratory analysis.

PubMed

Favot, Marinella; Grassetti, Luca

2017-09-01

This study looks at the performance of household electrical and electronic waste (WEEE) collection in 20 Italian regions from 2008 to 2015. The impact of several explicative variables on the results of e-waste collection is evaluated. The independent variables are socio-economic and demographic ones (age, gender, household size, education level, migration and income) along with technical-organisational variables (population density, presence of metropoles, macro regions, characteristics of the territory, percentage of household waste collected separately and number of e-waste collection points). The results show that the presence of collection points, the percentage of household waste collected separately and the percentage of females are positively correlated with the kg collected per inhabitant per year. For example, a variation of 1% of input (presence of collection points) corresponds to a 0.25% variation in the output (collection results) while 1% difference in the percentage of females in the population corresponds to a 7.549% difference in the collection rate. Population density, instead, is negatively correlated. It is interesting to note that there is a discrepancy between the Southern regions and the Centre regions (the former have an outcome 0.66 times lower than the latter) while the Northern regions perform similarly to the Centre ones. Moreover, the first year (2008) had a very low performance compared to the following years when the scheme constantly improved, mainly due to the additional collection points available. The Stochastic Frontier Model allows for the identification of the optimal production function among the 20 Italian regions. The best performing region is Tuscany (in the Centre), followed by Sardinia and Sicily (in the South). Copyright © 2017. Published by Elsevier Ltd.

The effect of health and dental insurance on US children's dental care utilization for urgent and non-urgent dental problems - 2008.

PubMed

Naavaal, Shillpa; Barker, Laurie K; Griffin, Susan O

2017-12-01

We examined the association between utilization of care for a dental problem (utilization-DP) and parent-reported dental problem (DP) urgency among children with DP by type of health care insurance coverage. We used weighted 2008 National Health Interview Survey data from 2,834 children, aged 2-17 years with at least one DP within the 6 months preceding survey. Explanatory variables were selected based on Andersen's model of healthcare utilization. Need was considered urgent if DP included toothache, bleeding gums, broken or missing teeth, broken or missing filling, or decayed teeth and otherwise as non-urgent. The primary enabling variable, insurance, had four categories: none, private health no dental coverage (PHND), private health and dental (PHD), or Medicaid/State Children's Health Insurance Program (SCHIP). Predisposing variables included sociodemographic characteristics. We used bivariate and multivariate analyses to identify explanatory variables' association with utilization-DP. Using logistic regression, we obtained adjusted estimates of utilization-DP by urgency for each insurance category. In bivariate analyses, utilization-DP was associated with both insurance and urgency. In multivariate analyses, the difference in percent utilizing care for an urgent versus non-urgent DP among children covered by Medicaid/SCHIP was 32 percentage points; PHD, 25 percentage points; PHND, 12 percentage points; and no insurance, 14 percentage points. The difference in utilization by DP urgency was higher for children with Medicaid/SCHIP compared with either PHND or uninsured children. Expansion of Medicaid/SCHIP may permit children to receive care for urgent DPs who otherwise may not, due to lack of dental insurance. © 2016 American Association of Public Health Dentistry.

A Comparison of Self-Reported Medication Adherence to Concordance Between Part D Claims and Medication Possession

PubMed Central

Savitz, Samuel T.; Stearns, Sally C.; Zhou, Lei; Thudium, Emily; Alburikan, Khalid A.; Tran, Richard; Rodgers, Jo E.

2017-01-01

Objective Medicare Part D claims indicate medication purchased, but people who are not fully adherent may extend prescription use beyond the interval prescribed. This study assessed concordance between Part D claims and medication possession at a study visit in relation to self-reported medication adherence. Methods We matched Part D claims for six common medications to medications brought to a study visit in 2011–2013 for the Atherosclerosis Risk in Communities Study (ARIC). The combined data consisted of 3,027 medication events (claims, medications possessed or both) for 2,099 ARIC participants. Multinomial logistic regression estimated the association of concordance (Visit Only, Part D Only, or Both) with self-reported medication adherence while controlling for socio-demographic characteristics, veteran status, and availability under Generic Drug Discount Programs (GDDPs). Results Relative to participants with high adherence (p<0.05), medication events for participants with low adherence were approximately 25 percentage points less likely to match and more likely to be Visit Only. The results were similar but smaller in magnitude (approximately 2–3 percentage points) for participants with medium adherence. Compared to females, medication events for male veterans were approximately 11 percentage points less likely to match and more likely to be Visit Only. Events for medications available through GDDP were 3 percentage points more likely to be Visit Only. Conclusions Part D claims were substantially less likely to be concordant with medications possessed at study visit for participants with low self-reported adherence. This result supports the construction of adherence proxies such as proportion days covered using Part D claims. PMID:28221276

The impact of health information technology on cancer care across the continuum: a systematic review and meta-analysis.

PubMed

Tarver, Will L; Menachemi, Nir

2016-03-01

Health information technology (HIT) has the potential to play a significant role in the management of cancer. The purpose of this review is to identify and examine empirical studies that investigate the impact of HIT in cancer care on different levels of the care continuum. Electronic searches were performed in four academic databases. The authors used a three-step search process to identify 122 studies that met specific inclusion criteria. Next, a coding sheet was used to extract information from each included article to use in an analysis. Logistic regression was used to determine study-specific characteristics that were associated with positive findings. Overall, 72.4% of published analyses reported a beneficial effect of HIT. Multivariate analysis found that the impact of HIT differs across the cancer continuum with studies targeting diagnosis and treatment being, respectively, 77 (P = .001) and 39 (P = .039) percentage points less likely to report a beneficial effect when compared to those targeting prevention. In addition, studies targeting HIT to patients were 31 percentage points less likely to find a beneficial effect than those targeting providers (P = .030). Lastly, studies assessing behavior change as an outcome were 41 percentage points less likely to find a beneficial effect (P = .006), while studies targeting decision making were 27 percentage points more likely to find a beneficial effect (P = .034). Based on current evidence, HIT interventions seem to be more successful when targeting physicians, care in the prevention phase of the cancer continuum, and/or decision making. An agenda for future research is discussed. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Comparison of Left Atrial Bipolar Voltage and Scar Using Multielectrode Fast Automated Mapping versus Point-by-Point Contact Electroanatomic Mapping in Patients With Atrial Fibrillation Undergoing Repeat Ablation.

PubMed

Liang, Jackson J; Elafros, Melissa A; Muser, Daniele; Pathak, Rajeev K; Santangeli, Pasquale; Supple, Gregory E; Schaller, Robert D; Frankel, David S; Dixit, Sanjay

2017-03-01

Bipolar voltage criteria to delineate left atrial (LA) scar have been derived using point-by-point (PBP) contact electroanatomical mapping. It remains unclear how PBP-derived LA scar correlates with multielectrode fast automated mapping (ME-FAM) derived scar. We aimed to correlate scar and bipolar voltages from LA maps created using PBP versus ME-FAM. In consecutive patients undergoing repeat AF ablation, 2 separate LA maps were created using PBP and ME-FAM during sinus rhythm before ablation. Contiguous areas in the LA with a bipolar voltage cutoff of ≤0.2 mV represented dense scar; LA scar percentage was calculated for each map. Each LA shell was divided into 9 regions and each region further subdivided into 4 quadrants for additional analysis; mean voltages of all points obtained using PBP versus ME-FAM in each region were compared. Forty maps (20 PBP: mean 228.5 ± 95.6 points; 20 ME-FAM: 923.0 ± 382.6 points) were created in 20 patients. Mapping time with ME-FAM was shorter compared with PBP (13.3 ± 5.3 vs. 34.4 ± 13.1 minutes; P < 0.001). Mean LA scar percentage was higher with PBP compared with ME-FAM (15.5 ± 17.1% vs. 12.8 ± 17.6%; P = 0.04). Mean PBP voltage distribution was lower (compared with ME-FAM) in the septum (0.95 ± 0.73 vs. 1.46 ± 0.99 mV; P = 0.009), posterior wall (0.84 ± 0.42 vs. 1.40 ± 0.83 mV; P = 0.0008), roof (0.78 ± 0.80 vs. 1.39 ± 1.09 mV; P = 0.0003), and right PV-LA junction (0.34 ± 0.25 vs. 0.59 ± 0.50 mV; P = 0.01) regions, while voltages were similar in all other LA regions (all P > 0.05). In AF patients undergoing repeat ablation, bipolar voltage is greater in certain LA segments with ME-FAM compared with PBP mapping. © 2016 Wiley Periodicals, Inc.

Long-Term Effectiveness of Sigmoidoscopy Screening on Colorectal Cancer Incidence and Mortality in Women and Men: A Randomized Trial.

PubMed

Holme, Øyvind; Løberg, Magnus; Kalager, Mette; Bretthauer, Michael; Hernán, Miguel A; Aas, Eline; Eide, Tor J; Skovlund, Eva; Lekven, Jon; Schneede, Jörn; Tveit, Kjell Magne; Vatn, Morten; Ursin, Giske; Hoff, Geir

2018-06-05

The long-term effects of sigmoidoscopy screening on colorectal cancer (CRC) incidence and mortality in women and men are unclear. To determine the effectiveness of flexible sigmoidoscopy screening after 15 years of follow-up in women and men. Randomized controlled trial. (ClinicalTrials.gov: NCT00119912). Oslo and Telemark County, Norway. Adults aged 50 to 64 years at baseline without prior CRC. Screening (between 1999 and 2001) with flexible sigmoidoscopy with and without additional fecal blood testing versus no screening. Participants with positive screening results were offered colonoscopy. Age-adjusted CRC incidence and mortality stratified by sex. Of 98 678 persons, 20 552 were randomly assigned to screening and 78 126 to no screening. Adherence rates were 64.7% in women and 61.4% in men. Median follow-up was 14.8 years. The absolute risks for CRC in women were 1.86% in the screening group and 2.05% in the control group (risk difference, -0.19 percentage point [95% CI, -0.49 to 0.11 percentage point]; HR, 0.92 [CI, 0.79 to 1.07]). In men, the corresponding risks were 1.72% and 2.50%, respectively (risk difference, -0.78 percentage point [CI, -1.08 to -0.48 percentage points]; hazard ratio [HR], 0.66 [CI, 0.57 to 0.78]) (P for heterogeneity = 0.004). The absolute risks for death from CRC in women were 0.60% in the screening group and 0.59% in the control group (risk difference, 0.01 percentage point [CI, -0.16 to 0.18 percentage point]; HR, 1.01 [CI, 0.77 to 1.33]). The corresponding risks for death from CRC in men were 0.49% and 0.81%, respectively (risk difference, -0.33 percentage point [CI, -0.49 to -0.16 percentage point]; HR, 0.63 [CI, 0.47 to 0.83]) (P for heterogeneity = 0.014). Follow-up through national registries. Offering sigmoidoscopy screening in Norway reduced CRC incidence and mortality in men but had little or no effect in women. Norwegian government and Norwegian Cancer Society.

Quality and equity of care in U.S. hospitals.

PubMed

Trivedi, Amal N; Nsa, Wato; Hausmann, Leslie R M; Lee, Jonathan S; Ma, Allen; Bratzler, Dale W; Mor, Maria K; Baus, Kristie; Larbi, Fiona; Fine, Michael J

2014-12-11

Nearly every U.S. hospital publicly reports its performance on quality measures for patients who are hospitalized for acute myocardial infarction, heart failure, or pneumonia. Because performance rates are not reported according to race or ethnic group, it is unclear whether improvements in equity of care have accompanied aggregate improvements in health care quality over time. We assessed performance rates for quality measures covering three conditions (six measures for acute myocardial infarction, four for heart failure, and seven for pneumonia). These rates, adjusted for patient- and hospital-level covariates, were compared among non-Hispanic white, non-Hispanic black, and Hispanic patients who received care between 2005 and 2010 in acute care hospitals throughout the United States. Adjusted performance rates for the 17 quality measures improved by 3.4 to 57.6 percentage points between 2005 and 2010 for white, black, and Hispanic adults (P<0.001 for all comparisons). In 2005, as compared with adjusted performance rates for white patients, adjusted performance rates were more than 5 percentage points lower for black patients on 3 measures (range of differences, 12.3 to 14.2) and for Hispanic patients on 6 measures (5.6 to 14.5). Gaps decreased significantly on all 9 of these measures between 2005 and 2010, with adjusted changes for differences between white patients and black patients ranging from -8.5 to -11.8 percentage points and from -6.2 to -15.1 percentage points for differences between white patients and Hispanic patients. Decreasing differences according to race or ethnic group were attributable to more equitable care for white patients and minority patients treated in the same hospital, as well as to greater performance improvements among hospitals that disproportionately serve minority patients. Improved performance on quality measures for white, black, and Hispanic adults hospitalized for acute myocardial infarction, heart failure, or pneumonia was accompanied by increased racial and ethnic equity in performance rates both within and among U.S. hospitals. (Funded by the Centers for Medicare and Medicaid Services and the Veterans Affairs Health Services Research and Development Career Development Program.).

Tai Chi and Postural Stability in Patients with Parkinson's Disease

PubMed Central

Li, Fuzhong; Harmer, Peter; Fitzgerald, Kathleen; Eckstrom, Elizabeth; Stock, Ronald; Galver, Johnny; Maddalozzo, Gianni; Batya, Sara S.

2012-01-01

Background Patients with Parkinson's disease have substantially impaired balance, leading to diminished functional ability and an increased risk of falling. Although exercise is routinely encouraged by health care providers, few programs have been proven effective. Methods We conducted a randomized, controlled trial to determine whether a tailored tai chi program could improve postural control in patients with idiopathic Parkinson's disease. We randomly assigned 195 patients with stage 1 to 4 disease on the Hoehn and Yahr staging scale (which ranges from 1 to 5, with higher stages indicating more severe disease) to one of three groups: tai chi, resistance training, or stretching. The patients participated in 60-minute exercise sessions twice weekly for 24 weeks. The primary outcomes were changes from baseline in the limits-of-stability test (maximum excursion and directional control; range, 0 to 100%). Secondary outcomes included measures of gait and strength, scores on functional-reach and timed up-and-go tests, motor scores on the Unified Parkinson's Disease Rating Scale, and number of falls. Results The tai chi group performed consistently better than the resistance-training and stretching groups in maximum excursion (between-group difference in the change from baseline, 5.55 percentage points; 95% confidence interval [CI], 1.12 to 9.97; and 11.98 percentage points; 95% CI, 7.21 to 16.74, respectively) and in directional control (10.45 percentage points; 95% CI, 3.89 to 17.00; and 11.38 percentage points; 95% CI, 5.50 to 17.27, respectively). The tai chi group also performed better than the stretching group in all secondary outcomes and outperformed the resistance-training group in stride length and functional reach. Tai chi lowered the incidence of falls as compared with stretching but not as compared with resistance training. The effects of tai chi training were maintained at 3 months after the intervention. No serious adverse events were observed. Conclusions Tai chi training appears to reduce balance impairments in patients with mild-to-moderate Parkinson's disease, with additional benefits of improved functional capacity and reduced falls. (Funded by the National Institute of Neurological Disorders and Stroke; ClinicalTrials.gov number, NCT00611481.) PMID:22316445

Clinical effects of using HEXORR (Hand Exoskeleton Rehabilitation Robot) for movement therapy in stroke rehabilitation.

PubMed

Godfrey, Sasha Blue; Holley, Rahsaan J; Lum, Peter S

2013-11-01

The goals of this pilot study were to quantify the clinical benefits of using the Hand Exoskeleton Rehabilitation Robot for hand rehabilitation after stroke and to determine the population best served by this intervention. Nine subjects with chronic stroke (one excluded from analysis) completed 18 sessions of training with the Hand Exoskeleton Rehabilitation Robot and a preevaluation, a postevaluation, and a 90-day clinical evaluation. Overall, the subjects improved in both range of motion and clinical measures. Compared with the preevaluation, the subjects showed significant improvements in range of motion, grip strength, and the hand component of the Fugl-Meyer (mean changes, 6.60 degrees, 8.84 percentage points, and 1.86 points, respectively). A subgroup of six subjects exhibited lower tone and received a higher dosage of training. These subjects had significant gains in grip strength, the hand component of the Fugl-Meyer, and the Action Research Arm Test (mean changes, 8.42 percentage points, 2.17 points, and 2.33 points, respectively). Future work is needed to better manage higher levels of hypertonia and provide more support to subjects with higher impairment levels; however, the current results support further study into the Hand Exoskeleton Rehabilitation Robot treatment.

Immunisation coverage annual report, 2014.

PubMed

Hull, Brynley P; Hendry, Alexandra J; Dey, Aditi; Beard, Frank H; Brotherton, Julia M; McIntyre, Peter B

2017-03-31

This 8th annual immunisation coverage report shows data for 2014 derived from the Australian Childhood Immunisation Register and the National Human Papillomavirus Vaccination Program Register. This report includes coverage data for 'fully immunised' and by individual vaccines at standard age milestones and timeliness of receipt at earlier ages according to Indigenous status. Overall, 'fully immunised' coverage has been mostly stable at the 12- and 24-month age milestones since late 2003, but at 60 months of age, it has increased by more than 10 percentage points since 2009. As in previous years, coverage for 'fully immunised' at 12 months of age among Indigenous children was 3.7% lower than for non-Indigenous children overall, varying from 6.9 percentage points in Western Australia to 0.3 of a percentage point in the Australian Capital Territory. In 2014, 73.4% of Australian females aged 15 years had 3 documented doses of human papillomavirus vaccine (jurisdictional range 67.7% to 77.4%), and 82.7% had at least 1 dose, compared with 71.4% and 81.5%, respectively, in 2013. The disparity in on-time vaccination between Indigenous and non-Indigenous children in 2014 diminished progressively from 20.2% for vaccines due by 12 months to 11.5% for those due by 24 months and 3.0% at 60 months of age.

Will Medicare Advantage payment reforms impact plan rebates and enrollment?

PubMed

Nicholas, Lauren Hersch

2014-01-01

To assess the relationship between Medicare Advantage (MA) plan rebates and enrollment and simulate the effects of Affordable Care Act (ACA) payment reforms. First difference regressions of county-level MA payment and enrollment data from CMS from 2006 to 2010. A $10 decrease in the per member/per month rebate to MA plans was associated with a 0.20 percentage point (0.9%) decrease in MA penetration (P < .001) and a 7.1% decline in the average MA enrollee's risk score (P < .001). These effects are small overall, but larger in counties with low levels of traditional Medicare spending; a $10 decrease in monthly rebates was associated with a 0.64 percentage point decline in MA penetration and a 10% decrease in risk score. ACA reforms are predicted to reduce the level of rebates in lower-spending counties, leading to enrollment decreases of 1.7 to 1.9 percentage points in the lowest-spending counties. The simulation predicts that the disenrollment would come from MA enrollees with higher risk scores. MA enrollment responds to availability of supplemental benefits supported by rebates. ACA provisions designed to lower MA spending will predominantly affect Medicare beneficiaries living in counties where MA plans may be unable to offer a comparable product at a price similar to that of traditional Medicare.

Two Propositions on the Application of Point Elasticities to Finite Price Changes.

ERIC Educational Resources Information Center

Daskin, Alan J.

1992-01-01

Considers counterintuitive propositions about using point elasticities to estimate quantity changes in response to price changes. Suggests that elasticity increases with price along a linear demand curve, but falling quantity demand offsets it. Argues that point elasticity with finite percentage change in price only approximates percentage change…

Effects of the Affordable Care Act's Dependent Coverage Mandate on Private Health Insurance Coverage in Urban and Rural Areas.

PubMed

Look, Kevin A; Kim, Nam Hyo; Arora, Prachi

2017-01-01

To evaluate the impact of the Affordable Care Act's (ACA) dependent coverage mandate on insurance coverage among young adults in metropolitan and nonmetropolitan areas. A cross-sectional analysis was conducted using data from 2006-2009 and 2011 waves of the Medical Expenditure Panel Survey. A difference-in-difference analysis was used to compare changes in full-year private health insurance coverage among young adults aged 19-25 years with an older cohort aged 27-34 years. Separate regressions were estimated for individuals in metropolitan and nonmetropolitan areas and were tested for a differential impact by area of residence. Full-year private health insurance coverage significantly increased by 9.2 percentage points for young adults compared to the older cohort after the ACA mandate (P = .00). When stratifying the regression model by residence area, insurance coverage among young adults significantly increased by 9.0 percentage points in metropolitan areas (P = .00) and 10.1 percentage points in nonmetropolitan areas (P = .03). These changes were not significantly different from each other (P = .82), which suggests the ACA mandate's effects were not statistically different by area of residence. Although young adults in metropolitan and nonmetropolitan areas experienced increased access to private health insurance following the ACA's dependent coverage mandate, it did not appear to directly impact rural-urban disparities in health insurance coverage. Despite residents in both areas gaining insurance coverage, over one-third of young adults still lacked access to full-year health insurance coverage. © 2016 National Rural Health Association.

Field data sets for seagrass biophysical properties for the Eastern Banks, Moreton Bay, Australia, 2004-2014

NASA Astrophysics Data System (ADS)

Roelfsema, Chris M.; Kovacs, Eva M.; Phinn, Stuart R.

2015-08-01

This paper describes seagrass species and percentage cover point-based field data sets derived from georeferenced photo transects. Annually or biannually over a ten year period (2004-2014) data sets were collected using 30-50 transects, 500-800 m in length distributed across a 142 km2 shallow, clear water seagrass habitat, the Eastern Banks, Moreton Bay, Australia. Each of the eight data sets include seagrass property information derived from approximately 3000 georeferenced, downward looking photographs captured at 2-4 m intervals along the transects. Photographs were manually interpreted to estimate seagrass species composition and percentage cover (Coral Point Count excel; CPCe). Understanding seagrass biology, ecology and dynamics for scientific and management purposes requires point-based data on species composition and cover. This data set, and the methods used to derive it are a globally unique example for seagrass ecological applications. It provides the basis for multiple further studies at this site, regional to global comparative studies, and, for the design of similar monitoring programs elsewhere.

Outcomes of PCI at hospitals with or without on-site cardiac surgery.

PubMed

Aversano, Thomas; Lemmon, Cynthia C; Liu, Li

2012-05-10

Performance of percutaneous coronary intervention (PCI) is usually restricted to hospitals with cardiac surgery on site. We conducted a noninferiority trial to compare the outcomes of PCI performed at hospitals without and those with on-site cardiac surgery. We randomly assigned participants to undergo PCI at a hospital with or without on-site cardiac surgery. Patients requiring primary PCI were excluded. The trial had two primary end points: 6-week mortality and 9-month incidence of major adverse cardiac events (the composite of death, Q-wave myocardial infarction, or target-vessel revascularization). Noninferiority margins for the risk difference were 0.4 percentage points for mortality at 6 weeks and 1.8 percentage points for major adverse cardiac events at 9 months. A total of 18,867 patients were randomly assigned in a 3:1 ratio to undergo PCI at a hospital without on-site cardiac surgery (14,149 patients) or with on-site cardiac surgery (4718 patients). The 6-week mortality rate was 0.9% at hospitals without on-site surgery versus 1.0% at those with on-site surgery (difference, -0.04 percentage points; 95% confidence interval [CI], -0.31 to 0.23; P=0.004 for noninferiority). The 9-month rates of major adverse cardiac events were 12.1% and 11.2% at hospitals without and those with on-site surgery, respectively (difference, 0.92 percentage points; 95% CI, 0.04 to 1.80; P=0.05 for noninferiority). The rate of target-vessel revascularization was higher in hospitals without on-site surgery (6.5% vs. 5.4%, P=0.01). We found that PCI performed at hospitals without on-site cardiac surgery was noninferior to PCI performed at hospitals with on-site cardiac surgery with respect to mortality at 6 weeks and major adverse cardiac events at 9 months. (Funded by the Cardiovascular Patient Outcomes Research Team [C-PORT] participating sites; ClinicalTrials.gov number, NCT00549796.).

7 CFR 4288.10 - Applicant eligibility.

Code of Federal Regulations, 2014 CFR

2014-01-01

... least minimum points for cost-effectiveness under § 4288.21(b)(1). (4) Percentage of reduction of fossil fuel use. The application must be awarded at least minimum points for percentage of reduction of fossil...

7 CFR 4288.10 - Applicant eligibility.

Code of Federal Regulations, 2013 CFR

2013-01-01

... least minimum points for cost-effectiveness under § 4288.21(b)(1). (4) Percentage of reduction of fossil fuel use. The application must be awarded at least minimum points for percentage of reduction of fossil...

7 CFR 4288.10 - Applicant eligibility.

Code of Federal Regulations, 2012 CFR

2012-01-01

... least minimum points for cost-effectiveness under § 4288.21(b)(1). (4) Percentage of reduction of fossil fuel use. The application must be awarded at least minimum points for percentage of reduction of fossil...

The Marketing of Residence Halls: A Question of Positioning.

ERIC Educational Resources Information Center

Parker, R. Stephen; And Others

1996-01-01

A survey of 343 college residence hall directors revealed percentages of private and public institutions offering different amenities, main selling points in promotional brochures, and the most common resident complaints. Results were compared with those of a resident survey concerning the importance of various housing attributes. Implications for…

The state of racial/ethnic diversity in North Carolina's health workforce.

PubMed

McGee, Victoria; Fraher, Erin

2012-01-01

Increasing the racial and ethnic diversity of the health care workforce is vital to achieving accessible, equitable health care. This study provides baseline data on the diversity of health care practitioners in North Carolina compared with the diversity of the state's population. We analyzed North Carolina health workforce diversity using licensure data from the respective state boards of selected professions from 1994-2009; the data are stored in the North Carolina Health Professions Data System. North Carolina's health care practitioners are less diverse than is the state's population as a whole; only 17% of the practitioners are nonwhite, compared with 33% of the state's population. Levels of diversity vary among the professions, which are diversifying slowly over time. Primary care physicians are diversifying more rapidly than are other types of practitioners; the percentage who are nonwhite increased by 14 percentage points between 1994 and 2009, a period during which 1,630 nonwhite practitioners were added to their ranks. The percentage of licensed practical nurses who are nonwhite increased by 7 percentage points over the same period with the addition of 1,542 nonwhite practitioners to their ranks. Nonwhite health professionals cluster regionally throughout the state, and 79% of them practice in metropolitan counties. This study reports on only a selected number of health professions and utilizes race/ethnicity data that were self-reported by practitioners. Tracking the diversity among North Carolina's health care practitioners provides baseline data that will facilitate future research on barriers to health workforce entry, allow assessment of diversity programs, and be useful in addressing racial and ethnic health disparities.

Gain in Insurance Coverage and Residual Uninsurance Under the Affordable Care Act: Texas, 2013-2016.

PubMed

Pickett, Stephen; Marks, Elena; Ho, Vivian

2017-01-01

To examine the effects of the Affordable Care Act's (ACA's) Marketplace on Texas residents and determine which population subgroups benefited the most and which the least. We analyzed insurance coverage rates among nonelderly Texas adults using the Health Reform Monitoring Survey-Texas from September 2013, just before the first open enrollment period in the Marketplace, through March 2016. Texas has experienced a roughly 6-percentage-point increase in insurance coverage (from 74.7% to 80.6%; P = .012) after implementation of the major insurance provisions of the ACA. The 4 subgroups with the largest increases in adjusted insurance coverage between 2013 and 2016 were persons aged 50 to 64 years (12.1 percentage points; P = .002), Hispanics (10.9 percentage points; P = .002), persons reporting fair or poor health status (10.2 percentage points; P = .038), and those with a high school diploma as their highest educational attainment (9.2 percentage points; P = .023). Many population subgroups have benefited from the ACA's Marketplace, but approximately 3 million Texas residents still lack health coverage. Adopting the ACA's Medicaid expansion is a means to address the lack of coverage.

Hospitalization for Suicide Ideation or Attempt: 2008-2015.

PubMed

Plemmons, Gregory; Hall, Matthew; Doupnik, Stephanie; Gay, James; Brown, Charlotte; Browning, Whitney; Casey, Robert; Freundlich, Katherine; Johnson, David P; Lind, Carrie; Rehm, Kris; Thomas, Susan; Williams, Derek

2018-06-01

Suicide ideation (SI) and suicide attempts (SAs) have been reported as increasing among US children over the last decade. We examined trends in emergency and inpatient encounters for SI and SA at US children's hospitals from 2008 to 2015. We used retrospective analysis of administrative billing data from the Pediatric Health Information System database. There were 115 856 SI and SA encounters during the study period. Annual percentage of all visits for SI and SA almost doubled, increasing from 0.66% in 2008 to 1.82% in 2015 (average annual increase 0.16 percentage points [95% confidence intervals (CIs) 0.15 to 0.17]). Significant increases were noted in all age groups but were higher in adolescents 15 to 17 years old (average annual increase 0.27 percentage points [95% CI 0.23 to 0.30]) and adolescents 12 to 14 years old (average annual increase 0.25 percentage points [95% CI 0.21 to 0.27]). Increases were noted in girls (average annual increase 0.14 percentage points [95% CI 0.13 to 0.15]) and boys (average annual increase 0.10 percentage points [95% CI 0.09 to 0.11]), but were higher for girls. Seasonal variation was also observed, with the lowest percentage of cases occurring during the summer and the highest during spring and fall. Encounters for SI and SA at US children's hospitals increased steadily from 2008 to 2015 and accounted for an increasing percentage of all hospital encounters. Increases were noted across all age groups, with consistent seasonal patterns that persisted over the study period. The growing impact of pediatric mental health disorders has important implications for children's hospitals and health care delivery systems. Copyright © 2018 by the American Academy of Pediatrics.

24 CFR 206.21 - Interest rate.

Code of Federal Regulations, 2010 CFR

2010-04-01

... interest rate is adjusted, the new interest rate applies to the entire mortgage balance. The difference... § 203.49(f)(1) to one percentage point shall mean two percentage points. (2) If a mortgage meeting the...

HPV vaccination coverage of teen girls: the influence of health care providers.

PubMed

Smith, Philip J; Stokley, Shannon; Bednarczyk, Robert A; Orenstein, Walter A; Omer, Saad B

2016-03-18

Between 2010 and 2014, the percentage of 13-17 year-old girls administered ≥3 doses of the human papilloma virus (HPV) vaccine ("fully vaccinated") increased by 7.7 percentage points to 39.7%, and the percentage not administered any doses of the HPV vaccine ("not immunized") decreased by 11.3 percentage points to 40.0%. To evaluate the complex interactions between parents' vaccine-related beliefs, demographic factors, and HPV immunization status. Vaccine-related parental beliefs and sociodemographic data collected by the 2010 National Immunization Survey-Teen among teen girls (n=8490) were analyzed. HPV vaccination status was determined from teens' health care provider (HCP) records. Among teen girls either unvaccinated or fully vaccinated against HPV, teen girls whose parent was positively influenced to vaccinate their teen daughter against HPV were 48.2 percentage points more likely to be fully vaccinated. Parents who reported being positively influenced to vaccinate against HPV were 28.9 percentage points more likely to report that their daughter's HCP talked about the HPV vaccine, 27.2 percentage points more likely to report that their daughter's HCP gave enough time to discuss the HPV shot, and 43.4 percentage points more likely to report that their daughter's HCP recommended the HPV vaccine (p<0.05). Among teen girls administered 1-2 doses of the HPV vaccine, 87.0% had missed opportunities for HPV vaccine administration. Results suggest that an important pathway to achieving higher ≥3 dose HPV vaccine coverage is by increasing HPV vaccination series initiation though HCP talking to parents about the HPV vaccine, giving parents time to discuss the vaccine, and by making a strong recommendation for the HPV. Also, HPV vaccination series completion rates may be increased by eliminating missed opportunities to vaccinate against HPV and scheduling additional follow-up visits to administer missing HPV vaccine doses. Published by Elsevier Ltd.

Adalimumab induction therapy for Crohn disease previously treated with infliximab: a randomized trial.

PubMed

Sandborn, William J; Rutgeerts, Paul; Enns, Robert; Hanauer, Stephen B; Colombel, Jean-Frédéric; Panaccione, Remo; D'Haens, Geert; Li, Ju; Rosenfeld, Marie R; Kent, Jeffrey D; Pollack, Paul F

2007-06-19

Adalimumab, a fully human tumor necrosis factor (TNF) antagonist, is an effective treatment for patients with Crohn disease who are naive to the chimeric TNF antagonist, infliximab. No anti-TNF agent has been evaluated prospectively in patients with Crohn disease who had responded to another anti-TNF agent and then lost that response or were intolerant of the agent. To determine whether adalimumab induces remissions more frequently than placebo in adult patients with Crohn disease who have symptoms despite infliximab therapy or who cannot take infliximab because of adverse events. 4-week, randomized, double-blind, placebo-controlled trial (November 2004 to December 2005). 52 sites in the United States, Canada, and Europe. 325 adults 18 to 75 years of age who had a history of Crohn disease for 4 months or more that was moderate to severe at baseline (Crohn's Disease Activity Index [CDAI] score, 220 to 450 points). Patients were randomly assigned to receive induction doses of adalimumab, 160 mg and 80 mg, at weeks 0 and 2, respectively, or placebo at the same time points. The primary end point was induction of remission at week 4. Decreases in CDAI score by 70 or more and 100 or more points (secondary end points) were also measured. A total of 301 patients completed the trial. Twenty-one percent (34 of 159) of patients in the adalimumab group versus 7% (12 of 166) of those in the placebo group achieved remission at week 4 (P < 0.001). The absolute difference in clinical remission rates was 14.2 percentage points (95% CI, 6.7 to 21.6 percentage points). A 70-point response occurred at week 4 in 52% (82 of 159) of patients in the adalimumab group versus 34% (56 of 166) of patients in the placebo group (P = 0.001). The absolute difference in 70-point response rates was 17.8 percentage points (CI, 7.3 to 28.4 percentage points). Two of 159 patients in the adalimumab group and 4 of 166 patients in the placebo group discontinued treatment because of adverse events. No patients in the adalimumab group and 4 of 166 patients in the placebo group had a serious infection. The trial did not directly compare alternative active treatments and did not evaluate maintenance of response or long-term immunogenicity of adalimumab. Adalimumab induces remissions more frequently than placebo in adult patients with Crohn disease who cannot tolerate infliximab or have symptoms despite receiving infliximab therapy. For more information on adalimumab in Crohn disease, click here. ClinicalTrials.gov registration number: NCT00105300.

Effect of laser acupuncture versus traditional acupuncture in neck pain of cervical spondylosis

NASA Astrophysics Data System (ADS)

El-Kharbotly, Ahmed M.; El-Gendy, Alyaa A.; Mohammed, Mouchira A.; El-Masry, Manal R.; Daoud, Eitedal M.; Hassan, Nagwa; Abdel-Wahab, Khaled G.; Helmy, Ghada; Mostafa, Taymour

2014-02-01

This prospective cohort study aimed to compare the efficiency of laser versus traditional acupuncture in treating cervical spondylosis (CS) pain. Forty female patients were randomized into two equal groups that received 3 sessions / week for 4 weeks. Group A received needle acupuncture therapy with electrical stimulation for 20 min at standard acupoints, ear points and Ashi point on the average 3 points. Group B received low level laser therapy (LLLT) acupuncture at the same acupoints. The results demonstrated that tenderness disappeared in 65% of patients in group A and 75% of patients in group B with improved percentage of 85.5% and 89.2%. Pain on VAS related to direction of motion at 6 directions was improved in all cases where with improvement percentage 76.45% and 85.88%. Pain on VAS at rest was improved in all patients with improvement percentage of 80.41% and 84.28%. NDIQ score improved in all patients with improvement percentage of 69.78% and 73.77%. Follow up of VAS after 6 months from the last session revealed persistent improvement in 55% of patients of group A vs 80% of patients of group B. Mean serum TNF-α was decreased in 85% of patients of group A vs 95% of patients of group B where serum beta endorphins was increased in all patients. It is concluded that both modes of treatment for CS gave improvement regarding pain intensity, disability and quality of life being more evident in LLLT followed for 6 months supported with improved serum TNFα and beta endorphin.

Questioning Points and Percentages: Standards-Based Grading (SBG) in Higher Education

ERIC Educational Resources Information Center

Buckmiller, Tom; Peters, Randal; Kruse, Jerrid

2017-01-01

Despite its growing use at the K-12 level, standards-based grading (alignment of grading to course standards) has been comparatively neglected in higher education. College students are often confronted with grading practices that reflect subjective, non-standardized formats incorporating a blend of academic and non-academic components. This case…

Home Use of Day-and-Night Hybrid Closed-Loop Insulin Delivery in Suboptimally Controlled Adolescents With Type 1 Diabetes: A 3-Week, Free-Living, Randomized Crossover Trial.

PubMed

Tauschmann, Martin; Allen, Janet M; Wilinska, Malgorzata E; Thabit, Hood; Acerini, Carlo L; Dunger, David B; Hovorka, Roman

2016-11-01

This study evaluated the feasibility, safety, and efficacy of day-and-night hybrid closed-loop insulin delivery in adolescents with type 1 diabetes under free-living conditions. In an open-label randomized crossover study, 12 suboptimally controlled adolescents on insulin pump therapy (mean ± SD age 14.6 ± 3.1 years; HbA 1c 69 ± 8 mmol/mol [8.5 ± 0.7%]; duration of diabetes 7.8 ± 3.5 years) underwent two 21-day periods in which hybrid closed-loop insulin delivery was compared with sensor-augmented insulin pump therapy in random order. During the closed-loop intervention, a model predictive algorithm automatically directed insulin delivery between meals and overnight. Participants used a bolus calculator to administer prandial boluses. The proportion of time that sensor glucose was in the target range (3.9-10 mmol/L; primary end point) was increased during the closed-loop intervention compared with sensor-augmented insulin pump therapy by 18.8 ± 9.8 percentage points (mean ± SD; P < 0.001), the mean sensor glucose level was reduced by 1.8 ± 1.3 mmol/L (P = 0.001), and the time spent above target was reduced by 19.3 ± 11.3 percentage points (P < 0.001). The time spent with sensor glucose levels below 3.9 mmol/L was low and comparable between interventions (median difference 0.4 [interquartile range -2.2 to 1.3] percentage points; P = 0.33). Improved glucose control during closed-loop was associated with increased variability of basal insulin delivery (P < 0.001) and an increase in the total daily insulin dose (53.5 [39.5-72.1] vs. 51.5 [37.6-64.3] units/day; P = 0.006). Participants expressed positive attitudes and experience with the closed-loop system. Free-living home use of day-and-night closed-loop in suboptimally controlled adolescents with type 1 diabetes is safe, feasible, and improves glucose control without increasing the risk of hypoglycemia. Larger and longer studies are warranted. © 2016 by the American Diabetes Association.

Comparing Matchplay Characteristics and Physical Demands of Junior and Professional Tennis Athletes in the Era of Big Data

PubMed Central

Kovalchik, Stephanie A.; Reid, Machar

2017-01-01

Differences in the competitive performance characteristics of junior and professional tennis players are not well understood. The present study provides a comprehensive comparative analysis of junior and professional matchplay. The study utilized multiple large-scale datasets covering match, point, and shot outcomes over multiple years of competition. Regression analysis was used to identify differences between junior and professional matchplay. Top professional men and women were found to play significantly more matches, sets, and games compared to junior players of an equivalent ranking. Professional players had a greater serve advantage, men winning 4 and women winning 2 additional percentage points on serve compared to juniors. Clutch ability in break point conversion was 6 to 8 percentage points greater for junior players. In general, shots were more powerful and more accurate at the professional level with the largest differences observed for male players on serve. Serving to the center of the court was more than two times more common for junior players on first serve. While male professionals performed 50% more total work in a Grand Slam match than juniors, junior girls performed 50% more work than professional women. Understanding how competitiveness, play demands, and the physical characteristics of shots differ between junior and professional tennis players can help set realistic expectations and developmentally appropriate training for transitioning players. Key points Junior players transitioning to professional level, must adapt to a field of a deeper and higher-quality athletes Junior players rise in the professional ranks, they can expect to compete in more events, matches, sets and games throughout the year The margins differentiating winners and losers of matches at the professional level are significantly narrower than at the junior level Some of the largest differences between junior and professional tennis are in its physical demands PMID:29238248

Gain in Insurance Coverage and Residual Uninsurance Under the Affordable Care Act: Texas, 2013–2016

PubMed Central

Pickett, Stephen; Marks, Elena

2017-01-01

Objectives. To examine the effects of the Affordable Care Act’s (ACA’s) Marketplace on Texas residents and determine which population subgroups benefited the most and which the least. Methods. We analyzed insurance coverage rates among nonelderly Texas adults using the Health Reform Monitoring Survey-Texas from September 2013, just before the first open enrollment period in the Marketplace, through March 2016. Results. Texas has experienced a roughly 6–percentage-point increase in insurance coverage (from 74.7% to 80.6%; P = .012) after implementation of the major insurance provisions of the ACA. The 4 subgroups with the largest increases in adjusted insurance coverage between 2013 and 2016 were persons aged 50 to 64 years (12.1 percentage points; P = .002), Hispanics (10.9 percentage points; P = .002), persons reporting fair or poor health status (10.2 percentage points; P = .038), and those with a high school diploma as their highest educational attainment (9.2 percentage points; P = .023). Conclusions. Many population subgroups have benefited from the ACA’s Marketplace, but approximately 3 million Texas residents still lack health coverage. Adopting the ACA’s Medicaid expansion is a means to address the lack of coverage. PMID:27854535

Medicaid Coverage Expansions and Cigarette Smoking Cessation Among Low-income Adults.

PubMed

Koma, Jonathan W; Donohue, Julie M; Barry, Colleen L; Huskamp, Haiden A; Jarlenski, Marian

2017-12-01

Expanding Medicaid coverage to low-income adults may have increased smoking cessation through improved access to evidence-based treatments. Our study sought to determine if states' decisions to expand Medicaid increased recent smoking cessation. Using pooled cross-sectional data from the Behavioral Risk Factor Surveillance Survey for the years 2011-2015, we examined the association between state Medicaid coverage and the probability of recent smoking cessation among low-income adults without dependent children who were current or former smokers (n=36,083). We used difference-in-differences estimation to examine the effects of Medicaid coverage on smoking cessation, comparing low-income adult smokers in states with Medicaid coverage to comparable adults in states without Medicaid coverage, with ages 18-64 years to those ages 65 years and above. Analyses were conducted for the full sample and stratified by sex. Residence in a state with Medicaid coverage among low-income adult smokers ages 18-64 years was associated with an increase in recent smoking cessation of 2.1 percentage points (95% confidence interval, 0.25-3.9). In the comparison group of individuals ages 65 years and above, residence in a state with Medicaid coverage expansion was not associated with a change in recent smoking cessation (-0.1 percentage point, 95% confidence interval, -2.1 to 1.8). Similar increases in smoking cessation among those ages 18-64 years were estimated for females and males (1.9 and 2.2 percentage point, respectively). Findings are consistent with the hypothesis that Medicaid coverage expansions may have increased smoking cessation among low-income adults without dependent children via greater access to preventive health care services, including evidence-based smoking cessation services.

Impact of Medicaid disenrollment in Tennessee on breast cancer stage at diagnosis and treatment.

PubMed

Tarazi, Wafa W; Bradley, Cathy J; Bear, Harry D; Harless, David W; Sabik, Lindsay M

2017-09-01

States routinely may consider rollbacks of Medicaid expansions to address statewide economic conditions. To the authors' knowledge, little is known regarding the effects of public insurance contractions on health outcomes. The current study examined the effects of the 2005 Medicaid disenrollment in Tennessee on breast cancer stage at the time of diagnosis and delays in treatment among nonelderly women. The authors used Tennessee Cancer Registry data from 2002 through 2008 and estimated a difference-in-difference model comparing women diagnosed with breast cancer who lived in low-income zip codes (and therefore were more likely to be subject to disenrollment) with a similar group of women who lived in high-income zip codes before and after the 2005 Medicaid disenrollment. The study outcomes were changes in stage of disease at the time of diagnosis and delays in treatment of >60 days and >90 days. Overall, nonelderly women in Tennessee were diagnosed at later stages of disease and experienced more delays in treatment in the period after disenrollment. Disenrollment was found to be associated with a 3.3-percentage point increase in late stage of disease at the time of diagnosis (P = .024), a 1.9-percentage point decrease in having a delay of >60 days in surgery (P = .024), and a 1.4-percentage point decrease in having a delay of >90 days in treatment (P = .054) for women living in low-income zip codes compared with women residing in high-income zip codes. The results of the current study indicate that Medicaid disenrollment is associated with a later stage of disease at the time of breast cancer diagnosis, thereby providing evidence of the potential negative health impacts of Medicaid contractions. Cancer 2017;123:3312-9. © 2017 American Cancer Society. © 2017 American Cancer Society.

Health Benefits and Cost-Effectiveness of Brief Clinician Tobacco Counseling for Youth and Adults.

PubMed

Maciosek, Michael V; LaFrance, Amy B; Dehmer, Steven P; McGree, Dana A; Xu, Zack; Flottemesch, Thomas J; Solberg, Leif I

2017-01-01

To help clinicians and care systems determine the priority for tobacco counseling in busy clinic schedules, we assessed the lifetime health and economic value of annually counseling youth to discourage smoking initiation and of annually counseling adults to encourage cessation. We conducted a microsimulation analysis to estimate the health impact and cost effectiveness of both types of tobacco counseling in a US birth cohort of 4,000,000. The model used for the analysis was constructed from nationally representative data sets and structured literature reviews. Compared with no tobacco counseling, the model predicts that annual counseling for youth would reduce the average prevalence of smoking cigarettes during adult years by 2.0 percentage points, whereas annual counseling for adults will reduce prevalence by 3.8 percentage points. Youth counseling would prevent 42,686 smoking-attributable fatalities and increase quality-adjusted life years (QALYs) by 756,601 over the lifetime of the cohort. Adult counseling would prevent 69,901 smoking-attributable fatalities and increase QALYs by 1,044,392. Youth and adult counseling would yield net savings of $225 and $580 per person, respectively. If annual tobacco counseling was provided to the cohort during both youth and adult years, then adult smoking prevalence would be 5.5 percentage points lower compared with no counseling, and there would be 105,917 fewer smoking-attributable fatalities over their lifetimes. Only one-third of the potential health and economic benefits of counseling are being realized at current counseling rates. Brief tobacco counseling provides substantial health benefits while producing cost savings. Both youth and adult intervention are high-priority uses of limited clinician time. © 2017 Annals of Family Medicine, Inc.

Health Benefits and Cost-Effectiveness of Brief Clinician Tobacco Counseling for Youth and Adults

PubMed Central

Maciosek, Michael V.; LaFrance, Amy B.; Dehmer, Steven P.; McGree, Dana A.; Xu, Zack; Flottemesch, Thomas J.; Solberg, Leif I.

2017-01-01

PURPOSE To help clinicians and care systems determine the priority for tobacco counseling in busy clinic schedules, we assessed the lifetime health and economic value of annually counseling youth to discourage smoking initiation and of annually counseling adults to encourage cessation. METHODS We conducted a microsimulation analysis to estimate the health impact and cost effectiveness of both types of tobacco counseling in a US birth cohort of 4,000,000. The model used for the analysis was constructed from nationally representative data sets and structured literature reviews. RESULTS Compared with no tobacco counseling, the model predicts that annual counseling for youth would reduce the average prevalence of smoking cigarettes during adult years by 2.0 percentage points, whereas annual counseling for adults will reduce prevalence by 3.8 percentage points. Youth counseling would prevent 42,686 smoking-attributable fatalities and increase quality-adjusted life years (QALYs) by 756,601 over the lifetime of the cohort. Adult counseling would prevent 69,901 smoking-attributable fatalities and increase QALYs by 1,044,392. Youth and adult counseling would yield net savings of $225 and $580 per person, respectively. If annual tobacco counseling was provided to the cohort during both youth and adult years, then adult smoking prevalence would be 5.5 percentage points lower compared with no counseling, and there would be 105,917 fewer smoking-attributable fatalities over their lifetimes. Only one-third of the potential health and economic benefits of counseling are being realized at current counseling rates. CONCLUSIONS Brief tobacco counseling provides substantial health benefits while producing cost savings. Both youth and adult intervention are high-priority uses of limited clinician time. PMID:28376459

Comparisons of percentage body fat, body mass index, waist circumference, and waist-stature ratio in adults.

PubMed

Flegal, Katherine M; Shepherd, John A; Looker, Anne C; Graubard, Barry I; Borrud, Lori G; Ogden, Cynthia L; Harris, Tamara B; Everhart, James E; Schenker, Nathaniel

2009-02-01

Body mass index (BMI), waist circumference (WC), and the waist-stature ratio (WSR) are considered to be possible proxies for adiposity. The objective was to investigate the relations between BMI, WC, WSR, and percentage body fat (measured by dual-energy X-ray absorptiometry) in adults in a large nationally representative US population sample from the National Health and Nutrition Examination Survey (NHANES). BMI, WC, and WSR were compared with percentage body fat in a sample of 12,901 adults. WC, WSR, and BMI were significantly more correlated with each other than with percentage body fat (P < 0.0001 for all sex-age groups). Percentage body fat tended to be significantly more correlated with WC than with BMI in men but significantly more correlated with BMI than with WC in women (P < 0.0001 except in the oldest age group). WSR tended to be slightly more correlated with percentage body fat than was WC. Percentile values of BMI, WC, and WSR are shown that correspond to percentiles of percentage body fat increments of 5 percentage points. More than 90% of the sample could be categorized to within one category of percentage body fat by each measure. BMI, WC, and WSR perform similarly as indicators of body fatness and are more closely related to each other than with percentage body fat. These variables may be an inaccurate measure of percentage body fat for an individual, but they correspond fairly well overall with percentage body fat within sex-age groups and distinguish categories of percentage body fat.

Utilization of a cognitive task analysis for laparoscopic appendectomy to identify differentiated intraoperative teaching objectives.

PubMed

Smink, Douglas S; Peyre, Sarah E; Soybel, David I; Tavakkolizadeh, Ali; Vernon, Ashley H; Anastakis, Dimitri J

2012-04-01

Experts become automated when performing surgery, making it difficult to teach complex procedures to trainees. Cognitive task analysis (CTA) enables experts to articulate operative steps and cognitive decisions in complex procedures such as laparoscopic appendectomy, which can then be used to identify central teaching points. Three local surgeon experts in laparoscopic appendectomy were interviewed using critical decision method-based CTA methodology. Interview transcripts were analyzed, and a cognitive demands table (CDT) was created for each expert. The individual CDTs were reviewed by each expert for completeness and then combined into a master CDT. Percentage agreement on operative steps and decision points was calculated for each expert. The experts then participated in a consensus meeting to review the master CDT. Each surgeon expert was asked to identify in the master CDT the most important teaching objectives for junior-level and senior-level residents. The experts' responses for junior-level and senior-level residents were compared using a χ(2) test. The surgeon experts identified 24 operative steps and 27 decision points. Eighteen of the 24 operative steps (75%) were identified by all 3 surgeon experts. The percentage of operative steps identified was high for each surgeon expert (96% for surgeon 1, 79% for surgeon 2, and 83% for surgeon 3). Of the 27 decision points, only 5 (19%) were identified by all 3 surgeon experts. The percentage of decision points identified varied by surgeon expert (78% for surgeon 1, 59% for surgeon 2, and 48% for surgeon 3). When asked to identify key teaching points, the surgeon experts were more likely to identify operative steps for junior residents (9 operative steps and 6 decision points) and decision points for senior residents (4 operative steps and 13 decision points) (P < .01). CTA can deconstruct the essential operative steps and decision points associated with performing a laparoscopic appendectomy. These results provide a framework to identify key teaching principles to guide intraoperative instruction. These learning objectives could be used to guide resident level-appropriate teaching of an essential general surgery procedure. Copyright © 2012 Elsevier Inc. All rights reserved.

The effect of a decision aid intervention on decision making about coronary heart disease risk reduction: secondary analyses of a randomized trial

PubMed Central

2014-01-01

Background Decision aids offer promise as a practical solution to improve patient decision making about coronary heart disease (CHD) prevention medications and help patients choose medications to which they are likely to adhere. However, little data is available on decision aids designed to promote adherence. Methods In this paper, we report on secondary analyses of a randomized trial of a CHD adherence intervention (second generation decision aid plus tailored messages) versus usual care in an effort to understand how the decision aid facilitates adherence. We focus on data collected from the primary study visit, when intervention participants presented 45 minutes early to a previously scheduled provider visit; viewed the decision aid, indicating their intent for CHD risk reduction after each decision aid component (individualized risk assessment and education, values clarification, and coaching); and filled out a post-decision aid survey assessing their knowledge, perceived risk, decisional conflict, and intent for CHD risk reduction. Control participants did not present early and received usual care from their provider. Following the provider visit, participants in both groups completed post-visit surveys assessing the number and quality of CHD discussions with their provider, their intent for CHD risk reduction, and their feelings about the decision aid. Results We enrolled 160 patients into our study (81 intervention, 79 control). Within the decision aid group, the decision aid significantly increased knowledge of effective CHD prevention strategies (+21 percentage points; adjusted p<.0001) and the accuracy of perceived CHD risk (+33 percentage points; adjusted p<.0001), and significantly decreased decisional conflict (-0.63; adjusted p<.0001). Comparing between study groups, the decision aid also significantly increased CHD prevention discussions with providers (+31 percentage points; adjusted p<.0001) and improved perceptions of some features of patient-provider interactions. Further, it increased participants’ intentions for any effective CHD risk reducing strategies (+21 percentage points; 95% CI 5 to 37 percentage points), with a majority of the effect from the educational component of the decision aid. Ninety-nine percent of participants found the decision aid easy to understand and 93% felt it easy to use. Conclusions Decision aids can play an important role in improving decisions about CHD prevention and increasing patient-provider discussions and intent to reduce CHD risk. PMID:24575882

Presenting numeric information with percentages and descriptive risk labels: A randomized trial

PubMed Central

Sinayev, Aleksandr; Peters, Ellen; Tusler, Martin; Fraenkel, Liana

2015-01-01

Background Previous research demonstrated that providing (vs. not providing) numeric information about medications’ adverse effects (AEs) increased comprehension and willingness to use medication, but left open the question about which numeric format is best. Objective To determine which of four tested formats (percentage, frequency, percentage+risk label, frequency+risk label) maximizes comprehension and willingness to use medication across age and numeracy levels. Design In a cross-sectional internet survey (N=368; American Life Panel, 5/15/08–6/18/08), respondents were presented with a hypothetical prescription medication for high cholesterol. AE likelihoods were described using one of four tested formats. Main outcome measures were risk comprehension (ability to identify AE likelihood from a table) and willingness to use the medication (7-point scale; not likely=0, very likely=6). Results The percentage+risk label format resulted in the highest comprehension and willingness to use the medication compared to the other three formats (mean comprehension in percentage + risk label format=95% vs mean across the other three formats = 81%; mean willingness= 3.3 vs 2.95, respectively). Comprehension differences between percentage and frequency formats were smaller among the less numerate. Willingness to use medication depended less on age and numeracy when labels were used. Limitations Generalizability is limited by use of a sample that was older, more educated, and better off financially than national averages. Conclusions Providing numeric AE-likelihood information in a percentage format with risk labels is likely to increase risk comprehension and willingness to use a medication compared to other numeric formats. PMID:25952743

Presenting Numeric Information with Percentages and Descriptive Risk Labels: A Randomized Trial.

PubMed

Sinayev, Aleksandr; Peters, Ellen; Tusler, Martin; Fraenkel, Liana

2015-11-01

Previous research demonstrated that providing (v. not providing) numeric information about the adverse effects (AEs) of medications increased comprehension and willingness to use medication but left open the question about which numeric format is best. The objective was to determine which of 4 tested formats (percentage, frequency, percentage + risk label, frequency + risk label) maximizes comprehension and willingness to use medication across age and numeracy levels. In a cross-sectional internet survey (N = 368; American Life Panel, 15 May 2008 to 18 June 2008), respondents were presented with a hypothetical prescription medication for high cholesterol. AE likelihoods were described using 1 of 4 tested formats. Main outcome measures were risk comprehension (ability to identify AE likelihood from a table) and willingness to use the medication (7-point scale; not likely = 0, very likely = 6). The percentage + risk label format resulted in the highest comprehension and willingness to use the medication compared with the other 3 formats (mean comprehension in percentage + risk label format = 95% v. mean across the other 3 formats = 81%; mean willingness = 3.3 v. 2.95, respectively). Comprehension differences between percentage and frequency formats were smaller among the less numerate. Willingness to use medication depended less on age and numeracy when labels were used. Generalizability is limited by the use of a sample that was older, more educated, and better off financially than national averages. Providing numeric AE-likelihood information in a percentage format with risk labels is likely to increase risk comprehension and willingness to use a medication compared with other numeric formats. © The Author(s) 2015.

A comparison of the Slaughter skinfold-thickness equations and BMI in predicting body fatness and cardiovascular disease risk factor levels in children1234

PubMed Central

Horlick, Mary; Berenson, Gerald S

2013-01-01

Background: Although estimation of percentage body fat with the Slaughter skinfold-thickness equations (PBFSlaughter) is widely used, the accuracy of this method has not been well studied. Objective: The objective was to determine the accuracy of the Slaughter skinfold-thickness equations. Design: We compared agreement between PBFSlaughter and estimations derived from dual-energy X-ray absorptiometry (PBFDXA) in 1169 children in the Pediatric Rosetta Body Composition Project and the relation to cardiovascular disease risk factors, as compared with body mass index (BMI), in 6725 children in the Bogalusa Heart Study. Results: PBFSlaughter was highly correlated (r = 0.90) with PBFDXA, but it markedly overestimated levels of PBFDXA in children with large skinfold thicknesses. In the 65 boys with a sum of skinfold thicknesses (subscapular- plus triceps-skinfold thicknesses) ≥50 mm, PBFSlaughter overestimated PBFDXA by 12 percentage points. The comparable overestimation in girls with a high skinfold sum was 6 percentage points. We also found that, after adjustment for sex and age, BMI showed slightly stronger associations with lipid, lipoprotein, insulin, and blood pressure values than did PBFSlaughter. Conclusions: These results indicate that PBFSlaughter, which was developed among a group of much thinner children and adolescents, is fairly accurate among nonobese children, but markedly overestimates the body fatness of children who have thick skinfold thicknesses. Furthermore, PBFSlaughter has no advantage over sex- and age-adjusted BMIs at identifying children who are at increased risk of cardiovascular disease based on lipid, lipoprotein, insulin, and blood pressure values. PMID:24153344

Cold-air performance of compressor-drive turbine of department of energy upgraded automobile gas turbine engine. 3: Performance of redesigned turbine

NASA Technical Reports Server (NTRS)

Roelke, R. J.; Haas, J. E.

1984-01-01

The aerodynamic performance of a redesigned compressor drive turbine of the gas turbine engine is determined in air at nominal inlet conditions of 325 K and 0.8 bar absolute. The turbine is designed with a lower flow factor, higher rotor reaction and a redesigned inlet volute compared to the first turbine. Comparisons between this turbine and the originally designed turbine show about 2.3 percentage points improvement in efficiency at the same rotor tip clearance. Two versions of the same rotor are tested: (1) an as cast rotor, and (2) the same rotor with reduced surface roughness. The effect of reducing surface roughness is about one half percentage point improvement in efficiency. Tests made to determine the effect of Reynolds number on the turbine performance show no effect for the range from 100,000 to 500,000.

The impact of diabetes on employment in Mexico.

PubMed

Seuring, Till; Goryakin, Yevgeniy; Suhrcke, Marc

2015-07-01

This study explores the impact of diabetes on employment in Mexico using data from the Mexican Family Life Survey (MxFLS) (2005), taking into account the possible endogeneity of diabetes via an instrumental variable estimation strategy. We find that diabetes significantly decreases employment probabilities for men by about 10 percentage points (p<0.01) and somewhat less so for women - 4.5 percentage points (p<0.1)--without any indication of diabetes being endogenous. Further analysis shows that diabetes mainly affects the employment probabilities of men and women above the age of 44 and also has stronger effects on the poor than on the rich, particularly for men. We also find some indication for more adverse effects of diabetes on those in the large informal labour market compared to those in formal employment. Our results highlight--for the first time--the detrimental employment impact of diabetes in a developing country. Copyright © 2015 Elsevier B.V. All rights reserved.

Two-Year Outcomes with a Magnetically Levitated Cardiac Pump in Heart Failure.

PubMed

Mehra, Mandeep R; Goldstein, Daniel J; Uriel, Nir; Cleveland, Joseph C; Yuzefpolskaya, Melana; Salerno, Christopher; Walsh, Mary N; Milano, Carmelo A; Patel, Chetan B; Ewald, Gregory A; Itoh, Akinobu; Dean, David; Krishnamoorthy, Arun; Cotts, William G; Tatooles, Antone J; Jorde, Ulrich P; Bruckner, Brian A; Estep, Jerry D; Jeevanandam, Valluvan; Sayer, Gabriel; Horstmanshof, Douglas; Long, James W; Gulati, Sanjeev; Skipper, Eric R; O'Connell, John B; Heatley, Gerald; Sood, Poornima; Naka, Yoshifumi

2018-04-12

In an early analysis of this trial, use of a magnetically levitated centrifugal continuous-flow circulatory pump was found to improve clinical outcomes, as compared with a mechanical-bearing axial continuous-flow pump, at 6 months in patients with advanced heart failure. In a randomized noninferiority and superiority trial, we compared the centrifugal-flow pump with the axial-flow pump in patients with advanced heart failure, irrespective of the intended goal of support (bridge to transplantation or destination therapy). The composite primary end point was survival at 2 years free of disabling stroke (with disabling stroke indicated by a modified Rankin score of >3; scores range from 0 to 6, with higher scores indicating more severe disability) or survival free of reoperation to replace or remove a malfunctioning device. The noninferiority margin for the risk difference (centrifugal-flow pump group minus axial-flow pump group) was -10 percentage points. Of 366 patients, 190 were assigned to the centrifugal-flow pump group and 176 to the axial-flow pump group. In the intention-to-treat population, the primary end point occurred in 151 patients (79.5%) in the centrifugal-flow pump group, as compared with 106 (60.2%) in the axial-flow pump group (absolute difference, 19.2 percentage points; 95% lower confidence boundary, 9.8 percentage points [P<0.001 for noninferiority]; hazard ratio, 0.46; 95% confidence interval [CI], 0.31 to 0.69 [P<0.001 for superiority]). Reoperation for pump malfunction was less frequent in the centrifugal-flow pump group than in the axial-flow pump group (3 patients [1.6%] vs. 30 patients [17.0%]; hazard ratio, 0.08; 95% CI, 0.03 to 0.27; P<0.001). The rates of death and disabling stroke were similar in the two groups, but the overall rate of stroke was lower in the centrifugal-flow pump group than in the axial-flow pump group (10.1% vs. 19.2%; hazard ratio, 0.47; 95% CI, 0.27 to 0.84, P=0.02). In patients with advanced heart failure, a fully magnetically levitated centrifugal-flow pump was superior to a mechanical-bearing axial-flow pump with regard to survival free of disabling stroke or reoperation to replace or remove a malfunctioning device. (Funded by Abbott; MOMENTUM 3 ClinicalTrials.gov number, NCT02224755 .).

Cost-Effectiveness Analysis of a Television Campaign to Promote Seasonal Influenza Vaccination Among the Elderly.

PubMed

Kim, Minchul; Yoo, Byung-Kwang

2015-07-01

The U.S. policy goals regarding influenza vaccination coverage rate among the elderly include the increase in the coverage rate and the elimination of disparities across racial/ethnic groups. To examine the potential effectiveness of a television (TV) campaign to increase seasonal influenza vaccination among the elderly. We estimated the incremental cost-effectiveness ratio (ICER, defined as incremental cost per additionally vaccinated Medicare individual) of a hypothetical nationwide TV campaign for influenza vaccination compared with no campaign. We measured the effectiveness of the nationwide TV campaign (advertised once a week at prime time for 30 seconds) during a 17-week influenza vaccination season among four racial/ethnic elderly groups (N=39 million): non-Hispanic white (W), non-Hispanic African American (AA), English-speaking Hispanic (EH), and Spanish-speaking Hispanic (SH). The hypothetical campaign cost was $5,960,000 (in 2012 US dollars). The estimated campaign effectiveness ranged from -1.1% (the SH group) to 1.42% (the W group), leading to an increased disparity in influenza vaccination among non-Hispanic white and non-Hispanic African American (W-AA) groups (0.6 percentage points), W-EH groups (0.1 percentage points), and W-SH groups (1.5 percentage points). The estimated ICER was $23.54 (95% confidence interval $14.21-$39.37) per additionally vaccinated Medicare elderly in a probabilistic analysis. Race/ethnicity-specific ICERs were lowest among the EH group ($22.27), followed by the W group ($22.47) and the AA group ($30.55). The nationwide TV campaign was concluded to be reasonably cost-effective compared with a benchmark intervention (with ICER $44.39 per vaccinated individual) of a school-located vaccination program. Break-even analyses estimated the maximum acceptable campaign cost to be $14,870,000, which was comparable to the benchmark ICER. The results could justify public expenditures on the implementation of a future nationwide TV campaign, which should include multilingual campaigns, for promoting seasonal influenza vaccination. Copyright © 2015. Published by Elsevier Inc.

Radical Prostatectomy versus Observation for Localized Prostate Cancer

PubMed Central

Wilt, Timothy J.; Brawer, Michael K.; Jones, Karen M.; Barry, Michael J.; Aronson, William J.; Fox, Steven; Gingrich, Jeffrey R.; Wei, John T.; Gilhooly, Patricia; Grob, B. Mayer; Nsouli, Imad; Iyer, Padmini; Cartagena, Ruben; Snider, Glenn; Roehrborn, Claus; Sharifi, Roohollah; Blank, William; Pandya, Parikshit; Andriole, Gerald L.; Culkin, Daniel; Wheeler, Thomas

2012-01-01

BACKGROUND The effectiveness of surgery versus observation for men with localized prostate cancer detected by means of prostate-specific antigen (PSA) testing is not known. METHODS From November 1994 through January 2002, we randomly assigned 731 men with localized prostate cancer (mean age, 67 years; median PSA value, 7.8 ng per milliliter) to radical prostatectomy or observation and followed them through January 2010. The primary outcome was all-cause mortality; the secondary outcome was prostate-cancer mortality. RESULTS During the median follow-up of 10.0 years, 171 of 364 men (47.0%) assigned to radical prostatectomy died, as compared with 183 of 367 (49.9%) assigned to observation (hazard ratio, 0.88; 95% confidence interval [CI], 0.71 to 1.08; P = 0.22; absolute risk reduction, 2.9 percentage points). Among men assigned to radical prostatectomy, 21 (5.8%) died from prostate cancer or treatment, as compared with 31 men (8.4%) assigned to observation (hazard ratio, 0.63; 95% CI, 0.36 to 1.09; P = 0.09; absolute risk reduction, 2.6 percentage points). The effect of treatment on all-cause and prostate-cancer mortality did not differ according to age, race, coexisting conditions, self-reported performance status, or histologic features of the tumor. Radical prostatectomy was associated with reduced all-cause mortality among men with a PSA value greater than 10 ng per milliliter (P = 0.04 for interaction) and possibly among those with intermediate-risk or high-risk tumors (P = 0.07 for interaction). Adverse events within 30 days after surgery occurred in 21.4% of men, including one death. CONCLUSIONS Among men with localized prostate cancer detected during the early era of PSA testing, radical prostatectomy did not significantly reduce all-cause or prostate-cancer mortality, as compared with observation, through at least 12 years of follow-up. Absolute differences were less than 3 percentage points. (Funded by the Department of Veterans Affairs Cooperative Studies Program and others; PIVOT ClinicalTrials.gov number, NCT00007644.) PMID:22808955

Diabetes treatment and control: the effect of public health insurance for the poor in Mexico.

PubMed

Sosa-Rubí, Sandra G; Galárraga, Omar; López-Ridaura, Ruy

2009-07-01

To analyse the effect of enrolment in the public health insurance scheme known as Seguro Popular [People's Insurance] on access to health resources, treatment and blood glucose control among poor adults with diabetes in Mexico. We analysed cross-sectional data from the 2006 National Health and Nutrition Survey and compared health care access and biological health outcomes, specifically glycosylated haemoglobin (HbA1c) levels, among adults with diabetes who were enrolled in the Seguro Popular (treatment group) and those who had no health insurance (control group). Standard propensity score matching was used to create a highly comparable control group. Adults with diabetes who were enrolled in the Seguro Popular had significantly more access than comparable uninsured adults to some type of blood glucose control test (by a difference of 9.5 percentage points; 95% confidence interval, CI: 2.4-16.6) and to insulin injections (3.13 more per week; 95% CI: 0.04-6.22). Those with insurance were also significantly more likely to have appropriately-controlled blood glucose levels (HbA1c 12%) was found in a significantly smaller proportion of adults in the insured group than in the uninsured group (by a difference of 17.5 percentage points; 95% CI: 6.5-28.5). The Seguro Popular appears to have improved access to health care and blood glucose control among poor adults with diabetes in Mexico, and it may have had a positive effect on the management of other chronic health conditions, but its long-term effects are yet to be demonstrated. Although the findings are most relevant to Mexico, they may also be applicable to other developing countries seeking to improve health-care coverage for the poor by expanding their public health insurance programmes.

Comparative performance of public and private sector delivery of BCG vaccination: evidence from Sub-Saharan Africa.

PubMed

Wagner, Zachary; Szilagyi, Peter G; Sood, Neeraj

2014-07-31

The private sector is an important source of health care in the developing world. However, there is limited evidence on how private providers compare to public providers, particularly for preventive services such as immunizations. We used data from Sub-Saharan Africa (SSA) to assess public-private differences in Bacillus Calmette-Guérin (BCG) vaccine delivery. We used demographic and health surveys from 102,629 children aged 0-59 months from 29 countries across SSA to measure differences in BCG status for children born at private versus public health facilities (BCG is recommended at birth). We used a probit model to estimate public-private differences in BCG delivery, while controlling for key confounders. Next, we estimated how differences in BCG status evolved over time for children born at private versus public facilities. Finally, we estimated heterogeneity in public-private differences based on wealth and rural-urban residency. We found that children born at a private facility were 7.1 percentage points less likely to receive BCG vaccine in the same month as birth than children born at a public facility (95% CI 6.3-8.0; p<0.001). Most of this difference was driven by for-profit private providers (as opposed to NGOs) where the BCG provision rate was 10.0 percentage points less than public providers (95% CI 9.0-11.2; p<0.001) compared to only 2.4 percentage points for NGOs (95% CI 1.0-3. 8; p<0.01). Moreover, children born at private for-profit facilities remained less likely to be vaccinated up to 59 months after birth. Finally, public-private differences were more pronounced for poorer children and children in rural areas. The for-profit private sector performed substantially worse than the public sector in providing BCG vaccine to newborns, resulting in a longer duration of vulnerability to tuberculosis. This disparity was greater for poorer children and children in rural areas. Copyright © 2014 Elsevier Ltd. All rights reserved.

Surgery versus physiotherapy for stress urinary incontinence.

PubMed

Labrie, Julien; Berghmans, Bary L C M; Fischer, Kathelijn; Milani, Alfredo L; van der Wijk, Ileana; Smalbraak, Dina J C; Vollebregt, Astrid; Schellart, René P; Graziosi, Giuseppe C M; van der Ploeg, J Marinus; Brouns, Joseph F G M; Tiersma, E Stella M; Groenendijk, Annette G; Scholten, Piet; Mol, Ben Willem; Blokhuis, Elisabeth E; Adriaanse, Albert H; Schram, Aaltje; Roovers, Jan-Paul W R; Lagro-Janssen, Antoine L M; van der Vaart, Carl H

2013-09-19

Physiotherapy involving pelvic-floor muscle training is advocated as first-line treatment for stress urinary incontinence; midurethral-sling surgery is generally recommended when physiotherapy is unsuccessful. Data are lacking from randomized trials comparing these two options as initial therapy. We performed a multicenter, randomized trial to compare physiotherapy and midurethral-sling surgery in women with stress urinary incontinence. Crossover between groups was allowed. The primary outcome was subjective improvement, measured by means of the Patient Global Impression of Improvement at 12 months. We randomly assigned 230 women to the surgery group and 230 women to the physiotherapy group. A total of 49.0% of women in the physiotherapy group and 11.2% of women in the surgery group crossed over to the alternative treatment. In an intention-to-treat analysis, subjective improvement was reported by 90.8% of women in the surgery group and 64.4% of women in the physiotherapy group (absolute difference, 26.4 percentage points; 95% confidence interval [CI], 18.1 to 34.5). The rates of subjective cure were 85.2% in the surgery group and 53.4% in the physiotherapy group (absolute difference, 31.8 percentage points; 95% CI, 22.6 to 40.3); rates of objective cure were 76.5% and 58.8%, respectively (absolute difference, 17.8 percentage points; 95% CI, 7.9 to 27.3). A post hoc per-protocol analysis showed that women who crossed over to the surgery group had outcomes similar to those of women initially assigned to surgery and that both these groups had outcomes superior to those of women who did not cross over to surgery. For women with stress urinary incontinence, initial midurethral-sling surgery, as compared with initial physiotherapy, results in higher rates of subjective improvement and subjective and objective cure at 1 year. (Funded by ZonMw, the Netherlands Organization for Health Research and Development; Dutch Trial Register number, NTR1248.).

The stature of the self-employed and its relation with earnings and satisfaction.

PubMed

Rietveld, Cornelius A; Hessels, Jolanda; van der Zwan, Peter

2015-04-01

Taller individuals have on average a higher socio-economic status than shorter individuals. In countries where entrepreneurs have high social status, we may therefore expect that entrepreneurs are taller than wage workers. Using data from the German Socio-Economic Panel (2002-2012), we find that a 1cm increase in an individual's height raises the probability of being self-employed (the most common proxy for entrepreneurship) versus paid employed by 0.15 percentage points. Within the self-employed, the probability of being an employer is increased by 0.10 percentage points as a result of a 1cm increase in height, whereas this increase is 0.05 percentage points for an own-account worker. This result corroborates the higher social status of employers compared to own-account workers. We find a height premium in earnings for self-employed and paid-employed individuals: an additional 1cm in height is associated with a 0.39% increase in hourly earnings for paid employees and a 0.52% increase for self-employed individuals. Our analysis reveals that approximately one third of the height premium in earnings is explained by differences in educational attainment. We also establish the existence of a height premium in terms of work and life satisfaction, which is more pronounced for paid employees than for self-employed individuals. Copyright © 2015 Elsevier B.V. All rights reserved.

A Participatory Randomized Controlled Trial in Knowledge Translation (KT) to Promote the Adoption of Self-Monitoring of Blood Glucose for Type 2 Diabetes Mellitus Patients in An Urban District of Thailand.

PubMed

Suriyawongpaisal, Paibul; Tansirisithikul, Rassamee; Sakulpipat, Thida; Charoensuk, Phikul; Aekplakorn, Wichai

2016-02-01

To examine effectiveness of self-monitoring of blood glucose (SMBG) in glycemic control for poor control diabetes patients, and test whether the glycemic outcome for those with the 7-point SMBG was better than those with 5-point SMBG or usual care. Randomized-controlled trial (RCT) of patients with type 2 diabetes mellitus aged 30 years or older HbA1c > 7. Patients were randomly allocated to one of three groups; 7-point SMBG 5-point SBMG and control group. Differences in HbA1c at 6 months and baseline were compared among groups. A total of 191 patients with poor control of diabetes were included. Compared with baseline, at 6 months, average change in HbAlc among control, 7-point, and 5-point SMBG were -0.38, -0.87, and -0.99 (p = 0.04), respectively. The corresponding percentages of patients with reduced HbA1c were 57.1%, 77.6% and 75.5%, respectively (p = 0.03). Using different cut-off values for HbA1c (< 7 and < 7.5) resulted in different percentage distribution of T2DM patients among the 3 groups, yet the differences were not statistically significant. Reductions in body weight were observed in both SMBG groups but not in the control group. Using RCT on participatory basis, SMBG with individual dietary counseling was effective in short term. Further engagement with the provider team, the patients/care takers and the health care financing agency to integrate SMBG in the care protocol for poor control diabetes should be considered.

Impacts of the Affordable Care Act's Medicaid Expansion on Women of Reproductive Age: Differences by Parental Status and State Policies.

PubMed

Johnston, Emily M; Strahan, Andrea E; Joski, Peter; Dunlop, Anne L; Adams, E Kathleen

We use data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2012 to 2015 to estimate the effects of the Affordable Care Act's (ACA) Medicaid expansions on insurance coverage and access to care for low-income women of reproductive age (19-44). We use two-way fixed effects difference-in-differences models to estimate the effects of Medicaid expansions on low-income (<100% of the Federal Poverty Level) women of reproductive age. Additional models are stratified to estimate effects based on women's parental status, pre-ACA state Medicaid eligibility levels, and the presence of a state Medicaid family planning waiver. ACA Medicaid expansions decreased uninsurance among low-income women of reproductive age by 13.2 percentage points. This decrease was driven by a decrease of 27.4 percentage points for women without dependent children, who also experienced a decrease in the likelihood of not having a personal doctor (13.3 percentage points). We find a 3.8-percentage point reduction in the likelihood of experiencing a cost barrier to care among all women, but no significant effects for other access measures or subgroups. When stratified by state policies, decreases in uninsurance were greater in states expanding from pre-ACA eligibility levels of less than 50% of Federal Poverty Level (19.4 percentage points) and in states without a Medicaid family planning waiver (17.6 percentage points). The ACA Medicaid expansion increased insurance coverage for low-income women of reproductive age, with the greatest effects for women without dependent children and women residing in states with relatively lower pre-ACA Medicaid eligibility levels or with no family planning waiver before the ACA. Copyright © 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Registry-based Study of Trends in Breast Cancer Screening Mammography before and after the 2009 U.S. Preventive Services Task Force Recommendations

PubMed Central

Bolton, Kenyon C.; Mace, John L.; Herschorn, Sally D.; James, Ted A.; Vacek, Pamela M.; Weaver, Donald L.; Geller, Berta M.

2014-01-01

Purpose To determine whether the 2009 U.S. Preventive Services Task Force (USPSTF) guidelines for breast cancer mammography screening were followed by changes in screening utilization in the state of Vermont. Materials and Methods This retrospective study was HIPAA compliant and approved by the institutional review board, with waiver of informed consent. Trends in screening mammography utilization during 1997–2011 were examined among approximately 150 000 women aged 40 years and older in the state of Vermont using statewide mammography registry data. Results The percentage of Vermont women aged 40 years and older screened in the past year declined from 45.3% in 2009% to 41.6% in 2011 (an absolute decrease of −3.7 percentage points; 95% confidence interval [CI]: −3.3, −4.1). The largest decline in utilization was among women aged 40–49 years (−4.8 percentage points; 95% CI: −4.1, −5.4), although substantial declines were also observed among women aged 50–74 years (−3.0 percentage points; 95% CI: −2.6, −3.5) and women aged 75 years and older (−3.1 percentage points; 95% CI: −2.3, −4.0). The percentage of women aged 50–74 years screened within the past 2 years declined by −3.4 percentage points (95% CI: −3.0, −3.9) from 65.4% in 2009 to 61.9% in 2011. Conclusion After years of increasing screening mammography utilization in Vermont, there was a decline in screening, which coincided with the release of the 2009 USPSTF recommendations. The age-specific patterns in utilization were generally consistent with the USPSTF recommendations, although there was also evidence that the percentage of women aged 50–74 years screened in the past 2 years declined since 2009. © RSNA, 2013 PMID:24072778

Reducing Stock-Outs of Life Saving Malaria Commodities Using Mobile Phone Text-Messaging: SMS for Life Study in Kenya

PubMed Central

Githinji, Sophie; Kigen, Samwel; Memusi, Dorothy; Nyandigisi, Andrew; Mbithi, Agneta M.; Wamari, Andrew; Muturi, Alex N.; Jagoe, George; Barrington, Jim; Snow, Robert W.; Zurovac, Dejan

2013-01-01

Background Health facility stock-outs of life saving malaria medicines are common across Africa. Innovative ways of addressing this problem are urgently required. We evaluated whether SMS based reporting of stocks of artemether-lumefantrine (AL) and rapid diagnostic tests (RDT) can result in reduction of stock-outs at peripheral facilities in Kenya. Methods/Findings All 87 public health facilities in five Kenyan districts were included in a 26 week project. Weekly facility stock counts of four AL packs and RDTs were sent via structured incentivized SMS communication process from health workers’ personal mobile phones to a web-based system accessed by district managers. The mean health facility response rate was 97% with a mean formatting error rate of 3%. Accuracy of stock count reports was 79% while accuracy of stock-out reports was 93%. District managers accessed the system 1,037 times at an average of eight times per week. The system was accessed in 82% of the study weeks. Comparing weeks 1 and 26, stock-out of one or more AL packs declined by 38 percentage-points. Total AL stock-out declined by 5 percentage-points and was eliminated by the end of the project. Stock-out declines of individual AL packs ranged from 14 to 32 percentage-points while decline in RDT stock-outs was 24 percentage-points. District managers responded to 44% of AL and 73% of RDT stock-out signals by redistributing commodities between facilities. In comparison with national trends, stock-out declines in study areas were greater, sharper and more sustained. Conclusions Use of simple SMS technology ensured high reporting rates of reasonably accurate, real-time facility stock data that were used by district managers to undertake corrective actions to reduce stock-outs. Future work on stock monitoring via SMS should focus on assessing response rates without use of incentives and demonstrating effectiveness of such interventions on a larger scale. PMID:23349786

Early impact of Medicare accountable care organizations on cancer surgery outcomes.

PubMed

Herrel, Lindsey A; Norton, Edward C; Hawken, Scott R; Ye, Zaojun; Hollenbeck, Brent K; Miller, David C

2016-09-01

Accountable care organizations (ACOs) were established to improve care and outcomes for beneficiaries requiring highly coordinated, complex care. The objective of this study was to evaluate the association between hospital ACO participation and the outcomes of major surgical oncology procedures. This was a retrospective cohort study of Medicare beneficiaries older than 65 years who were undergoing a major surgical resection for colorectal, bladder, esophageal, kidney, liver, ovarian, pancreatic, lung, or prostate cancer from 2011 through 2013. A difference-in-differences analysis was implemented to compare the postimplementation period (January 2013 through December 2013) with the baseline period (January 2011 through December 2012) to assess the impact of hospital ACO participation on 30-day mortality, complications, readmissions, and length of stay (LOS). Among 384,519 patients undergoing major cancer surgery at 106 ACO hospitals and 2561 control hospitals, this study found a 30-day mortality rate of 3.4%, a readmission rate of 12.5%, a complication rate of 43.8%, and a prolonged LOS rate of 10.0% in control hospitals and similar rates in ACO hospitals. Secular trends were noted, with reductions in perioperative adverse events in control hospitals between the baseline and postimplementation periods: mortality (percentage-point reduction, 0.1%; P = .19), readmissions (percentage-point reduction, 0.4%; P = .001), complications (percentage-point reduction, 1.0%; P < .001), and prolonged LOS (percentage-point reduction, 1.1%; P < .001). After accounting for these secular trends, this study identified no significant effect of hospital participation in an ACO on the frequency of perioperative outcomes (difference-in-differences estimator P values, .24-.72). Early hospital participation in the Medicare Shared Savings Program ACO program was not associated with greater reductions in adverse perioperative outcomes for patients undergoing major cancer surgery in comparison with control hospitals. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2739-2746. © 2016 American Cancer Society. © 2016 American Cancer Society.

Effect of adding systematic family history enquiry to cardiovascular disease risk assessment in primary care: a matched-pair, cluster randomized trial.

PubMed

Qureshi, Nadeem; Armstrong, Sarah; Dhiman, Paula; Saukko, Paula; Middlemass, Joan; Evans, Philip H; Kai, Joe

2012-02-21

Evidence of the value of systematically collecting family history in primary care is limited. To evaluate the feasibility of systematically collecting family history of coronary heart disease in primary care and the effect of incorporating these data into cardiovascular risk assessment. Pragmatic, matched-pair, cluster randomized, controlled trial. (International Standardized Randomized Controlled Trial Number Register: ISRCTN 17943542). 24 family practices in the United Kingdom. 748 persons aged 30 to 65 years with no previously diagnosed cardiovascular risk, seen between July 2007 and March 2009. Participants in control practices had the usual Framingham-based cardiovascular risk assessment with and without use of existing family history information in their medical records. Participants in intervention practices also completed a questionnaire to systematically collect their family history. All participants were informed of their risk status. Participants with high cardiovascular risk were invited for a consultation. The primary outcome was the proportion of participants with high cardiovascular risk (10-year risk ≥ 20%). Other measures included questionnaire completion rate and anxiety score. 98% of participants completed the family history questionnaire. The mean increase in proportion of participants classified as having high cardiovascular risk was 4.8 percentage points in the intervention practices, compared with 0.3 percentage point in control practices when family history from patient records was incorporated. The 4.5-percentage point difference between groups (95% CI, 1.7 to 7.2 percentage points) remained significant after adjustment for participant and practice characteristics (P = 0.007). Anxiety scores were similar between groups. Relatively few participants were from ethnic minority or less-educated groups. The potential to explore behavioral change and clinical outcomes was limited. Many data were missing for anxiety scores. Systematically collecting family history increases the proportion of persons identified as having high cardiovascular risk for further targeted prevention and seems to have little or no effect on anxiety. Genetics Health Services Research program of the United Kingdom Department of Health.

The nature of surgeon human capital depreciation.

PubMed

Hockenberry, Jason M; Helmchen, Lorens A

2014-09-01

To test how practice interruptions affect worker productivity, we estimate how temporal breaks affect surgeons' performance of coronary artery bypass grafting (CABG). Examining 188 surgeons who performed 56,315 CABG surgeries in Pennsylvania between 2006 and 2010, we find that a surgeon's additional day away from the operating room raised patients' inpatient mortality by up to 0.067 percentage points (2.4% relative effect) but reduced total hospitalization costs by up to 0.59 percentage points. Among emergent patients treated by high-volume providers, where temporal distance is most plausibly exogenous, an additional day away raised mortality risk by 0.398 percentage points (11.4% relative effect) but reduced cost by up to 1.4 percentage points. This is consistent with the hypothesis that as temporal distance increases, surgeons are less likely to recognize and address life-threatening complications. Our estimates imply additional intraprocedural treatment intensity has a cost per life-year preserved of $7871-18,500, well within conventional cost-effectiveness cutoffs. Copyright © 2014 Elsevier B.V. All rights reserved.

Does Raising the Early Retirement Age Increase Employment of Older Workers?*

PubMed Central

Staubli, Stefan; Zweimüller, Josef

2013-01-01

Two pension reforms in Austria increased the early retirement age (ERA) from 60 to 62 for men and from 55 to 58.25 for women. We find that raising the ERA increased employment by 9.75 percentage points among affected men and by 11 percentage points among affected women. The reforms had large spillover effects on the unemployment insurance program but negligible effects on disability insurance claims. Specifically, unemployment increased by 12.5 percentage points among men and by 11.8 percentage points among women. The employment response was largest among high-wage and healthy workers, while low-wage and less healthy workers either continued to retire early via disability benefits or bridged the gap to the ERA via unemployment benefits. Taking spillover effects and additional tax revenues into account, we find that for a typical birth-year cohort a one year increase in the ERA resulted in a reduction of net government expenditures of 107 million euros for men and of 122 million euros for women. PMID:24319299

Does Raising the Early Retirement Age Increase Employment of Older Workers?

PubMed

Staubli, Stefan; Zweimüller, Josef

2013-12-01

Two pension reforms in Austria increased the early retirement age (ERA) from 60 to 62 for men and from 55 to 58.25 for women. We find that raising the ERA increased employment by 9.75 percentage points among affected men and by 11 percentage points among affected women. The reforms had large spillover effects on the unemployment insurance program but negligible effects on disability insurance claims. Specifically, unemployment increased by 12.5 percentage points among men and by 11.8 percentage points among women. The employment response was largest among high-wage and healthy workers, while low-wage and less healthy workers either continued to retire early via disability benefits or bridged the gap to the ERA via unemployment benefits. Taking spillover effects and additional tax revenues into account, we find that for a typical birth-year cohort a one year increase in the ERA resulted in a reduction of net government expenditures of 107 million euros for men and of 122 million euros for women.

Comparative analysis of respiratory motion tracking using Microsoft Kinect v2 sensor.

PubMed

Silverstein, Evan; Snyder, Michael

2018-05-01

To present and evaluate a straightforward implementation of a marker-less, respiratory motion-tracking process utilizing Kinect v2 camera as a gating tool during 4DCT or during radiotherapy treatments. Utilizing the depth sensor on the Kinect as well as author written C# code, respiratory motion of a subject was tracked by recording depth values obtained at user selected points on the subject, with each point representing one pixel on the depth image. As a patient breathes, specific anatomical points on the chest/abdomen will move slightly within the depth image across pixels. By tracking how depth values change for a specific pixel, instead of how the anatomical point moves throughout the image, a respiratory trace can be obtained based on changing depth values of the selected pixel. Tracking these values was implemented via marker-less setup. Varian's RPM system and the Anzai belt system were used in tandem with the Kinect to compare respiratory traces obtained by each using two different subjects. Analysis of the depth information from the Kinect for purposes of phase- and amplitude-based binning correlated well with the RPM and Anzai systems. Interquartile Range (IQR) values were obtained comparing times correlated with specific amplitude and phase percentages against each product. The IQR time spans indicated the Kinect would measure specific percentage values within 0.077 s for Subject 1 and 0.164 s for Subject 2 when compared to values obtained with RPM or Anzai. For 4DCT scans, these times correlate to less than 1 mm of couch movement and would create an offset of 1/2 an acquired slice. By tracking depth values of user selected pixels within the depth image, rather than tracking specific anatomical locations, respiratory motion can be tracked and visualized utilizing the Kinect with results comparable to that of the Varian RPM and Anzai belt. © 2018 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

The effect of organizational climate on patient-centered medical home implementation.

PubMed

Reddy, Ashok; Shea, Judy A; Canamucio, Anne; Werner, Rachel M

2015-01-01

Organizational climate is a key determinant of successful adoption of innovations; however, its relation to medical home implementation is unknown. This study examined the association between primary care providers' (PCPs') perception of organization climate and medical home implementation in the Veterans Health Administration. Multivariate regression was used to test the hypothesis that organizational climate predicts medical home implementation. This analysis of 191 PCPs found that higher scores in 2 domains of organizational climate (communication and cooperation, and orientation to quality improvement) were associated with a statistically significantly higher percentage (from 7 to 10 percentage points) of PCPs implementing structural changes to support the medical home model. In addition, some aspects of a better organizational climate were associated with improved organizational processes of care, including a higher percentage of patients contacted within 2 days of hospital discharge (by 2 to 3 percentage points) and appointments made within 3 days of a patient request (by 2 percentage points). © The Author(s) 2014.

Behavior change communication activities improve infant and young child nutrition knowledge and practice of neighboring non-participants in a cluster-randomized trial in rural Bangladesh.

PubMed

Hoddinott, John; Ahmed, Ishita; Ahmed, Akhter; Roy, Shalini

2017-01-01

To examine the impact on infant and young child nutrition knowledge and practice of mothers who were neighbors of mothers participating in a nutrition Behavior Change Communication (BCC) intervention in rural Bangladesh. We analyzed data from 300 mothers whose neighbor participated in a nutrition BCC intervention and 600 mothers whose neighbor participated in an intervention that did not include BCC. We constructed measures capturing mothers' knowledge of infant and young child nutrition (IYCN) and measures of food consumption by children 6-24m. The effect on these outcomes of exposure to a neighbor receiving a nutrition BCC intervention was estimated using ordinary least squares and probit regressions. The study was registered with ClinicalTrials.gov (Study ID: NCT02237144). Having a neighboring mother participate in a nutrition BCC intervention increased non-participant mothers' IYCN knowledge by 0.17 SD (translating to 0.3 more correct answers). They were 14.1 percentage points more likely to feed their 6-24m children legumes and nuts; 11.6 percentage points more likely to feed these children vitamin A rich fruits and vegetables; and 10.0 percentage points more likely to feed these children eggs. Children of non-participant mothers who had a neighboring mother participate in a nutrition BCC intervention were 13.8 percentage points more likely to meet World Health Organization (WHO) guidelines for minimum diet diversity, 11.9 percentage points more likely to meet WHO guidelines for minimum acceptable diet, and 10.3 percentage points more likely to meet WHO guidelines for minimum meal frequency for children who continue to be breastfed after age 6m. Children aged 0-6m of non-participant mothers who are neighbors of mothers receiving BCC were 7.1 percentage points less likely to have ever consumed water-based liquids. Studies of nutrition BCC that do not account for information spillovers to non-participants may underestimate its benefits in terms of IYCN knowledge and practice.

Behavior change communication activities improve infant and young child nutrition knowledge and practice of neighboring non-participants in a cluster-randomized trial in rural Bangladesh

PubMed Central

Ahmed, Ishita; Ahmed, Akhter; Roy, Shalini

2017-01-01

Objective To examine the impact on infant and young child nutrition knowledge and practice of mothers who were neighbors of mothers participating in a nutrition Behavior Change Communication (BCC) intervention in rural Bangladesh. Methods We analyzed data from 300 mothers whose neighbor participated in a nutrition BCC intervention and 600 mothers whose neighbor participated in an intervention that did not include BCC. We constructed measures capturing mothers’ knowledge of infant and young child nutrition (IYCN) and measures of food consumption by children 6-24m. The effect on these outcomes of exposure to a neighbor receiving a nutrition BCC intervention was estimated using ordinary least squares and probit regressions. The study was registered with ClinicalTrials.gov (Study ID: NCT02237144). Results Having a neighboring mother participate in a nutrition BCC intervention increased non-participant mothers’ IYCN knowledge by 0.17 SD (translating to 0.3 more correct answers). They were 14.1 percentage points more likely to feed their 6-24m children legumes and nuts; 11.6 percentage points more likely to feed these children vitamin A rich fruits and vegetables; and 10.0 percentage points more likely to feed these children eggs. Children of non-participant mothers who had a neighboring mother participate in a nutrition BCC intervention were 13.8 percentage points more likely to meet World Health Organization (WHO) guidelines for minimum diet diversity, 11.9 percentage points more likely to meet WHO guidelines for minimum acceptable diet, and 10.3 percentage points more likely to meet WHO guidelines for minimum meal frequency for children who continue to be breastfed after age 6m. Children aged 0-6m of non-participant mothers who are neighbors of mothers receiving BCC were 7.1 percentage points less likely to have ever consumed water-based liquids. Conclusions Studies of nutrition BCC that do not account for information spillovers to non-participants may underestimate its benefits in terms of IYCN knowledge and practice. PMID:28636674

Comparison of the Relative Effectiveness of Different Kinds of Reinforcers: A PEM Approach

ERIC Educational Resources Information Center

Ma, Hsen-Hsing

2009-01-01

The purpose of the present study was to apply the percentage of data points exceeding the median of baseline phase (PEM) approach for a meta-analysis of single-case experiments to compare the relative effectiveness of different kinds of reinforcers used in behavior modification. Altogether 153 studies were located, which produced 1091 effect…

Does Having Digital Skills Really Pay Off? Adult Skills in Focus. No. 1

ERIC Educational Resources Information Center

OECD Publishing, 2015

2015-01-01

Having the highest levels of skills in problem solving using ICT (information and communication technologies) increases chances of participating in the labour force by six percentage points compared with adults who have the lowest levels of these skills, even after accounting for various other factors, such as age, gender, level of education,…

Longitudinal Indicators of the Social Context of Families: Beyond the Snapshot

ERIC Educational Resources Information Center

Moore, Kristin Anderson; Vandivere, Sharon

2007-01-01

Longitudinal indicators are measures of an individual or family behavior, interaction, attitude, or value that are assessed consistently or comparably across multiple points in time and cumulated over time. Examples include the percentage of time a family lived in poverty or the proportion of childhood a person lived in a single-parent family.…

A dementia care management intervention: which components improve quality?

PubMed

Chodosh, Joshua; Pearson, Marjorie L; Connor, Karen I; Vassar, Stefanie D; Kaisey, Marwa; Lee, Martin L; Vickrey, Barbara G

2012-02-01

To analyze whether types of providers and frequency of encounters are associated with higher quality of care within a coordinated dementia care management (CM) program for patients and caregivers. Secondary analysis of intervention-arm data from a dementia CM cluster-randomized trial, where intervention participants interacted with healthcare organization care managers (HOCMs), community agency care managers (CACMs), and/ or healthcare organization primary care providers (HOPCPs) over 18 months. Encounters of 238 patient/caregivers (dyads) with HOCMs, CACMs, and HOPCPs were abstracted from care management electronic records. The quality domains of assessment, treatment, education/support, and safety were measured from medical record abstractions and caregiver surveys. Mean percentages of met quality indicators associated with exposures to each provider type and frequency were analyzed using multivariable regression, adjusting for participant characteristics and baseline quality. As anticipated, for all 4 domains, the mean percentage of met dementia quality indicators was 15.5 to 47.2 percentage points higher for dyads with HOCM--only exposure than for dyads with none (all P < .008); not anticipated were higher mean percentages with increasing combinations of provider-type exposure-up to 73.7 percentage points higher for safety (95% confidence interval 65.2%-82.1%) with exposure to all 3 provider types compared with no exposure. While greater frequency of HOCM-dyad encounters was associated with higher quality (P < .04), this was not so for other provider types. HOCMs' interactions with dyads was essential for dementia care quality improvement. Additional coordinated interactions with primary care and community agency staff yielded even higher quality.

The impact of HMOs on hospital-based uncompensated care.

PubMed

Thorpe, K E; Seiber, E E; Florence, C S

2001-06-01

Managed care in general and HMOs in particular have become the vehicle of choice for controlling health care spending in the private sector. By several accounts, managed care has achieved its cost-containment objectives. At the same time, the percentage of Americans without health insurance coverage continues to rise. For-profit and not-for-profit hospitals have traditionally financed care for the uninsured from profits derived from patients with insurance. Thus the relationship between growth in managed care and HMOs, hospital "profits," and care for the uninsured represent an important policy question. Using national data over an eight-year period, we find that a ten-percentage point increase in managed care penetration is associated with a two-percentage point reduction in hospital total profit margin and a 0.6 percentage point decrease in uncompensated care.

Methods and Apparatuses for Signaling with Geometric Constellations

NASA Technical Reports Server (NTRS)

Barsoum, Maged F. (Inventor); Jones, Christopher R. (Inventor)

2018-01-01

Communication systems are described that use signal constellations, which have unequally spaced (i.e. `geometrically` shaped) points. In many embodiments, the communication systems use specific geometric constellations that are capacity optimized at a specific SNR. In addition, ranges within which the constellation points of a capacity optimized constellation can be perturbed and are still likely to achieve a given percentage of the optimal capacity increase compared to a constellation that maximizes d.sub.min, are also described. Capacity measures that are used in the selection of the location of constellation points include, but are not limited to, parallel decode (PD) capacity and joint capacity.

Methods and apparatuses for signaling with geometric constellations

NASA Technical Reports Server (NTRS)

Jones, Christopher R. (Inventor); Barsoum, Maged F. (Inventor)

2012-01-01

Communication systems are described that use signal constellations, which have unequally spaced (i.e. geometrically shaped) points. In many embodiments, the communication systems use specific geometric constellations that are capacity optimized at a specific SNR. In addition, ranges within which the constellation points of a capacity optimized constellation can be perturbed and are still likely to achieve a given percentage of the optimal capacity increase compared to a constellation that maximizes d.sub.min, are also described. Capacity measures that are used in the selection of the location of constellation points include, but are not limited to, parallel decode (PD) capacity and joint capacity.

Image registration with uncertainty analysis

DOEpatents

Simonson, Katherine M [Cedar Crest, NM

2011-03-22

In an image registration method, edges are detected in a first image and a second image. A percentage of edge pixels in a subset of the second image that are also edges in the first image shifted by a translation is calculated. A best registration point is calculated based on a maximum percentage of edges matched. In a predefined search region, all registration points other than the best registration point are identified that are not significantly worse than the best registration point according to a predetermined statistical criterion.

Prospective and retrospective examination of an easily applicable score to predict the probability of premature birth defined by weight.

PubMed

Thalhammer, O; Coradello, H; Pollak, A; Scheibenreiter, S; Simbruner, G

1976-01-01

An easily applicable score to predict the risk of prematurity (Tab. I) (defined by weight) is examined prospectively (scoring during 6 th month of pregnancy) in 431 and retrospectively (obtained after delivery) in 1183 pregnancies. In the prospective study (Tab. II) 71.4% of all pregnancies resulting in babies below 2501 g exceed the proposed 50 points risk probabilty limit whereas only 18.7% of pregnancies with babies of more than 3000 g do so. Excluding pregnancies with 20 or more risk points and excellent prenatal care (8 or more consultations) - which should change the outcome of risk-pregnancies - the percentages are 77.8% and 12.2% respectively (Tab. III). Pregnancies resulting in babies with birth weight of 2501 g -2750 g exceeded the limit in 38.9% and those with babies of 2751 g-3000 g in 20.7%. If 60 risk points are used as the limit the percentages for more than 3000 g until less than 2501 g would be 8.2%, 6.9%, 33.3% and 66.7%. In the resrospective study (Tab. V) 14.7% of all pregnancies with babies above 3000 g exceeded the 50 risk points limit compared with 57.2 of those with babies below 2501 g. Excluding pregnancies with 20 or more risk points and excellent prental care the percentages are 7.6 and 59.4 respectively. In the retrospective study the influence of the quality of prenatal care by the number of consultations (3-4; 5-7; 8 or more) is clearly demonstrable: Pregnancies with more than 50 risk points resulted in 80.7%, 57.1% and 19.8% depending on the quality of care in babies below 2501 g. Pregnancies with 31-50 risk points did so in 47.2%, 20.4% and 11.8%. In 334 women the score could be applied twice, in the 6th month and at delivery. Comparing both scores it was found that only 1.8% of these women exceeded the 50 risk points limit by events occurring after the 6th month scoring (Tab. IV). The score, simple enough to be applied by nurses and midwives, seems to be able to select 77.8% of pregnancies resulting in babies below 2501 g already during the 6th month of pregnancy, i.e. early enough for preventive measures to be taken that decrease the frequency of underweight births by three quarters.

5 CFR 841.703 - Increases on basic annuities and survivor annuities.

Code of Federal Regulations, 2011 CFR

2011-01-01

... annuities are the greater of— (1) One dollar per month; or (2)(i) If the percentage change is less than 2 percent, the percentage change; (ii) If the percentage change is at least 2 percent and not greater than 3 percent, 2 percent; and (iii) If the percentage change exceeds 3 percent, 1 percentage point less than the...

5 CFR 841.703 - Increases on basic annuities and survivor annuities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... annuities are the greater of— (1) One dollar per month; or (2)(i) If the percentage change is less than 2 percent, the percentage change; (ii) If the percentage change is at least 2 percent and not greater than 3 percent, 2 percent; and (iii) If the percentage change exceeds 3 percent, 1 percentage point less than the...

The impact of an integrated population health enhancement and disease management program on employee health risk, health conditions, and productivity.

PubMed

Loeppke, Ron; Nicholson, Sean; Taitel, Michael; Sweeney, Matthew; Haufle, Vince; Kessler, Ronald C

2008-12-01

This study evaluated the impact of an integrated population health enhancement program on employee health risks, health conditions, and productivity. Specifically, we analyzed changes in these measures among a cohort of 543 employees who completed a health risk assessment in both 2003 and 2005. We compared these findings with 2 different sets of employees who were not offered health enhancement programming. We found that the DIRECTV cohort showed a significant reduction in health risks after exposure to the program. Relative to a matched comparison group, the proportion of low-risk employees at DIRECTV in 2005 was 8.2 percentage points higher; the proportion of medium-risk employees was 7.1 percentage points lower; and the proportion of high-risk employees was 1.1 percentage points lower (p < 0.001). The most noticeable changes in health risk were a reduction in the proportion of employees with high cholesterol; an improvement in diet; a reduction of heavy drinking; management of high blood pressure; improved stress management; increased exercise; fewer smokers; and a drop in obesity rates. We also found that a majority of employees who improved their risk levels from 2003 to 2005 maintained their gains in 2006. Employees who improved their risks levels also demonstrated relative improvement in absenteeism. Overall, this study provides additional evidence that integrated population health enhancement positively impacts employees' health risk and productivity; it also reinforces the view that "good health is good business."

Rural Poverty at Record Low in 2000.

ERIC Educational Resources Information Center

Jolliffe, Dean

2002-01-01

In 2000 the nonmetro poverty rate was 13.4 percent, the lowest level on record; was 2.8 percentage points higher than the metro rate; and was highest in the West and the South, which also had the largest rural-urban disparities. The nonmetro child poverty rate was 19 percent, compared to 13 percent for nonelderly adults, a persistent disparity for…

Increasing Seat Belt Use on a College Campus: An Evaluation of Two Prompting Procedures

ERIC Educational Resources Information Center

Clayton, Michael C.; Helms, Bridgett P.

2009-01-01

Seat belt use is an important factor in the prevention of automobile accidents involving injuries and fatalities. The current study used a multielement design to compare the "Click It or Ticket" and "Please Buckle Up--I Care" procedures. Results indicate that the Click It or Ticket prompt resulted in a 20-percentage-point increase in seat belt…

Two-stage fan. 4: Performance data for stator setting angle optimization

NASA Technical Reports Server (NTRS)

Burger, G. D.; Keenan, M. J.

1975-01-01

Stator setting angle optimization tests were conducted on a two-stage fan to improve efficiency at overspeed, stall margin at design speed, and both efficiency and stall margin at partspeed. The fan has a design pressure ratio of 2.8, a flow rate of 184.2 lb/sec (83.55 kg/sec) and a 1st-stage rotor tip speed of 1450 ft/sec (441.96 in/sec). Performance was obtained at 70,100, and 105 percent of design speed with different combinations of 1st-stage and 2nd-stage stator settings. One combination of settings, other than design, was common to all three speeds. At design speed, a 2.0 percentage point increase in stall margin was obtained at the expense of a 1.3 percentage point efficiency decrease. At 105 percent speed, efficiency was improved by 1.8 percentage points but stall margin decreased 4.7 percentage points. At 70 percent speed, no change in stall margin or operating line efficiency was obtained with stator resets although considerable speed-flow requlation occurred.

Geographic Disparities in Access to Nursing Home Services: Assessing Fiscal Stress and Quality of Care.

PubMed

Park, Young Joo; Martin, Erika G

2017-11-12

We test whether nursing homes serving predominately low-income and racial minority residents (compositional explanation) or located in neighborhoods with higher concentrations of low-income and racial minority residents (contextual explanation) have worse financial outcomes and care quality. Healthcare Cost Report Information System, Nursing Home Compare, Online Survey Certification and Reporting Certification, and American Community Survey. A cross-sectional study design of nursing homes within U.S. metropolitan areas. Data were obtained from Centers for Medicare & Medicaid Services and U.S. Census Bureau. Medicaid-dependent nursing homes have a 3.5 percentage point lower operating ratio. Those serving primarily racial minorities have a 2.64-point lower quality rating. A 1 percent increase in the neighborhood population living in poverty is associated with a 1.20-point lower quality rating, on a scale from 10 to 50, and a 1 percent increase in the portion of neighborhood black residents is associated with a 0.8 percentage point lower operating ratio and a 0.37 lower quality rating. Medicaid dependency (compositional effect) and concentration of racial minority residents in neighborhoods (contextual effect) are associated with higher fiscal stress and lower quality of care, indicating that nursing homes' geographic location may exacerbate long-term care inequalities. © Health Research and Educational Trust.

Topical tofacitinib for atopic dermatitis: a phase IIa randomized trial.

PubMed

Bissonnette, R; Papp, K A; Poulin, Y; Gooderham, M; Raman, M; Mallbris, L; Wang, C; Purohit, V; Mamolo, C; Papacharalambous, J; Ports, W C

2016-11-01

Despite unmet need, 15 years have passed since a topical therapy with a new mechanism of action for atopic dermatitis (AD) has been approved. Janus kinase (JAK) inhibitor treatment effect via topical application in patients with AD is unknown. Tofacitinib, a small-molecule JAK inhibitor, was investigated for the topical treatment of AD. In this 4-week, phase IIa, randomized, double-blind, vehicle-controlled study (NCT02001181), 69 adults with mild-to-moderate AD were randomized 1:1 to 2% tofacitinib or vehicle ointment twice daily. Percentage change from baseline (CFB) in Eczema Area and Severity Index (EASI) score at week 4 was the primary end point. Secondary efficacy end points included percentage CFB in body surface area (BSA), CFB in EASI Clinical Signs Severity Sum Score, proportion of patients with Physician's Global Assessment (PGA) response and CFB in patient-reported pruritus. Safety, local tolerability and pharmacokinetics were monitored. The mean percentage CFB at week 4 in EASI score was significantly greater (P < 0·001) for tofacitinib (-81·7%) vs. vehicle (-29·9%). Patients treated with tofacitinib showed significant (P < 0·001) improvements vs. vehicle across all prespecified efficacy end points and for pruritus at week 4. Significant improvements in EASI, PGA and BSA were observed by week 1 and improvements in pruritus were observed by day 2. Safety/local tolerability were generally similar for both treatments, although more adverse events were observed for vehicle vs. tofacitinib. Tofacitinib ointment showed significantly greater efficacy vs. vehicle across end points, with early onset of effect and comparable safety/local tolerability to vehicle. JAK inhibition through topical delivery is potentially a promising therapeutic target for AD. © 2016 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.

Azithromycin versus Doxycycline for Urogenital Chlamydia trachomatis Infection.

PubMed

Geisler, William M; Uniyal, Apurva; Lee, Jeannette Y; Lensing, Shelly Y; Johnson, Shacondra; Perry, Raymond C W; Kadrnka, Carmel M; Kerndt, Peter R

2015-12-24

Urogenital Chlamydia trachomatis infection remains prevalent and causes substantial reproductive morbidity. Recent studies have raised concern about the efficacy of azithromycin for the treatment of chlamydia infection. We conducted a randomized trial comparing oral azithromycin with doxycycline for the treatment of urogenital chlamydia infection among adolescents in youth correctional facilities, to evaluate the noninferiority of azithromycin (1 g in one dose) to doxycycline (100 mg twice daily for 7 days). The treatment was directly observed. The primary end point was treatment failure at 28 days after treatment initiation, with treatment failure determined on the basis of nucleic acid amplification testing, sexual history, and outer membrane protein A (OmpA) genotyping of C. trachomatis strains. Among the 567 participants enrolled, 284 were randomly assigned to receive azithromycin, and 283 were randomly assigned to receive doxycycline. A total of 155 participants in each treatment group (65% male) made up the per-protocol population. There were no treatment failures in the doxycycline group. In the azithromycin group, treatment failure occurred in 5 participants (3.2%; 95% confidence interval, 0.4 to 7.4%). The observed difference in failure rates between the treatment groups was 3.2 percentage points, with an upper boundary of the 90% confidence interval of 5.9 percentage points, which exceeded the prespecified absolute 5-percentage-point cutoff for establishing the noninferiority of azithromycin. In the context of a closed population receiving directly observed treatment for urogenital chlamydia infection, the efficacy of azithromycin was 97%, and the efficacy of doxycycline was 100%. The noninferiority of azithromycin was not established in this setting. (Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT00980148.).

Technology, Incentives, or Both? Factors Related to Level of Hospital Health Information Exchange.

PubMed

Lin, Sunny C; Everson, Jordan; Adler-Milstein, Julia

2018-02-28

To assess whether the level of health information exchange (HIE) in U.S. hospitals is related to technology capabilities, incentives to exchange, or both. A total of 1,812 hospitals attesting to stage 2 of Medicare's Meaningful Use Incentive Program through April 2016. Hospital-level, multivariate OLS regression with state fixed effects was used to analyze the relationship between technology capability and incentives measures, and percent of care transitions with summary of care records (SCRs) sent electronically to subsequent providers. Stage 2 hospitals reported sending SCRs electronically for an average of 41 percent (median = 33 percent) of transitions. HIE level is related to four capability measures, one incentive measure, and one measure that is related to both capability and incentive. Percent of transitions with SCRs sent electronically was 3 percentage points higher (95 percent CI: 0.1-5.1) for hospitals with a third-party HIE vendor, 3 percentage points higher (95 percent CI: 0.5-5.4) for hospitals with an EHR vendor as their HIE vendor, and 3 percentage points higher (95 percent CI: 0.4-5.4) for hospitals that automatically alert primary care providers. The direction and statistical significance of the relationships between specific EHR vendor and electronic SCR transmission level varied by vendor. Nonprofits and government hospitals performed 5 percentage points higher (95 percent CI: 1.5-9.1) and 8 percentage points higher (95 percent CI: 3.4-12.3) than for-profits. Hospitals in systems performed 3 percentage points higher (95 percent CI: 0.8-6.1). The overall level of HIE is low, with hospitals sending an SCR electronically for less than half of patient transitions. Specific hospital characteristics related to both technology capabilities and incentives were associated with higher levels of HIE. © Health Research and Educational Trust.

Family planning in sub-Saharan Africa: progress or stagnation?

PubMed

Cleland, John G; Ndugwa, Robert P; Zulu, Eliya M

2011-02-01

To review progress towards adoption of contraception among married or cohabiting women in western and eastern Africa between 1991 and 2004 by examining subjective need, approval, access and use. Indicators of attitudes towards and use of contraception were derived from Demographic and Health Surveys, which are nationally representative and yield internationally comparable data. Trends were examined for 24 countries that had conducted at least two surveys between 1986 and 2007. In western Africa, the subjective need for contraception remained unchanged; about 46% of married or cohabiting women reported a desire to stop and/or postpone childbearing for at least two years. The percentage of women who approved of contraception rose from 32 to 39 and the percentage with access to contraceptive methods rose from 8 to 29. The proportion of women who were using a modern method when interviewed increased from 7 to 15% (equivalent to an average annual increase of 0.6 percentage points). In eastern African countries, trends were much more favourable, with contraceptive use showing an average annual increase of 1.4 percentage points (from 16% in 1986 to 33% in 2007). In western Africa, progress towards adoption of contraception has been dismally slow. Attitudinal resistance remains a barrier and access to contraceptives, though improving, is still shockingly limited. If this situation does not change radically in the short run, the United Nations population projections for this subregion are likely to be exceeded. In eastern Africa, the prospects for a future decline in fertility are much more positive.

Leisure Time Physical Activity Among U.S. Adults With Arthritis, 2008-2015.

PubMed

Murphy, Louise B; Hootman, Jennifer M; Boring, Michael A; Carlson, Susan A; Qin, Jin; Barbour, Kamil E; Brady, Teresa J; Helmick, Charles G

2017-09-01

In 2016, leisure time physical activity among U.S. adults aged ≥18 years with and without arthritis was studied to provide estimates using contemporary guidelines (2008 Physical Activity Guidelines for Americans) and population-based data (U.S. National Health Interview Survey). Estimated prevalence of: (1) meeting aerobic, muscle strengthening, and both aerobic and muscle strengthening guidelines, by arthritis status, from 2008 to 2015; and (2) meeting guidelines across selected sociodemographic characteristics and health status and behaviors, among adults with arthritis, in 2015. In 2015, 36.2%, 17.9%, and 13.7% of adults with arthritis met aerobic, muscle strengthening, and both guidelines, respectively; age-standardized prevalence of meeting each guideline was significantly lower among those with arthritis versus those without (e.g., 41.9% [95% CI=39.5%, 44.3%] and 52.2% [95% CI=51.2%, 53.2%] met the aerobic guideline, respectively; p<0.001). From 2008 to 2015, meeting aerobic guideline rose modestly (3 percentage points) among those with arthritis compared with larger gains (7 percentage points) among those without arthritis; the percentage of adults with arthritis meeting muscle strengthening and both guidelines remained the same in contrast to modest (statistically significant) increases among those without arthritis. Among adults with arthritis, age-standardized percentage meeting each guideline was highest among those with at least a university degree. Percentage meeting each guideline was persistently low among adults with arthritis. The lower prevalence among adults with arthritis versus those without suggests that adults with arthritis need additional strategies to address potential barriers (e.g., pain, psychological distress, inadequate medical support) to physical activity. Published by Elsevier Inc.

Methods and Apparatuses for Signaling with Geometric Constellations in a Raleigh Fading Channel

NASA Technical Reports Server (NTRS)

Barsoum, Maged F. (Inventor); Jones, Christopher R. (Inventor)

2017-01-01

Communication systems are described that use signal constellations, which have unequally spaced (i.e. `geometrically` shaped) points. In many embodiments, the communication systems use specific geometric constellations that are capacity optimized at a specific SNR, over the Raleigh fading channel. In addition, ranges within which the constellation points of a capacity optimized constellation can be perturbed and are still likely to achieve a given percentage of the optimal capacity increase compared to a constellation that maximizes d.sub.min, are also described. Capacity measures that are used in the selection of the location of constellation points include, but are not limited to, parallel decode (PD) capacity and joint capacity.

Methods and Apparatuses for Signaling with Geometric Constellations in a Raleigh Fading Channel

NASA Technical Reports Server (NTRS)

Jones, Christopher R. (Inventor); Barsoum, Maged F. (Inventor)

2015-01-01

Communication systems are described that use signal constellations, which have unequally spaced (i.e., `geometrically` shaped) points. In many embodiments, the communication systems use specific geometric constellations that are capacity optimized at a specific SNR (signal to noise ratio). In addition, ranges within which the constellation points of a capacity optimized constellation can be perturbed and are still likely to achieve a given percentage of the optimal capacity increase compared to a constellation that maximizes d (sub min) (i.e. minimum distance between constellations) are also described. Capacity measures that are used in the selection of the location of constellation points include, but are not limited to, parallel decode (PD) capacity and joint capacity.

Voting on Embryonic Stem Cell Research: Citizens More Supportive than Politicians.

PubMed

Stadelmann, David; Torgler, Benno

2017-01-01

As the public debate over stem cell research continues, the observable voting behaviour in Switzerland offers a unique opportunity to compare the voting behaviour of politicians with that of voters. By analysing the outcomes of a referendum on a liberal new bill regulating such research, we reveal an about 10 percentage point lower conditional probability of the bill being accepted by politicians than by voters. Whereas the behaviour of politicians is driven almost entirely by party affiliation, citizen votes are driven not only by party attachment but also by church attendance. Seldom or never attending church increases the probability of bill acceptance by over 15 percentage points, while supporting the Liberal Party and the Social Democratic Party instead of the Christian Democratic Party makes supporting the bill more likely for voters, suggesting that religious observance is important. The observance of these tendencies in Switzerland-an environment that promotes discussion through direct democratic rights-strongly suggests that citizens see the benefits of stem cell research.

Design with limited anthropometric data: A method of interpreting sums of percentiles in anthropometric design.

PubMed

Albin, Thomas J

2017-07-01

Occasionally practitioners must work with single dimensions defined as combinations (sums or differences) of percentile values, but lack information (e.g. variances) to estimate the accommodation achieved. This paper describes methods to predict accommodation proportions for such combinations of percentile values, e.g. two 90th percentile values. Kreifeldt and Nah z-score multipliers were used to estimate the proportions accommodated by combinations of percentile values of 2-15 variables; two simplified versions required less information about variance and/or correlation. The estimates were compared to actual observed proportions; for combinations of 2-15 percentile values the average absolute differences ranged between 0.5 and 1.5 percentage points. The multipliers were also used to estimate adjusted percentile values, that, when combined, estimate a desired proportion of the combined measurements. For combinations of two and three adjusted variables, the average absolute difference between predicted and observed proportions ranged between 0.5 and 3.0 percentage points. Copyright © 2017 Elsevier Ltd. All rights reserved.

Breast feeding and the weekend effect: an observational study

PubMed Central

Fitzsimons, Emla; Vera-Hernández, Marcos

2016-01-01

Objective To compare the incidence of breast feeding by day of week of birth. Design Retrospective database study using 16 508 records from the 2005 and 2010 Infant Feeding Surveys. Setting England and Wales, UK. Participants Mothers of a sample of births from among all registered births in the periods August–September 2005 and August–October 2010. Main outcome measure Incidence of breast feeding after birth. Results Among babies of mothers who left full-time education aged 16 or under, the incidence of breast feeding was 6.7 percentage points lower (95% CI 1.4 to 12.1 percentage points) for those born on Saturdays than for those born on Mondays–Thursdays. No such differences by day of week of birth were observed among babies of mothers who left school aged 17 or over. Conclusions Breastfeeding policy should take into account differences in breast feeding by day of week of birth, which are apparent among low-educated mothers. Further research is needed to ascertain the reason for this finding. PMID:27401354

Social interactions and college enrollment: A combined school fixed effects/instrumental variables approach.

PubMed

Fletcher, Jason M

2015-07-01

This paper provides some of the first evidence of peer effects in college enrollment decisions. There are several empirical challenges in assessing the influences of peers in this context, including the endogeneity of high school, shared group-level unobservables, and identifying policy-relevant parameters of social interactions models. This paper addresses these issues by using an instrumental variables/fixed effects approach that compares students in the same school but different grade-levels who are thus exposed to different sets of classmates. In particular, plausibly exogenous variation in peers' parents' college expectations are used as an instrument for peers' college choices. Preferred specifications indicate that increasing a student's exposure to college-going peers by ten percentage points is predicted to raise the student's probability of enrolling in college by 4 percentage points. This effect is roughly half the magnitude of growing up in a household with married parents (vs. an unmarried household). Copyright © 2015 Elsevier Inc. All rights reserved.

Social Interactions and College Enrollment: A Combined School Fixed Effects/Instrumental Variables Approach

PubMed Central

Fletcher, Jason M.

2015-01-01

This paper provides some of the first evidence of peer effects in college enrollment decisions. There are several empirical challenges in assessing the influences of peers in this context, including the endogeneity of high school, shared group-level unobservables, and identifying policy-relevant parameters of social interactions models. This paper addresses these issues by using an instrumental variables/fixed effects approach that compares students in the same school but different grade-levels who are thus exposed to different sets of classmates. In particular, plausibly exogenous variation in peers’ parents’ college expectations are used as an instrument for peers’ college choices. Preferred specifications indicate that increasing a student’s exposure to college-going peers by ten percentage points is predicted to raise the student’s probability of enrolling in college by 4 percentage points. This effect is roughly half the magnitude of growing up in a household with married parents (vs. an unmarried household). PMID:26004476

Long-Term Pioglitazone Treatment for Patients With Nonalcoholic Steatohepatitis and Prediabetes or Type 2 Diabetes Mellitus: A Randomized Trial.

PubMed

Cusi, Kenneth; Orsak, Beverly; Bril, Fernando; Lomonaco, Romina; Hecht, Joan; Ortiz-Lopez, Carolina; Tio, Fermin; Hardies, Jean; Darland, Celia; Musi, Nicolas; Webb, Amy; Portillo-Sanchez, Paola

2016-09-06

The metabolic defects of nonalcoholic steatohepatitis (NASH) and prediabetes or type 2 diabetes mellitus (T2DM) seem to be specifically targeted by pioglitazone. However, information about its long-term use in this population is limited. To determine the efficacy and safety of long-term pioglitazone treatment in patients with NASH and prediabetes or T2DM. Randomized, double-blind, placebo-controlled trial. (ClinicalTrials.gov: NCT00994682). University hospital. Patients (n = 101) with prediabetes or T2DM and biopsy-proven NASH were recruited from the general population and outpatient clinics. All patients were prescribed a hypocaloric diet (500-kcal/d deficit from weight-maintaining caloric intake) and then randomly assigned to pioglitazone, 45 mg/d, or placebo for 18 months, followed by an 18-month open-label phase with pioglitazone treatment. The primary outcome was a reduction of at least 2 points in the nonalcoholic fatty liver disease activity score in 2 histologic categories without worsening of fibrosis. Secondary outcomes included other histologic outcomes, hepatic triglyceride content measured by magnetic resonance and proton spectroscopy, and metabolic parameters. Among patients randomly assigned to pioglitazone, 58% achieved the primary outcome (treatment difference, 41 percentage points [95% CI, 23 to 59 percentage points]) and 51% had resolution of NASH (treatment difference, 32 percentage points [CI, 13 to 51 percentage points]) (P < 0.001 for each). Pioglitazone treatment also was associated with improvement in individual histologic scores, including the fibrosis score (treatment difference, -0.5 [CI, -0.9 to 0.0]; P = 0.039); reduced hepatic triglyceride content from 19% to 7% (treatment difference, -7 percentage points [CI, -10 to -4 percentage points]; P < 0.001); and improved adipose tissue, hepatic, and muscle insulin sensitivity (P < 0.001 vs. placebo for all). All 18-month metabolic and histologic improvements persisted over 36 months of therapy. The overall rate of adverse events did not differ between groups, although weight gain was greater with pioglitazone (2.5 kg vs. placebo). Single-center study. Long-term pioglitazone treatment is safe and effective in patients with prediabetes or T2DM and NASH. Burroughs Wellcome Fund and American Diabetes Association.

The Effects of Antipsychotic Quality Reporting on Antipsychotic and Psychoactive Medication Use

PubMed Central

Bowblis, John R; Lucas, Judith A; Brunt, Christopher S

2015-01-01

Objective The objective of this study is to examine how nursing homes changed their use of antipsychotic and other psychoactive medications in response to Nursing Home Compare’s initiation of publicly reporting antipsychotic use in July 2012. Research Design and Subjects The study includes all state recertification surveys (n = 40,415) for facilities six quarters prior and post the initiation of public reporting. Using a difference-in-difference framework, the change in use of antipsychotics and other psychoactive medications is compared for facilities subject to public reporting and facilities not subject to reporting. Principal Findings The percentage of residents using antipsychotics, hypnotics, or any psychoactive medication is found to decline after public reporting. Facilities subject to reporting experienced an additional decline in antipsychotic use (−1.94 vs. −1.40 percentage points) but did not decline as much for hypnotics (−0.60 vs. −1.21 percentage points). Any psychoactive use did not vary with reporting status, and the use of antidepressants and anxiolytics did not change. Conclusion Public reporting of an antipsychotic quality measure can be an effective policy tool for reducing the use of antipsychotic medications—though the effect many only exist in the short run. PMID:25600861

One-point fitting of the flux density produced by a heliostat

DOE Office of Scientific and Technical Information (OSTI.GOV)

Collado, Francisco J.

Accurate and simple models for the flux density reflected by an isolated heliostat should be one of the basic tools for the design and optimization of solar power tower systems. In this work, the ability and the accuracy of the Universidad de Zaragoza (UNIZAR) and the DLR (HFCAL) flux density models to fit actual energetic spots are checked against heliostat energetic images measured at Plataforma Solar de Almeria (PSA). Both the fully analytic models are able to acceptably fit the spot with only one-point fitting, i.e., the measured maximum flux. As a practical validation of this one-point fitting, the interceptmore » percentage of the measured images, i.e., the percentage of the energetic spot sent by the heliostat that gets the receiver surface, is compared with the intercept calculated through the UNIZAR and HFCAL models. As main conclusions, the UNIZAR and the HFCAL models could be quite appropriate tools for the design and optimization, provided the energetic images from the heliostats to be used in the collector field were previously analyzed. Also note that the HFCAL model is much simpler and slightly more accurate than the UNIZAR model. (author)« less

Comparison of Body Mass Index (BMI) Categories Based on Asian and Universal Standards and Language Spoken at Home among Asian American University Students

ERIC Educational Resources Information Center

Ng, Tiffany; McMahan, Shari; Mouttapa, Michele; Tanjasiri, Sora Park; Beam, William

2009-01-01

Background: The World Health Organization released lower Body Mass Index (BMI) cutoff points for Asian individuals to account for increased body fat percentage (BF%) and risk of obesity-related conditions at a lower body mass index. Purpose: This preliminary study: (1) explores the impact of utilizing Asian BMI standards (compared to universal…

Starting School at a Disadvantage: The School Readiness of Poor Children. The Social Genome Project

ERIC Educational Resources Information Center

Isaacs, Julia B.

2012-01-01

Poor children in the United States start school at a disadvantage in terms of their early skills, behaviors, and health. Fewer than half (48 percent) of poor children are ready for school at age five, compared to 75 percent of children from families with moderate and high income, a 27 percentage point gap. This paper examines the reasons why poor…

Liking Health Reform But Turned Off By Toxic Politics.

PubMed

Jacobs, Lawrence R; Mettler, Suzanne

2016-05-01

Six years after the Affordable Care Act (ACA) became law, the number of nonelderly Americans with health insurance has expanded by twenty million, and the uninsurance rate has declined nearly 9 percentage points. Nevertheless, public opinion about the law remains deeply divided. We investigated how individuals may be experiencing and responding to health reform implementation by analyzing three waves of a panel study we conducted in 2010, 2012, and 2014. While public opinion about the ACA remains split (45.6 percent unfavorable and 36.2 percent favorable), there have been several detectable shifts. The share of respondents believing that reform had little or no impact on access to health insurance or medical care diminished by 18 percentage points from 2010 to 2014, while those considering reform to have some or a great impact increased by 19 percentage points. Among individuals who held unfavorable views toward the law in 2010, the percentage who supported repeal-while still high, at 72 percent-shrank by 9 percentage points from 2010 to 2014. We found that party affiliation and distrust in government were influential factors in explaining the continuing divide over the law. The ACA has delivered discernible benefits, and some Americans are increasingly recognizing that it is improving access to health insurance and medical care. Project HOPE—The People-to-People Health Foundation, Inc.

Clinical trial: lubiprostone in patients with constipation-associated irritable bowel syndrome--results of two randomized, placebo-controlled studies.

PubMed

Drossman, D A; Chey, W D; Johanson, J F; Fass, R; Scott, C; Panas, R; Ueno, R

2009-02-01

Effective treatments for irritable bowel syndrome with constipation (IBS-C) are lacking. To assess the efficacy and safety of lubiprostone in IBS-C. A combined analysis was performed among 1171 patients with a Rome II diagnosis of IBS-C in two phase-3 randomized trials of lubiprostone 8 mcg vs. placebo twice daily for 12 weeks. Using a balanced seven-point Likert scale ranging from significantly relieved (+3), to significantly worse (-3), patients responded on their electronic diary to the question: 'How would you rate your relief of IBS symptoms over the past week compared to how you felt before you entered the study?'. The primary efficacy endpoint was the percentage of overall responders. Using an intent-to-treat analysis with last observation carried forward, a significantly higher percentage of lubiprostone-treated patients were considered overall responders compared with those treated with placebo (17.9% vs. 10.1%, P=0.001). Patients treated with lubiprostone reported a similar incidence of adverse events to those treated with placebo. The percentage of overall responders based on patient-rated assessments of IBS-C symptoms was significantly improved in patients treated with lubiprostone 8 mcg twice daily compared to those treated with placebo. Lubiprostone was well tolerated with a favourable safety profile.

Heart Rate Fragmentation: A Symbolic Dynamical Approach.

PubMed

Costa, Madalena D; Davis, Roger B; Goldberger, Ary L

2017-01-01

Background: We recently introduced the concept of heart rate fragmentation along with a set of metrics for its quantification. The term was coined to refer to an increase in the percentage of changes in heart rate acceleration sign, a dynamical marker of a type of anomalous variability. The effort was motivated by the observation that fragmentation, which is consistent with the breakdown of the neuroautonomic-electrophysiologic control system of the sino-atrial node, could confound traditional short-term analysis of heart rate variability. Objective: The objectives of this study were to: (1) introduce a symbolic dynamical approach to the problem of quantifying heart rate fragmentation; (2) evaluate how the distribution of the different dynamical patterns ("words") varied with the participants' age in a group of healthy subjects and patients with coronary artery disease (CAD); and (3) quantify the differences in the fragmentation patterns between the two sample populations. Methods: The symbolic dynamical method employed here was based on a ternary map of the increment NN interval time series and on the analysis of the relative frequency of symbolic sequences (words) with a pre-defined set of features. We analyzed annotated, open-access Holter databases of healthy subjects and patients with CAD, provided by the University of Rochester Telemetric and Holter ECG Warehouse (THEW). Results: The degree of fragmentation was significantly higher in older individuals than in their younger counterparts. However, the fragmentation patterns were different in the two sample populations. In healthy subjects, older age was significantly associated with a higher percentage of transitions from acceleration/deceleration to zero acceleration and vice versa (termed "soft" inflection points). In patients with CAD, older age was also significantly associated with higher percentages of frank reversals in heart rate acceleration (transitions from acceleration to deceleration and vice versa , termed "hard" inflection points). Compared to healthy subjects, patients with CAD had significantly higher percentages of soft and hard inflection points, an increased percentage of words with a high degree of fragmentation and a decreased percentage of words with a lower degree of fragmentation. Conclusion: The symbolic dynamical method employed here was useful to probe the newly recognized property of heart rate fragmentation. The findings from these cross-sectional studies confirm that CAD and older age are associated with higher levels of heart rate fragmentation. Furthermore, fragmentation with healthy aging appears to be phenotypically different from fragmentation in the context of CAD.

Evaluating health worker performance in Benin using the simulated client method with real children.

PubMed

Rowe, Alexander K; Onikpo, Faustin; Lama, Marcel; Deming, Michael S

2012-10-08

The simulated client (SC) method for evaluating health worker performance utilizes surveyors who pose as patients to make surreptitious observations during consultations. Compared to conspicuous observation (CO) by surveyors, which is commonly done in developing countries, SC data better reflect usual health worker practices. This information is important because CO can cause performance to be better than usual. Despite this advantage of SCs, the method's full potential has not been realized for evaluating performance for pediatric illnesses because real children have not been utilized as SCs. Previous SC studies used scenarios of ill children that were not actually brought to health workers. During a trial that evaluated a quality improvement intervention in Benin (the Integrated Management of Childhood Illness [IMCI] strategy), we conducted an SC survey with adult caretakers as surveyors and real children to evaluate the feasibility of this approach and used the results to assess the validity of CO. We conducted an SC survey and a CO survey (one right after the other) of health workers in the same 55 health facilities. A detailed description of the SC survey process was produced. Results of the two surveys were compared for 27 performance indicators using logistic regression modeling. SC and CO surveyors observed 54 and 185 consultations, respectively. No serious problems occurred during the SC survey. Performance levels measured by CO were moderately higher than those measured by SCs (median CO - SC difference = 16.4 percentage-points). Survey differences were sometimes much greater for IMCI-trained health workers (median difference = 29.7 percentage-points) than for workers without IMCI training (median difference = 3.1 percentage-points). SC surveys can be done safely with real children if appropriate precautions are taken. CO can introduce moderately large positive biases, and these biases might be greater for health workers exposed to quality improvement interventions. http://clinicaltrials.gov Identifier NCT00510679.

A new transmission methodology for quality assurance in radiotherapy based on radiochromic film measurements

PubMed Central

do Amaral, Leonardo L.; Pavoni, Juliana F.; Sampaio, Francisco; Netto, Thomaz Ghilardi

2015-01-01

Despite individual quality assurance (QA) being recommended for complex techniques in radiotherapy (RT) treatment, the possibility of errors in dose delivery during therapeutic application has been verified. Therefore, it is fundamentally important to conduct in vivo QA during treatment. This work presents an in vivo transmission quality control methodology, using radiochromic film (RCF) coupled to the linear accelerator (linac) accessory holder. This QA methodology compares the dose distribution measured by the film in the linac accessory holder with the dose distribution expected by the treatment planning software. The calculated dose distribution is obtained in the coronal and central plane of a phantom with the same dimensions of the acrylic support used for positioning the film but in a source‐to‐detector distance (SDD) of 100 cm, as a result of transferring the IMRT plan in question with all the fields positioned with the gantry vertically, that is, perpendicular to the phantom. To validate this procedure, first of all a Monte Carlo simulation using PENELOPE code was done to evaluate the differences between the dose distributions measured by the film in a SDD of 56.8 cm and 100 cm. After that, several simple dose distribution tests were evaluated using the proposed methodology, and finally a study using IMRT treatments was done. In the Monte Carlo simulation, the mean percentage of points approved in the gamma function comparing the dose distribution acquired in the two SDDs were 99.92%±0.14%. In the simple dose distribution tests, the mean percentage of points approved in the gamma function were 99.85%±0.26% and the mean percentage differences in the normalization point doses were −1.41%. The transmission methodology was approved in 24 of 25 IMRT test irradiations. Based on these results, it can be concluded that the proposed methodology using RCFs can be applied for in vivo QA in RT treatments. PACS number: 87.55.Qr, 87.55.km, 87.55.N‐ PMID:26699306

America's Health Centers: reducing racial and ethnic disparities in perinatal care and birth outcomes.

PubMed

Shi, Leiyu; Stevens, Gregory D; Wulu, John T; Politzer, Robert M; Xu, Jiahong

2004-12-01

To examine whether community health centers (CHCs) reduce racial/ethnic disparities in perinatal care and birth outcomes, and to identify CHC characteristics associated with better outcomes. Despite great national wealth, the U.S. continues to rank poorly relative to other industrialized nations on infant mortality and other birth outcomes, and with wide inequities by race/ethnicity. Disparities in primary care (including perinatal care) may contribute to disparities in birth outcomes, which may be addressed by CHCs that provide safety-net medical services to vulnerable populations. Data are from annual Uniform Data System reports submitted to the Bureau of Primary Health Care over six years (1996-2001) by about 700 CHCs each year. Across all years, about 60% of CHC mothers received first-trimester prenatal care and more than 70% received postpartum and newborn care. In 2001, Asian mothers were the most likely to receive both postpartum and newborn care (81.7% and 80.3%), followed by Hispanics (75.0% and 76.3%), blacks (70.8% and 69.9%), and whites (70.7% and 66.7%). In 2001, blacks had higher rates of low birth weight (LBW) babies (10.4%), but the disparity in rates for blacks and whites was smaller in CHCs (3.3 percentage points) compared to national disparities for low-socioeconomic status mothers (5.8 percentage points) and the total population (6.2 percentage points). In CHCs, greater perinatal care capacity was associated with higher rates of first-trimester prenatal care, which was associated with a lower LBW rate. Racial/ethnic disparities in certain prenatal services and birth outcomes may be lower in CHCs compared to the general population, despite serving higher-risk groups. Within CHCs, increasing first-trimester prenatal care use through perinatal care capacity may lead to further improvement in birth outcomes for the underserved.

Nurse opinions and pulse oximeter saturation target limits for preterm infants.

PubMed

Nghiem, Tuyet-Hang; Hagadorn, James I; Terrin, Norma; Syke, Sally; MacKinnon, Brenda; Cole, Cynthia H

2008-05-01

The objectives of this study were to compare pulse oximeter saturation limits targeted by nurses for extremely preterm infants during routine care with nurse opinions regarding appropriate pulse oximeter saturation limits and with policy-specified pulse oximeter saturation limits and to identify factors that influence pulse oximeter saturation limits targeted by nurses. We surveyed nurses in US NICUs with neonatal-perinatal fellowships in 2004. Data collected included pulse oximeter saturation limits targeted by nurses and by NICU policy when present, nurses' opinions about appropriate pulse oximeter saturation limits, and NICU and nurse characteristics. Factors associated with pulse oximeter saturation limits targeted by nurses were identified with hierarchical linear modeling. Among those eligible, 2805 (45%) nurses in 59 (60%) NICUs responded. Forty (68%) of 59 NICUs had a policy that specified a pulse oximeter saturation target range for extremely preterm infants. Among 1957 nurses at NICUs with policies, 540 (28%) accurately identified the upper and lower limits of their NICU's policy and also targeted these values in practice. NICU-specific SDs for individual nurse target limits were less at NICUs with versus without a policy for both upper and lower limits. Hierarchical linear modeling identified presence of pulse oximeter saturation policy, NICU-specific nurse group opinion, and individual nurse opinion as factors significantly associated with individual pulse oximeter saturation target limits. For each percentage point increase in individual opinion upper limit, the individual target upper limit increased by 0.41 percentage point at NICUs with a policy compared with 0.6 percentage point at NICUs with no policy. Presence of policy-specified pulse oximeter saturation limits, nurse group opinion, and individual nurse opinion were independently associated with individual nurse pulse oximeter saturation target limits during routine care of extremely preterm infants. The presence of a policy reduced the influence of individual nurse opinion on targeted pulse oximeter saturation limits and reduced variation among nurse target limits within NICUs.

Simple versus composite indicators of socioeconomic status in resource allocation formulae: the case of the district resource allocation formula in Malawi

PubMed Central

2010-01-01

Background The district resource allocation formula in Malawi was recently reviewed to include stunting as a proxy measure of socioeconomic status. In many countries where the concept of need has been incorporated in resource allocation, composite indicators of socioeconomic status have been used. In the Malawi case, it is important to ascertain whether there are differences between using single variable or composite indicators of socioeconomic status in allocations made to districts, holding all other factors in the resource allocation formula constant. Methods Principal components analysis was used to calculate asset indices for all districts from variables that capture living standards using data from the Malawi Multiple Indicator Cluster Survey 2006. These were normalized and used to weight district populations. District proportions of national population weighted by both the simple and composite indicators were then calculated for all districts and compared. District allocations were also calculated using the two approaches and compared. Results The two types of indicators are highly correlated, with a spearman rank correlation coefficient of 0.97 at the 1% level of significance. For 21 out of the 26 districts included in the study, proportions of national population weighted by the simple indicator are higher by an average of 0.6 percentage points. For the remaining 5 districts, district proportions of national population weighted by the composite indicator are higher by an average of 2 percentage points. Though the average percentage point differences are low and the actual allocations using both approaches highly correlated (ρ of 0.96), differences in actual allocations exceed 10% for 8 districts and have an average of 4.2% for the remaining 17. For 21 districts allocations based on the single variable indicator are higher. Conclusions Variations in district allocations made using either the simple or composite indicators of socioeconomic status are not statistically different to recommend one over the other. However, the single variable indicator is favourable for its ease of computation. PMID:20053274

Comparison of the dose distribution obtained from dosimetric systems with intensity modulated radiotherapy planning system in the treatment of prostate cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gökçe, M., E-mail: mgokce@adu.edu.tr; Uslu, D. Koçyiğit; Ertunç, C.

The aim of this study is to compare Intensity Modulated Radiation Therapy (IMRT) plan of prostate cancer patients with different dose verification systems in dosimetric aspects and to compare these systems with each other in terms of reliability, applicability and application time. Dosimetric control processes of IMRT plan of three prostate cancer patients were carried out using thermoluminescent dosimeter (TLD), ion chamber (IC) and 2D Array detector systems. The difference between the dose values obtained from the dosimetric systems and treatment planning system (TPS) were found to be about % 5. For the measured (TLD) and calculated (TPS) doses %3more » percentage differences were obtained for the points close to center while percentage differences increased at the field edges. It was found that TLD and IC measurements will increase the precision and reliability of the results of 2D Array.« less

Modeling syngas-fired gas turbine engines with two dilutants

NASA Astrophysics Data System (ADS)

Hawk, Mitchell E.

2011-12-01

Prior gas turbine engine modeling work at the University of Wyoming studied cycle performance and turbine design with air and CO2-diluted GTE cycles fired with methane and syngas fuels. Two of the cycles examined were unconventional and innovative. The work presented herein reexamines prior results and expands the modeling by including the impacts of turbine cooling and CO2 sequestration on GTE cycle performance. The simple, conventional regeneration and two alternative regeneration cycle configurations were examined. In contrast to air dilution, CO2 -diluted cycle efficiencies increased by approximately 1.0 percentage point for the three regeneration configurations examined, while the efficiency of the CO2-diluted simple cycle decreased by approximately 5.0 percentage points. For CO2-diluted cycles with a closed-exhaust recycling path, an optimum CO2-recycle pressure was determined for each configuration that was significantly lower than atmospheric pressure. Un-cooled alternative regeneration configurations with CO2 recycling achieved efficiencies near 50%, which was approximately 3.0 percentage points higher than the conventional regeneration cycle and simple cycle configurations that utilized CO2 recycling. Accounting for cooling of the first two turbine stages resulted in a 2--3 percentage point reduction in un-cooled efficiency, with air dilution corresponding to the upper extreme. Additionally, when the work required to sequester CO2 was accounted for, cooled cycle efficiency decreased by 4--6 percentage points, and was more negatively impacted when syngas fuels were used. Finally, turbine design models showed that turbine blades are shorter with CO2 dilution, resulting in fewer design restrictions.

Comparative Effectiveness of After-School Programs to Increase Physical Activity

PubMed Central

Gesell, Sabina B.; Sommer, Evan C.; Lambert, E. Warren; Vides de Andrade, Ana Regina; Davis, Lauren; Beech, Bettina M.; Mitchell, Stephanie J.; Neloms, Stevon; Ryan, Colleen K.

2013-01-01

Background. We conducted a comparative effectiveness analysis to evaluate the difference in the amount of physical activity children engaged in when enrolled in a physical activity-enhanced after-school program based in a community recreation center versus a standard school-based after-school program. Methods. The study was a natural experiment with 54 elementary school children attending the community ASP and 37 attending the school-based ASP. Accelerometry was used to measure physical activity. Data were collected at baseline, 6 weeks, and 12 weeks, with 91% retention. Results. At baseline, 43% of the multiethnic sample was overweight/obese, and the mean age was 7.9 years (SD = 1.7). Linear latent growth models suggested that the average difference between the two groups of children at Week 12 was 14.7 percentage points in moderate-vigorous physical activity (P < .001). Cost analysis suggested that children attending traditional school-based ASPs—at an average cost of $17.67 per day—would need an additional daily investment of $1.59 per child for 12 weeks to increase their moderate-vigorous physical activity by a model-implied 14.7 percentage points. Conclusions. A low-cost, alternative after-school program featuring adult-led physical activities in a community recreation center was associated with increased physical activity compared to standard-of-care school-based after-school program. PMID:23984052

A 2-Year Integrated Agriculture and Nutrition Program Targeted to Mothers of Young Children in Burkina Faso Reduces Underweight among Mothers and Increases Their Empowerment: A Cluster-Randomized Controlled Trial.

PubMed

Olney, Deanna K; Bliznashka, Lilia; Pedehombga, Abdoulaye; Dillon, Andrew; Ruel, Marie T; Heckert, Jessica

2016-05-01

Recent evidence demonstrates the benefits of integrated agriculture and nutrition programs for children's health and nutrition outcomes. These programs may also improve mothers' nutrition and empowerment outcomes. However, evidence from rigorous evaluations is scarce. We examined impacts of Helen Keller International's 2-y enhanced-homestead food production (E-HFP) program in Burkina Faso on the secondary impact measures of mothers' nutrition and empowerment. We used a cluster-randomized controlled trial whereby 55 villages with 1767 mothers of young children were randomly assigned to 3 groups: 1) control, 2) E-HFP with the behavior change communication (BCC) strategy implemented by older women leaders, or 3) E-HFP with BCC implemented by health committee members. Data for the treatment groups were pooled for this analysis because no differences were found between the 2 groups in key mothers' outcomes. We used difference-in-differences (DID) estimates to assess impacts on mothers' dietary intake, diversity, body mass index (BMI; in kg/m(2)), prevalence of underweight (BMI <18.5), and empowerment. The E-HFP program significantly increased mothers' intake of fruit (DID = 15.8 percentage points; P = 0.02) and marginally increased their intake of meat/poultry (DID = 7.5 percentage points; P = 0.08) and dietary diversity (DID = 0.3 points; P = 0.08). The prevalence of underweight was significantly reduced among mothers in treatment compared with control villages by 8.7 percentage points (P < 0.01). Although the changes in BMI did not differ between mothers in treatment and control villages, there was a marginally significant interaction (baseline underweight × change in BMI; P-interaction = 0.07), indicating that underweight mothers had a greater increase in BMI than did mothers who were not underweight. The E-HFP program also positively affected mothers' overall empowerment score (DID = 3.13 points out of 37 possible points; P < 0.01) and 3 components of empowerment: meeting with women (DID = 1.21 points out of 5 possible points; P < 0.01), purchasing decisions (DID = 0.86 points out of 8 possible points; P = 0.01), and health care decisions (DID = 0.24 points out of 2 possible points; P = 0.05). Helen Keller International's E-HFP program in Burkina Faso substantially improved mothers' nutrition and empowerment outcomes. These positive impacts benefit the mothers themselves and may also improve their ability to care for their children. This trial was registered at clinicaltrials.gov as NCT01825226. © 2016 American Society for Nutrition.

What causes EBRI retirement readiness ratings to vary: results from the 2014 Retirement Security Projection Model.

PubMed

VanDerhei, Jack

2014-02-01

RETIREMENT INCOME ADEQUACY IMPROVED SLIGHTLY IN 2013: Due to the increase in financial market and housing values during 2013, the probability that Baby Boomers and Generation Xers would NOT run short of money in retirement increases between 0.5 and 1.6 percentage points, based on the Employee Benefit Research Institute (EBRI) Retirement Readiness Ratings (RRRs). ELIGIBILITY FOR PARTICIPATION IN AN EMPLOYER-SPONSORED DEFINED CONTRIBUTION PLAN REMAINS ONE OF THE MOST IMPORTANT FACTORS FOR RETIREMENT INCOME ADEQUACY: RRR values double for Gen Xers in the lowest-income quartile when comparing those with 20 or more years of future eligibility with those with no years of future eligibility, while those in the middle income quartiles experience increases in RRR values by 27.1-30.3 percentage points. FUTURE SOCIAL SECURITY BENEFITS MAKE A HUGE DIFFERENCE FOR THE RETIREMENT INCOME ADEQUACY OF SOME HOUSEHOLDS, ESPECIALLY GEN XERS IN THE LOWEST-INCOME QUARTILE: If Social Security benefits are subject to proportionate decreases beginning in 2033 (according to the values in Figure 8), the RRR values for those households will drop by more than 50 percent: from 20.9 percent to 10.3 percent. LONGEVITY RISK AND STOCHASTIC HEALTH CARE RISK ARE ASSOCIATED WITH HUGE VARIATIONS IN RETIREMENT INCOME ADEQUACY: For both of these factors, a comparison between the most "risky" quartile with the least risky quartile shows a spread of approximately 30 percentage points for the lowest income range, approximately 25 to 40 percentage points for the highest income range, and even larger spreads for those in the middle income ranges. A GREAT DEAL OF THE VARIABILITY IN RETIREMENT INCOME ADEQUACY COULD BE MITIGATED BY APPROPRIATE RISK-MANAGEMENT TECHNIQUES AT OR NEAR RETIREMENT AGE: For example, the annuitization of a portion of the defined contribution and IRA balances may substantially increase the probability of not running short of money in retirement. Moreover, a well-functioning market in long-term care insurance would appear to provide an extremely useful technique to help control the volatility from the stochastic, long-term health care risk, especially for those in the middle income quartiles.

77 FR 47223 - Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System-Update for Fiscal...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-07

... and SCHIP (State Children's Health Insurance Program) Balanced Budget Refinement Act of the 1999 (BBRA....7 percent adjusted by a 0.1 percentage point reduction as required by section 1886(s)(2)(A)(ii) of the Social Security Act (the Act) and a 0.7 percentage point reduction as required by 1886(s)(2)(A)(i...

School Entry Requirements and Coverage of Nontargeted Adolescent Vaccines

PubMed Central

Reiter, Paul L.; Truong, Young K.; Rimer, Barbara K.; Brewer, Noel T.

2016-01-01

BACKGROUND: Low human papillomavirus (HPV) vaccination coverage is an urgent public health problem requiring action. To identify policy remedies to suboptimal HPV vaccination, we assessed the relationship between states’ school entry requirements and adolescent vaccination. METHODS: We gathered data on states’ school entry requirements for adolescent vaccination (tetanus, diphtheria, and pertussis [Tdap] booster; meningococcal; and HPV) from 2007 to 2012 from Immunization Action Coalition. The National Immunization Survey–Teen provided medical record–verified vaccination data for 99 921 adolescents. We calculated coverage (among 13- to 17-year-olds) for individual vaccinations and concomitant vaccination. HPV vaccination outcomes were among female adolescents. Analyses used weighted longitudinal multivariable models. RESULTS: States with requirements for Tdap booster and meningococcal vaccination had 22 and 24 percentage point increases in coverage for these vaccines, respectively, compared with other states (both P < .05). States with HPV vaccination requirements had <1 percentage point increase in coverage for this vaccine (P < .05). Tdap booster and meningococcal vaccination requirements, respectively, were associated with 8 and 4 percentage point spillover increases for HPV vaccination coverage (both P < .05) and with increases for concomitant vaccination (all P < .05). CONCLUSIONS: Ensuring all states have meningococcal vaccination requirements could improve the nation’s HPV vaccination coverage, given that many states already require Tdap booster but not meningococcal vaccination for school entry. Vaccination programs and clinicians should capitalize on changes in adolescent vaccination, including concomitant vaccination, that may arise after states adopt vaccination requirements. Additional studies are needed on the effects of HPV vaccination requirements and opt-out provisions. PMID:27940689

School Entry Requirements and Coverage of Nontargeted Adolescent Vaccines.

PubMed

Moss, Jennifer L; Reiter, Paul L; Truong, Young K; Rimer, Barbara K; Brewer, Noel T

2016-12-01

Low human papillomavirus (HPV) vaccination coverage is an urgent public health problem requiring action. To identify policy remedies to suboptimal HPV vaccination, we assessed the relationship between states' school entry requirements and adolescent vaccination. We gathered data on states' school entry requirements for adolescent vaccination (tetanus, diphtheria, and pertussis [Tdap] booster; meningococcal; and HPV) from 2007 to 2012 from Immunization Action Coalition. The National Immunization Survey-Teen provided medical record-verified vaccination data for 99 921 adolescents. We calculated coverage (among 13- to 17-year-olds) for individual vaccinations and concomitant vaccination. HPV vaccination outcomes were among female adolescents. Analyses used weighted longitudinal multivariable models. States with requirements for Tdap booster and meningococcal vaccination had 22 and 24 percentage point increases in coverage for these vaccines, respectively, compared with other states (both P < .05). States with HPV vaccination requirements had <1 percentage point increase in coverage for this vaccine (P < .05). Tdap booster and meningococcal vaccination requirements, respectively, were associated with 8 and 4 percentage point spillover increases for HPV vaccination coverage (both P < .05) and with increases for concomitant vaccination (all P < .05). Ensuring all states have meningococcal vaccination requirements could improve the nation's HPV vaccination coverage, given that many states already require Tdap booster but not meningococcal vaccination for school entry. Vaccination programs and clinicians should capitalize on changes in adolescent vaccination, including concomitant vaccination, that may arise after states adopt vaccination requirements. Additional studies are needed on the effects of HPV vaccination requirements and opt-out provisions. Copyright © 2016 by the American Academy of Pediatrics.

Does Migration Limit the Effect of Health Insurance on Hypertension Management in China?

PubMed

Fang, Hai; Jin, Yinzi; Zhao, Miaomiao; Zhang, Huyang; A Rizzo, John; Zhang, Donglan; Hou, Zhiyuan

2017-10-20

Background: In China, rapid urbanization has caused migration from rural to urban areas, and raised the prevalence of hypertension. However, public health insurance is not portable from one place to another, and migration may limit the effectiveness of this non-portable health insurance on healthcare. Our study aims to investigate whether migration limits the effectiveness of health insurance on hypertension management in China. Methods: Data were obtained from the national baseline survey of the China Health and Retirement Longitudinal Study in 2011, including 4926 hypertensive respondents with public health insurance. Outcome measures included use of primary care, hypertension awareness, medication use, blood pressure monitoring, physician advice, and blood pressure control. Multivariate logistic regressions were estimated to examine whether the effects of rural health insurance on hypertension management differed between those who migrated to urban areas and those who did not migrate and lived in rural areas. Results: Among hypertensive respondents, 60.7% were aware of their hypertensive status. Compared to rural residents, the non-portable feature of rural health insurance significantly reduced rural-to-urban migrants' probabilities of using primary care by 7.8 percentage points, hypertension awareness by 8.8 percentage points, and receiving physician advice by 18.3 percentage points. Conclusions: In China, migration to urban areas limited the effectiveness of rural health insurance on hypertension management due to its non-portable nature. It is critical to improve the portability of rural health insurance, and to extend urban health insurance and primary care coverage to rural-to-urban migrants to achieve better chronic disease management.

Levels and trends of childhood undernutrition by wealth and education according to a Composite Index of Anthropometric Failure: evidence from 146 Demographic and Health Surveys from 39 countries.

PubMed

Vollmer, Sebastian; Harttgen, Kenneth; Kupka, Roland; Subramanian, S V

2017-01-01

Governments have endorsed global targets to reduce childhood undernutrition as part of the Sustainable Development Goals. Understanding the socioeconomic differences in childhood undernutrition has the potential to be helpful for targeting policy to reach these goals. We specify a logistic regression model with the Composite Index of Anthropometric Failure (CIAF) as the outcome and indicator variables for wealth quartiles, maternal education categories and a set of covariates as explanatory variables. Wealth and education variables are interacted with a period indicator for 1990-2000 compared with 2001-2014 to observe differences over time. Based on these regressions we calculate predicted CIAF prevalence by wealth and education categories and over time. The sample included 146 surveys from 39 low-income and lower-middle-income countries with an overall sample size of 533 217 children. CIAF prevalence was 47.5% in 1990-2000, and it declined to 42.6% in 2001-2014. In 1990-2000 the CIAF prevalence of children with mothers with less than primary education was 31 percentage points higher than for mothers with secondary or higher education. This difference slightly decreased to 27 percentage points in 2001-2014. The difference in predicted CIAF prevalence of children from the highest and lowest wealth quartiles was 21 percentage points and did not change over time. We find evidence for persistent and even increasing socioeconomic inequalities in childhood undernutrition, which underlines the importance of previous calls for equity-driven approaches targeting the most vulnerable to reduce childhood malnutrition.

Does exposure to conflict of interest policies in psychiatry residency affect antidepressant prescribing?

PubMed

Epstein, Andrew J; Busch, Susan H; Busch, Alisa B; Asch, David A; Barry, Colleen L

2013-02-01

Academic medical institutions have instituted conflict of interest (COI) policies in response to concerns about pharmaceutical industry influence. To determine whether exposure to COI policies during psychiatry residency training affects psychiatrists' antidepressant prescribing patterns after graduation. We used 2009 physician-level national administrative prescribing data from IMS Health for 1652 psychiatrists from 162 residency programs. We used difference-in-differences estimation to compare antidepressant prescribing based on graduation before (2001) or after (2008) COI policy adoption across residency program groups with maximally, moderately, and minimally restrictive COI policies. The primary outcomes were shares of psychiatrists' prescribing of heavily promoted, brand reformulated, and brand antidepressants. Rates of prescribing heavily promoted, brand reformulated, and brand antidepressants in 2009 were lower among post-COI graduates than pre-COI graduates at all levels of COI restrictiveness. However, differences between pre-COI and post-COI graduates' prescribing of heavily promoted medications were larger for maximally restrictive programs than both minimally restrictive programs [-4.3 percentage points; 95% confidence interval (CI), -7.0, -1.6] and moderately restrictive programs (-3.6 percentage points; 95% CI, -6.2, -1.1). The difference in prescribing reformulations was larger for maximally restrictive programs than minimally restrictive programs (-3.0 percentage points; 95% CI, -5.3, -0.7). Results were consistent for prescribing of brand drugs. This study provides the first empirical evidence of the effects of COI policies. Our results suggest that COI policies can help inoculate physicians against persuasive aspects of pharmaceutical promotion. Further research should assess whether these policies affect other drug classes and physician specialties similarly.

Does Migration Limit the Effect of Health Insurance on Hypertension Management in China?

PubMed Central

Fang, Hai; Jin, Yinzi; Zhang, Huyang; A. Rizzo, John; Zhang, Donglan; Hou, Zhiyuan

2017-01-01

Background: In China, rapid urbanization has caused migration from rural to urban areas, and raised the prevalence of hypertension. However, public health insurance is not portable from one place to another, and migration may limit the effectiveness of this non-portable health insurance on healthcare. Our study aims to investigate whether migration limits the effectiveness of health insurance on hypertension management in China. Methods: Data were obtained from the national baseline survey of the China Health and Retirement Longitudinal Study in 2011, including 4926 hypertensive respondents with public health insurance. Outcome measures included use of primary care, hypertension awareness, medication use, blood pressure monitoring, physician advice, and blood pressure control. Multivariate logistic regressions were estimated to examine whether the effects of rural health insurance on hypertension management differed between those who migrated to urban areas and those who did not migrate and lived in rural areas. Results: Among hypertensive respondents, 60.7% were aware of their hypertensive status. Compared to rural residents, the non-portable feature of rural health insurance significantly reduced rural-to-urban migrants’ probabilities of using primary care by 7.8 percentage points, hypertension awareness by 8.8 percentage points, and receiving physician advice by 18.3 percentage points. Conclusions: In China, migration to urban areas limited the effectiveness of rural health insurance on hypertension management due to its non-portable nature. It is critical to improve the portability of rural health insurance, and to extend urban health insurance and primary care coverage to rural-to-urban migrants to achieve better chronic disease management. PMID:29053607

Body mass index as discriminator of the lean mass deficit and excess body fat in institutionalized elderly people.

PubMed

Barbosa, Maria Helena; Bolina, Alisson F; Luiz, Raíssa B; de Oliveira, Karoline F; Virtuoso, Jair S; Rodrigues, Rosalina A P; Silva, Larissa C; da Cunha, Daniel F; De Mattia, Ana Lúcia; Barichello, Elizabeth

2015-01-01

The objective of this study was to identify the discriminating criterion for body mass index (BMI) in the prediction of low fat free mass and high body fat percentage according to sex among older people. Observational analytical study with cross-sectional design was used for this study. All institutionalized older people from the city of Uberaba (Minas Gerais, Brazil) who fit within the inclusion and exclusion criteria were approached. Sixty-five institutionalized older people were evaluated after signing a Free and Informed Consent Form. Descriptive and inferential statistical procedures were employed for the analysis, using Student's t-test and multiple linear regression. Receiver Operating Characteristic (ROC) curves were constructed to determine the BMI (kg/m(2)) cut-off points. The study complied with all the ethical norms for research involving human beings. In comparing the anthropometric measurements obtained via bioimpedance, elder male had higher mean height and body water volume than females. However, women had higher mean triceps skinfold and fat free mass than men. The BMI cut-off points, as discriminators of low fat free mass percentage and high body fat percentage in women, were ≤22.4 kg/m(2) and >26.6 kg/m(2), respectively; while for men they were ≤19.2 kg/m(2) and >23.8 kg/m(2). The results of this study indicate the need for multicenter studies aimed at suggesting BMI cut-off points for institutionalized older people, taking into account specific sex characteristics. Copyright © 2015 Elsevier Inc. All rights reserved.

The effect of an anti-malarial subsidy programme on the quality of service provision of artemisinin-based combination therapy in Kenya: a cluster-randomized, controlled trial

PubMed Central

2013-01-01

Background Many patients with suspected malaria in sub-Saharan Africa seek treatment from private providers, but this sector suffers from sub-standard medicine dispensing practices. To improve the quality of care received for presumptive malaria from the highly accessed private retail sector in western Kenya, subsidized pre-packaged artemether-lumefantrine (AL) was provided to private retailers, together with a one day training for retail staff on malaria diagnosis and treatment, job aids and community engagement activities. Methods The intervention was assessed using a cluster-randomized, controlled design. Provider and mystery-shopper cross-sectional surveys were conducted at baseline and eight months post-intervention to assess provider practices. Data were analysed based on cluster-level summaries, comparing control and intervention arms. Results On average, 564 retail outlets were interviewed per year. At follow-up, 43% of respondents reported that at least one staff member had attended the training in the intervention arm. The intervention significantly increased the percentage of providers knowing the first line treatment for uncomplicated malaria by 24.2% points (confidence interval (CI): 14.8%, 33.6%; adjusted p=0.0001); the percentage of outlets stocking AL by 31.7% points (CI: 22.0%, 41.3%; adjusted p=0.0001); and the percentage of providers prescribing AL for presumptive malaria by 23.6% points (CI: 18.7%, 28.6%; adjusted p=0.0001). Generally outlets that received training and job aids performed better than those receiving one or none of these intervention components. Conclusion Overall, subsidizing ACT and retailer training can significantly increase the percentage of outlets stocking and selling AL for the presumptive treatment of malaria, but further research is needed on strategies to improve the provision of counselling advice to retail customers. PMID:23452547

[Drug-promoting advertisements in the Dutch Journal of Medicine and Pharmaceutical Weekly: not always evidence based].

PubMed

van Eeden, Annelies E; Roach, Rachel E J; Halbesma, Nynke; Dekker, Friedo W

2012-01-01

To determine and compare the foundation of claims in drug-promoting advertisements in a Dutch journal for physicians and a Dutch journal for pharmacists. A cross-sectional study. We included all the drug-promoting advertisements referring to a randomized controlled trial (RCT) we could find on Medline from 2 volumes of the Dutch Journal of Medicine (Nederlands Tijdschrift voor Geneeskunde; NTvG) and the (also Dutch) Pharmaceutical Weekly (Pharmaceutisch Weekblad; PW). The validity of the advertisements (n = 54) and the methodological quality of the referenced RCTs (n = 150) were independently scored by 250 medical students using 2 standardised questionnaires. The advertisements' sources were concealed from the students. Per journal, the percentage of drug-promoting advertisements having a valid claim and the percentage of high-quality RCT references were determined. Average scores on quality and validity were compared between the 2 journals. On a scale of 0-18 points, the mean quality scores of the RCTs differed 0.3 (95% CI: -0.1-0.7) between the NTvG (score: 14.8; SD: 2.2) and the PW (score: 14.5; SD: 2.6). The difference between the validity scores of drug-promoting advertisements in the NTvG (score: 5.8; SD: 3.3) and the PW (score: 5.6; SD: 3.6) was 0.3 (95% CI: -0.3-0.9) on a scale of 0-10 points. For both journals, an average of 15% of drug-promoting advertisements was valid (defined as a validity score of > 8 points); 35% of the RCTs referred to was of good methodological quality (defined as a quality score of > 16 points). The substantiation of many claims in drug-promoting advertisements in the NTvG and the PW was mediocre. There was no difference between the 2 journals.

Reliability and agreement in the use of four- and six-point ordinal scales for the assessment of erythema in digital images of canine skin.

PubMed

Hill, Peter B

2015-06-01

Grading of erythema in clinical practice is a subjective assessment that cannot be confirmed using a definitive test; nevertheless, erythema scores are typically measured in clinical trials assessing the response to treatment interventions. Most commonly, ordinal scales are used for this purpose, but the optimal number of categories in such scales has not been determined. This study aimed to compare the reliability and agreement of a four-point and a six-point ordinal scale for the assessment of erythema in digital images of canine skin. Fifteen digital images showing varying degrees of erythema were assessed by specialist dermatologists and laypeople, using either the four-point or the six-point scale. Reliability between the raters was assessed using intraclass correlation coefficients and Cronbach's α. Agreement was assessed using the variation ratio (the percentage of respondents who chose the mode, the most common answer). Intraobserver variability was assessed by comparing the results of two grading sessions, at least 6 weeks apart. Both scales demonstrated high reliability, with intraclass correlation coefficient values and Cronbach's α above 0.99. However, the four-point scale demonstrated significantly superior agreement, with variation ratios for the four-point scale averaging 74.8%, compared with 56.2% for the six-point scale. Intraobserver consistency for the four-point scale was very high. Although both scales demonstrated high reliability, the four-point scale was superior in terms of agreement. For the assessment of erythema in clinical trials, a four-point ordinal scale is recommended. © 2014 ESVD and ACVD.

Decrease in Prostate Cancer Testing Following the US Preventive Services Task Force (USPSTF) Recommendations.

PubMed

Li, Jun; Berkowitz, Zahava; Hall, Ingrid J

2015-01-01

To assess changes of prostate-specific antigen (PSA) testing following recent US Preventive Services Task Force (USPSTF) prostate cancer screening recommendations using 2005 to 2013 National Health Interview Survey data. We calculated the percentage of PSA testing among men ≥40 years by age group and age-adjusted race for each survey year. Differences between years were assessed with linear contrasts after combining all years' data. The overall percentage of PSA testing was highest in 2008 and decreased significantly in 2013. Compared with 2008, each age group had significantly lower screening percentages in 2013, especially men ≥75 years old (-14.0% points; P < .001). Both men aged 50 to 74 and men aged ≥75 had significantly lower percentages in 2013 than in 2010. For white and black men, the PSA testing percentages were highest in 2008 and decreased significantly in 2013. Only white men had a significantly lower percentage in 2013 than in 2010. Significant declines in PSA testing from 2008 to 2013 in men ≥75 years old may reflect the impact of the 2008 USPSTF recommendations. While the cause of the decreases in PSA testing between 2010 and 2013 among men aged 50 to 74 years old and white men is unknown, the decreases may suggest the early effects of the 2012 recommendations. © Copyright 2015 by the American Board of Family Medicine.

Extended physical education in children aged 6-15 years was associated with improved academic achievement in boys.

PubMed

Cöster, M E; Fritz, J; Karlsson, C; Rosengren, B E; Karlsson, M K

2018-06-01

Physical activity (PA) has been associated with enhanced cognition, brain development and concentration. This study evaluated whether increased physical education (PE) improved academic achievement. We recruited 304 children (55% boys) from a Swedish school in Skane County in 1998-2002 when they were six to seven years of age and followed them through all nine mandatory school years. Their PE level was increased from 60 to 200 minutes per week, and their results were compared with 73 885 control children (51% boys) in the county who graduated in the same years and did the standard 60 minutes of PE per week. Their academic achievements were measured as their final grade scores and the proportion of students eligible for upper secondary school. The eligibility for further education increased in the intervention boys by 6.8 percentage points and the mean grade score by 12.1 points, while in the control group as a whole, the eligibility rate decreased by 0.7 percentage points and the mean grade score increased by 1.7 points. No changes in eligibility rates or mean grade scores were seen in the intervention girls. Increasing weekly PE over nine years was associated with improved academic achievement in boys. ©2018 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Thermal, physiological and perceptual strain mediate alterations in match-play tennis under heat stress.

PubMed

Périard, Julien D; Racinais, Sébastien; Knez, Wade L; Herrera, Christopher P; Christian, Ryan J; Girard, Olivier

2014-04-01

This study compared the thermal, physiological and perceptual responses associated with match-play tennis in HOT (∼34°C wet-bulb-globe temperature (WBGT)) and COOL (∼19°C WBGT) conditions, along with the accompanying alterations in match characteristics. 12 male tennis players undertook two matches for an effective playing time (ie, ball in play) of 20 min, corresponding to ∼119 and ∼102 min of play in HOT and COOL conditions, respectively. Rectal and skin temperatures, heart rate, subjective ratings of thermal comfort, thermal sensation and perceived exertion were recorded, along with match characteristics. End-match rectal temperature increased to a greater extent in the HOT (∼39.4°C) compared with the COOL (∼38.7°C) condition (p<0.05). Thigh skin temperature was higher throughout the HOT match (p<0.001). Heart rate, thermal comfort, thermal sensation and perceived exertion were also higher during the HOT match (p<0.001). Total playing time was longer in the HOT compared with the COOL match (p<0.05). Point duration (∼7.1 s) was similar between conditions, while the time between points was ∼10 s longer in the HOT relative to the COOL match (p<0.05). This led to a ∼3.4% lower effective playing percentage in the heat (p<0.05). Although several thermal, physiological and perceptual variables were individually correlated to the adjustments in time between points and effective playing percentage, thermal sensation was the only predictor variable associated with both adjustments (p<0.005). These adjustments in match-play tennis characteristics under severe heat stress appear to represent a behavioural strategy adopted to minimise or offset the sensation of environmental conditions being rated as difficult.

Topical Clonazepam Solution for the Management of Burning Mouth Syndrome: A Retrospective Study.

PubMed

Kuten-Shorrer, Michal; Treister, Nathaniel S; Stock, Shannon; Kelley, John M; Ji, Yisi D; Woo, Sook-Bin; Lerman, Mark A; Palmason, Stefan; Sonis, Stephen T; Villa, Alessandro

2017-01-01

To evaluate and compare the effectiveness of two concentrations of topical clonazepam solution in improving symptoms of burning mouth syndrome (BMS). A retrospective chart review was conducted of patients diagnosed with BMS and managed with topical clonazepam solution between 2008 and 2015. A 0.5-mg/mL solution was prescribed until 2012, when this was changed to a 0.1 mg/mL solution. Patients were instructed to swish with 5 mL for 5 minutes and spit two to four times daily. The efficacies of the two concentrations were compared using patient-reported outcome measures at the first follow-up, including the reported percentage of improvement in burning symptoms and the change in burning severity from baseline ranked on an 11-point numeric rating scale (NRS). Response to treatment was compared between the two concentrations using Wilcoxon rank sum test. A total of 57 subjects were included, 32 in the 0.1-mg/mL cohort and 25 in the 0.5-mg/mL cohort, and evaluated at a median follow-up of 7 weeks. The median overall percentage improvement was 32.5% in the 0.1-mg/mL cohort and 75% in the 0.5-mg/mL cohort. The median reduction in NRS score was 0.5 points in the 0.1-mg/mL cohort and 6 points in the 0.5-mg/mL cohort. The use of either outcome measure revealed that the response to treatment with the 0.5-mg/mL solution was superior to that of the 0.1 mg/mL solution (P < .01). These findings suggest that a 0.5-mg/mL topical clonazepam solution is effective in the management of BMS. Future randomized clinical trials are warranted.

Patient Protection and Affordable Care Act Medicaid expansion and gains in health insurance coverage and access among cancer survivors.

PubMed

Nikpay, Sayeh S; Tebbs, Margaret G; Castellanos, Emily H

2018-04-17

The Patient Protection and Affordable Care Act extends Medicaid coverage to millions of low-income adults, including many survivors of cancer who were unable to purchase affordable health insurance coverage in the individual health insurance market. Using data from the 2011 to 2015 Behavioral Risk Factor Surveillance System, the authors compared changes in coverage and health care access measures for low-income cancer survivors in states that did and did not expand Medicaid. The study population of 17,381 individuals included adults aged 18 to 64 years, and was predominantly female, white, and unmarried. The authors found a relative reduction in the uninsured rate of 11.7 percentage points and a relative increase in the probability of having a personal physician of 5.8 percentage points. Stratifying by whether states expanded Medicaid by 2015, the authors found that relative gains in coverage and access were larger among those individuals residing in states with expanded Medicaid compared with those residing in nonexpansion states. The results of the current study suggest that the Patient Protection and Affordable Care Act Medicaid expansion has improved coverage and access for cancer survivors. Cancer 2018. © 2018 American Cancer Society. © 2018 American Cancer Society.

Investigating the historic long-term population health impact of the US National School Lunch Program.

PubMed

Peterson, Cora

2014-12-01

The present research aimed to compare historic participation in the US National School Lunch Program (NSLP) during childhood and subsequent prevalence of overweight and obesity among adults at the population level. Regression models examined cross-sectional, state- and age-based panel data constructed from multiple sources, including the Behavioural Risk Factor Surveillance System, US Congressional Record, US Census and the US Department of Agriculture. Models controlled for cohorts' racial/ethnic composition and state poverty rates. Adult-age cohorts (18-34, 35-49, 50-64 and 18-64 years) by US state over a 25-year period (1984-2008). The cohorts' prevalence of overweight and obesity was compared with the cohorts' estimated NSLP participation during schooling (1925-2007; the NSLP began in 1946). Among adults aged 18-64 years, a one percentage-point increase in estimated NSLP participation during schooling between 1925 and 2007 was significantly associated with a 0·29 percentage-point increase in the cohort's later prevalence of overweight and obesity. Analysis of narrower age cohorts and different schooling periods produced mixed results. The NSLP might have influenced population health historically. Longitudinal analysis of individuals from studies now underway will likely facilitate more robust conclusions about the NSLP's long-term health impact based on more recent experiences.

Excessive Gestational Weight Gain and Subsequent Maternal Obesity at Age 40: A Hypothetical Intervention.

PubMed

Abrams, Barbara; Coyle, Jeremy; Cohen, Alison K; Headen, Irene; Hubbard, Alan; Ritchie, Lorrene; Rehkopf, David H

2017-09-01

To model the hypothetical impact of preventing excessive gestational weight gain on midlife obesity and compare the estimated reduction with the US Healthy People 2020 goal of a 10% reduction of obesity prevalence in adults. We analyzed 3917 women with 1 to 3 pregnancies in the prospective US National Longitudinal Survey of Youth, from 1979 to 2012. We compared the estimated obesity prevalence between 2 scenarios: gestational weight gain as reported and under the scenario of a hypothetical intervention that all women with excessive gestational weight gain instead gained as recommended by the Institute of Medicine (2009). A hypothetical intervention was associated with a significantly reduced estimated prevalence of obesity for first (3.3 percentage points; 95% confidence interval [CI] = 1.0, 5.6) and second (3.0 percentage points; 95% CI = 0.7, 5.2) births, and twice as high in Black as in White mothers, but not significant in Hispanics. The population attributable fraction was 10.7% (95% CI = 3.3%, 18.1%) in first and 9.3% (95% CI = 2.2%, 16.5%) in second births. Development of effective weight-management interventions for childbearing women could lead to meaningful reductions in long-term obesity.

Competition in the economic crisis: Analysis of procurement auctions.

PubMed

Gugler, Klaus; Weichselbaumer, Michael; Zulehner, Christine

2015-01-01

We study the effects of the recent economic crisis on firms׳ bidding behavior and markups in sealed bid auctions. Using data from Austrian construction procurements, we estimate bidders׳ construction costs within a private value auction model. We find that markups of all bids submitted decrease by 1.5 percentage points in the recent economic crisis, markups of winning bids decrease by 3.3 percentage points. We also find that without the government stimulus package this decrease would have been larger. These two pieces of evidence point to pro-cyclical markups.

Trends in Disparities in Low-Income Children's Health Insurance Coverage and Access to Care by Family Immigration Status.

PubMed

Jarlenski, Marian; Baller, Julia; Borrero, Sonya; Bennett, Wendy L

2016-03-01

To examine time trends in disparities in low-income children's health insurance coverage and access to care by family immigration status. We used data from the National Survey of Children's Health in 2003 to 2011-2012, including 83,612 children aged 0 to 17 years with family incomes <200% of the federal poverty level. We examined 3 immigration status categories: citizen children with nonimmigrant parents; citizen children with immigrant parents; and immigrant children. We used multivariable regression analyses to obtain adjusted trends in health insurance coverage and access to care. All low-income children experienced gains in health insurance coverage and access to care from 2003 to 2011-2012, regardless of family immigration status. Relative to citizen children with nonimmigrant parents, citizen children with immigrant parents had a 5 percentage point greater increase in health insurance coverage (P = .06), a 9 percentage point greater increase in having a personal doctor or nurse (P < .01), and an 11 percentage point greater increase in having no unmet medical need (P < .01). Immigrant children had significantly lower health insurance coverage than other groups. However, the group had a 14 percentage point greater increase in having a personal doctor or nurse (P < .01) and a 26 percentage point greater increase in having no unmet medical need (P < .01) relative to citizen children with nonimmigrant parents. Some disparities in access to care related to family immigration status have lessened over time among children in low-income families, although large disparities still exist. Policy efforts are needed to ensure that children of immigrant parents and immigrant children are able to access health insurance and health care. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Overview of Global, Regional, and National Routine Vaccination Coverage Trends and Growth Patterns From 1980 to 2009: Implications for Vaccine-Preventable Disease Eradication and Elimination Initiatives

PubMed Central

Wallace, Aaron S.; Ryman, Tove K.; Dietz, Vance

2015-01-01

Background Review of the historical growth in annual vaccination coverage across countries and regions can better inform decision makers’ development of future goals and strategies to improve routine vaccination services. Methods Using the World Health Organization (WHO) and the United Nations Children's Fund estimates of annual national third dose of diphtheria-tetanus-pertussis–containing vaccine (DTP3) and third dose of polio vaccine (POL3) coverage for 1980–2009, we calculated the mean absolute annual rate of change in national DTP3 coverage among all countries (globally) and among countries within each WHO region, as well as the number of years taken by each region to reach specific regional coverage levels. Last, we assessed differences in mean absolute annual rate of change in DTP3 coverage, stratified by baseline level of DTP3 coverage. Results During the 1980s, global DTP3 coverage increased a mean of 5.3 percentage points/year. Annual rate of change decreased to 0.5 percentage points/year in the 1990s and then increased to 0.9 percentage points/year during the 2000s. Mean annual rate of change in coverage across all countries was highest (9.2 percentage points) when national coverage levels were 26%–30% and lowest (−0.9 percentage points) when national coverage levels were 96%–100%. Regional differences existed as both WHO South-East Asia Region and WHO African Region countries experienced mean negative DTP3 coverage growth at lower coverage levels (81%–85%) than other regions. The regions that have achieved 95% DTP3 coverage (Americas, Western Pacific, and European) took 25–29 years to reach that level from a level of 50% DTP3 coverage. POL3 coverage change trends were similar to described DTP3 coverage change trends. Conclusions Mean national coverage growth patterns across all regions are nonlinear as coverage levels increase. Saturation points of mean 0 percentage-point growth in annual coverage varies by region and require further investigation. The achievement of >90% routine coverage is observed to take decades, which has implications for disease eradication and elimination initiatives. PMID:25316875

Treatment of Endometriosis-Associated Pain with Elagolix, an Oral GnRH Antagonist.

PubMed

Taylor, Hugh S; Giudice, Linda C; Lessey, Bruce A; Abrao, Mauricio S; Kotarski, Jan; Archer, David F; Diamond, Michael P; Surrey, Eric; Johnson, Neil P; Watts, Nelson B; Gallagher, J Chris; Simon, James A; Carr, Bruce R; Dmowski, W Paul; Leyland, Nicholas; Rowan, Jean P; Duan, W Rachel; Ng, Juki; Schwefel, Brittany; Thomas, James W; Jain, Rita I; Chwalisz, Kristof

2017-07-06

Endometriosis is a chronic, estrogen-dependent condition that causes dysmenorrhea and pelvic pain. Elagolix, an oral, nonpeptide, gonadotropin-releasing hormone (GnRH) antagonist, produced partial to nearly full estrogen suppression in previous studies. We performed two similar, double-blind, randomized, 6-month phase 3 trials (Elaris Endometriosis I and II [EM-I and EM-II]) to evaluate the effects of two doses of elagolix - 150 mg once daily (lower-dose group) and 200 mg twice daily (higher-dose group) - as compared with placebo in women with surgically diagnosed endometriosis and moderate or severe endometriosis-associated pain. The two primary efficacy end points were the proportion of women who had a clinical response with respect to dysmenorrhea and the proportion who had a clinical response with respect to nonmenstrual pelvic pain at 3 months. Each of these end points was measured as a clinically meaningful reduction in the pain score and a decreased or stable use of rescue analgesic agents, as recorded in a daily electronic diary. A total of 872 women underwent randomization in Elaris EM-I and 817 in Elaris EM-II; of these women, 653 (74.9%) and 632 (77.4%), respectively, completed the intervention. At 3 months, a significantly greater proportion of women who received each elagolix dose met the clinical response criteria for the two primary end points than did those who received placebo. In Elaris EM-I, the percentage of women who had a clinical response with respect to dysmenorrhea was 46.4% in the lower-dose elagolix group and 75.8% in the higher-dose elagolix group, as compared with 19.6% in the placebo group; in Elaris EM-II, the corresponding percentages were 43.4% and 72.4%, as compared with 22.7% (P<0.001 for all comparisons). In Elaris EM-I, the percentage of women who had a clinical response with respect to nonmenstrual pelvic pain was 50.4% in the lower-dose elagolix group and 54.5% in the higher-dose elagolix group, as compared with 36.5% in the placebo group (P<0.001 for all comparisons); in Elaris EM-II, the corresponding percentages were 49.8% and 57.8%, as compared with 36.5% (P=0.003 and P<0.001, respectively). The responses with respect to dysmenorrhea and nonmenstrual pelvic pain were sustained at 6 months. Women who received elagolix had higher rates of hot flushes (mostly mild or moderate), higher levels of serum lipids, and greater decreases from baseline in bone mineral density than did those who received placebo; there were no adverse endometrial findings. Both higher and lower doses of elagolix were effective in improving dysmenorrhea and nonmenstrual pelvic pain during a 6-month period in women with endometriosis-associated pain. The two doses of elagolix were associated with hypoestrogenic adverse effects. (Funded by AbbVie; Elaris EM-I and EM-II ClinicalTrials.gov numbers, NCT01620528 and NCT01931670 .).

Diabetes and Hypertension in India: A Nationally Representative Study of 1.3 Million Adults.

PubMed

Geldsetzer, Pascal; Manne-Goehler, Jennifer; Theilmann, Michaela; Davies, Justine I; Awasthi, Ashish; Vollmer, Sebastian; Jaacks, Lindsay M; Bärnighausen, Till; Atun, Rifat

2018-03-01

Understanding how diabetes and hypertension prevalence varies within a country as large as India is essential for targeting of prevention, screening, and treatment services. However, to our knowledge there has been no prior nationally representative study of these conditions to guide the design of effective policies. To determine the prevalence of diabetes and hypertension in India, and its variation by state, rural vs urban location, and individual-level sociodemographic characteristics. This was a cross-sectional, nationally representative, population-based study carried out between 2012 and 2014. A total of 1 320 555 adults 18 years or older with plasma glucose (PG) and blood pressure (BP) measurements were included in the analysis. State, rural vs urban location, age, sex, household wealth quintile, education, and marital status. Diabetes (PG level ≥126 mg/dL if the participant had fasted or ≥200 mg/dL if the participant had not fasted) and hypertension (systolic BP≥140 mm Hg or diastolic BP≥90 mm Hg). Of the 1 320 555 adults, 701 408 (53.1%) were women. The crude prevalence of diabetes and hypertension was 7.5% (95% CI, 7.3%-7.7%) and 25.3% (95% CI, 25.0%-25.6%), respectively. Notably, hypertension was common even among younger age groups (eg, 18-25 years: 12.1%; 95% CI, 11.8%-12.5%). Being in the richest household wealth quintile compared with being in the poorest quintile was associated with only a modestly higher probability of diabetes (rural: 2.81 percentage points; 95% CI, 2.53-3.08 and urban: 3.47 percentage points; 95% CI, 3.03-3.91) and hypertension (rural: 4.15 percentage points; 95% CI, 3.68-4.61 and urban: 3.01 percentage points; 95% CI, 2.38-3.65). The differences in the probability of both conditions by educational category were generally small (≤2 percentage points). Among states, the crude prevalence of diabetes and hypertension varied from 3.2% (95% CI, 2.7%-3.7%) to 19.9% (95% CI, 17.6%-22.3%), and 18.0% (95% CI, 16.6%-19.5%) to 41.6% (95% CI, 37.8%-45.5%), respectively. Diabetes and hypertension prevalence is high in middle and old age across all geographical areas and sociodemographic groups in India, and hypertension prevalence among young adults is higher than previously thought. Evidence on the variations in prevalence by state, age group, and rural vs urban location is critical to effectively target diabetes and hypertension prevention, screening, and treatment programs to those most in need.

12 CFR 226.14 - Determination of annual percentage rate.

Code of Federal Regulations, 2010 CFR

2010-01-01

... percentage point above or below the annual percentage rate determined in accordance with this section. 31a... finance charge for the billing cycle by the sum of the balances to which the periodic rates were applied... of the balance(s) to which it is applicable 32 and multiplying the quotient (expressed as a...

For All Kids: How Kentucky Is Closing the High School Graduation Gap for Low-Income Students

ERIC Educational Resources Information Center

Fox, Joanna Hornig; Ingram, Erin S.; Depaoli, Jennifer L.

2016-01-01

In the 2012-13 school year, Kentucky led the nation with an 85.4 percent high school graduation rate for low-income students and a one-percentage-point graduation gap between low-income and non-low-income students. In 2013-14 the state ranked fourth in the nation with a seven-percentage-point incomebased graduation rate gap. Even though Kentucky's…

Oregon's On-Time High School Graduation Rate Shows Strong Growth in 2014-15. Research Brief

ERIC Educational Resources Information Center

Oregon Department of Education, 2016

2016-01-01

Oregon continues to make gains in its on-time high school graduation rate. The rate increased to 74% for the 2014-15 school year--up from 72% the year before. The graduation rate for almost all student groups rose, led by Hispanic students (2.4 percentage points) and Black students (2.4 percentage points). The rate for economically disadvantaged…

Relative household wealth and non-fatal road crashes: analysis of population-representative data of Kenyan adults.

PubMed

Kraemer, John D

2018-05-18

This study aims to examine potential road crash disparities across relative wealth and location of residence in Kenya by analyzing population-representative Demographic and Health Survey data. Relative wealth was measured by household assets, converted into an index by polychoric principal components analysis. Location and sex-stratified associations between wealth quantiles and crashes were flexibly estimated using fractional polynomial models. Structural equation models were fit to examine whether observed differences may operate through previously identified determinants. In rural areas, crashes were least common for both the poorest men (-5.2 percentage points, 95% CI: -7.3 to -3.2) and women (-1.6 percentage points, 95% CI: -2.9 to -0.4). In urban areas, male crashes were lowest (-3.0 percentage points, 95% CI: -5.2 to -0.8) among the wealthiest, while they peaked in the middle of the female wealth distribution (2.0 percentage points, 95% CI: 0.3-3.8). Male differences operate partially though occupational driving and vehicle ownership. Urban female differences operate partially through household vehicle ownership, but differences for rural women were not explained by modeled determinants. Relative wealth and road crash have opposite associations in rural and urban areas. Especially in rural areas, it is important to mitigate potential unintended effects of economic development.

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease.

PubMed

Ridker, Paul M; Everett, Brendan M; Thuren, Tom; MacFadyen, Jean G; Chang, William H; Ballantyne, Christie; Fonseca, Francisco; Nicolau, Jose; Koenig, Wolfgang; Anker, Stefan D; Kastelein, John J P; Cornel, Jan H; Pais, Prem; Pella, Daniel; Genest, Jacques; Cifkova, Renata; Lorenzatti, Alberto; Forster, Tamas; Kobalava, Zhanna; Vida-Simiti, Luminita; Flather, Marcus; Shimokawa, Hiroaki; Ogawa, Hisao; Dellborg, Mikael; Rossi, Paulo R F; Troquay, Roland P T; Libby, Peter; Glynn, Robert J

2017-09-21

Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P=0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P=0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P=0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P=0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P=0.31). Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846 .).

Comparison of Different Risk Perception Measures in Predicting Seasonal Influenza Vaccination among Healthy Chinese Adults in Hong Kong: A Prospective Longitudinal Study

PubMed Central

Liao, Qiuyan; Wong, Wing Sze; Fielding, Richard

2013-01-01

Background Risk perception is a reported predictor of vaccination uptake, but which measures of risk perception best predict influenza vaccination uptake remain unclear. Methodology During the main influenza seasons (between January and March) of 2009 (Wave 1) and 2010 (Wave 2),505 Chinese students and employees from a Hong Kong university completed an online survey. Multivariate logistic regression models were conducted to assess how well different risk perceptions measures in Wave 1 predicted vaccination uptake against seasonal influenza in Wave 2. Principal Findings The results of the multivariate logistic regression models showed that feeling at risk (β = 0.25, p = 0.021) was the better predictor compared with probability judgment while probability judgment (β = 0.25, p = 0.029 ) was better than beliefs about risk in predicting subsequent influenza vaccination uptake. Beliefs about risk and feeling at risk seemed to predict the same aspect of subsequent vaccination uptake because their associations with vaccination uptake became insignificant when paired into the logistic regression model. Similarly, to compare the four scales for assessing probability judgment in predicting vaccination uptake, the 7-point verbal scale remained a significant and stronger predictor for vaccination uptake when paired with other three scales; the 6-point verbal scale was a significant and stronger predictor when paired with the percentage scale or the 2-point verbal scale; and the percentage scale was a significant and stronger predictor only when paired with the 2-point verbal scale. Conclusions/Significance Beliefs about risk and feeling at risk are not well differentiated by Hong Kong Chinese people. Feeling at risk, an affective-cognitive dimension of risk perception predicts subsequent vaccination uptake better than do probability judgments. Among the four scales for assessing risk probability judgment, the 7-point verbal scale offered the best predictive power for subsequent vaccination uptake. PMID:23894292

Comparison of different risk perception measures in predicting seasonal influenza vaccination among healthy Chinese adults in Hong Kong: a prospective longitudinal study.

PubMed

Liao, Qiuyan; Wong, Wing Sze; Fielding, Richard

2013-01-01

Risk perception is a reported predictor of vaccination uptake, but which measures of risk perception best predict influenza vaccination uptake remain unclear. During the main influenza seasons (between January and March) of 2009 (Wave 1) and 2010 (Wave 2),505 Chinese students and employees from a Hong Kong university completed an online survey. Multivariate logistic regression models were conducted to assess how well different risk perceptions measures in Wave 1 predicted vaccination uptake against seasonal influenza in Wave 2. The results of the multivariate logistic regression models showed that feeling at risk (β = 0.25, p = 0.021) was the better predictor compared with probability judgment while probability judgment (β = 0.25, p = 0.029 ) was better than beliefs about risk in predicting subsequent influenza vaccination uptake. Beliefs about risk and feeling at risk seemed to predict the same aspect of subsequent vaccination uptake because their associations with vaccination uptake became insignificant when paired into the logistic regression model. Similarly, to compare the four scales for assessing probability judgment in predicting vaccination uptake, the 7-point verbal scale remained a significant and stronger predictor for vaccination uptake when paired with other three scales; the 6-point verbal scale was a significant and stronger predictor when paired with the percentage scale or the 2-point verbal scale; and the percentage scale was a significant and stronger predictor only when paired with the 2-point verbal scale. Beliefs about risk and feeling at risk are not well differentiated by Hong Kong Chinese people. Feeling at risk, an affective-cognitive dimension of risk perception predicts subsequent vaccination uptake better than do probability judgments. Among the four scales for assessing risk probability judgment, the 7-point verbal scale offered the best predictive power for subsequent vaccination uptake.

Educational campaigns at point of purchase in rural supermarkets improve stroke knowledge.

PubMed

Inoue, Yasuteru; Honda, Shoji; Watanabe, Masaki; Ando, Yukio

2015-02-01

The number of elderly people is dramatically increasing, and this trend is especially pronounced in rural populations. The aim of the present study was to verify the effectiveness of stroke education in a rural area. The stroke educational flyers were distributed for 3 weeks at the point of purchase within supermarkets. Questionnaires were used to determine knowledge about stroke and appropriate emergent action on identifying stroke. A total of 882 people responded to the questionnaires before (n = 409) and 3 months after (n = 473) the campaign. Of these, 686 (77.8%) were aged 65 years or older. The percentages of correct answers for hemiplegia and one-sided numbness (P < .05 for both) and calling emergency medical services (EMS) on identifying stroke occurrence (P < .001) were higher after the campaign compared with those before the campaign. Of the respondents aged 65 years or older, the percentages of correct answers for numbness on one side and calling for EMS on identifying stroke were higher after the campaign (P < .05 and P < .001, respectively). A simple point-of-purchase stroke campaign using educational flyers could meaningfully affect stroke knowledge among elderly persons in a rural community. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Lowering bronchoaspiration rate in an acute stroke unit by means of a 2 volume/3 texture dysphagia screening test with pulsioximetry.

PubMed

Cocho, D; Sagales, M; Cobo, M; Homs, I; Serra, J; Pou, M; Perez, G; Pujol, G; Tantinya, S; Bao, P; Aloy, A; Sabater, R; Gendre, J; Otermin, P

During acute stroke, 30% of all patients present dysphagia and 50% of that subgroup will experience bronchoaspiration. Our aim was to compare mortality and bronchoaspiration rates associated with the water test compared to those associated with a 2 volume/3 texture test controlled with pulse oximetry (2v/3t-P test) in our stroke unit. Over a 5-year period, we performed a prospective analysis of all consecutive acute ischaemic stroke patients hospitalised in the Stroke Unit. Dysphagia was evaluated using the water test between 2008 and 2010 (group 0 or G0), and the 2v/3t-P test (group 1 or G1) between 2011 and 2012. We analysed demographic data, vascular risk factors, neurological deficit on the NIHSS, aetiological subtype according to TOAST criteria, clinical subtype according to the Oxfordshire classification, prevalence of dysphagia, percentage of patients with bronchoaspiration, and mortality. We examined 418 patients with acute stroke (G0=275, G1=143). There were significant differences between the 2 groups regarding the percentage of patients with TACI (17% in G0 vs. 29% in G1, P=.005) and median NIHSS score (4 points in G0 vs. 7 points in G1, P=.003). Since adopting the new swallowing test, we detected a non-significant increase in the percentage of dysphagia (22% in G0 vs. 25% in G1, P=.4), lower mortality (1.7% in G0 vs. 0.7% in G1, P=.3) and a significant decrease in the bronchoaspiration rate (6.2% in G0 vs. 2.1% in G1, P=.05). Compared to the water test used for dysphagia screening, the new 2v/3t-P test lowered bronchoaspiration rates in acute stroke patients. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Migration, Agribusiness and Nutritional Status of Children under Five in Northwest Mexico

PubMed Central

Ortega, María-Isabel; Rosales, Cecilia; de Zapien, Jill Guernsey; Aranda, Patricia; Castañeda, Alejandro; Saucedo, Socorro; Montaño, Cecilia; Contreras, Alma

2011-01-01

The aim of this study was to examine the nutritional status of children of Mexican migrant worker families under five years of age within the context of global food markets. The sample included 404 children less than five years old from farms and agricultural communities in northwest Mexico. Prevalence of stunting and underweight of children appeared very similar to that of indigenous children from the national sample survey (difference 0.9 and 1.6 percentage points, respectively). Compared to the national sample of Mexican children, stunting and underweight seemed higher in migrant children (difference 17.7 and 4.5 percentage points, respectively), but wasting, an indicator of both chronic and acute undernutrition, appeared to indicate a process of nutritional recuperation. Migrant children living in poverty and suffering from chronic undernutrition, poor performance and scarce education opportunities, can be expected to eventually become agricultural workers with low productivity and poor general health. Consumer’s demands on social and environmental standards of fresh food production in developed countries could be an opportunity to impact the lives of migrant agricultural workers, their families and communities. PMID:22470276

The income body weight gradients in the developing economy of China.

PubMed

Tafreschi, Darjusch

2015-01-01

Existing theories predict the income gradient of individual body weight to change sign from positive to negative in process of economic development. However, there are only few empirical studies which test this hypothesis. This paper adds to the literature on that topic by investigating the case of China. Using individual and community data from 1991 to 2009 waves of the China Health and Nutrition Survey regression analyses suggest that after controlling for important confounding factors (1) higher income is positively related to future growth of individuals' BMI in less developed areas (i.e. BMI growth is 0.7-1.5 percentage points higher when comparing the richest with the poorest individuals), but negatively related to BMI growth in more developed areas (i.e. BMI growth is 0.8-1.6 percentage points lower for the richest individuals), and (2) that concentrations of overweight are "trickling down" to lower income ranks as regions become more developed. Moreover, the reversal of the income gradient appears to happen at earlier stages of development for females. Copyright © 2014 Elsevier B.V. All rights reserved.

Medicaid Stage 1 Meaningful Use EHR Incentive Payments Are Associated With Higher Quality but Not Improvements in Quality.

PubMed

Grinspan, Zachary M; Bao, Yuhua; Edwards, Alison; Johnson, Phyllis; Kaushal, Rainu; Kern, Lisa M

This was a retrospective cohort study of ambulatory care quality by physicians who received payment for Medicaid Stage 1 Meaningful Use (MU) in 2012 using New York State Medicaid Claims (2010-2013). Eight quality measures were used to compare performance of physicians who received payments to Adopt, Implement, or Use (AIU) an electronic health record in 2011 but not for MU in 2012 (AIU-only group) and physicians who cared for Medicaid patients but received no payments (no-incentive group), using propensity score-weighted difference-in-difference logistic regression analyses, clustering by physician. In all, 13 697 physicians and 913 476 patients were studied. In 2010, the MU group scored higher than both groups (vs AIU-only in 3 of 8 measures, 0.8-1.3 adjusted percentage points; vs no-incentive, 2 of 8 measures, 0.9-2.0 adjusted percentage points). The difference-in-difference analysis found no additional improvements in quality over time relative to either control group. Longer follow-up is needed to determine the effects of Stage 2 MU.

Socioeconomic inequalities in breast and cervical screening coverage in England: are we closing the gap?

PubMed

Douglas, Elaine; Waller, Jo; Duffy, Stephen W; Wardle, Jane

2016-06-01

Health policy in the UK is committed to tackling inequalities in cancer screening participation. We examined whether socioeconomic inequalities in breast and cervical cancer screening participation in England have reduced over five years. Cross-sectional analyses compared cervical and breast screening coverage between 2007/8 and 2012/13 in Primary Care Trusts (PCTs) in England in relation to area-level income deprivation. At the start and the end of this five year period, there were socioeconomic inequalities in screening coverage for breast and cervical screening. Inequalities were highest for breast screening. Over time, the coverage gap between the highest and lowest quintiles of income deprivation significantly reduced for breast screening (from 12.3 to 8.3 percentage points), but not for cervical screening (5.3 to 4.9 percentage points). Efforts to reduce screening inequalities appear to have resulted in a significant improvement in equitable delivery of breast screening, although not of cervical screening. More work is needed to understand the differences, and see whether broader lessons can be learned from the reduction of inequalities in breast screening participation. © The Author(s) 2015.

Performance, intestinal microflora, and amino acid digestibility altered by exogenous enzymes in broilers fed wheat- or sorghum-based diets.

PubMed

Wu, D; Wu, S B; Choct, M; Swick, R A

2017-02-01

The objective of the current study was to compare the effects of dietary enzymes and nutrient restriction on performance and bone mineralization in birds fed wheat- or sorghum-based diets. A total of 720 d-old male broiler chicks were randomly allocated to 8 treatments, with 6 replicates per treatment and 15 birds per replicate. Birds were reared in floor pens from 0 to 35 d. The study used a 2 × 4 factorial arrangement with 2 grains (sorghum or wheat) and 4 diets: positive control (no enzyme and ME, digestible Lys, Ca, and P sufficient, negative control (NC; no enzyme and reduced ME [-100 kcal/kg], digestible AA [-2%], Ca [-0.12 percentage points], and available P [-0.18 percentage points in the starter phase and -0.22 percentage points in the grower phase]), NC + nonstarch polysaccharide-degrading enzymes + phytase (500 phytase units [FTU]; NCCP), and NC + phytase (1,000 FTU; NCP). From 0 to 35 d, birds fed wheat-based diets had greater G:F (4.5%), BW gain (9.2%), breast meat yield (6.8%), and tibia ash (2.0%) compared with birds fed sorghum-based diets. Across grain types, the NCCP treatment improved BW gain ( < 0.001), feed intake ( < 0.001), G:F ( < 0.05), and livability ( < 0.001) compared with the NC treatment. Birds fed NCP had greater BW gain ( < 0.001), feed intake ( < 0.001), G:F ( < 0.001), and livability ( < 0.001) compared with birds fed NC. Birds fed the NCP diet had greater BW gain ( < 0.001), toe ash ( < 0.01), and tibia ash ( < 0.001) compared with birds fed the NCCP diet. There was a grain × diet interaction for feed intake ( < 0.01), BW gain ( < 0.001), tibia ash ( < 0.01), and tibia breaking strength ( < 0.05). The influence of enzymes was more pronounced in sorghum-based diets than in wheat-based diets. Birds fed wheat-based diets had greater ileal digestibility of His, Met, Val, Phe, Ile, Leu, Trp, Glu, Pro, Ala, Tyr, and Cys compared with those fed sorghum-based diets ( < 0.05). Across grain types, NCP had greater apparent ileal digestibility of Met, Lys, Ser, Pro, Gly, and Cys than NC ( < 0.05). The results suggest that wheat is superior to sorghum for broilers, as expected, but that enzyme supplementation has the capability to restore the compromised bird performance due to feeding sorghum. In addition, compared with nonstarch polysaccharide-degrading enzymes and phytase (500 FTU/kg feed) added in concert, phytase supplemented at 1,000 FTU/kg resulted in a further improvement of some of the performance and bone mineralization parameters in male broilers fed sorghum-based diets.

Knowledge as a Predictor of Insurance Coverage Under the Affordable Care Act.

PubMed

Hoerl, Maximiliane; Wuppermann, Amelie; Barcellos, Silvia H; Bauhoff, Sebastian; Winter, Joachim K; Carman, Katherine G

2017-04-01

The Affordable Care Act established policy mechanisms to increase health insurance coverage in the United States. While insurance coverage has increased, 10%-15% of the US population remains uninsured. To assess whether health insurance literacy and financial literacy predict being uninsured, covered by Medicaid, or covered by Marketplace insurance, holding demographic characteristics, attitudes toward risk, and political affiliation constant. Analysis of longitudinal data from fall 2013 and spring 2015 including financial and health insurance literacy and key covariates collected in 2013. A total of 2742 US residents ages 18-64, 525 uninsured in fall 2013, participating in the RAND American Life Panel, a nationally representative internet panel. Self-reported health insurance status and type as of spring 2015. Among the uninsured in 2013, higher financial and health insurance literacy were associated with greater probability of being insured in 2015. For a typical uninsured individual in 2013, the probability of being insured in 2015 was 8.3 percentage points higher with high compared with low financial literacy, and 9.2 percentage points higher with high compared with low health insurance literacy. For the general population, those with high financial and health insurance literacy were more likely to obtain insurance through Medicaid or the Marketplaces compared with being uninsured. The magnitude of coefficients for these predictors was similar to that of commonly used demographic covariates. A lack of understanding about health insurance concepts and financial illiteracy predict who remains uninsured. Outreach and consumer-education programs should consider these characteristics.

Efficacy of escitalopram compared to citalopram: a meta-analysis.

PubMed

Montgomery, Stuart; Hansen, Thomas; Kasper, Siegfried

2011-03-01

The aim of this review was to assess the clinical relevance of the relative antidepressant efficacy of escitalopram and citalopram by meta-analysis. Studies in major depressive disorder (MDD) with both escitalopram and citalopram treatment arms were identified. Adult patients had to meet DSM-IV criteria for MDD. The primary outcome measure was the treatment difference in Montgomery-Asberg Depression Rating Scale (MADRS) total score at week 8 (or last assessment if <8 wk). Secondary outcome measures were response (≥ 50% improvement from baseline) and remission (MADRS ≤ 12). A search of the literature and websites found eight randomized controlled trials (RCTs) and onr naturalistic trial, with a total of 2009 patients (escitalopram, n=995; citalopram, n=1014). Escitalopram was significantly more effective than citalopram in overall treatment effect, with an estimated mean treatment difference of 1.7 points at week 8 (or last assessment if <8 wk) on the MADRS (95% CI 0.8-2.6, p=0.0002) (six RCTs used the MADRS), and in responder rate (8.3 percentage points, 95% CI 4.4-12.3) (eight RCTs) and remitter rate (17.6 percentage points, 95% CI 12.1-23.1) analyses (reported for four RCTs), corresponding to number-needed-to-treat (NNT) values of 11.9 (p<0.0001) for response and 5.7 (p<0.0001) for remission. The overall odds ratios were 1.44 (p<0.0003) for response and 1.86 (p<0.0001) for remission, in favour of escitalopram. In this meta-analysis, the statistically significant superior efficacy of escitalopram compared to citalopram was shown to be clinically relevant.

Health Reform and Utilization of High-Volume Hospitals for Complex Cancer Operations.

PubMed

Loehrer, Andrew P; Chang, David C; Song, Zirui; Chang, George J

2018-01-01

Underinsured patients are less likely to receive complex cancer operations at hospitals with high surgical volumes (high-volume hospitals, or HVHs), which contributes to disparities in care. To date, the impact of insurance coverage expansion on site of complex cancer surgery remains unknown. Using the 2006 Massachusetts coverage expansion as a natural experiment, we searched the Hospital Cost and Utilization Project state inpatient databases for Massachusetts and control states (New York, New Jersey, and Florida) between 2001 and 2011 to evaluate changes in the utilization of HVHs for resections of bladder, esophageal, stomach, pancreatic, rectal, or lung cancer after the expansion of insurance coverage. We studied nonelderly, adult patients with private insurance and those with government-subsidized or self-pay (GSSP) coverage with a difference-in-differences framework. We studied 11,687 patients in Massachusetts and 56,300 patients in control states. Compared with control states, the 2006 Massachusetts insurance expansion was associated with a 14% increased rate of surgical intervention for GSSP patients (incident rate ratio, 1.14; P = .015), but there was no significant change in the probability of GSSP patients undergoing surgery at an HVH (1.0 percentage-point increase; P = .710). The reform was associated with no change in the uninsured payer-mix at HVHs (0.6 percentage-point increase; P = .244) and with a 5.1 percentage-point decrease for the uninsured payer mix at low-volume hospitals ( P < .001). The 2006 Massachusetts insurance expansion, a model for the Affordable Care Act, was associated with increased rates of complex cancer operations and increased insurance coverage but with no change in utilization of HVH for complex cancer operations.

Progressing beyond SLMTA: Are internal audits and corrective action the key drivers of quality improvement?

PubMed

Maina, Robert N; Mengo, Doris M; Mohamud, Abdikher D; Ochieng, Susan M; Milgo, Sammy K; Sexton, Connie J; Moyo, Sikhulile; Luman, Elizabeth T

2014-01-01

Kenya has implemented the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme to facilitate quality improvement in medical laboratories and to support national accreditation goals. Continuous quality improvement after SLMTA completion is needed to ensure sustainability and continue progress toward accreditation. Audits were conducted by qualified, independent auditors to assess the performance of five enrolled laboratories using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. End-of-programme (exit) and one year post-programme (surveillance) audits were compared for overall score, star level (from zero to five, based on scores) and scores for each of the 12 Quality System Essential (QSE) areas that make up the SLIPTA checklist. All laboratories improved from exit to surveillance audit (median improvement 38 percentage points, range 5-45 percentage points). Two laboratories improved from zero to one star, two improved from zero to three stars and one laboratory improved from three to four stars. The lowest median QSE scores at exit were: internal audit; corrective action; and occurrence management and process improvement (< 20%). Each of the 12 QSEs improved substantially at surveillance audit, with the greatest improvement in client management and customer service, internal audit and information management (≥ 50 percentage points). The two laboratories with the greatest overall improvement focused heavily on the internal audit and corrective action QSEs. Whilst all laboratories improved from exit to surveillance audit, those that focused on the internal audit and corrective action QSEs improved substantially more than those that did not; internal audits and corrective actions may have acted as catalysts, leading to improvements in other QSEs. Systematic identification of core areas and best practices to address them is a critical step toward strengthening public medical laboratories.

Progressing beyond SLMTA: Are internal audits and corrective action the key drivers of quality improvement?

PubMed Central

Mengo, Doris M.; Mohamud, Abdikher D.; Ochieng, Susan M.; Milgo, Sammy K.; Sexton, Connie J.; Moyo, Sikhulile; Luman, Elizabeth T.

2014-01-01

Background Kenya has implemented the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme to facilitate quality improvement in medical laboratories and to support national accreditation goals. Continuous quality improvement after SLMTA completion is needed to ensure sustainability and continue progress toward accreditation. Methods Audits were conducted by qualified, independent auditors to assess the performance of five enrolled laboratories using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. End-of-programme (exit) and one year post-programme (surveillance) audits were compared for overall score, star level (from zero to five, based on scores) and scores for each of the 12 Quality System Essential (QSE) areas that make up the SLIPTA checklist. Results All laboratories improved from exit to surveillance audit (median improvement 38 percentage points, range 5–45 percentage points). Two laboratories improved from zero to one star, two improved from zero to three stars and one laboratory improved from three to four stars. The lowest median QSE scores at exit were: internal audit; corrective action; and occurrence management and process improvement (< 20%). Each of the 12 QSEs improved substantially at surveillance audit, with the greatest improvement in client management and customer service, internal audit and information management (≥ 50 percentage points). The two laboratories with the greatest overall improvement focused heavily on the internal audit and corrective action QSEs. Conclusion Whilst all laboratories improved from exit to surveillance audit, those that focused on the internal audit and corrective action QSEs improved substantially more than those that did not; internal audits and corrective actions may have acted as catalysts, leading to improvements in other QSEs. Systematic identification of core areas and best practices to address them is a critical step toward strengthening public medical laboratories. PMID:29043193

Public pensions and unmet medical need among older people: cross-national analysis of 16 European countries, 2004–2010

PubMed Central

Reeves, Aaron; McKee, Martin; Mackenbach, Johan; Whitehead, Margaret; Stuckler, David

2017-01-01

Background Since the onset of the Great Recession in Europe, unmet need for medical care has been increasing, especially in persons aged 65 or older. It is possible that public pensions buffer access to healthcare in older persons during times of economic crisis, but to our knowledge, this has not been tested empirically in Europe. Methods We integrated panel data on 16 European countries for years 2004–2010 with indicators of public pension, unemployment insurance and sickness insurance entitlement from the Comparative Welfare Entitlements Dataset and unmet need (due to cost) prevalence rates from EuroStat 2014 edition. Using country-level fixed-effects regression models, we evaluate whether greater public pension entitlement, which helps reduce old-age poverty, reduces the prevalence of unmet medical need in older persons and whether it reduces inequalities in unmet medical need across the income distribution. Results We found that each 1-unit increase in public pension entitlement is associated with a 1.11 percentage-point decline in unmet medical need due to cost among over 65s (95% CI −0.55 to −1.66). This association is strongest for the lowest income quintile (1.65 percentage points, 95% CI −1.19 to −2.10). Importantly, we found consistent evidence that out-of-pocket payments were linked with greater unmet needs, but that this association was mitigated by greater public pension entitlement (β=−1.21 percentage points, 95% CI −0.37 to −2.06). Conclusions Greater public pension entitlement plays a crucial role in reducing inequalities in unmet medical need among older persons, especially in healthcare systems which rely heavily on out-of-pocket payments. PMID:27965315

Diet quality and physical activity in relation to childhood obesity.

PubMed

An, Ruopeng

2017-04-01

Healthy lifestyles such as being physically active and eating a healthy diet help reduce the childhood obesity risk. However, population-level studies on the relationship between lifestyles and childhood obesity typically focus on either physical activity or diet but seldom both. This study examined physical activity and diet quality in relation to obesity in a nationally representative sample of U.S. children and adolescents. The study sample of 2818 children 6-17 years old came from the National Health and Nutrition Examination Survey 2003-2006 waves. A healthy eating index (HEI)-2010 was constructed based on two nonconsecutive 24-h dietary recalls. Participants at or above the 60th percentile of the HEI-2010 score were classified as consuming a healthy diet. Participants engaging in at least 60 min of moderate-vigorous physical activity daily measured by accelerometer were classified as being physically active. Adjusted average marginal effect of diet quality and physical activity on obesity was calculated based on estimates from logistic regressions. Compared with those consuming a healthy diet who are physically active, the estimated probabilities for overweight and obesity were 19.03 (95% confidence interval: 11.31, 26.74) and 15.84 (10.48, 21.21) percentage points higher among children consuming an unhealthy diet and who are physically inactive, 16.53 (7.58, 25.48) and 13.48 (5.68, 21.29) percentage points higher among children consuming a healthy diet but who are physically inactive and 3.22 (-3.43, 9.88) and 3.10 (-3.08, 9.29) percentage points higher among children consuming an unhealthy diet but physically active, respectively. Healthy habit formation at an early age is essential in obesity prevention.

2013 Workplace and Equal Opportunity Survey of Active Duty Members: Overview Report

DTIC Science & Technology

2014-10-01

because they resolve the problem independently or fear negative consequences for reporting, such as retaliation. This type of information can help...enough to report (44% - 8 percentage points lower than 2009), they took care of the problem themselves (37% - 7 percentage points lower than 2009), they...a single category of “large extent.”  The large majority of members indicated no problems with these issues at their installation/ship

The child health implications of privatizing Africa's urban water supply.

PubMed

Kosec, Katrina

2014-05-01

Can private sector participation (PSP) in the piped water sector improve child health? I use child-level data from 39 African countries during 1986-2010 to show that PSP decreases diarrhea among urban-dwelling, under-five children by 2.6 percentage points, or 16% of its mean prevalence. Children from the poorest households benefit most. PSP is also associated with a 7.8 percentage point increase in school attendance of 7-17 year olds. Importantly, PSP increases usage of piped water by 9.7 percentage points, suggesting a possible causal channel explaining health improvements. To attribute causality, I exploit time-variation in the private water market share controlled by African countries' former colonizers. A placebo analysis reveals that PSP does not affect respiratory illness, nor does it affect a control group of rural children. Copyright © 2014 Elsevier B.V. All rights reserved.

The role of retiree health insurance in the early retirement of public sector employees.

PubMed

Shoven, John B; Slavov, Sita Nataraj

2014-12-01

Most government employees have access to retiree health coverage, which provides them with group health coverage even if they retire before Medicare eligibility. We study the impact of retiree health coverage on the labor supply of public sector workers between the ages of 55 and 64. We find that retiree health coverage raises the probability of stopping full time work by 4.3 percentage points (around 38 percent) over two years among public sector workers aged 55-59, and by 6.7 percentage points (around 26 percent) over two years among public sector workers aged 60-64. In the younger age group, retiree health insurance mostly seems to facilitate transitions to part-time work rather than full retirement. However, in the older age group, it increases the probability of stopping work entirely by 4.3 percentage points (around 22 percent). Copyright © 2014 Elsevier B.V. All rights reserved.

Physicians' prescribing responses to a restricted formulary: the impact of Medicaid preferred drug lists in Illinois and Louisiana.

PubMed

Virabhak, Suchin; Shinogle, Judith A

2005-01-01

To determine the extent to which the strictness of the criteria used to control utilization of drugs not on a Medicaid preferred drug list (PDL) changes physician prescribing habits for non-Medicaid patients. Quasi-experimental design based on different timing of states' enactment of PDLs for cardiovascular medications. A regression model was developed to analyze the effect that PDL implementation had on off-PDL product market share across 3 patient types (Medicaid, third-party insurance, and cash paying). The models included data from 2 states (Illinois and Louisiana) with different PDL prior-authorization criteria. The data allowed examination of different physician responses according to the proportion of Medicaid patients treated by the physician. The analysis also followed prescribing patterns longitudinally to determine whether the PDL-induced prescribing behaviors changed over time. There was a decrease of 9 percentage points (67.7%) and 6.2 percentage points (40.5%) in the Medicaid prescription share of restricted cardiovascular drugs post-PDL for Illinois and Louisiana, respectively. In the third-party insurance market, prescription shares of off-PDL drugs decreased 0.9 percentage points (6.8%) in Illinois and 1.3 percentage points (8.6%) in Louisiana. For physicians with a high percentage of prescriptions paid for by Medicaid, the share loss for off-PDL drugs was estimated to be more than 37% for the non-Medicaid portion of the practice. The effects of a Medicaid PDL on prescribing behavior extend beyond the Medicaid population. The health outcomes and economic consequences of these "spillover" effects are poorly understood and warrant further research.

SU-F-T-264: VMAT QA with 2D Radiation Measuring Equipment Attached to Gantry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fung, A

2016-06-15

Purpose: To introduce a method of VMAT QA by 2D measuring device. The 2D device is attached to the gantry throughout measurement duration. This eliminates error caused by the angular dependence of the radiation detectors. Methods: A 2D radiation measuring device was attached to the gantry of linear accelerator. The center of the detector plane was at the isocenter. For each patient plan, two verification plans were created for QA purpose. One was like an ordinary VMAT plan, to be used for radiation delivery. The other is a plan with gantry angle fixed at zero, so the dose distribution asmore » seen by the rotating 2D device. Points above 10% dose threshold were analyzed. Data is in tolerance if it fits within the 3 mm or 3% dose gamma criteria. For each patient, the plan was passed when 95% of all the points in the 2D matrix fit the gamma criteria. The following statistics were calculated: number of patient plans passed, percentage of all points passed, average percentage difference of all points. Results: VMAT QA was performed for patients during one year in our department, and the results were analyzed. All irradiation was with 6 MV photon beam. Each plan has calculated and measured doses compared. After collecting one year’s result, with 81 patient plans analyzed, all (100%) of the plans passed the gamma criteria. Of the points analyzed from all plans, 98.8% of all points passed. Conclusion: This method of attaching a 2D measuring device on the linac gantry proves to be an accurate way for VMAT QA. It is simple to use and low cost, and it eliminates the problem of directional dependence.« less

An ultrasound-assisted system for the optimization of biodiesel production from chicken fat oil using a genetic algorithm and response surface methodology.

PubMed

Fayyazi, E; Ghobadian, B; Najafi, G; Hosseinzadeh, B; Mamat, R; Hosseinzadeh, J

2015-09-01

Biodiesel is a green (clean), renewable energy source and is an alternative for diesel fuel. Biodiesel can be produced from vegetable oil, animal fat and waste cooking oil or fat. Fats and oils react with alcohol to produce methyl ester, which is generally known as biodiesel. Because vegetable oil and animal fat wastes are cheaper, the tendency to produce biodiesel from these materials is increasing. In this research, the effect of some parameters such as the alcohol-to-oil molar ratio (4:1, 6:1, 8:1), the catalyst concentration (0.75%, 1% and 1.25% w/w) and the time for the transesterification reaction using ultrasonication on the rate of the fatty acids-to-methyl ester (biodiesel) conversion percentage have been studied (3, 6 and 9 min). In biodiesel production from chicken fat, when increasing the catalyst concentration up to 1%, the oil-to-biodiesel conversion percentage was first increased and then decreased. Upon increasing the molar ratio from 4:1 to 6:1 and then to 8:1, the oil-to-biodiesel conversion percentage increased by 21.9% and then 22.8%, respectively. The optimal point is determined by response surface methodology (RSM) and genetic algorithms (GAs). The biodiesel production from chicken fat by ultrasonic waves with a 1% w/w catalyst percentage, 7:1 alcohol-to-oil molar ratio and 9 min reaction time was equal to 94.8%. For biodiesel that was produced by ultrasonic waves under a similar conversion percentage condition compared to the conventional method, the reaction time was decreased by approximately 87.5%. The time reduction for the ultrasonic method compared to the conventional method makes the ultrasonic method superior. Copyright © 2015. Published by Elsevier B.V.

Fast object detection algorithm based on HOG and CNN

NASA Astrophysics Data System (ADS)

Lu, Tongwei; Wang, Dandan; Zhang, Yanduo

2018-04-01

In the field of computer vision, object classification and object detection are widely used in many fields. The traditional object detection have two main problems:one is that sliding window of the regional selection strategy is high time complexity and have window redundancy. And the other one is that Robustness of the feature is not well. In order to solve those problems, Regional Proposal Network (RPN) is used to select candidate regions instead of selective search algorithm. Compared with traditional algorithms and selective search algorithms, RPN has higher efficiency and accuracy. We combine HOG feature and convolution neural network (CNN) to extract features. And we use SVM to classify. For TorontoNet, our algorithm's mAP is 1.6 percentage points higher. For OxfordNet, our algorithm's mAP is 1.3 percentage higher.

Mechanical Properties of SiC, Al2O3 Reinforced Aluminium 6061-T6 Hybrid Matrix Composite

NASA Astrophysics Data System (ADS)

Murugan, S. Senthil; Jegan, V.; Velmurugan, M.

2018-04-01

This paper contains the investigation of tensile, compression and impact characterization of SiC, Al2O3 reinforced Aluminium 6061-T6 matrix hybrid composite. Hybrid matrix composite fabrication was done by stir casting method. An attempt has been made by keeping Al2O3 percentage (7%) constant and increasing SiC percentage (10, 15, and 20%). After fabricating, the samples were prepared and tested to find out the various mechanical properties like tensile, compressive, and impact strength of the developed composites of different weight % of silicon carbide and Alumina in Aluminium alloy. The main objective of the study is to compare the values obtained and choose the best composition of the hybrid matrix composite from the mechanical properties point of view.

Twelve-year trends in health insurance coverage among Latinos, by subgroup and immigration status.

PubMed

Shah, N Sarita; Carrasquillo, Olveen

2006-01-01

We examine twelve-year trends in the Latino uninsured population by ethnic subgroup and immigration status. From 1993 to 1999, most Latino subgroups, particularly Puerto Ricans, had large decreases in Medicaid coverage. For some subgroups these were offset by increases in employer coverage, but not for Mexicans, resulting in a four-percentage-point increase in their uninsured population. During 2000-2004, Medicaid/SCHIP expansions benefited most subgroups and mitigated smaller losses in employer coverage. However, during 1993-2004, the percentage of noncitizen Latinos lacking coverage increased by several percentage points. This was attributable to Medicaid losses during 1993-1999 and losses in employer coverage during 2000-2004.

Discrepancies in describing pain: is there agreement between numeric rating scale scores and pain reduction percentage reported by patients with musculoskeletal pain after corticosteroid injection?

PubMed

Cushman, Daniel; McCormick, Zachary; Casey, Ellen; Plastaras, Christopher T

2015-05-01

Pain intensity is commonly rated on an 11-point Numerical Pain Rating Scale which can be expressed as a calculated percentage pain reduction (CPPR), or by patient-reported percentage pain reduction (PRPPR). We aimed to determine the agreement between CPPR and PRPPR in quantifying musculoskeletal pain improvement at short-term follow-up after a corticosteroid injection. Retrospective cohort study. Urban, academic, physical medicine, and rehabilitation outpatient interventional musculoskeletal and spine center. The agreement between CPPR and PRPPR was determined by concordance correlation coefficient (CCC) in subjects who had experienced improvement in musculoskeletal or radicular pain 3 weeks after a first-time injection at our clinic. Subjects who experienced unchanged pain (PRPPR = 0) were compared to CPPR with paired t-test. We examined 197 subjects with greater than 3/10 pain who underwent first-time fluoroscopic-guided corticosteroid injections. Ninety-three subjects reported higher PRPPR than CPPR values, and 41 subjects reported higher CPPR values. The CCC between CPPR and PRPPR was 0.44 (95% CI 0.35-0.54), with a precision of 0.54 and an accuracy of 0.81, and 95% limits of agreement ranging between -41% and +73%. Values for CCC, precision, and accuracy were higher for males compared to females and were highest in the youngest age group (18-40) and lowest in the middle age group (41-60). PRPPR may not agree with CPPR at 3 week follow-up, as these individuals tend to report a higher estimated percentage improvement compared to the value calculated from their pain scores. Wiley Periodicals, Inc.

A comparison of volume clamp method-based continuous noninvasive cardiac output (CNCO) measurement versus intermittent pulmonary artery thermodilution in postoperative cardiothoracic surgery patients.

PubMed

Wagner, Julia Y; Körner, Annmarie; Schulte-Uentrop, Leonie; Kubik, Mathias; Reichenspurner, Hermann; Kluge, Stefan; Reuter, Daniel A; Saugel, Bernd

2018-04-01

The CNAP technology (CNSystems Medizintechnik AG, Graz, Austria) allows continuous noninvasive arterial pressure waveform recording based on the volume clamp method and estimation of cardiac output (CO) by pulse contour analysis. We compared CNAP-derived CO measurements (CNCO) with intermittent invasive CO measurements (pulmonary artery catheter; PAC-CO) in postoperative cardiothoracic surgery patients. In 51 intensive care unit patients after cardiothoracic surgery, we measured PAC-CO (criterion standard) and CNCO at three different time points. We conducted two separate comparative analyses: (1) CNCO auto-calibrated to biometric patient data (CNCO bio ) versus PAC-CO and (2) CNCO calibrated to the first simultaneously measured PAC-CO value (CNCO cal ) versus PAC-CO. The agreement between the two methods was statistically assessed by Bland-Altman analysis and the percentage error. In a subgroup of patients, a passive leg raising maneuver was performed for clinical indications and we present the changes in PAC-CO and CNCO in four-quadrant plots (exclusion zone 0.5 L/min) in order to evaluate the trending ability of CNCO. The mean difference between CNCO bio and PAC-CO was +0.5 L/min (standard deviation ± 1.3 L/min; 95% limits of agreement -1.9 to +3.0 L/min). The percentage error was 49%. The concordance rate was 100%. For CNCOcal, the mean difference was -0.3 L/min (±0.5 L/min; -1.2 to +0.7 L/min) with a percentage error of 19%. In this clinical study in cardiothoracic surgery patients, CNCO cal showed good agreement when compared with PAC-CO. For CNCO bio , we observed a higher percentage error and good trending ability (concordance rate 100%).

Using a quality improvement model to enhance providers' performance in maternal and newborn health care: a post-only intervention and comparison design.

PubMed

Ayalew, Firew; Eyassu, Gizachew; Seyoum, Negash; van Roosmalen, Jos; Bazant, Eva; Kim, Young Mi; Tekleberhan, Alemnesh; Gibson, Hannah; Daniel, Ephrem; Stekelenburg, Jelle

2017-04-12

The Standards Based Management and Recognition (SBM-R © ) approach to quality improvement has been implemented in Ethiopia to strengthen routine maternal and newborn health (MNH) services. This evaluation assessed the effect of the intervention on MNH providers' performance of routine antenatal care (ANC), uncomplicated labor and delivery and immediate postnatal care (PNC) services. A post-only evaluation design was conducted at three hospitals and eight health centers implementing SBM-R and the same number of comparison health facilities. Structured checklists were used to observe MNH providers' performance on ANC (236 provider-client interactions), uncomplicated labor and delivery (226 provider-client interactions), and immediate PNC services in the six hours after delivery (232 provider-client interactions); observations were divided equally between intervention and comparison groups. Main outcomes were provider performance scores, calculated as the percentage of essential tasks in each service area completed by providers. Multilevel analysis was used to calculate adjusted mean percentage performance scores and standard errors to compare intervention and comparison groups. There was no statistically significant difference between intervention and comparison facilities in overall mean performance scores for ANC services (63.4% at intervention facilities versus 61.0% at comparison facilities, p = 0.650) or in any specific ANC skill area. MNH providers' overall mean performance score for uncomplicated labor and delivery care was 11.9 percentage points higher in the intervention than in the comparison group (77.5% versus 65.6%; p = 0.002). Overall mean performance scores for immediate PNC were 22.2 percentage points higher at intervention than at comparison facilities (72.8% versus 50.6%; p = 0.001); and there was a significant difference of 22 percentage points between intervention and comparison facilities for each PNC skill area: care for the newborn and health check for the mother. The SBM-R quality improvement intervention made a significant positive impact on MNH providers' performance during labor and delivery and immediate PNC services, but not during ANC services. Scaling up the intervention to other facilities and regions may increase the availability of good quality MNH services across Ethiopia. The findings will also guide implementation of the government's five-year (2015-2020) health sector transformation plan and health care quality strategies needed to meet the country's MNH goals.

Improvements in diabetes processes of care and intermediate outcomes: United States, 1988-2002.

PubMed

Saaddine, Jinan B; Cadwell, Betsy; Gregg, Edward W; Engelgau, Michael M; Vinicor, Frank; Imperatore, Giuseppina; Narayan, K M Venkat

2006-04-04

Progress of diabetes care is a subject of public health concern. To assess changes in quality of diabetes care in the United States by using standardized measures. National population-based, serial cross-sectional surveys. National Health and Nutrition Examination Survey (1988-1994 and 1999-2002) and the Behavioral Risk Factor Surveillance System (1995 and 2002). Survey participants 18 to 75 years of age who reported a diagnosis of diabetes. Glycemic control, blood pressure, low-density lipoprotein (LDL) cholesterol level, annual cholesterol level monitoring, and annual foot and dilated eye examination, as defined by the National Diabetes Quality Improvement Alliance measures. In the past decade, the proportion of persons with diabetes with poor glycemic control (hemoglobin A1c > 9%) showed a nonstatistically significant decrease of 3.9% (95% CI, -10.4% to 2.5%), while the proportion of persons with fair or good lipid control (LDL cholesterol level < 3.4 mmol/L [<130 mg/dL]) had a statistically significant increase of 21.9% (CI, 12.4% to 31.3%). Mean LDL cholesterol level decreased by 0.5 mmol/L (18.8 mg/dL). Although mean hemoglobin A1c did not change, the proportion of persons with hemoglobin A(1c) of 6% to 8% increased from 34.2% to 47.0%. The blood pressure distribution did not change. Annual lipid testing, dilated eye examination, and foot examination increased by 8.3% (CI, 4.0% to 12.7%), 4.5% (CI, 0.5% to 8.5%), and 3.8% (CI, -0.1% to 7.7%), respectively. The proportion of persons reporting annual influenza vaccination and aspirin use improved by 6.8 percentage points (CI, 2.9 percentage points to 10.7 percentage points) and 13.1 percentage points (CI, 5.4 percentage points to 20.7 percentage points), respectively. Data are self-reported, and the surveys do not have all National Diabetes Quality Improvement Alliance indicators. Diabetes processes of care and intermediate outcomes have improved nationally in the past decade. But 2 in 5 persons with diabetes still have poor LDL cholesterol control, 1 in 3 persons still has poor blood pressure control, and 1 in 5 persons still has poor glycemic control.

Vedolizumab as induction and maintenance therapy for ulcerative colitis.

PubMed

Feagan, Brian G; Rutgeerts, Paul; Sands, Bruce E; Hanauer, Stephen; Colombel, Jean-Frédéric; Sandborn, William J; Van Assche, Gert; Axler, Jeffrey; Kim, Hyo-Jong; Danese, Silvio; Fox, Irving; Milch, Catherine; Sankoh, Serap; Wyant, Tim; Xu, Jing; Parikh, Asit

2013-08-22

Gut-selective blockade of lymphocyte trafficking by vedolizumab may constitute effective treatment for ulcerative colitis. We conducted two integrated randomized, double-blind, placebo-controlled trials of vedolizumab in patients with active disease. In the trial of induction therapy, 374 patients (cohort 1) received vedolizumab (at a dose of 300 mg) or placebo intravenously at weeks 0 and 2, and 521 patients (cohort 2) received open-label vedolizumab at weeks 0 and 2, with disease evaluation at week 6. In the trial of maintenance therapy, patients in either cohort who had a response to vedolizumab at week 6 were randomly assigned to continue receiving vedolizumab every 8 or 4 weeks or to switch to placebo for up to 52 weeks. A response was defined as a reduction in the Mayo Clinic score (range, 0 to 12, with higher scores indicating more active disease) of at least 3 points and a decrease of at least 30% from baseline, with an accompanying decrease in the rectal bleeding subscore of at least 1 point or an absolute rectal bleeding subscore of 0 or 1. Response rates at week 6 were 47.1% and 25.5% among patients in the vedolizumab group and placebo group, respectively (difference with adjustment for stratification factors, 21.7 percentage points; 95% confidence interval [CI], 11.6 to 31.7; P<0.001). At week 52, 41.8% of patients who continued to receive vedolizumab every 8 weeks and 44.8% of patients who continued to receive vedolizumab every 4 weeks were in clinical remission (Mayo Clinic score ≤2 and no subscore >1), as compared with 15.9% of patients who switched to placebo (adjusted difference, 26.1 percentage points for vedolizumab every 8 weeks vs. placebo [95% CI, 14.9 to 37.2; P<0.001] and 29.1 percentage points for vedolizumab every 4 weeks vs. placebo [95% CI, 17.9 to 40.4; P<0.001]). The frequency of adverse events was similar in the vedolizumab and placebo groups. Vedolizumab was more effective than placebo as induction and maintenance therapy for ulcerative colitis. (Funded by Millennium Pharmaceuticals; GEMINI 1 ClinicalTrials.gov number, NCT00783718.).

Within country inequalities in caesarean section rates: observational study of 72 low and middle income countries

PubMed Central

Boatin, Adeline Adwoa; Schlotheuber, Anne; Betran, Ana Pilar; Moller, Ann-Beth; Barros, Aluisio J D; Boerma, Ties; Torloni, Maria Regina; Victora, Cesar G

2018-01-01

Abstract Objective To provide an update on economic related inequalities in caesarean section rates within countries. Design Secondary analysis of demographic and health surveys and multiple indicator cluster surveys. Setting 72 low and middle income countries with a survey conducted between 2010 and 2014 for analysis of the latest situation of inequality, and 28 countries with a survey also conducted between 2000 and 2004 for analysis of the change in inequality over time. Participants Women aged 15-49 years with a live birth during the two or three years preceding the survey. Main outcome measures Data on caesarean section were disaggregated by asset based household wealth status and presented separately for five subgroups, ranging from the poorest to the richest fifth. Absolute and relative inequalities were measured using difference and ratio measures. The pace of change in the poorest and richest fifths was compared using a measure of excess change. Results National caesarean section rates ranged from 0.6% in South Sudan to 58.9% in the Dominican Republic. Within countries, caesarean section rates were lowest in the poorest fifth (median 3.7%) and highest in the richest fifth (median 18.4%). 18 out of 72 study countries reported a difference of 20 percentage points or higher between the richest and poorest fifth. The highest caesarean section rates and greatest levels of absolute inequality were observed in countries from the region of the Americas, whereas countries from the African region had low levels of caesarean use and comparatively lower levels of absolute inequality, although relative inequality was quite high in some countries. 26 out of 28 countries reported increases in caesarean section rates over time. Rates tended to increase faster in the richest fifth (median 0.9 percentage points per year) compared with the poorest fifth (median 0.2 percentage points per year), indicating an increase in inequality over time in most of these countries. Conclusions Substantial within country economic inequalities in caesarean deliveries remain. These inequalities might be due to a combination of inadequate access to emergency obstetric care among the poorest subgroups and high levels of caesarean use without medical indication in the richest subgroups, especially in middle income countries. Country specific strategies should address these inequalities to improve maternal and newborn health. PMID:29367432

Intelligence Support to Urban Operations

DTIC Science & Technology

2015-12-01

Elevated systems and mass transit routes provide exposed lines of communications between city sectors while also offering points for good observation...Per capita income.  Percentage of population by economic sector (industry, service, other).  Percentage of population living in poverty...Percentage of population dependent on economic aid.  Type of aid.  Unemployment rate.  Underemployment rate.  Status of trade unions.  Whether

On the impact of improved dosimetric accuracy on head and neck high dose rate brachytherapy.

PubMed

Peppa, Vasiliki; Pappas, Eleftherios; Major, Tibor; Takácsi-Nagy, Zoltán; Pantelis, Evaggelos; Papagiannis, Panagiotis

2016-07-01

To study the effect of finite patient dimensions and tissue heterogeneities in head and neck high dose rate brachytherapy. The current practice of TG-43 dosimetry was compared to patient specific dosimetry obtained using Monte Carlo simulation for a sample of 22 patient plans. The dose distributions were compared in terms of percentage dose differences as well as differences in dose volume histogram and radiobiological indices for the target and organs at risk (mandible, parotids, skin, and spinal cord). Noticeable percentage differences exist between TG-43 and patient specific dosimetry, mainly at low dose points. Expressed as fractions of the planning aim dose, percentage differences are within 2% with a general TG-43 overestimation except for the spine. These differences are consistent resulting in statistically significant differences of dose volume histogram and radiobiology indices. Absolute differences of these indices are however small to warrant clinical importance in terms of tumor control or complication probabilities. The introduction of dosimetry methods characterized by improved accuracy is a valuable advancement. It does not appear however to influence dose prescription or call for amendment of clinical recommendations for the mobile tongue, base of tongue, and floor of mouth patient cohort of this study. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

[Bellows or bag? Testing 10 ventilators and some medical history comments].

PubMed

Kötter, K P; Maleck, W H; Altmannsberger, S; Herchet, J; Petroianu, G A

1998-01-01

We compared a new bellows ventilator (Kendall Cardiovent) with two other bellows (Dräger Resutator 63, Tagg Breathsaver) and seven bag or ball ventilators (Aerodyne Hope, Ambu Mark 3, Ambu Silicon, Dräger Resutator 2000, Laerdal Resu, Mercury CPR, Weinmann Combibag). Tidal volumes were measured with two Laerdal Recording Resusci Annies, one lying on the floor, one in a bed. Twelve participants performed mask ventilation with all ten devices on both manikins for two minutes, trying to achieve tidal volumes of between 0.8 and 1.21 as recommended by the AHA. The last ten ventilations each on the graphic strips were analysed for volume. The participants scored handling of the devices on a 6-point scale (1 = very good, 6 = insufficient). The results of the Cardiovent were compared to those of the other devices by rank sum test (percentage of correct ventilations) and sign test (subjective handling). The Cardiovent provided exact ventilation with 95% of ventilations) on the floor and 78% of ventilations in bed in the recommended range. However, the percentage of correct ventilations with the Cardiovent was not significantly different to the other devices except for a lower percentage of correct ventilations with the Combibag in the in bed setting. Concerning subjective handling, the Cardiovent was significantly superior to several ball ventilators.

Web-based education in systems-based practice: a randomized trial.

PubMed

Kerfoot, B Price; Conlin, Paul R; Travison, Thomas; McMahon, Graham T

2007-02-26

All accredited US residency programs are expected to offer curricula and evaluate their residents in 6 general competencies. Medical schools are now adopting similar competency frameworks. We investigated whether a Web-based program could effectively teach and assess elements of systems-based practice. We enrolled 276 medical students and 417 residents in the fields of surgery, medicine, obstetrics-gynecology, and emergency medicine in a 9-week randomized, controlled, crossover educational trial. Participants were asked to sequentially complete validated Web-based modules on patient safety and the US health care system. The primary outcome measure was performance on a 26-item validated online test administered before, between, and after the participants completed the modules. Six hundred forty (92.4%) of the 693 enrollees participated in the study; 512 (80.0%) of the participants completed all 3 tests. Participants' test scores improved significantly after completion of the first module (P<.001). Overall learning from the 9-week Web-based program, as measured by the increase in scores (posttest scores minus pretest scores), was 16 percentage points (95% confidence interval, 14-17 percentage points; P<.001) in public safety topics and 22 percentage points (95% confidence interval, 20-23 percentage points; P<.001) in US health care system topics. A Web-based educational program on systems-based practice competencies generated significant and durable learning across a broad range of medical students and residents.

Uncompensated Care Decreased At Hospitals In Medicaid Expansion States But Not At Hospitals In Nonexpansion States.

PubMed

Dranove, David; Garthwaite, Craig; Ody, Christopher

2016-08-01

One pillar of the Affordable Care Act (ACA) was its expected impact on the growing burden of uncompensated care costs for the uninsured at hospitals. However, little is known about how this burden changed as a result of the ACA's enactment. We examine how the Affordable Care Act (ACA)'s coverage expansions affected uncompensated care costs at a large, diverse sample of hospitals. We estimate that in states that expanded Medicaid under the ACA, uncompensated care costs decreased from 4.1 percentage points to 3.1 percentage points of operating costs. The reductions in Medicaid expansion states were larger at hospitals that had higher pre-ACA uncompensated care burdens and in markets where we predicted larger gains in coverage through expanded eligibility for Medicaid. Our estimates suggest that uncompensated care costs would have decreased from 5.7 percentage points to 4.0 percentage points of operating costs in nonexpansion states if they had expanded Medicaid. Thus, while the ACA decreased the variation in uncompensated care costs across hospitals within Medicaid expansion states, the difference between expansion and nonexpansion states increased substantially. Policy makers and researchers should consider how the shifting uncompensated care burden affects other hospital decisions as well as the distribution of supplemental public funding to hospitals. Project HOPE—The People-to-People Health Foundation, Inc.

Community-based intervention to promote breast cancer awareness and screening: The Korean experience

PubMed Central

2011-01-01

Background There are many differences in culture, community identity, community participation, and ownership between communities in Western and Asian countries; thus, it is difficult to adopt the results of community intervention studies from Western countries. In this study, we conducted a multicity, multicomponent community intervention trial to correct breast cancer myths and promote screening mammography for women living in an urban community in Korea. Methods A 6-month, 2-city community intervention trial was conducted. In the intervention city, 480 women were surveyed at baseline and 7 months later to evaluate the effects of the intervention program. Strategies implemented in the intervention city included community outreach and clinic and pharmacy-based in-reach strategies. Results This study showed a 20.4-percentage-point decrease in myths about the link between cancer and breast size, a 19.2-percentage-point decrease in myths concerning mammography costs, and a 14.1-percentage-point increase in intention to undergo screening mammography. We also saw a 23.4-percentage-point increase in the proportion of women at the action stage of the transtheoretical model in the intervention city. In the comparison city, smaller decreases and increases were observed. Conclusions Our study showed the value of an intervention study aimed at reducing belief in breast cancer myths in an urban community in Korea. The invention also made women more likely to undergo mammography in future. PMID:21669004

Food Safety Practices in the Egg Products Industry.

PubMed

Viator, Catherine L; Cates, Sheryl C; Karns, Shawn A; Muth, Mary K; Noyes, Gary

2016-07-01

We conducted a national census survey of egg product plants (n = 57) to obtain information on the technological and food safety practices of the egg products industry and to assess changes in these practices from 2004 to 2014. The questionnaire asked about operational and sanitation practices, microbiological testing practices, food safety training for employees, other food safety issues, and plant characteristics. The findings suggest that improvements were made in the industry's use of food safety technologies and practices between 2004 and 2014. The percentage of plants using advanced pasteurization technology and an integrated, computerized processing system increased by almost 30 percentage points. Over 90% of plants voluntarily use a written hazard analysis and critical control point (HACCP) plan to address food safety for at least one production step. Further, 90% of plants have management employees who are trained in a written HACCP plan. Most plants (93%) conduct voluntary microbiological testing. The percentage of plants conducting this testing on egg products before pasteurization has increased by almost 30 percentage points since 2004. The survey findings identify strengths and weaknesses in egg product plants' food safety practices and can be used to guide regulatory policymaking and to conduct required regulatory impact analysis of potential regulations.

Wax inhibitor based on ethylene vinyl acetate with methyl methacrylate and diethanolamine for crude oil pipeline

NASA Astrophysics Data System (ADS)

Anisuzzaman, S. M.; Abang, S.; Bono, A.; Krishnaiah, D.; Karali, R.; Safuan, M. K.

2017-06-01

Wax precipitation and deposition is one of the most significant flow assurance challenges in the production system of the crude oil. Wax inhibitors are developed as a preventive strategy to avoid an absolute wax deposition. Wax inhibitors are polymers which can be known as pour point depressants as they impede the wax crystals formation, growth, and deposition. In this study three formulations of wax inhibitors were prepared, ethylene vinyl acetate, ethylene vinyl acetate co-methyl methacrylate (EVA co-MMA) and ethylene vinyl acetate co-diethanolamine (EVA co-DEA) and the comparison of their efficiencies in terms of cloud point¸ pour point, performance inhibition efficiency (%PIE) and viscosity were evaluated. The cloud point and pour point for both EVA and EVA co-MMA were similar, 15°C and 10-5°C, respectively. Whereas, the cloud point and pour point for EVA co-DEA were better, 10°C and 10-5°C respectively. In conclusion, EVA co-DEA had shown the best % PIE (28.42%) which indicates highest percentage reduction of wax deposit as compared to the other two inhibitors.

The associations between US state and local social spending, income inequality, and individual all-cause and cause-specific mortality: The National Longitudinal Mortality Study.

PubMed

Kim, Daniel

2016-03-01

To investigate government state and local spending on public goods and income inequality as predictors of the risks of dying. Data on 431,637 adults aged 30-74 and 375,354 adults aged 20-44 in the 48 contiguous US states were used from the National Longitudinal Mortality Study to estimate the impacts of state and local spending and income inequality on individual risks of all-cause and cause-specific mortality for leading causes of death in younger and middle-aged adults and older adults. To reduce bias, models incorporated state fixed effects and instrumental variables. Each additional $250 per capita per year spent on welfare predicted a 3-percentage point (-0.031, 95% CI: -0.059, -0.0027) lower probability of dying from any cause. Each additional $250 per capita spent on welfare and education predicted 1.6-percentage point (-0.016, 95% CI: -0.031, -0.0011) and 0.8-percentage point (-0.008, 95% CI: -0.0156, -0.00024) lower probabilities of dying from coronary heart disease (CHD), respectively. No associations were found for colon cancer or chronic obstructive pulmonary disease; for diabetes, external injury, and suicide, estimates were inverse but modest in magnitude. A 0.1 higher Gini coefficient (higher income inequality) predicted 1-percentage point (0.010, 95% CI: 0.0026, 0.0180) and 0.2-percentage point (0.002, 95% CI: 0.001, 0.002) higher probabilities of dying from CHD and suicide, respectively. Empirical linkages were identified between state-level spending on welfare and education and lower individual risks of dying, particularly from CHD and all causes combined. State-level income inequality predicted higher risks of dying from CHD and suicide. Copyright © 2015 The Author. Published by Elsevier Inc. All rights reserved.

High-dose rifapentine with moxifloxacin for pulmonary tuberculosis.

PubMed

Jindani, Amina; Harrison, Thomas S; Nunn, Andrew J; Phillips, Patrick P J; Churchyard, Gavin J; Charalambous, Salome; Hatherill, Mark; Geldenhuys, Hennie; McIlleron, Helen M; Zvada, Simbarashe P; Mungofa, Stanley; Shah, Nasir A; Zizhou, Simukai; Magweta, Lloyd; Shepherd, James; Nyirenda, Sambayawo; van Dijk, Janneke H; Clouting, Heather E; Coleman, David; Bateson, Anna L E; McHugh, Timothy D; Butcher, Philip D; Mitchison, Denny A

2014-10-23

Tuberculosis regimens that are shorter and simpler than the current 6-month daily regimen are needed. We randomly assigned patients with newly diagnosed, smear-positive, drug-sensitive tuberculosis to one of three regimens: a control regimen that included 2 months of ethambutol, isoniazid, rifampicin, and pyrazinamide administered daily followed by 4 months of daily isoniazid and rifampicin; a 4-month regimen in which the isoniazid in the control regimen was replaced by moxifloxacin administered daily for 2 months followed by moxifloxacin and 900 mg of rifapentine administered twice weekly for 2 months; or a 6-month regimen in which isoniazid was replaced by daily moxifloxacin for 2 months followed by one weekly dose of both moxifloxacin and 1200 mg of rifapentine for 4 months. Sputum specimens were examined on microscopy and after culture at regular intervals. The primary end point was a composite treatment failure and relapse, with noninferiority based on a margin of 6 percentage points and 90% confidence intervals. We enrolled a total of 827 patients from South Africa, Zimbabwe, Botswana, and Zambia; 28% of patients were coinfected with the human immunodefiency virus. In the per-protocol analysis, the proportion of patients with an unfavorable response was 4.9% in the control group, 3.2% in the 6-month group (adjusted difference from control, -1.8 percentage points; 90% confidence interval [CI], -6.1 to 2.4), and 18.2% in the 4-month group (adjusted difference from control, 13.6 percentage points; 90% CI, 8.1 to 19.1). In the modified intention-to-treat analysis these proportions were 14.4% in the control group, 13.7% in the 6-month group (adjusted difference from control, 0.4 percentage points; 90% CI, -4.7 to 5.6), and 26.9% in the 4-month group (adjusted difference from control, 13.1 percentage points; 90% CI, 6.8 to 19.4). The 6-month regimen that included weekly administration of high-dose rifapentine and moxifloxacin was as effective as the control regimen. The 4-month regimen was not noninferior to the control regimen. (Funded by the European and Developing Countries Clinical Trials Partnership and the Wellcome Trust; RIFAQUIN Current Controlled Trials number, ISRCTN44153044.).

The impact of childhood malnutrition on schooling: evidence from Bangladesh.

PubMed

Khanam, Rasheda; Nghiem, Hong Son; Rahman, Mohammad Mafizur

2011-07-01

This paper examines the impact of childhood malnutrition on schooling performance in rural Bangladesh. The results reveal that malnourished children are less likely to enrol in school on time and achieve an age-appropriate grade by 26 percentage points and 31 percentage points, respectively. Other important determinants of schooling outcomes include infrastructure and education level of parents. One major contribution of this paper is the control for the endogeneity of malnutrition status, which otherwise might lead to bias estimates. © Cambridge University Press, 2011

20 CFR 345.303 - Computation of rate.

Code of Federal Regulations, 2010 CFR

2010-04-01

... a percentage rate, and then round such rate to the nearest 100th of one percent. If the rate so computed is zero or less than zero, the percentage rate will be deemed zero at this point; (5) Step 5. Add...

Single-dose oritavancin in the treatment of acute bacterial skin infections.

PubMed

Corey, G Ralph; Kabler, Heidi; Mehra, Purvi; Gupta, Sandeep; Overcash, J Scott; Porwal, Ashwin; Giordano, Philip; Lucasti, Christopher; Perez, Antonio; Good, Samantha; Jiang, Hai; Moeck, Greg; O'Riordan, William

2014-06-05

Oritavancin is a lipoglycopeptide with bactericidal activity against gram-positive bacteria. Its concentration-dependent activity and prolonged half-life allow for single-dose treatment. We conducted a randomized, double-blind trial in which adults with acute bacterial skin and skin-structure infections received either a single intravenous dose of 1200 mg of oritavancin or a regimen of intravenous vancomycin twice daily for 7 to 10 days. Three efficacy end points were tested for noninferiority. The primary composite end point was defined as cessation of spreading or reduction in lesion size, absence of fever, and no need for administration of a rescue antibiotic 48 to 72 hours after administration of oritavancin. Secondary end points were clinical cure 7 to 14 days after the end of treatment, as determined by a study investigator, and a reduction in lesion size of 20% or more 48 to 72 hours after administration of oritavancin. The modified intention-to-treat population comprised 475 patients who received oritavancin and 479 patients who received vancomycin. All three efficacy end points met the prespecified noninferiority margin of 10 percentage points for oritavancin versus vancomycin: primary end point, 82.3% versus 78.9% (95% confidence interval [CI] for the difference, -1.6 to 8.4 percentage points); investigator-assessed clinical cure, 79.6% versus 80.0% (95% CI for the difference, -5.5 to 4.7 percentage points); and proportion of patients with a reduction in lesion area of 20% or more, 86.9% versus 82.9% (95% CI for the difference, -0.5 to 8.6 percentage points). Efficacy outcomes measured according to type of pathogen, including methicillin-resistant Staphylococcus aureus, were similar in the two treatment groups. The overall frequency of adverse events was also similar, although nausea was more common among those treated with oritavancin. A single dose of oritavancin was noninferior to twice-daily vancomycin administered for 7 to 10 days for the treatment of acute bacterial skin and skin-structure infections caused by gram-positive pathogens. (Funded by the Medicines Company; SOLO I ClinicalTrials.gov number, NCT01252719.).

A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in patients with uncontrolled type 2 diabetes.

PubMed

Safren, Steven A; Gonzalez, Jeffrey S; Wexler, Deborah J; Psaros, Christina; Delahanty, Linda M; Blashill, Aaron J; Margolina, Aleksandra I; Cagliero, Enrico

2014-01-01

To test cognitive behavioral therapy for adherence and depression (CBT-AD) in type 2 diabetes. We hypothesized that CBT-AD would improve adherence; depression; and, secondarily, hemoglobin A1c (A1C). Eighty-seven adults with unipolar depression and uncontrolled type 2 diabetes received enhanced treatment as usual (ETAU), including medication adherence, self-monitoring of blood glucose (SMBG), and lifestyle counseling; a provider letter documented psychiatric diagnoses. Those randomized to the intervention arm also received 9-11 sessions of CBT-AD. Immediately after acute treatment (4 months), adjusting for baseline, CBT-AD had 20.7 percentage points greater oral medication adherence on electronic pill cap (95% CI -31.14 to -10.22, P = 0.000); 30.2 percentage points greater SMBG adherence through glucometer downloads (95% CI -42.95 to -17.37, P = 0.000); 6.44 points lower depression scores on the Montgomery-Asberg Depression Rating Scale (95% CI 2.33-10.56, P = 0.002); 0.74 points lower on the Clinical Global Impression (95% CI 0.16-1.32, P = 0.01); and 0.72 units lower A1C (95% CI 0.29-1.15, P = 0.001) relative to ETAU. Analyses of 4-, 8-, and 12-month follow-up time points indicated that CBT-AD maintained 24.3 percentage points higher medication adherence (95% CI -38.2 to -10.3, P = 0.001); 16.9 percentage points greater SMBG adherence (95% CI -33.3 to -0.5, P = 0.043); and 0.63 units lower A1C (95% CI 0.06-1.2, P = 0.03) after acute treatment ended. For depression, there was some evidence of continued improvement posttreatment, but no between-group differences. CBT-AD is an effective intervention for adherence, depression, and glycemic control, with enduring and clinically meaningful benefits for diabetes self-management and glycemic control in adults with type 2 diabetes and depression.

Differences in the relationship between BMI and percentage body fat between Japanese and Australian-Caucasian young men.

PubMed

Kagawa, Masaharu; Kerr, Deborah; Uchida, Hayato; Binns, Colin W

2006-05-01

This cross-sectional study aimed to determine ethnic and environmental influences on the relationship between BMI and percentage body fat, using a sample of 144 Japanese and 140 Australian-Caucasian men living in Australia, and eighty-eight Japanese men living in Japan. Body composition was assessed by anthropometry using standard international methods (International Society for the Advancement of Kinanthropometry protocol). Body density was predicted using Durnin and Womersley's (1974) equation, and percentage body fat was calculated from Siri's (1961) equation. Significant (P<0.05) ethnic differences in stature, body mass and BMI were observed between Japanese and Australian men, but no ethnic differences were observed in their percentage body fat and height-corrected sum of skinfold thicknesses. No differences were found in the BMI-percentage body fat relationship between the Japanese subjects living in Australia and in Japan. Significant (P<0.05) ethnic differences in the BMI-percentage body fat relationship observed from a comparison between pooled Japanese men (aged 18-40 years, BMI range 16.6-32.8 kg/m2) and Australians (aged 18-39 years, BMI range 16.1-31.4 kg/m2) suggest that Japanese men are likely to have a greater percentage body fat than Australian men at any given BMI value. From the analyses, the Japanese men were estimated to have an equivalent amount of body fat to the Australian men at BMI values that were about 1.5 units lower than those of the Australians (23.5 kg/m2 and 28.2 kg/m2, respectively). It was concluded that Japanese men have greater body fat deposition than Australian-Caucasians at the same BMI value. Japanese men may therefore require lower BMI cut-off points to identify obese individuals compared with Australian-Caucasian men.

Effectiveness of employee internet-based weight management program.

PubMed

Petersen, Ruth; Sill, Stewart; Lu, Chifung; Young, Joyce; Edington, Dee W

2008-02-01

To evaluate an employee Internet-based weight management program. Changes in eating habits, stage of change, body weight, and weight categories were compared between enrollment and 6 months after enrollment. Weights and weight categories were compared among a subset of participants and non-participants at 12 months. Seven thousand seven hundred forty-three International Business Machines employees enrolled in the program between December 2004 and February 2006, and 74% were overweight or obese (body mass index > or =25). At 6 months, follow-up survey respondents (1639) had significantly increased most healthy eating habits (eg, 20% decrease in junk foods) and the frequency of healthy foods eaten (eg, 12% increase in fruits). The percentage of participants in the normal weight category had increased from 27.0% to 29.8%, while average weight decreased from 182.6 to 180.2 lbs (P < 0.05). Increased web site usage was associated with increased weight loss and stage of change improvements. At 12 months, a higher percentage of participants had moved into the normal weight category compared with the percentage of non-participants (+2.0% points; P < 0.05), although there were no differences in average weight change. Despite issues of limited penetration and potential self-selection, this Internet-based program had utility in reaching a large number of employees in dispersed work settings, and it led to improved eating habits and improved stage of change at 6 months and more individuals moving into the normal weight category at 6 and 12 months.

Measuring changes in the illicit cigarette market using government revenue data: the example of South Africa

PubMed Central

van Walbeek, Corné

2014-01-01

Background The tobacco industry claims that illicit trade in cigarettes has increased sharply since the 1990s and that government has lost substantial tax revenue. Objectives (1) To determine whether cigarette excise tax revenue has been below budget in recent years, compared with previous decades. (2) To determine trends in the size of the illicit market since 1995. Methods For (1), mean percentage errors and root mean square percentage errors were calculated for budget revenue deviation for three products (cigarettes, beer and spirits), for various subperiods. For (2), predicted changes in total consumption, using actual cigarette price and GDP changes and previously published price and income elasticity estimates, were calculated and compared with changes in tax-paid consumption. Results Cigarette excise revenues were 0.7% below budget for 2000–2012 on average, compared with 3.0% below budget for beer and 4.7% below budget for spirits. There is no evidence that illicit trade in cigarettes in South Africa increased between 2002 and 2009. There is a substantial increase in illicit trade in 2010, probably peaking in 2011. In 2012 tax-paid consumption of cigarettes increased 2.6%, implying that the illicit market share decreased an estimated 0.6 percentage points. Conclusions Other than in 2010, there is no evidence that illicit trade is significantly undermining government revenue. Claims that illicit trade has consistently increased over the past 15 years, and has continued its sharp increase since 2010, are not supported. PMID:24431121

Which skills and factors better predict winning and losing in high-level men's volleyball?

PubMed

Peña, Javier; Rodríguez-Guerra, Jorge; Buscà, Bernat; Serra, Núria

2013-09-01

The aim of this study was to determine which skills and factors better predicted the outcomes of regular season volleyball matches in the Spanish "Superliga" and were significant for obtaining positive results in the game. The study sample consisted of 125 matches played during the 2010-11 Spanish men's first division volleyball championship. Matches were played by 12 teams composed of 148 players from 17 different nations from October 2010 to March 2011. The variables analyzed were the result of the game, team category, home/away court factors, points obtained in the break point phase, number of service errors, number of service aces, number of reception errors, percentage of positive receptions, percentage of perfect receptions, reception efficiency, number of attack errors, number of blocked attacks, attack points, percentage of attack points, attack efficiency, and number of blocks performed by both teams participating in the match. The results showed that the variables of team category, points obtained in the break point phase, number of reception errors, and number of blocked attacks by the opponent were significant predictors of winning or losing the matches. Odds ratios indicated that the odds of winning a volleyball match were 6.7 times greater for the teams belonging to higher rankings and that every additional point in Complex II increased the odds of winning a match by 1.5 times. Every reception and blocked ball error decreased the possibility of winning by 0.6 and 0.7 times, respectively.

Design and performance of controlled-diffusion stator compared with original double-circular-arc stator

NASA Technical Reports Server (NTRS)

Gelder, Thomas F.; Schmidt, James F.; Suder, Kenneth L.; Hathaway, Michael D.

1987-01-01

The capabilities of two stators, one with controlled-diffusion (CD) blade sections and one with double-circular-arc (DCA) blade sections, were compared. A CD stator was designed and tested that had the same chord length but half the blades of the DCA stator. The same fan rotor (tip speed, 429 m/sec; pressure ratio, 1.65) was used with each stator row. The design and analysis system is briefly described. The overall stage and rotor performances with each stator are compared, as are selected blade element data. The minimum overall efficiency decrement across the stator was approximately 1 percentage point greater with the CD balde sections than with the DCA blade sections.

Design and performance of controlled-diffusion stator compared with original double-circular-arc stator

NASA Technical Reports Server (NTRS)

Gelder, Thomas F.; Schmidt, James F.; Suder, Kenneth L.; Hathaway, Michael D.

1987-01-01

The capabilities of two stators, one with controlled-diffusion (CD) blade sections and one with double-circular-arc (DCA) blade sections, were compared. A CD stator was designed and tested that had the same chord length but half the blades of the DCA stator. The same fan rotor (tip speed, 429 m/sec; pressure ratio, 1.65) was used with each stator row. The design and analysis system is briefly described. The overall stage and rotor performances with each stator are compared, as are selected blade element data. The minimum overall efficiency decrement across the stator was approximately 1 percentage point greater with the CD blade sections than with the DCA blade sections.

Two-point discrimination and kinesthetic sense disorders in productive age individuals with carpal tunnel syndrome.

PubMed

Wolny, Tomasz; Saulicz, Edward; Linek, Paweł; Myśliwiec, Andrzej

2016-06-16

The aim of this study was to evaluate two-point discrimination (2PD) sense and kinesthetic sense dysfunctions in carpal tunnel syndrome (CTS) patients compared with a healthy group. The 2PD sense, muscle force, and kinesthetic differentiation (KD) of strength; the range of motion in radiocarpal articulation; and KD of motion were assessed. The 2PD sense assessment showed significantly higher values in all the examined fingers in the CTS group than in those in the healthy group (p<0.01). There was a significant difference in the percentage value of error in KD of pincer and cylindrical grip (p<0.01) as well as in KD of flexion and extension movement in the radiocarpal articulation (p<0.01) between the studied groups. There are significant differences in the 2PD sense and KD of strength and movement between CTS patients compared with healthy individuals.

Two-point discrimination and kinesthetic sense disorders in productive age individuals with carpal tunnel syndrome

PubMed Central

Wolny, Tomasz; Saulicz, Edward; Linek, Paweł; Myśliwiec, Andrzej

2016-01-01

Objectives: The aim of this study was to evaluate two-point discrimination (2PD) sense and kinesthetic sense dysfunctions in carpal tunnel syndrome (CTS) patients compared with a healthy group. Methods: The 2PD sense, muscle force, and kinesthetic differentiation (KD) of strength; the range of motion in radiocarpal articulation; and KD of motion were assessed. Results: The 2PD sense assessment showed significantly higher values in all the examined fingers in the CTS group than in those in the healthy group (p<0.01). There was a significant difference in the percentage value of error in KD of pincer and cylindrical grip (p<0.01) as well as in KD of flexion and extension movement in the radiocarpal articulation (p<0.01) between the studied groups. Conclusions: There are significant differences in the 2PD sense and KD of strength and movement between CTS patients compared with healthy individuals. PMID:27108640

HIV Salvage Therapy Does Not Require Nucleoside Reverse Transcriptase Inhibitors: A Randomized, Controlled Trial.

PubMed

Tashima, Karen T; Smeaton, Laura M; Fichtenbaum, Carl J; Andrade, Adriana; Eron, Joseph J; Gandhi, Rajesh T; Johnson, Victoria A; Klingman, Karin L; Ritz, Justin; Hodder, Sally; Santana, Jorge L; Wilkin, Timothy; Haubrich, Richard H

2015-12-15

Nucleoside reverse transcriptase inhibitors (NRTIs) are often included in antiretroviral regimens in treatment-experienced patients in the absence of data from randomized trials. To compare treatment success between participants who omit versus those who add NRTIs to an optimized antiretroviral regimen of 3 or more agents. Multicenter, randomized, controlled trial. (ClinicalTrials.gov: NCT00537394). Outpatient HIV clinics. Treatment-experienced patients with HIV infection and viral resistance. Open-label optimized regimens (not including NRTIs) were selected on the basis of treatment history and susceptibility testing. Participants were randomly assigned to omit or add NRTIs. The primary efficacy outcome was regimen failure through 48 weeks using a noninferiority margin of 15%. The primary safety outcome was time to initial episode of a severe sign, symptom, or laboratory abnormality before discontinuation of NRTI assignment. 360 participants were randomly assigned, and 93% completed a 48-week visit. The cumulative probability of regimen failure was 29.8% in the omit-NRTIs group versus 25.9% in the add-NRTIs group (difference, 3.2 percentage points [95% CI, -6.1 to 12.5 percentage points]). No significant between-group differences were found in the primary safety end points or the proportion of participants with HIV RNA level less than 50 copies/mL. No deaths occurred in the omit-NRTIs group compared with 7 deaths in the add-NRTIs group. Unblinded study design, and the study may not be applicable to resource-poor settings. Treatment-experienced patients with HIV infection starting a new optimized regimen can safely omit NRTIs without compromising virologic efficacy. Omitting NRTIs will reduce pill burden, cost, and toxicity in this patient population. National Institute of Allergy and Infectious Diseases, Boehringer Ingelheim, Janssen, Merck, ViiV Healthcare, Roche, and Monogram Biosciences (LabCorp).

The rising burden of chronic conditions among urban poor: a three-year follow-up survey in Bengaluru, India.

PubMed

Gowda, Mrunalini J; Bhojani, Upendra; Devadasan, Narayanan; Beerenahally, Thriveni S

2015-08-15

Chronic conditions are on rise globally and in India. Prevailing intra-urban inequities in access to healthcare services compounds the problems faced by urban poor. This paper reports the trends in self-reported prevalence of chronic conditions and health-seeking pattern among residents of a poor urban neighborhood in south India. A cross sectional survey of 1099 households (5340 individuals) was conducted using a structured questionnaire. The prevalence and health-seeking pattern for chronic conditions in general and for hypertension and diabetes in particular were assessed and compared with a survey conducted in the same community three years ago. The predictors of prevalence and health-seeking pattern were analyzed through a multivariable logistic regression analysis. The overall self-reported prevalence of chronic conditions was 12%, with hypertension (7%) and diabetes (5.8%) being the common conditions. The self-reported prevalence of chronic conditions increased by 3.8 percentage point over a period of three years (OR: 1.5). Older people, women and people living below the poverty line had greater odds of having chronic conditions across the two studies compared. Majority of patients (89.3%) sought care from private health facilities indicating a decrease by 8.7 percentage points in use of government health facility compared to the earlier study (OR: 0.5). Patients seeking care from super specialty hospitals and those living below the poverty line were more likely to seek care from government health facilities. There is need to strengthen health services with a preferential focus on government services to assure affordable care for chronic conditions to urban poor.

A systems approach to improving maternal health in the Philippines

PubMed Central

Banzon, Eduardo; Recidoro, Zenaida Dy

2012-01-01

Abstract Objective To examine the impact of health-system-wide improvements on maternal health outcomes in the Philippines. Methods A retrospective longitudinal controlled study was used to compare a province that fast tracked the implementation of health system reforms with other provinces in the same region that introduced reforms less systematically and intensively between 2006 and 2009. Findings The early reform province quickly upgraded facilities in the tertiary and first level referral hospitals; other provinces had just begun reforms by the end of the study period. The early reform province had created 871 women’s health teams by the end of 2009, compared with 391 teams in the only other province that reported such teams. The amount of maternal-health-care benefits paid by the Philippine Health Insurance Corporation in the early reform province grew by approximately 45%; in the other provinces, the next largest increase was 16%. The facility-based delivery rate increased by 44 percentage points in the early reform province, compared with 9–24 percentage points in the other provinces. Between 2006 and 2009, the actual number of maternal deaths in the early reform province fell from 42 to 18, and the maternal mortality ratio from 254 to 114. Smaller declines in maternal deaths over this period were seen in Camarines Norte (from 12 to 11) and Camarines Sur (from 26­ to 23). The remaining three provinces reported increases in maternal deaths. Conclusion Making health-system-wide reforms to improve maternal health has positive synergistic effects. PMID:22423161

Knowledge as a predictor of insurance coverage under the Affordable Care Act

PubMed Central

Hoerl, Maximiliane; Wuppermann, Amelie; Barcellos, Silvia H.; Bauhoff, Sebastian; Winter, Joachim K.

2016-01-01

Background The Affordable Care Act established policy mechanisms to increase health insurance coverage in the United States. While insurance coverage has increased, 10 to 15% of the U.S. population remains uninsured. Objectives To assess whether health insurance literacy and financial literacy predict being uninsured, covered by Medicaid, or covered by Marketplace insurance, holding demographic characteristics, attitudes toward risk, and political affiliation constant. Research Design Analysis of longitudinal data from fall 2013 and spring 2015 including financial and health insurance literacy and key covariates collected in 2013. Subjects 2,742 U.S. residents ages 18-64, 525 uninsured in fall 2013, participating in the RAND American Life Panel, a nationally representative internet panel. Measures Self-reported health insurance status and type as of spring 2015. Results Among the uninsured in 2013, higher financial and health insurance literacy were associated with greater probability of being insured in 2015. For a typical uninsured individual in 2013, the probability of being insured in 2015 was 8.3 percentage points higher with high compared to low financial literacy, and 9.2 percentage points higher with high compared to low health insurance literacy. For the general population, those with high financial and health insurance literacy were more likely to obtain insurance via Medicaid or the Marketplaces compared to being uninsured. The magnitude of coefficients for these predictors was similar to that of commonly used demographic covariates. Conclusions A lack of understanding about health insurance concepts and financial illiteracy predict who remains uninsured. Outreach and consumer-education programs should consider these characteristics. PMID:27820594

Evaluation of scanning 2D barcoded vaccines to improve data accuracy of vaccines administered.

PubMed

Daily, Ashley; Kennedy, Erin D; Fierro, Leslie A; Reed, Jenica Huddleston; Greene, Michael; Williams, Warren W; Evanson, Heather V; Cox, Regina; Koeppl, Patrick; Gerlach, Ken

2016-11-11

Accurately recording vaccine lot number, expiration date, and product identifiers, in patient records is an important step in improving supply chain management and patient safety in the event of a recall. These data are being encoded on two-dimensional (2D) barcodes on most vaccine vials and syringes. Using electronic vaccine administration records, we evaluated the accuracy of lot number and expiration date entered using 2D barcode scanning compared to traditional manual or drop-down list entry methods. We analyzed 128,573 electronic records of vaccines administered at 32 facilities. We compared the accuracy of records entered using 2D barcode scanning with those entered using traditional methods using chi-square tests and multilevel logistic regression. When 2D barcodes were scanned, lot number data accuracy was 1.8 percentage points higher (94.3-96.1%, P<0.001) and expiration date data accuracy was 11 percentage points higher (84.8-95.8%, P<0.001) compared with traditional methods. In multivariate analysis, lot number was more likely to be accurate (aOR=1.75; 99% CI, 1.57-1.96) as was expiration date (aOR=2.39; 99% CI, 2.12-2.68). When controlling for scanning and other factors, manufacturer, month vaccine was administered, and vaccine type were associated with variation in accuracy for both lot number and expiration date. Two-dimensional barcode scanning shows promise for improving data accuracy of vaccine lot number and expiration date records. Adapting systems to further integrate with 2D barcoding could help increase adoption of 2D barcode scanning technology. Published by Elsevier Ltd.

The effect of Health Savings Accounts on group health insurance coverage.

PubMed

Ye, Jinqi

2015-12-01

This paper presents new empirical evidence on the impact of tax subsidies for Health Savings Accounts (HSAs) on group insurance coverage. HSAs are tax-free health care expenditure savings accounts. Coupled with high deductible health insurance plans (HDHPs), they together represent new health insurance options. The tax advantage of HSAs expands the group health insurance market by making health care more affordable. Using individual level data from the Current Population Survey and exploiting policy variation by state and year from 2004 to 2012, I find that HSA tax subsidies increase small-group coverage by a statistically significant 2.5 percentage points, although not coverage in larger firms. Moreover, if the tax price of HSA contribution decreases by 10 cents, small-group insurance coverage increases by almost 2 percentage points. I also find that for older workers or less-educated workers, HSA subsidies are associated with 2-3 percentage point increase in their group insurance coverage. Copyright © 2015 Elsevier B.V. All rights reserved.

A proposed method for world weightlifting championships team selection.

PubMed

Chiu, Loren Z F

2009-08-01

The caliber of competitors at the World Weightlifting Championships (WWC) has increased greatly over the past 20 years. As the WWC are the primary qualifiers for Olympic slots (1996 to present), it is imperative for a nation to select team members who will finish with a high placing and score team points. Previous selection methods were based on a simple percentage system. Analysis of the results from the 2006 and 2007 WWC indicates a curvilinear trend in each weight class, suggesting a simple percentage system will not maximize the number of team points earned. To maximize team points, weightlifters should be selected based on their potential to finish in the top 25. A 5-tier ranking system is proposed that should ensure the athletes with the greatest potential to score team points are selected.

Military Retirement and Social Security: A Comparative Analysis,

DTIC Science & Technology

1986-10-01

8217 service but of different ages , the younger one does not have a much stronger t5’ incentive to retire than the older one. The benefit formula defines the...income) under the exempt level. The exempt level changes annually and differs by age . In 1984 the exempt level for $6960 for those age 65 and older ...percentage points below the inflation rate, while the adjustment for retirees -a age 62 and older was left intact. Whether this change worked optimally

Chronic alcohol consumption results in higher simian immunodeficiency virus replication in mucosally inoculated rhesus macaques.

PubMed

Poonia, Bhawna; Nelson, Steve; Bagby, Greg J; Zhang, Ping; Quniton, Lee; Veazey, Ronald S

2005-10-01

The influence of alcohol consumption on HIV pathogenesis is not well understood. In this study we used the simian immunodeficiency virus (SIV)/macaque model of HIV infection to study the influence of chronic binge alcohol consumption on SIV infection. Rhesus macaques were fed alcohol or isocaloric amounts of sucrose via indwelling intragastric catheters and then inoculated with SIVmac251 by the rectal route. Real-time RT-PCR for SIV gag mRNA showed significantly higher plasma viral copies in alcohol-consuming macaques at 4 and 6 weeks pi, compared with sucrose controls. The viral copies were 1 to 2 logs higher in these animals. The percentage of CD8+ lymphocytes in the duodenum of alcohol-consuming macaques was significantly lower than in sucrose-consuming macaques both before infection as well as at different time points postinfection. Also, the percentage of CD4(+)CD3+ lymphocytes in the intestines was significantly higher in alcohol-consuming macaques before infection. These findings suggest that a higher percentage of SIV target cells (CD4) in the gut coupled with lower percentages of CD8 cells, which could be important in controlling virus replication, may be responsible for the higher SIV loads observed in alcohol-consuming macaques.

Chronic alcohol consumption results in higher simian immunodeficiency virus replication in mucosally inoculated rhesus macaques.

PubMed

Poonia, Bhawna; Nelson, Steve; Bagby, Greg J; Zhang, Ping; Quniton, Lee; Veazey, Ronald S

2006-06-01

The influence of alcohol consumption on HIV pathogenesis is not well understood. In this study we used the SIV/macaque model of HIV infection to study the influence of chronic binge alcohol consumption on simian immunodeficiency virus (SIV) infection. Rhesus macaques were fed alcohol or isocaloric amounts of sucrose via indwelling intragastric catheters and then inoculated with SIVmac251 by the rectal route. Real-time RTPCR for SIV gag mRNA showed significantly higher plasma viral copies in alcohol-consuming macaques at 4 and 6 weeks pi, compared with sucrose controls. The viral copies were 1 to 2 logs higher in these animals. The percentage of CD8+ lymphocytes in the duodenum of alcohol-consuming macaques was significantly lower than in sucrose-consuming macaques both before infection as well as at different time points postinfection. Also, the percentage of CD4+CD3+ lymphocytes in the intestines was significantly higher in alcohol-consuming macaques before infection. These findings suggest that a higher percentage of SIV target cells (CD4) in the gut coupled with lower percentages of CD8 cells, which could be important in controlling virus replication, may be responsible for the higher SIV loads observed in alcohol-consuming macaques.

Validity of vaccination cards and parental recall to estimate vaccination coverage: a systematic review of the literature.

PubMed

Miles, Melody; Ryman, Tove K; Dietz, Vance; Zell, Elizabeth; Luman, Elizabeth T

2013-03-15

Immunization programs frequently rely on household vaccination cards, parental recall, or both to calculate vaccination coverage. This information is used at both the global and national level for planning and allocating performance-based funds. However, the validity of household-derived coverage sources has not yet been widely assessed or discussed. To advance knowledge on the validity of different sources of immunization coverage, we undertook a global review of literature. We assessed concordance, sensitivity, specificity, positive and negative predictive value, and coverage percentage point difference when subtracting household vaccination source from a medical provider source. Median coverage difference per paper ranged from -61 to +1 percentage points between card versus provider sources and -58 to +45 percentage points between recall versus provider source. When card and recall sources were combined, median coverage difference ranged from -40 to +56 percentage points. Overall, concordance, sensitivity, specificity, positive and negative predictive value showed poor agreement, providing evidence that household vaccination information may not be reliable, and should be interpreted with care. While only 5 papers (11%) included in this review were from low-middle income countries, low-middle income countries often rely more heavily on household vaccination information for decision making. Recommended actions include strengthening quality of child-level data and increasing investments to improve vaccination card availability and card marking. There is also an urgent need for additional validation studies of vaccine coverage in low and middle income countries. Copyright © 2013. Published by Elsevier Ltd.

Effectiveness of a multi-component quality improvement intervention on rates of hyperglycaemia

PubMed Central

Franco, Thérèse; Aaronson, Barry; Brown, Laurel; Blackmore, Craig; Rupp, Stephen; Lee, Grace

2017-01-01

Purpose To evaluate the effectiveness of a multifaceted, hospital-wide glycaemic control quality improvement programme. Methods The quality improvement intervention comprised three components, derived through root cause analysis: standardising and simplifying care (including evidence-based order sets), increasing visibility (through provider access to clinical data and direct feedback) and educational outreach (directed at the entire institution). Effectiveness was determined at a single urban acute care hospital through time-series analysis with statistical process control charts. Primary outcomes included rate of hyperglycaemia and rate of hypoglycaemia. Results The study included 70 992 hospital admissions for 50 404 patients, with 3 35 645 patient days. The hyperglycaemia ratio decreased 25.2% from 14.1% to 10.5% (95% CI 3.3 to 3.9 percentage points, p<0.001). The ratio of patient days with highly elevated blood glucose (>299 mg/dL) decreased 31.8% from 4.8% to 3.3% (95% CI 1.4 to 1.7 percentage points, p<0.001). Hypoglycaemia ratio decreased from 5.2% to 4.6% (95% CI 0.27 to 0.89 percentage points, p<0.001) in patients with diabetes, but increased in patients without diabetes from 1.2% to 1.7% (95% CI 0.46 to 0.70 percentage points, p<0.001). Conclusions We demonstrate improved hospital-wide glycaemic control after a multifaceted quality improvement intervention in the context of strong institutional commitment, national mentorship and Lean management PMID:29450273

Increasing Health Insurance Costs and the Decline in Insurance Coverage

PubMed Central

Chernew, Michael; Cutler, David M; Keenan, Patricia Seliger

2005-01-01

Objective To determine the impact of rising health insurance premiums on coverage rates. Data Sources & Study Setting Our analysis is based on two cohorts of nonelderly Americans residing in 64 large metropolitan statistical areas (MSAs) surveyed in the Current Population Survey in 1989–1991 and 1998–2000. Measures of premiums are based on data from the Health Insurance Association of America and the Kaiser Family Foundation/Health Research and Educational Trust Survey of Employer-Sponsored Health Benefits. Study Design Probit regression and instrumental variable techniques are used to estimate the association between rising local health insurance costs and the falling propensity for individuals to have any health insurance coverage, controlling for a rich array of economic, demographic, and policy covariates. Principal Findings More than half of the decline in coverage rates experienced over the 1990s is attributable to the increase in health insurance premiums (2.0 percentage points of the 3.1 percentage point decline). Medicaid expansions led to a 1 percentage point increase in coverage. Changes in economic and demographic factors had little net effect. The number of people uninsured could increase by 1.9–6.3 million in the decade ending 2010 if real, per capita medical costs increase at a rate of 1–3 percentage points, holding all else constant. Conclusions Initiatives aimed at reducing the number of uninsured must confront the growing pressure on coverage rates generated by rising costs. PMID:16033490

Minimum Wage and Overweight and Obesity in Adult Women: A Multilevel Analysis of Low and Middle Income Countries.

PubMed

Conklin, Annalijn I; Ponce, Ninez A; Frank, John; Nandi, Arijit; Heymann, Jody

2016-01-01

To describe the relationship between minimum wage and overweight and obesity across countries at different levels of development. A cross-sectional analysis of 27 countries with data on the legislated minimum wage level linked to socio-demographic and anthropometry data of non-pregnant 190,892 adult women (24-49 y) from the Demographic and Health Survey. We used multilevel logistic regression models to condition on country- and individual-level potential confounders, and post-estimation of average marginal effects to calculate the adjusted prevalence difference. We found the association between minimum wage and overweight/obesity was independent of individual-level SES and confounders, and showed a reversed pattern by country development stage. The adjusted overweight/obesity prevalence difference in low-income countries was an average increase of about 0.1 percentage points (PD 0.075 [0.065, 0.084]), and an average decrease of 0.01 percentage points in middle-income countries (PD -0.014 [-0.019, -0.009]). The adjusted obesity prevalence difference in low-income countries was an average increase of 0.03 percentage points (PD 0.032 [0.021, 0.042]) and an average decrease of 0.03 percentage points in middle-income countries (PD -0.032 [-0.036, -0.027]). This is among the first studies to examine the potential impact of improved wages on an important precursor of non-communicable diseases globally. Among countries with a modest level of economic development, higher minimum wage was associated with lower levels of obesity.

Associations of cycling with urban sprawl and the gasoline price.

PubMed

Rashad, Inas

2009-01-01

Determine the relationships between cycling and urban sprawl and between cycling and the gasoline price. Cross-sectional multivariate regression analyses using pooled data from two individual-level national surveys to analyze the effects of variations in levels of urban sprawl and the gasoline price on cycling as a form of physical activity. Metropolitan areas representative of the U.S. population, 1990 to 2001. Behavioral Risk Factor Surveillance System: 146,730 individuals at least 18-years-old in the United States; Nationwide Personal Transportation Survey: 73,903 individuals at least 18-years-old in the United States. Self-reported information on bicycling served as the dependent variable. Urban sprawl and the gasoline price served as key independent variables. Living in a metropolitan area with a lower degree of urban sprawl increased the probability of cycling in the past month by 3.4 to 4.4 percentage points and 1.6 to 2.1 percentage points from the means for men and women, respectively. Increasing the gasoline price by one dollar increased the probability of cycling by 4.3 to 4.7 percentage points and 2.9 to 3.5 percentage points for men and women, respectively. Results indicate that the prevalence of cycling is higher in less sprawling areas and areas with higher gasoline prices. More research is needed to refine results on how individuals respond to incentives and the roles that monetary and time costs play in improving public health.

[An investigation of psychological state at different stages of occupational AIDS exposure and related influencing factors in Nanning, China].

PubMed

Lin, Q; Ge, X M; Mo, J C; Li, S S; Chen, C C; Chen, S Y

2016-10-20

Objective: To investigate the changes in psychological state after occupational exposure in the AIDS occupational exposure population and related influencing factors, and to provide baseline data and a basis for related departments to conduct mental health prevention and intervention for personnel with occupational AIDS exposure. Methods: AIDS risk assessment was performed for all personnel with occupational AIDS exposure in 2014 in Nanning, China, and the Symptom Checklist - 90 (SCL - 90) psychological scale was used for psychological state evaluation at 24 hours, 1 week, and 3 months after occupational exposure in all persons who met the research criteria. Results: Most of the persons with occupational AIDS exposure came from secondary and tertiary hospitals (85%) , and nurses accounted for the highest percentage (78.3% ). The age ranged from 21 to 50 years, and the mean age was 31.02 ± 7.92 years. The persons with occupational AIDS exposure aged 20~29 years accounted for the highest percentage (51.6%) , and most persons (76.7%) graduated from junior colleges. Compared with the adult norm, there was significant increases in the total psychological score and the number of positive items after occupational exposure ( P <0.05). The scores of all items at 24 hours were significantly higher than those at the other time points, and the scores of all items gradually decreased over time ( F =227.24, 267.57, and 287.46, P <0.05). Compared with the adult norm, there were significant increases in the factor points at 24 hours and significant reductions in the factor points at 3 months ( P <0.05). Compared with those at 24 hours, the factor scores at 3 months decreased significantly ( P <0.05). Conclusion: Occupational AIDS exposure affects the mental status of related personnel, and the mental status at 24 hours after exposure is poor. Related departments should provide corresponding psychological counseling for the occupational exposure population at different exposure times.

Thermal, physiological and perceptual strain mediate alterations in match-play tennis under heat stress

PubMed Central

Périard, Julien D; Racinais, Sébastien; Knez, Wade L; Herrera, Christopher P; Christian, Ryan J; Girard, Olivier

2014-01-01

Objectives This study compared the thermal, physiological and perceptual responses associated with match-play tennis in HOT (∼34°C wet-bulb-globe temperature (WBGT)) and COOL (∼19°C WBGT) conditions, along with the accompanying alterations in match characteristics. Methods 12 male tennis players undertook two matches for an effective playing time (ie, ball in play) of 20 min, corresponding to ∼119 and ∼102 min of play in HOT and COOL conditions, respectively. Rectal and skin temperatures, heart rate, subjective ratings of thermal comfort, thermal sensation and perceived exertion were recorded, along with match characteristics. Results End-match rectal temperature increased to a greater extent in the HOT (∼39.4°C) compared with the COOL (∼38.7°C) condition (p<0.05). Thigh skin temperature was higher throughout the HOT match (p<0.001). Heart rate, thermal comfort, thermal sensation and perceived exertion were also higher during the HOT match (p<0.001). Total playing time was longer in the HOT compared with the COOL match (p<0.05). Point duration (∼7.1 s) was similar between conditions, while the time between points was ∼10 s longer in the HOT relative to the COOL match (p<0.05). This led to a ∼3.4% lower effective playing percentage in the heat (p<0.05). Although several thermal, physiological and perceptual variables were individually correlated to the adjustments in time between points and effective playing percentage, thermal sensation was the only predictor variable associated with both adjustments (p<0.005). Conclusions These adjustments in match-play tennis characteristics under severe heat stress appear to represent a behavioural strategy adopted to minimise or offset the sensation of environmental conditions being rated as difficult. PMID:24668377

Breast feeding and the weekend effect: an observational study.

PubMed

Fitzsimons, Emla; Vera-Hernández, Marcos

2016-07-08

To compare the incidence of breast feeding by day of week of birth. Retrospective database study using 16 508 records from the 2005 and 2010 Infant Feeding Surveys. England and Wales, UK. Mothers of a sample of births from among all registered births in the periods August-September 2005 and August-October 2010. Incidence of breast feeding after birth. Among babies of mothers who left full-time education aged 16 or under, the incidence of breast feeding was 6.7 percentage points lower (95% CI 1.4 to 12.1 percentage points) for those born on Saturdays than for those born on Mondays-Thursdays. No such differences by day of week of birth were observed among babies of mothers who left school aged 17 or over. Breastfeeding policy should take into account differences in breast feeding by day of week of birth, which are apparent among low-educated mothers. Further research is needed to ascertain the reason for this finding. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Influence of wholesale lamb marketing options and merchandising styles on retail yield and fabrication time.

PubMed

Lorenzen, C L; Martin, A M; Griffin, D B; Dockerty, T R; Walter, J P; Johnson, H K; Savell, J W

1997-01-01

Lamb carcasses (n = 94) from five packing plants, selected to vary in weight class and fat thickness, were used to determine retail yield and labor requirements of wholesale lamb fabrication. Carcasses were allotted randomly according to weight class to be fabricated as whole carcasses (n = 20), three-piece boxes (n = 22), or subprimals (n = 52). Processing times (seconds) were recorded and wholesale and retail weights (kilograms) were obtained to calculate retail yield. Subprimals were fabricated into bone-in retail cuts or boneless or semi-boneless retail cuts. Retail yield for subprimal lamb legs decreased from 85.3 +/- .6% for bone-in to 68.0 +/- .7% for a completely boneless retail product. Correspondingly, processing times increased from 126.1 +/- 5.4 s to 542.0 +/- 19.2 s for bone-in and boneless legs, respectively. For all subprimals, retail yield percentage tended to decrease and total processing time increase as cuts were fabricated to boneless or semi-boneless end points compared with a bone-in end point. Percentage retail yield did not differ (P > .05) among whole carcass, three-piece box, and subprimal marketing methods. Total processing time was shorter for subprimals (P < .05) than for the other two marketing methods.

New porcine test-model reveals remarkable differences between algorithms for spectrophotometrical haemoglobin saturation measurements with VLS.

PubMed

Gade, John; Greisen, Gorm

2016-09-01

The study created an 'ex vivo' model to test different algorithms for measurements of mucosal haemoglobin saturation with visible light spectrophotometry (VLS). The model allowed comparison between algorithms, but it also allowed comparison with co-oximetry using a 'gold standard' method. This has not been described before. Seven pigs were used. They were perfused with cold Haemaxel, and thus killed, chilled and becoming bloodless. The bronchial artery was perfused with cold blood with known saturation and spectrophotometrical measurements were made through a bronchoscope. Based on 42 spectrophotometrical measurements of porcine bronchial mucosa saturation with fully oxygenated blood and 21 with de-oxygenated blood, six algorithms were applied to the raw-spectra of the measurements and compared with co-oxymetry. The difference from co-oxymetry in the oxygenated and de-oxygenated state ranged from  -32.8 to  +29.9 percentage points and from  -5.0 to  +9.2 percentage points, respectively. the algorithms showed remarkable in-between differences when tested on raw-spectra from an 'ex vivo' model. All algorithms had bias, more marked at high oxygenation than low oxygenation. Three algorithms were dis-recommended.

Socioeconomic inequalities in breast and cervical screening coverage in England: are we closing the gap?

PubMed Central

Douglas, Elaine; Waller, Jo; Duffy, Stephen W

2015-01-01

Objective Health policy in the UK is committed to tackling inequalities in cancer screening participation. We examined whether socioeconomic inequalities in breast and cervical cancer screening participation in England have reduced over five years. Methods Cross-sectional analyses compared cervical and breast screening coverage between 2007/8 and 2012/13 in Primary Care Trusts (PCTs) in England in relation to area-level income deprivation. Results At the start and the end of this five year period, there were socioeconomic inequalities in screening coverage for breast and cervical screening. Inequalities were highest for breast screening. Over time, the coverage gap between the highest and lowest quintiles of income deprivation significantly reduced for breast screening (from 12.3 to 8.3 percentage points), but not for cervical screening (5.3 to 4.9 percentage points). Conclusions Efforts to reduce screening inequalities appear to have resulted in a significant improvement in equitable delivery of breast screening, although not of cervical screening. More work is needed to understand the differences, and see whether broader lessons can be learned from the reduction of inequalities in breast screening participation. PMID:26377810

Diabetes's 'health shock' to schooling and earnings: increased dropout rates and lower wages and employment in young adults.

PubMed

Fletcher, Jason M; Richards, Michael R

2012-01-01

Despite a growing diabetes crisis, the nonmedical implications for young adults have gone virtually unexplored. We investigated the effects of diabetes on two key outcomes for this age group-schooling and earnings-and found that it delivers an increasingly common "health shock" to both. We identified effects in several measures of educational attainment, including a high school dropout rate that was six percentage points higher than among young adults without the disease. We also found lower employment and wages: A person with diabetes can conservatively expect to lose more than $160,000 over his or her working life, compared to a peer without the disease. For young adults with diabetes, having a parent with diabetes also leads to poorer outcomes than if one more parents do not have the disease-for example, reducing the likelihood of attending college by four to six percentage points, even after the child's health status is controlled for. These results highlight the urgency of attacking this growing health problem, as well as the need for measures such as in-school screening for whether diabetes's impact on individual learning and performance begins before the classic manifestations of clinical diabetes appear.

Spillover Effects of Adult Medicaid Expansions on Children's Use of Preventive Services.

PubMed

Venkataramani, Maya; Pollack, Craig Evan; Roberts, Eric T

2017-12-01

Since the passage of the Affordable Care Act, Medicaid enrollment has increased by ∼17 million adults, including many low-income parents. One potentially important, but little studied, consequence of expanding health insurance for parents is its effect on children's receipt of preventive services. By using state Medicaid eligibility thresholds linked to the 2001-2013 Medical Expenditure Panel Surveys, we assessed the relationship between changes in adult Medicaid eligibility and children's likelihood of receiving annual well-child visits (WCVs). In instrumental variable analyses, we used these changes in Medicaid eligibility to estimate the relationship between parental enrollment in Medicaid and children's receipt of WCVs. Our analytic sample consisted of 50 622 parent-child dyads in families with incomes <200% of the federal poverty level, surveyed from 2001 to 2013. On average, a 10-point increase in a state's parental Medicaid eligibility (measured relative to the federal poverty level) was associated with a 0.27 percentage point higher probability that a child received an annual WCV (95% confidence interval: 0.058 to 0.48 percentage points, P = .012). Instrumental variable analyses revealed that parental enrollment in Medicaid was associated with a 29 percentage point higher probability that their child received an annual WCV (95% confidence interval: 11 to 47 percentage points, P = .002). In our study, we demonstrate that Medicaid expansions targeted at low-income adults are associated with increased receipt of recommended pediatric preventive care for their children. This finding reveals an important spillover effect of parental insurance coverage that should be considered in future policy decisions surrounding adult Medicaid eligibility. Copyright © 2017 by the American Academy of Pediatrics.

Association Between Academic Medical Center Pharmaceutical Detailing Policies and Physician Prescribing.

PubMed

Larkin, Ian; Ang, Desmond; Steinhart, Jonathan; Chao, Matthew; Patterson, Mark; Sah, Sunita; Wu, Tina; Schoenbaum, Michael; Hutchins, David; Brennan, Troyen; Loewenstein, George

2017-05-02

In an effort to regulate physician conflicts of interest, some US academic medical centers (AMCs) enacted policies restricting pharmaceutical representative sales visits to physicians (known as detailing) between 2006 and 2012. Little is known about the effect of these policies on physician prescribing. To analyze the association between detailing policies enacted at AMCs and physician prescribing of actively detailed and not detailed drugs. The study used a difference-in-differences multivariable regression analysis to compare changes in prescribing by physicians before and after implementation of detailing policies at AMCs in 5 states (California, Illinois, Massachusetts, Pennsylvania, and New York) that made up the intervention group with changes in prescribing by a matched control group of similar physicians not subject to a detailing policy. Academic medical center implementation of policies regulating pharmaceutical salesperson visits to attending physicians. The monthly within-drug class market share of prescriptions written by an individual physician for detailed and nondetailed drugs in 8 drug classes (lipid-lowering drugs, gastroesophageal reflux disease drugs, diabetes drugs, antihypertensive drugs, hypnotic drugs approved for the treatment of insomnia [sleep aids], attention-deficit/hyperactivity disorder drugs, antidepressant drugs, and antipsychotic drugs) comparing the 10- to 36-month period before implementation of the detailing policies with the 12- to 36-month period after implementation, depending on data availability. The analysis included 16 121 483 prescriptions written between January 2006 and June 2012 by 2126 attending physicians at the 19 intervention group AMCs and by 24 593 matched control group physicians. The sample mean market share at the physician-drug-month level for detailed and nondetailed drugs prior to enactment of policies was 19.3% and 14.2%, respectively. Exposure to an AMC detailing policy was associated with a decrease in the market share of detailed drugs of 1.67 percentage points (95% CI, -2.18 to -1.18 percentage points; P < .001) and an increase in the market share of nondetailed drugs of 0.84 percentage points (95% CI, 0.54 to 1.14 percentage points; P < .001). Associations were statistically significant for 6 of 8 study drug classes for detailed drugs (lipid-lowering drugs, gastroesophageal reflux disease drugs, antihypertensive drugs, sleep aids, attention-deficit/hyperactivity disorder drugs, and antidepressant drugs) and for 9 of the 19 AMCs that implemented policies. Eleven of the 19 AMCs regulated salesperson gifts to physicians, restricted salesperson access to facilities, and incorporated explicit enforcement mechanisms. For 8 of these 11 AMCs, there was a significant change in prescribing. In contrast, there was a significant change at only 1 of 8 AMCs that did not enact policies in all 3 areas. Implementation of policies at AMCs that restricted pharmaceutical detailing between 2006 and 2012 was associated with modest but significant reductions in prescribing of detailed drugs across 6 of 8 major drug classes; however, changes were not seen in all of the AMCs that enacted policies.

Performance of two-stage fan with larger dampers on first-stage rotor

NASA Technical Reports Server (NTRS)

Urasek, D. C.; Cunnan, W. S.; Stevans, W.

1979-01-01

The performance of a two stage, high pressure-ratio fan, having large, part-span vibration dampers on the first stage rotor is presented and compared with an identical aerodynamically designed fan having smaller dampers. Comparisons of the data for the two damper configurations show that with increased damper size: (1) very high losses in the damper region reduced overall efficiency of first stage rotor by approximately 3 points, (2) the overall performance of each blade row, downstream of the damper was not significantly altered, although appreciable differences in the radial distributions of various performance parameters were noted, and (3) the lower performance of the first stage rotor decreased the overall fan efficiency more than 1 percentage point.

Subsidising artemisinin-based combination therapy in the private retail sector.

PubMed

Opiyo, Newton; Yamey, Gavin; Garner, Paul

2016-03-09

Malaria causes ill health and death in Africa. Treating illness promptly with artemisinin-based combination therapy (ACT) is likely to cure people and avoid the disease progressing to more severe forms and death. In many countries, ACT use remains low. Part of the problem is that most people seek treatment from the retail sector where ACTs are expensive; this expense is a barrier to their use.The Global Fund and other international organisations are subsidising the cost of ACTs for private retail providers to improve access to ACTs. The subsidy was initially organised through a stand-alone initiative, called the Affordable Medicines Facility-malaria (AMFm), but has since been integrated into the Global Fund core grant management and financial processes. To assess the effect of programmes that include ACT price subsidies for private retailers on ACT use, availability, price and market share. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 1, The Cochrane Library, including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register); MEDLINE (OvidSP), EMBASE (OvidSP), CINAHL (EbscoHost), EconLit (ProQuest), Global Health (OvidSP), Regional Indexes (Global Health Library, WHO), LILACS (Global Health Library, WHO), Science Citation Index and Social Sciences Citation Index (ISI Web of Science) and Health Management (ProQuest). All databases were searched February 2015, except for Health Management which was searched November 2013, without any date, language or publication status restrictions. We also searched the International Clinical Trials Registry Platform (ICTRP; WHO), ClinicalTrials.gov (NIH) and various grey literature sources. We also conducted a cited reference search for all included studies in ISI Web of Knowledge, checked references of identified articles and contacted authors to identify additional studies. Randomised trials, non-randomised trials, controlled before-after studies and interrupted-time-series studies that compared the effects of ACT price subsidies for private retailers to no subsidies or alternative ACT financing mechanisms were eligible for inclusion. Two authors independently screened and selected studies for inclusion. Two review authors independently extracted data, assessed study risk of bias and confidence in effect estimates (certainty of evidence) using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). We included four trials (two cluster-randomised trials reported in three articles and two non-randomised cluster trials). Three trials assessed retail sector ACT subsidies combined with supportive interventions (retail outlet provider training, community awareness and mass media campaigns). One trial assessed vouchers provided to households to purchase subsidised ACTs. Price subsidies ranged from 80% to 95%. One trial enrolled children under five years of age; the other three trials studied people of all age groups. The studies were done in rural districts in East Africa (Kenya, Uganda and Tanzania).In this East Africa setting, these ACT subsidy programmes increased the percentage of children under five years of age receiving ACTs on the day, or following day, of fever onset by 25 percentage points (95% confidence interval (CI) 14.1 to 35.9 percentage points; 1 study, high certainty evidence). This suggests that in practice, among febrile children under five years of age with an ACT usage rate of 5% without a subsidy, subsidy programmes would increase usage by between 19% and 41% over a one year period.The ACT subsidy programmes increased the percentage of retail outlets stocking ACTs for children under five years of age by 31.9 percentage points (95% CI 26.3 to 37.5 percentage points; 1 study, high certainty evidence). Effects on ACT stocking for patients of any age is unknown because the certainty of evidence was very low.The ACT subsidy programmes decreased the median cost of ACTs for children under five years of age by US$ 0.84 (median cost per ACT course without subsidy: US$ 1.08 versus with subsidy: US$ 0.24; 1 study, high certainty evidence).The ACT subsidy programmes increased the market share of ACTs for children under five years of age by between 23.6 and 63.0 percentage points (1 study, high certainty evidence).The ACT subsidy programmes decreased the use of older antimalarial drugs (such as amodiaquine and sulphadoxine-pyrimethamine) among children under five years of age by 10.4 percentage points (95% CI 3.9 to 16.9 percentage points; 1 study, high certainty evidence).None of the three studies of ACT subsidies reported the number of patients treated who had confirmed malaria.Vouchers increased the likelihood that an illness is treated with an ACT by 16 to 23 percentage points; however, vouchers were associated with a high rate of over-treatment of malaria (only 56% of patients taking ACTs from the drug shop tested positive for malaria under the 92% subsidy; 1 study, high certainty evidence). Programmes that include substantive subsidies for private sector retailers combined with training of providers and social marketing improved use and availability of ACTs for children under five years of age with suspected malaria in research studies from three countries in East Africa. These programmes also reduced prices of ACTs, improved market share of ACTs and reduced the use of older antimalarial drugs among febrile children under five years of age. The research evaluates drug delivery but does not assess whether the patients had confirmed (parasite-diagnosed) malaria. None of the included studies assessed patient outcomes; it is therefore not known whether the effects seen in the studies would translate to an impact on health.

26 CFR 1.483-2 - Unstated interest.

Code of Federal Regulations, 2010 CFR

2010-04-01

... percentage points above the yield on 6-month Treasury bills at the mid-point of the semiannual period immediately preceding each interest payment date. Assume that the interest rate is a qualified floating rate...

A randomized, controlled trial of an aerosolized vaccine against measles.

PubMed

Low, Nicola; Bavdekar, Ashish; Jeyaseelan, Lakshmanan; Hirve, Siddhivinayak; Ramanathan, Kavitha; Andrews, Nicholas J; Shaikh, Naseem; Jadi, Ramesh S; Rajagopal, Arunachalam; Brown, Kevin E; Brown, David; Fink, James B; John, Oommen; Scott, Pippa; Riveros-Balta, A Ximena; Greco, Michel; Dhere, Rajeev; Kulkarni, Prasad S; Henao Restrepo, Ana Maria

2015-04-16

Aerosolized vaccine can be used as a needle-free method of immunization against measles, a disease that remains a major cause of illness and death. Data on the immunogenicity of aerosolized vaccine against measles in children are inconsistent. We conducted an open-label noninferiority trial involving children 9.0 to 11.9 months of age in India who were eligible to receive a first dose of measles vaccine. Children were randomly assigned to receive a single dose of vaccine by means of either aerosol inhalation or a subcutaneous injection. The primary end points were seropositivity for antibodies against measles and adverse events 91 days after vaccination. The noninferiority margin was 5 percentage points. A total of 1001 children were assigned to receive aerosolized vaccine, and 1003 children were assigned to receive subcutaneous vaccine; 1956 of all the children (97.6%) were followed to day 91, but outcome data were missing for 331 children because of thawed specimens. In the per-protocol population, data on 1560 of 2004 children (77.8%) could be evaluated. At day 91, a total of 662 of 775 children (85.4%; 95% confidence interval [CI], 82.5 to 88.0) in the aerosol group, as compared with 743 of 785 children (94.6%; 95% CI, 92.7 to 96.1) in the subcutaneous group, were seropositive, a difference of -9.2 percentage points (95% CI, -12.2 to -6.3). Findings were similar in the full-analysis set (673 of 788 children in the aerosol group [85.4%] and 754 of 796 children in the subcutaneous group [94.7%] were seropositive at day 91, a difference of -9.3 percentage points [95% CI, -12.3 to -6.4]) and after multiple imputation of missing results. No serious adverse events were attributable to measles vaccination. Adverse-event profiles were similar in the two groups. Aerosolized vaccine against measles was immunogenic, but, at the prespecified margin, the aerosolized vaccine was inferior to the subcutaneous vaccine with respect to the rate of seropositivity. (Funded by the Bill and Melinda Gates Foundation; Measles Aerosol Vaccine Project Clinical Trials Registry-India number, CTRI/2009/091/000673.).

Stability of INFIT and OUTFIT Compared to Simulated Estimates in Applied Setting.

PubMed

Hodge, Kari J; Morgan, Grant B

Residual-based fit statistics are commonly used as an indication of the extent to which the item response data fit the Rash model. Fit statistic estimates are influenced by sample size and rules-of thumb estimates may result in incorrect conclusions about the extent to which the model fits the data. Estimates obtained in this analysis were compared to 250 simulated data sets to examine the stability of the estimates. All INFIT estimates were within the rule-of-thumb range of 0.7 to 1.3. However, only 82% of the INFIT estimates fell within the 2.5th and 97.5th percentile of the simulated item's INFIT distributions using this 95% confidence-like interval. This is a 18 percentage point difference in items that were classified as acceptable. Fourty-eight percent of OUTFIT estimates fell within the 0.7 to 1.3 rule- of-thumb range. Whereas 34% of OUTFIT estimates fell within the 2.5th and 97.5th percentile of the simulated item's OUTFIT distributions. This is a 13 percentage point difference in items that were classified as acceptable. When using the rule-of- thumb ranges for fit estimates the magnitude of misfit was smaller than with the 95% confidence interval of the simulated distribution. The findings indicate that the use of confidence intervals as critical values for fit statistics leads to different model data fit conclusions than traditional rule of thumb critical values.

Urine specific gravity measurement: reagent strip versus refractometer.

PubMed

Brandon, C A

1994-01-01

To compare the results of urinalysis screenings for specific gravity (SG) using the reagent strip and the refractometer. United Hospital, Grand Forks, North Dakota. United Hospital is a 384-bed teaching hospital. PRODUCT COMPARISON: The Ames Multistix 10 SG reagent strip (Miles, Inc., Elkhart, IN 46515) was compared with the TS Meter (Leica, Inc., Deerfield, IL 60015). The degree of correlation between the results produced by each method. The percentage of difference between the means of the direct strip readings and the refractometer readings was 9.68%. The percentage of difference between the means of the adjusted strip readings and the refractometer readings was 22.58%, which was significantly different. When the direct strip readings and the refractometer readings were plotted together on a graph, the points were widely scattered; this fact, and a correlation coefficient of 0.725, suggest that random error occurred in both methods. Analysis of the slope and intercept of the correlation indicated systematic error. The reagent strip method of measuring SG is accurate only in a narrow range of "average" values, and should not be used as the basis for medical diagnoses.

The heterogeneity statistic I(2) can be biased in small meta-analyses.

PubMed

von Hippel, Paul T

2015-04-14

Estimated effects vary across studies, partly because of random sampling error and partly because of heterogeneity. In meta-analysis, the fraction of variance that is due to heterogeneity is estimated by the statistic I(2). We calculate the bias of I(2), focusing on the situation where the number of studies in the meta-analysis is small. Small meta-analyses are common; in the Cochrane Library, the median number of studies per meta-analysis is 7 or fewer. We use Mathematica software to calculate the expectation and bias of I(2). I(2) has a substantial bias when the number of studies is small. The bias is positive when the true fraction of heterogeneity is small, but the bias is typically negative when the true fraction of heterogeneity is large. For example, with 7 studies and no true heterogeneity, I(2) will overestimate heterogeneity by an average of 12 percentage points, but with 7 studies and 80 percent true heterogeneity, I(2) can underestimate heterogeneity by an average of 28 percentage points. Biases of 12-28 percentage points are not trivial when one considers that, in the Cochrane Library, the median I(2) estimate is 21 percent. The point estimate I(2) should be interpreted cautiously when a meta-analysis has few studies. In small meta-analyses, confidence intervals should supplement or replace the biased point estimate I(2).

Growth faltering and recovery in children aged 1-8 years in four low- and middle-income countries: Young Lives.

PubMed

Lundeen, Elizabeth A; Behrman, Jere R; Crookston, Benjamin T; Dearden, Kirk A; Engle, Patrice; Georgiadis, Andreas; Penny, Mary E; Stein, Aryeh D

2014-09-01

We characterized post-infancy child growth patterns and determined the incidence of becoming stunted and of recovery from stunting. Data came from Young Lives, a longitudinal study of childhood poverty in four low- and middle-income countries. We analysed length/height measurements for children at ages 1, 5 and 8 years. Children (n 7171) in Ethiopia, India, Peru and Vietnam. Mean height-for-age Z-score (HAZ) at age 1 year ranged from -1·51 (Ethiopia) to -1·08 (Vietnam). From age 1 to 5 years, mean HAZ increased by 0·27 in Ethiopia (P < 0·001) and decreased among the other cohorts (range: -0·19 (Peru) to -0·32 (India); all P < 0·001). From 5 to 8 years, mean HAZ increased in all cohorts (range: 0·19 (India) to 0·38 (Peru); all P < 0·001). Prevalence of stunting (HAZ<-2·0) at 1 year ranged from 21 % (Vietnam) to 46 % (Ethiopia). From age 1 to 5 years, stunting prevalence decreased by 15·1 percentage points in Ethiopia (P < 0·001) and increased in the other cohorts (range: 3·0 percentage points (Vietnam) to 5·3 percentage points (India); all P ≤ 0·001). From 5 to 8 years, stunting prevalence decreased in all cohorts (range: 5·0 percentage points (Vietnam) to 12·7 percentage points (Peru); all P < 0·001). The incidence of becoming stunted between ages 1 to 5 years ranged from 11 % (Vietnam) to 22 % (India); between ages 5 to 8 years, it ranged from 3 % (Peru) to 6 % (India and Ethiopia). The incidence of recovery from stunting between ages 1 and 5 years ranged from 27 % (Vietnam) to 53 % (Ethiopia); between ages 5 and 8 years, it ranged from 30 % (India) to 47 % (Ethiopia). We found substantial recovery from early stunting among children in four low- and middle-income countries.

Consumer Choice Between Hospital-Based and Freestanding Facilities for Arthroscopy: Impact on Prices, Spending, and Surgical Complications.

PubMed

Robinson, James C; Brown, Timothy T; Whaley, Christopher; Bozic, Kevin J

2015-09-16

Hospital-based outpatient departments traditionally charge higher prices for ambulatory procedures, compared with freestanding surgery centers. Under emerging reference-based benefit designs, insurers establish a contribution limit that they will pay, requiring the patient to pay the difference between that contribution limit and the actual price charged by the facility. The purpose of this study was to evaluate the impact of reference-based benefits on consumer choices, facility prices, employer spending, and surgical outcomes for orthopaedic procedures performed at ambulatory surgery centers. We obtained data on 3962 patients covered by the California Public Employees' Retirement System (CalPERS) who underwent arthroscopy of the knee or shoulder in the three years prior to the implementation of reference-based benefits in January 2012 and on 2505 patients covered by CalPERS who underwent arthroscopy in the two years after implementation. Control group data were obtained on 57,791 patients who underwent arthroscopy and were not subject to reference-based benefits. The impact of reference-based benefits on consumer choices between hospital-based and freestanding facilities, facility prices, employer spending, and surgical complications was assessed with use of difference-in-differences multivariable regressions to adjust for patient demographic characteristics, comorbidities, and geographic location. By the second year of the program, the shift to reference-based benefits was associated with an increase in the utilization of freestanding ambulatory surgery centers by 14.3 percentage points (95% confidence interval, 8.1 to 20.5 percentage points) for knee arthroscopy and by 9.9 percentage points (95% confidence interval, 3.2 to 16.7 percentage points) for shoulder arthroscopy and a corresponding decrease in the use of hospital-based facilities. The mean price paid by CalPERS fell by 17.6% (95% confidence interval, -24.9% to -9.6%) for knee procedures and by 17.0% (95% confidence interval, -29.3% to -2.5%) for shoulder procedures. The shift to reference-based benefits was not associated with a change in the rate of surgical complications. In the first two years after the implementation of reference-based benefits, CalPERS saved $2.3 million (13%) on these two orthopaedic procedures. Reference-based benefits increase consumer sensitivity to price differences between freestanding and hospital-based surgical facilities. This study shows that the implementation of reference-based benefits does not result in a significant increase in measured complication rates for those subject to reference-based benefits. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Consumer Choice Between Hospital-Based and Freestanding Facilities for Arthroscopy

PubMed Central

Robinson, James C.; Brown, Timothy T.; Whaley, Christopher; Bozic, Kevin J.

2015-01-01

Background: Hospital-based outpatient departments traditionally charge higher prices for ambulatory procedures, compared with freestanding surgery centers. Under emerging reference-based benefit designs, insurers establish a contribution limit that they will pay, requiring the patient to pay the difference between that contribution limit and the actual price charged by the facility. The purpose of this study was to evaluate the impact of reference-based benefits on consumer choices, facility prices, employer spending, and surgical outcomes for orthopaedic procedures performed at ambulatory surgery centers. Methods: We obtained data on 3962 patients covered by the California Public Employees’ Retirement System (CalPERS) who underwent arthroscopy of the knee or shoulder in the three years prior to the implementation of reference-based benefits in January 2012 and on 2505 patients covered by CalPERS who underwent arthroscopy in the two years after implementation. Control group data were obtained on 57,791 patients who underwent arthroscopy and were not subject to reference-based benefits. The impact of reference-based benefits on consumer choices between hospital-based and freestanding facilities, facility prices, employer spending, and surgical complications was assessed with use of difference-in-differences multivariable regressions to adjust for patient demographic characteristics, comorbidities, and geographic location. Results: By the second year of the program, the shift to reference-based benefits was associated with an increase in the utilization of freestanding ambulatory surgery centers by 14.3 percentage points (95% confidence interval, 8.1 to 20.5 percentage points) for knee arthroscopy and by 9.9 percentage points (95% confidence interval, 3.2 to 16.7 percentage points) for shoulder arthroscopy and a corresponding decrease in the use of hospital-based facilities. The mean price paid by CalPERS fell by 17.6% (95% confidence interval, −24.9% to −9.6%) for knee procedures and by 17.0% (95% confidence interval, −29.3% to −2.5%) for shoulder procedures. The shift to reference-based benefits was not associated with a change in the rate of surgical complications. In the first two years after the implementation of reference-based benefits, CalPERS saved $2.3 million (13%) on these two orthopaedic procedures. Conclusions: Reference-based benefits increase consumer sensitivity to price differences between freestanding and hospital-based surgical facilities. Clinical Relevance: This study shows that the implementation of reference-based benefits does not result in a significant increase in measured complication rates for those subject to reference-based benefits. PMID:26378263

Socioeconomic Gaps in Parents' Discipline Strategies From 1988 to 2011.

PubMed

Ryan, Rebecca M; Kalil, Ariel; Ziol-Guest, Kathleen M; Padilla, Christina

2016-12-01

The prevalence of corporal punishment is high in the United States despite a 1998 American Academy of Pediatrics policy statement urging against its use. The current study tests whether the socioeconomic difference in its use by parents has changed over the past quarter century. It goes on to test whether socioeconomic differences in the use of nonphysical discipline have also changed over time. Data are drawn from 4 national studies conducted between 1988 and 2011. Each asked how often a kindergarten-aged child was spanked in the past week and what the parents would do if the child misbehaved, with physical discipline, time-out, and talking to child as possible responses. We use regression models to estimate parents' responses to these questions at the 90th, 50th, and 10th percentiles of the income and education distributions and t tests to compare estimates across cohorts. The proportion of mothers at the 50th income-percentile who endorse physical discipline decreased from 46% to 21% over time. Gaps between the 90th and 10th income-percentiles were stable at 11 and 18 percentage points in 1988 and 2011. The percentage of mothers at the 10th income-percentile endorsing time-outs increased from 51% to 71%, and the 90/10 income gap decreased from 23 to 14 percentage points between 1998 and 2011. Decline in popular support for physical discipline reflects real changes in parents' discipline strategies. These changes have occurred at all socioeconomic levels, producing for some behaviors a significant reduction in socioeconomic differences. Copyright © 2016 by the American Academy of Pediatrics.

Predicting 3D pose in partially overlapped X-ray images of knee prostheses using model-based Roentgen stereophotogrammetric analysis (RSA).

PubMed

Hsu, Chi-Pin; Lin, Shang-Chih; Shih, Kao-Shang; Huang, Chang-Hung; Lee, Chian-Her

2014-12-01

After total knee replacement, the model-based Roentgen stereophotogrammetric analysis (RSA) technique has been used to monitor the status of prosthetic wear, misalignment, and even failure. However, the overlap of the prosthetic outlines inevitably increases errors in the estimation of prosthetic poses due to the limited amount of available outlines. In the literature, quite a few studies have investigated the problems induced by the overlapped outlines, and manual adjustment is still the mainstream. This study proposes two methods to automate the image processing of overlapped outlines prior to the pose registration of prosthetic models. The outline-separated method defines the intersected points and segments the overlapped outlines. The feature-recognized method uses the point and line features of the remaining outlines to initiate registration. Overlap percentage is defined as the ratio of overlapped to non-overlapped outlines. The simulated images with five overlapping percentages are used to evaluate the robustness and accuracy of the proposed methods. Compared with non-overlapped images, overlapped images reduce the number of outlines available for model-based RSA calculation. The maximum and root mean square errors for a prosthetic outline are 0.35 and 0.04 mm, respectively. The mean translation and rotation errors are 0.11 mm and 0.18°, respectively. The errors of the model-based RSA results are increased when the overlap percentage is beyond about 9%. In conclusion, both outline-separated and feature-recognized methods can be seamlessly integrated to automate the calculation of rough registration. This can significantly increase the clinical practicability of the model-based RSA technique.

Minimum Wage and Overweight and Obesity in Adult Women: A Multilevel Analysis of Low and Middle Income Countries

PubMed Central

Conklin, Annalijn I.; Ponce, Ninez A.; Frank, John; Nandi, Arijit; Heymann, Jody

2016-01-01

Objectives To describe the relationship between minimum wage and overweight and obesity across countries at different levels of development. Methods A cross-sectional analysis of 27 countries with data on the legislated minimum wage level linked to socio-demographic and anthropometry data of non-pregnant 190,892 adult women (24–49 y) from the Demographic and Health Survey. We used multilevel logistic regression models to condition on country- and individual-level potential confounders, and post-estimation of average marginal effects to calculate the adjusted prevalence difference. Results We found the association between minimum wage and overweight/obesity was independent of individual-level SES and confounders, and showed a reversed pattern by country development stage. The adjusted overweight/obesity prevalence difference in low-income countries was an average increase of about 0.1 percentage points (PD 0.075 [0.065, 0.084]), and an average decrease of 0.01 percentage points in middle-income countries (PD -0.014 [-0.019, -0.009]). The adjusted obesity prevalence difference in low-income countries was an average increase of 0.03 percentage points (PD 0.032 [0.021, 0.042]) and an average decrease of 0.03 percentage points in middle-income countries (PD -0.032 [-0.036, -0.027]). Conclusion This is among the first studies to examine the potential impact of improved wages on an important precursor of non-communicable diseases globally. Among countries with a modest level of economic development, higher minimum wage was associated with lower levels of obesity. PMID:26963247

Impact of the China Healthy Cities Initiative on Urban Environment.

PubMed

Yue, Dahai; Ruan, Shiman; Xu, Jin; Zhu, Weiming; Zhang, Luyu; Cheng, Gang; Meng, Qingyue

2017-04-01

The China Healthy Cities initiative, a nationwide public health campaign, has been implemented for 25 years. As "Healthy China 2030" becomes the key national strategy for improving population health, this initiative is an important component. However, the effects of the initiative have not been well studied. This paper aims to explore its impact on urban environment using a multiple time series design. We adopted a stratified and systematic sampling method to choose 15 China healthy cities across the country. For the selected healthy cities, 1:1 matched non-healthy cities were selected as the comparison group. We collected longitudinal data from 5 years before cities achieved the healthy city title up to 2012. We used hierarchical models to calculate difference-in-differences estimates for examining the impact of the initiative. We found that the China Healthy Cities initiative was associated with increases in the proportion of urban domestic sewage treated (32 percentage points), the proportion of urban domestic garbage treated (30 percentage points), and the proportion of qualified farmers' markets (40 percentage points), all of which are statistically significant (P < 0.05). No significant change was found for increases in green coverage of urban built-up area (5 percentage points), green space per capita (2 square meter), and days with Air Quality Index/Air Pollution Index ≤ 100 (25 days). In conclusion, the China Healthy Cities initiative was associated with significant improved urban environment in terms of infrastructure construction, yet had little impact on green space and air quality.

Child care choices, food intake, and children's obesity status in the United States.

PubMed

Mandal, Bidisha; Powell, Lisa M

2014-07-01

This article studies two pathways in which selection into different types of child care settings may affect likelihood of childhood obesity. Frequency of intake of high energy-dense and low energy-dense food items may vary across care settings, affecting weight outcomes. We find that increased use of paid and regulated care settings, such as center care and Head Start, is associated with higher consumption of fruits and vegetables. Among children from single-mother households, the probability of obesity increases by 15 percentage point with an increase in intake of soft drinks from four to six times a week to daily consumption and by 25 percentage point with an increase in intake of fast food from one to three times a week to four to six times a week. Among children from two-parent households, eating vegetables one additional time a day is associated with 10 percentage point decreased probability of obesity, while one additional drink of juice a day is associated with 10 percentage point increased probability of obesity. Second, variation across care types could be manifested through differences in the structure of the physical environment not captured by differences in food intake alone. This type of effect is found to be marginal and is statistically significant among children from two-parent households only. Data are used from the Early Childhood Longitudinal Study - Birth Cohort surveys (N=10,700; years=2001-2008). Children's age ranged from four to six years in the sample. Copyright © 2014 Elsevier B.V. All rights reserved.

Do flexible work policies improve parents' health? A natural experiment based on the UK Millennium Cohort Study.

PubMed

Avendano, Mauricio; Panico, Lidia

2018-03-01

There is limited evidence of the impact of policies to promote work-family balance on family health. Exploiting the introduction of the UK Flexible Working Act (2003), we examined whether a policy that grants parents the right to request flexible work influences their health and well-being. Using the UK Millennium Cohort Study, we focus on 6424 mothers employed in 2001-2002, when the cohort child was 9 months old, until their child's seventh birthday. We used a difference-in-differences (DiD) approach to compare changes in outcomes before and after the policy among mothers most likely to benefit and mothers unlikely to benefit from the policy. Flexible working increased in a small group of mothers (n=548) whose employer did not offer work flexibility before the reform (treatment group). By contrast, among mothers whose employer already offered flexible work before the reform (control group, n=5810), there was little change or a slight decline in flexible working. DiD estimates suggest that the policy was associated with an increase in flexible working (37.5 percentage points, 95% CI 32.9 to 41.6), but it had no impact on self-rated health (-1.6 percentage points, 95% CI -4.4 to 1.1), long-term illness (-1.87 percentage points, 95% CI -4.3 to 0.5) or life satisfaction scores (β=0.04, 95% CI -0.08 to 0.16). The Flexible Working Act increased flexible working only among a small group of mothers who had not yet the right to request work flexibility, but it had no impact on their health and well-being. Policies promoting work flexibility may require stronger incentives for both parents and employers. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Effects of healthcare reforms on coverage, access, and disparities: quasi-experimental analysis of evidence from Massachusetts.

PubMed

Pande, Aakanksha H; Ross-Degnan, Dennis; Zaslavsky, Alan M; Salomon, Joshua A

2011-07-01

The 2010 Patient Protection and Affordable Care Act (PPACA) has been controversial. The potential impact of national healthcare reform may be considered using a similar set of state-level reforms including exchanges and a mandate, enacted in 2006 in Massachusetts. To evaluate the effects of reforms on healthcare access, affordability, and disparities. Interrupted time series with comparison series. Longitudinal survey data from 2002 to 2009 from the Behavioral Risk Factor Surveillance System including 178,040 nonelderly adults residing in Massachusetts, Vermont, New Hampshire, Rhode Island, and Connecticut. Analysis was conducted from January to August 2010. Massachusetts 2006 healthcare reform, which included an individual health insurance mandate. Being uninsured, having no personal doctor, and forgoing care because of cost, evaluated in Massachusetts and four comparison states before (2002-2005) and after (2007-2009) the healthcare reform. Effects on disparities defined by race, education, income, and employment also were assessed. Living in Massachusetts in 2009 was associated with a 7.6 percentage point (95% CI=3.9, 11.3) higher probability of being insured; 4.8 percentage point (-0.9, 10.6) lower probability of forgoing care because of cost; and a 6.6 percentage point (1.9, 11.3) higher probability of having a personal doctor, compared to expected levels in the absence of reform, defined by trends in control states and adjusting for socioeconomic factors. The effects of the reform on insurance coverage attenuated from 2008 to 2009. In a socioeconomically disadvantaged group, the reforms had a greater effect in improving outcomes on the absolute but not relative scale. Healthcare reforms in Massachusetts, which included a health insurance mandate, were associated with significant increases in insurance coverage and access. The absolute effects of the reform were greater for disadvantaged populations. This is important evidence to consider as debate over national healthcare reform continues. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Improving Primary Care Residents' Proficiency in the Diagnosis of Skin Cancer

PubMed Central

Gerbert, Barbara; Bronstone, Amy; Wolff, Mimi; Maurer, Toby; Berger, Timothy; Pantilat, Steven; McPhee, Stephen J

1998-01-01

OBJECTIVE To determine whether a brief, multicomponent intervention could improve the skin cancer diagnosis and evaluation planning performance of primary care residents to a level equivalent to that of dermatologists. PARTICIPANTS Fifty-two primary care residents (26 in the control group and 26 in the intervention group) and 13 dermatologists completed a pretest and posttest. DESIGN A randomized, controlled trial with pretest and posttest measurements of residents' ability to diagnose and make evaluation plans for lesions indicative of skin cancer. INTERVENTION The intervention included face-to-face feedback sessions focusing on residents' performance deficiencies; an interactive seminar including slide presentations, case examples, and live demonstrations; and the Melanoma Prevention Kit including a booklet, magnifying tool, measuring tool, and skin color guide. MEASUREMENTS AND MAIN RESULTS We compared the abilities of a control and an intervention group of primary care residents, and a group of dermatologists to diagnose and make evaluation plans for six categories of skin lesions including three types of skin cancer—malignant melanoma, squamous cell carcinoma, and basal cell carcinoma. At posttest, both the intervention and control group demonstrated improved performance, with the intervention group revealing significantly larger gains. The intervention group showed greater improvement than the control group across all six diagnostic categories (a gain of 13 percentage points vs 5, p < .05), and in evaluation planning for malignant melanoma (a gain of 46 percentage points vs 36, p < .05) and squamous cell carcinoma (a gain of 42 percentage points vs 21, p < .01). The intervention group performed as well as the dermatologists on five of the six skin cancer diagnosis and evaluation planning scores with the exception of the diagnosis of basal cell carcinoma. CONCLUSIONS Primary care residents can diagnose and make evaluation plans for cancerous skin lesions, including malignant melanoma, at a level equivalent to that of dermatologists if they receive relevant, targeted education. PMID:9502368

Impact of health insurance for tertiary care on postoperative outcomes and seeking care for symptoms: quasi-experimental evidence from Karnataka, India

PubMed Central

Sood, Neeraj; Wagner, Zachary

2016-01-01

Objectives To evaluate the effects of a government insurance programme covering tertiary care for the poor in Karnataka, India—Vajpayee Arogyashree Scheme (VAS)—on treatment seeking and postoperative outcomes. Design Geographic regression discontinuity. Setting 572 villages in Karnataka, India. Participants 3478 households in 300 villages where VAS was implemented and 3486 households in 272 neighbouring matched villages ineligible for VAS. Intervention A government insurance programme that provided free tertiary care to households below the poverty line in half of villages in Karnataka from February 2010 to August 2012. Main outcome measure Seeking treatment for symptoms, posthospitalisation well-being, occurrence of infections during hospitalisation and need for rehospitalisation. Results The prevalence of symptoms was nearly identical for households in VAS-eligible villages compared with households in VAS-ineligible villages. However, households eligible for VAS were 4.96 percentage points (95% CI 1 to 8.9; p=0.014) more likely to seek treatment for their symptoms. The increase in treatment seeking was more pronounced for symptoms of cardiac conditions, the condition most frequently covered by VAS. Respondents from VAS-eligible villages reported greater improvements in well-being after a hospitalisation in all categories assessed and they were statistically significant in 3 of the 6 categories (walking ability, pain and anxiety). Respondents eligible for VAS were 9.4 percentage points less likely to report any infection after their hospitalisation (95% CI −20.2 to 1.4; p=0.087) and 16.5 percentage points less likely to have to be rehospitalised after the initial hospitalisation (95% CI −28.7 to −4.3; p<0.01). Conclusions Insurance for tertiary care increased treatment seeking among eligible households. Moreover, insured patients experienced better posthospitalisation outcomes, suggesting better quality of care received. These results suggest that there are several pathways through which tertiary care insurance could improve health, aside from increasing utilisation of the services that the programme directly subsidises. PMID:26739744

Financial Incentives, Workplace Wellness Program Participation, and Utilization of Health Care Services and Spending.

PubMed

Fronstin, Paul; Roebuck, M Christopher

2015-08-01

This paper analyzes data from a large employer that enhanced financial incentives to encourage participation in its workplace wellness programs. It examines, first, the effect of financial incentives on wellness program participation, and second, it estimates the impact of wellness program participation on utilization of health care services and spending. The Patient Protection and Affordable Care Act of 2010 (PPACA) allows employers to provide financial incentives of as much as 30 percent of the total cost of coverage when tied to participation in a wellness program. Participation in health risk assessments (HRAs) increased by 50 percentage points among members of unions that bargained in the incentive, and increased 22 percentage points among non-union employees. Participation in the biometric screening program increased 55 percentage points when financial incentives were provided. Biometric screenings led to an average increase of 0.31 annual prescription drug fills, with related spending higher by $56 per member per year. Otherwise, no significant effects of participation in HRAs or biometric screenings on utilization of health care services and spending were found. The largest increase in medication utilization as a result of biometric screening was for statins, which are widely used to treat high cholesterol. This therapeutic class accounted for one-sixth of the overall increase in prescription drug utilization. Second were antidepressants, followed by ACE inhibitors (for hypertension), and thyroid hormones (for hypothyroidism). Biometric screening also led to significantly higher utilization of biologic response modifiers and immunosuppressants. These specialty medications are used to treat autoimmune diseases, such as rheumatoid arthritis and multiple sclerosis, and are relatively expensive compared with non-specialty medications. The added spending associated with the combined increase in fills of 0.02 was $27 per member per year--about one-half of the overall increase in prescription drug spending from those who participated in biometric screenings.

Public pensions and unmet medical need among older people: cross-national analysis of 16 European countries, 2004-2010.

PubMed

Reeves, Aaron; McKee, Martin; Mackenbach, Johan; Whitehead, Margaret; Stuckler, David

2017-02-01

Since the onset of the Great Recession in Europe, unmet need for medical care has been increasing, especially in persons aged 65 or older. It is possible that public pensions buffer access to healthcare in older persons during times of economic crisis, but to our knowledge, this has not been tested empirically in Europe. We integrated panel data on 16 European countries for years 2004-2010 with indicators of public pension, unemployment insurance and sickness insurance entitlement from the Comparative Welfare Entitlements Dataset and unmet need (due to cost) prevalence rates from EuroStat 2014 edition. Using country-level fixed-effects regression models, we evaluate whether greater public pension entitlement, which helps reduce old-age poverty, reduces the prevalence of unmet medical need in older persons and whether it reduces inequalities in unmet medical need across the income distribution. We found that each 1-unit increase in public pension entitlement is associated with a 1.11 percentage-point decline in unmet medical need due to cost among over 65s (95% CI -0.55 to -1.66). This association is strongest for the lowest income quintile (1.65 percentage points, 95% CI -1.19 to -2.10). Importantly, we found consistent evidence that out-of-pocket payments were linked with greater unmet needs, but that this association was mitigated by greater public pension entitlement (β=-1.21 percentage points, 95% CI -0.37 to -2.06). Greater public pension entitlement plays a crucial role in reducing inequalities in unmet medical need among older persons, especially in healthcare systems which rely heavily on out-of-pocket payments. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Breast Density Notification Legislation and Breast Cancer Stage at Diagnosis: Early Evidence from the SEER Registry.

PubMed

Richman, Ilana; Asch, Steven M; Bendavid, Eran; Bhattacharya, Jay; Owens, Douglas K

2017-06-01

Twenty-eight states have passed breast density notification laws, which require physicians to inform women of a finding of dense breasts on mammography. To evaluate changes in breast cancer stage at diagnosis after enactment of breast density notification legislation. Using a difference-in-differences analysis, we examined changes in stage at diagnosis among women with breast cancer in Connecticut, the first state to enact legislation, compared to changes among women in control states. We used data from the Surveillance, Epidemiology, and End Results Program (SEER) registry, 2005-2013. Women ages 40-74 with breast cancer. Breast density notification legislation, enacted in Connecticut in October of 2009. Breast cancer stage at diagnosis. Our study included 466,930 women, 25,592 of whom lived in Connecticut. Legislation was associated with a 1.38-percentage-point (95 % CI 0.12 to 2.63) increase in the proportion of women in Connecticut versus control states who had localized invasive cancer at the time of diagnosis, and a 1.12-percentage-point (95 % CI -2.21 to -0.08) decline in the proportion of women with ductal carcinoma in situ at diagnosis. Breast density notification legislation was not associated with a change in the proportion of women in Connecticut versus control states with regional-stage (-0.09 percentage points, 95 % CI -1.01 to 1.02) or metastatic disease (-0.24, 95 % CI -0.75 to 0.28). County-level analyses and analyses limited to women younger than 50 found no statistically significant associations. Single intervention state, limited follow-up, potential confounding from unobserved trends. Breast density notification legislation in Connecticut was associated with a small increase in the proportion of women diagnosed with localized invasive breast cancer in individual-level but not county-level analyses. Whether this finding reflects potentially beneficial early detection or potentially harmful overdiagnosis is not known. Legislation was not associated with changes in regional or metastatic disease.

Regulatory T cells and other lymphocyte subpopulations in patients with melanoma developing interferon-induced thyroiditis during high-dose interferon-α2b treatment.

PubMed

Soldevila, Berta; Alonso, Núria; Martínez-Arconada, Maria J; Granada, Maria L; Boada, Aram; Vallejos, Virginia; Fraile, Manuel; Fernández-Sanmartín, Marco A; Pujol-Borrell, Ricardo; Puig-Domingo, Manel; Sanmartí, Anna; Martínez-Cáceres, Eva M

2013-04-01

One of the side effects of interferon-alpha therapy is interferon-induced thyroiditis (IIT). The role of lymphocyte subpopulations in IIT melanoma patients remains to be defined. Our objective was to assess different peripheral blood lymphocyte subpopulations, mainly regulatory T cells (Tregs), in melanoma patients who developed IIT. From 30 melanoma patients receiving high-dose interferon (HDI)-alpha 2b (IFN-α2b) treatment, those who developed IIT (IIT patients) were selected and compared with patients who did not develop IIT (Co-MM) and healthy controls (Co-H). Peripheral blood mononuclear cells were obtained before treatment (BT), mid-treatment (MT), end of treatment (ET), 24 weeks post-treatment and at appearance of IIT (TT). Nine patients developed IIT (30%): four Hashimoto's thyroiditis and five destructive thyroiditis. An increase in Tregs was observed in both melanoma groups during HDI treatment. A decrease in CD3(+) , NKT lymphocyte subpopulations and Bcl2 expression on B cells was also observed in both groups. However, no changes were observed in the percentage of CD4(+) , CD8(+) , CD3(+) γδ(+) , CD19(+) , transitional B cells (CD24(high) CD38(high) CD19(+) CD27(-) ), natural killer (NK), invariant NKT (iNKT) lymphocytes and Th1/Th2 balance when BT was compared with ET. At TT, IIT patients had a higher Tregs percentage than Co-MM (P = 0·012) and Co-H (P = 0·004), a higher iNKT percentage than Co-MM (P = 0·011), a higher transitional B cells percentage than Co-H (P = 0·015), a lower CD3(+) percentage than Co-H (P = 0·001) and a lower Bcl2 expression on B cells than Co-H (P < 0·001). Our results point to the immunomodulatory effects of IFN-α on different lymphocyte subpopulations and a possible role of Tregs in melanoma patients who developed IIT. © 2012 Blackwell Publishing Ltd.

Surveillance of Vaccination Coverage among Adult Populations - United States, 2015.

PubMed

Williams, Walter W; Lu, Peng-Jun; O'Halloran, Alissa; Kim, David K; Grohskopf, Lisa A; Pilishvili, Tamara; Skoff, Tami H; Nelson, Noele P; Harpaz, Rafael; Markowitz, Lauri E; Rodriguez-Lainz, Alfonso; Fiebelkorn, Amy Parker

2017-05-05

Overall, the prevalence of illness attributable to vaccine-preventable diseases is greater among adults than among children. Adults are recommended to receive vaccinations based on their age, underlying medical conditions, lifestyle, prior vaccinations, and other considerations. Updated vaccination recommendations from CDC are published annually in the U.S. Adult Immunization Schedule. Despite longstanding recommendations for use of many vaccines, vaccination coverage among U.S. adults is low. August 2014-June 2015 (for influenza vaccination) and January-December 2015 (for pneumococcal, tetanus and diphtheria [Td] and tetanus and diphtheria with acellular pertussis [Tdap], hepatitis A, hepatitis B, herpes zoster, and human papillomavirus [HPV] vaccination). The National Health Interview Survey (NHIS) is a continuous, cross-sectional national household survey of the noninstitutionalized U.S. civilian population. In-person interviews are conducted throughout the year in a probability sample of households, and NHIS data are compiled and released annually. The survey objective is to monitor the health of the U.S. population and provide estimates of health indicators, health care use and access, and health-related behaviors. Compared with data from the 2014 NHIS, increases in vaccination coverage occurred for influenza vaccine among adults aged ≥19 years (a 1.6 percentage point increase compared with the 2013-14 season to 44.8%), pneumococcal vaccine among adults aged 19-64 years at increased risk for pneumococcal disease (a 2.8 percentage point increase to 23.0%), Tdap vaccine among adults aged ≥19 years and adults aged 19-64 years (a 3.1 percentage point and 3.3 percentage point increase to 23.1% and to 24.7%, respectively), herpes zoster vaccine among adults aged ≥60 years and adults aged ≥65 years (a 2.7 percentage point and 3.2 percentage point increase to 30.6% and to 34.2%, respectively), and hepatitis B vaccine among health care personnel (HCP) aged ≥19 years (a 4.1 percentage point increase to 64.7%). Herpes zoster vaccination coverage in 2015 met the Healthy People 2020 target of 30%. Aside from these modest improvements, vaccination coverage among adults in 2015 was similar to estimates from 2014. Racial/ethnic differences in coverage persisted for all seven vaccines, with higher coverage generally for whites compared with most other groups. Adults without health insurance reported receipt of influenza vaccine (all age groups), pneumococcal vaccine (adults aged 19-64 years at increased risk), Td vaccine (adults aged ≥19 years, 19-64 years, and 50-64 years), Tdap vaccine (adults aged ≥19 years and 19-64 years), hepatitis A vaccine (adults aged ≥19 years overall and among travelers), hepatitis B vaccine (adults aged ≥19 years, 19-49 years, and among travelers), herpes zoster vaccine (adults aged ≥60 years), and HPV vaccine (males and females aged 19-26 years) less often than those with health insurance. Adults who reported having a usual place for health care generally reported receipt of recommended vaccinations more often than those who did not have such a place, regardless of whether they had health insurance. Vaccination coverage was higher among adults reporting one or more physician contacts in the past year compared with those who had not visited a physician in the past year, regardless of whether they had health insurance. Even among adults who had health insurance and ≥10 physician contacts within the past year, depending on the vaccine, 18.2%-85.6% reported not having received vaccinations that were recommended either for all persons or for those with specific indications. Overall, vaccination coverage among U.S.-born adults was higher than that among foreign-born adults, with few exceptions (influenza vaccination [adults aged 19-49 years and 50-64 years], hepatitis A vaccination [adults aged ≥19 years], and hepatitis B vaccination [adults aged ≥19 years with diabetes or chronic liver conditions]). Coverage for all vaccines for adults remained low but modest gains occurred in vaccination coverage for influenza (adults aged ≥19 years), pneumococcal (adults aged 19-64 years with increased risk), Tdap (adults aged ≥19 years and adults aged 19-64 years), herpes zoster (adults aged ≥60 years and ≥65 years), and hepatitis B (HCP aged ≥19 years); coverage for other vaccines and groups with vaccination indications did not improve. The 30% Healthy People 2020 target for herpes zoster vaccination was met. Racial/ethnic disparities persisted for routinely recommended adult vaccines. Missed opportunities to vaccinate remained. Although having health insurance coverage and a usual place for health care were associated with higher vaccination coverage, these factors alone were not associated with optimal adult vaccination coverage. HPV vaccination coverage for males and females has increased since CDC recommended vaccination to prevent cancers caused by HPV, but many adolescents and young adults remained unvaccinated. Assessing factors associated with low coverage rates and disparities in vaccination is important for implementing strategies to improve vaccination coverage. Evidence-based practices that have been demonstrated to improve vaccination coverage should be used. These practices include assessment of patients' vaccination indications by health care providers and routine recommendation and offer of needed vaccines to adults, implementation of reminder-recall systems, use of standing-order programs for vaccination, and assessment of practice-level vaccination rates with feedback to staff members. For vaccination coverage to be improved among those who reported lower coverage rates of recommended adult vaccines, efforts also are needed to identify adults who do not have a regular provider or insurance and who report fewer health care visits.

Surveillance of Vaccination Coverage among Adult Populations — United States, 2015

PubMed Central

Lu, Peng-Jun; O’Halloran, Alissa; Kim, David K.; Grohskopf, Lisa A.; Pilishvili, Tamara; Skoff, Tami H.; Nelson, Noele P.; Harpaz, Rafael; Markowitz, Lauri E.; Rodriguez-Lainz, Alfonso; Fiebelkorn, Amy Parker

2017-01-01

Problem/Condition Overall, the prevalence of illness attributable to vaccine-preventable diseases is greater among adults than among children. Adults are recommended to receive vaccinations based on their age, underlying medical conditions, lifestyle, prior vaccinations, and other considerations. Updated vaccination recommendations from CDC are published annually in the U.S. Adult Immunization Schedule. Despite longstanding recommendations for use of many vaccines, vaccination coverage among U.S. adults is low. Period Covered August 2014–June 2015 (for influenza vaccination) and January–December 2015 (for pneumococcal, tetanus and diphtheria [Td] and tetanus and diphtheria with acellular pertussis [Tdap], hepatitis A, hepatitis B, herpes zoster, and human papillomavirus [HPV] vaccination). Description of System The National Health Interview Survey (NHIS) is a continuous, cross-sectional national household survey of the noninstitutionalized U.S. civilian population. In-person interviews are conducted throughout the year in a probability sample of households, and NHIS data are compiled and released annually. The survey objective is to monitor the health of the U.S. population and provide estimates of health indicators, health care use and access, and health-related behaviors. Results Compared with data from the 2014 NHIS, increases in vaccination coverage occurred for influenza vaccine among adults aged ≥19 years (a 1.6 percentage point increase compared with the 2013–14 season to 44.8%), pneumococcal vaccine among adults aged 19–64 years at increased risk for pneumococcal disease (a 2.8 percentage point increase to 23.0%), Tdap vaccine among adults aged ≥19 years and adults aged 19–64 years (a 3.1 percentage point and 3.3 percentage point increase to 23.1% and to 24.7%, respectively), herpes zoster vaccine among adults aged ≥60 years and adults aged ≥65 years (a 2.7 percentage point and 3.2 percentage point increase to 30.6% and to 34.2%, respectively), and hepatitis B vaccine among health care personnel (HCP) aged ≥19 years (a 4.1 percentage point increase to 64.7%). Herpes zoster vaccination coverage in 2015 met the Healthy People 2020 target of 30%. Aside from these modest improvements, vaccination coverage among adults in 2015 was similar to estimates from 2014. Racial/ethnic differences in coverage persisted for all seven vaccines, with higher coverage generally for whites compared with most other groups. Adults without health insurance reported receipt of influenza vaccine (all age groups), pneumococcal vaccine (adults aged 19–64 years at increased risk), Td vaccine (adults aged ≥19 years, 19–64 years, and 50–64 years), Tdap vaccine (adults aged ≥19 years and 19–64 years), hepatitis A vaccine (adults aged ≥19 years overall and among travelers), hepatitis B vaccine (adults aged ≥19 years, 19–49 years, and among travelers), herpes zoster vaccine (adults aged ≥60 years), and HPV vaccine (males and females aged 19–26 years) less often than those with health insurance. Adults who reported having a usual place for health care generally reported receipt of recommended vaccinations more often than those who did not have such a place, regardless of whether they had health insurance. Vaccination coverage was higher among adults reporting one or more physician contacts in the past year compared with those who had not visited a physician in the past year, regardless of whether they had health insurance. Even among adults who had health insurance and ≥10 physician contacts within the past year, depending on the vaccine, 18.2%–85.6% reported not having received vaccinations that were recommended either for all persons or for those with specific indications. Overall, vaccination coverage among U.S.-born adults was higher than that among foreign-born adults, with few exceptions (influenza vaccination [adults aged 19–49 years and 50–64 years], hepatitis A vaccination [adults aged ≥19 years], and hepatitis B vaccination [adults aged ≥19 years with diabetes or chronic liver conditions]). Interpretation Coverage for all vaccines for adults remained low but modest gains occurred in vaccination coverage for influenza (adults aged ≥19 years), pneumococcal (adults aged 19–64 years with increased risk), Tdap (adults aged ≥19 years and adults aged 19–64 years), herpes zoster (adults aged ≥60 years and ≥65 years), and hepatitis B (HCP aged ≥19 years); coverage for other vaccines and groups with vaccination indications did not improve. The 30% Healthy People 2020 target for herpes zoster vaccination was met. Racial/ethnic disparities persisted for routinely recommended adult vaccines. Missed opportunities to vaccinate remained. Although having health insurance coverage and a usual place for health care were associated with higher vaccination coverage, these factors alone were not associated with optimal adult vaccination coverage. HPV vaccination coverage for males and females has increased since CDC recommended vaccination to prevent cancers caused by HPV, but many adolescents and young adults remained unvaccinated. Public Health Actions Assessing factors associated with low coverage rates and disparities in vaccination is important for implementing strategies to improve vaccination coverage. Evidence-based practices that have been demonstrated to improve vaccination coverage should be used. These practices include assessment of patients’ vaccination indications by health care providers and routine recommendation and offer of needed vaccines to adults, implementation of reminder-recall systems, use of standing-order programs for vaccination, and assessment of practice-level vaccination rates with feedback to staff members. For vaccination coverage to be improved among those who reported lower coverage rates of recommended adult vaccines, efforts also are needed to identify adults who do not have a regular provider or insurance and who report fewer health care visits. PMID:28472027

Carcass classification in suckling lambs. Discrimination ability of the European Union scale.

PubMed

Miguel, E; Onega, E; Cañeque, V; Velasco, S; Díaz, M T; Lauzurica, S; Pérez, C; Blázquez, B; Ruiz de Huidobro, F

2003-01-01

Forty-nine Manchega suckling lambs were used in this trial. Lambs were slaughtered at 10, 12 and 14 kg liveweight (cold carcass weight lower than 13 kg). The degree of fatness was assessed by three assessors on colour photographs of the carcasses, using the European Union scale for light lambs (EU), and another new scale developed in our laboratory (Suckling Lamb scale, SL). Carcass degree of fatness was reassessed using the same scales divided into 0.25 point-intervals (EUI, SLI). Carcasses were allocated into four groups by means of a tree classification algorithm (cluster analysis), according to 27 variates, namely muscle percentage, whole fat percentage, subcutaneous fat, intermuscular fat, kidney knob and channel fat percentage and muscle percentage, both in the carcass and in three joints (leg, best end neck plus loin, and shoulder). SL scale groups showed a higher number of variates well correlated to assessors' scoring than EU scale groups. Nevertheless, the EU scale showed significant between-groups differences in a higher number of variates (P<0.01). Using 0.25-points interval scales, EUI scale scoring was the best correlated to tissue composition. However, most variates were better correlated to dorsal fat thickness measurement (4 cm back from last rib and 4 cm from the carcass midline) than to assessors' scoring. All four groups in the tree classification were statistically different from one another, but assessors only were able to detect differences between whole fat percentage in group 1 and the rest. These results suggest that it is possible to improve the photographic standards of the EU method by using a 0.25 points interval scale. In abattoir conditions, the new SL method (1.0 point intervals) proved to be better. Measure of dorsal fat thickness proved to be a very good predictor of carcass tissue composition, but it is a more expensive measure.

The impact of rehabilitation and counseling services on the labor market activity of Social Security Disability Insurance (SSDI) beneficiaries.

PubMed

Weathers, Robert R; Bailey, Michelle Stegman

2014-01-01

We use data from a social experiment to estimate the impact of a rehabilitation and counseling program on the labor market activity of newly entitled Social Security Disability Insurance (SSDI) beneficiaries. Our results indicate that the program led to a 4.6 percentage point increase in the receipt of employment services within the first year following random assignment and a 5.1 percentage point increase in participation in the Social Security Administration's Ticket to Work program within the first three years following random assignment. The program led to a 5.3 percentage point increase, or almost 50 percent increase, in employment, and an $831 increase in annual earnings in the second calendar year after the calendar year of random assignment. The employment and earnings impacts are smaller and not statistically significant in the third calendar year following random assignment, and we describe SSDI rules that are consistent with this finding. Our findings indicate that disability reform proposals focusing on restoring the work capacity of people with disabilities can increase the disability employment rate.

Breakfast Skipping, Extreme Commutes, and the Sex Composition at Birth.

PubMed

Mazumder, Bhashkar; Seeskin, Zachary

2015-01-01

A growing body of literature has shown that environmental exposures in the period around conception can affect the sex ratio at birth through selective attrition that favors the survival of female conceptuses. Glucose availability is considered a key indicator of the fetal environment, and its absence as a result of meal skipping may inhibit male survival. We hypothesize that breakfast skipping during pregnancy may lead to a reduction in the fraction of male births. Using time use data from the United States we show that women with commute times of 90 minutes or longer are 20 percentage points more likely to skip breakfast. Using U.S. census data we show that women with commute times of 90 minutes or longer are 1.2 percentage points less likely to have a male child under the age of 2. Under some assumptions, this implies that routinely skipping breakfast around the time of conception leads to a 6 percentage point reduction in the probability of a male child. Skipping breakfast during pregnancy may therefore constitute a poor environment for fetal health more generally.

A randomized clinical trial comparing the efficacy of mandibular implant-supported overdentures and conventional dentures in diabetic patients. Part V: food preference comparisons.

PubMed

Roumanas, Eleni D; Garrett, Neal R; Hamada, Michael O; Diener, Randy M; Kapur, Krishan K

2002-01-01

The functional benefits of replacing old dentures with new conventional mandibular dentures or implant-supported overdentures has not been fully determined. This study assessed the impact of these 2 types of replacement dentures on the food choices of diabetic patients. A total of 68 diabetic patients with original complete dentures participated in this study. Diabetes was controlled with insulin in 38 patients (IT) and without insulin in 30 patients (NIT). All subjects received conventional maxillary dentures; 25 received mandibular conventional dentures (CD), and 43 received overdentures with plastic clips and a Hader bar attached to 2 osseointegrated implants (IOD). Subjects rated their perceptions of taste acceptability, texture acceptability, and chewing ease on a 4-point nominal scale and eating frequency on a 5-point scale for 13 specific foods at baseline (with original dentures) and at 6 months post-treatment completion (PTC). Fisher exact tests were used to compare the change in percentage distributions of responses with treatment. A 2 x 2 x 2 repeated-measures analysis of variance (ANOVA) was performed to compare mean scores between the 2 denture groups, 2 diabetic groups, and 2 time intervals for each of the 13 foods and 4 questions related to food acceptability. At baseline, no significant differences were found between the frequency distributions of responses in the CD and IOD groups or the IT and NIT groups for all 52 comparisons. With both types of study dentures, a higher percentage of patients perceived deterioration rather than improvement in function. When percentage distributions based on actual positive or negative change (treatment effect) in patient responses were compared, significant differences were found for 3 of the 52 responses, in favor of the IOD group. ANOVA demonstrated significant mean differences for 4 of the 52 comparisons. Both types of study dentures resulted in declines in the perceived taste and texture acceptability of almost all test foods. Declines in perceived chewing ease and eating frequency were more common and greater in the CD than in the IOD group. Both types of study dentures failed to affect food choices, as evidenced by declines or limited improvement in the perceived frequency with which most foods were eaten.

Evaluation of generic medical information accessed via mobile phones at the point of care in resource-limited settings

PubMed Central

Goldbach, Hayley; Chang, Aileen Y; Kyer, Andrea; Ketshogileng, Dineo; Taylor, Lynne; Chandra, Amit; Dacso, Matthew; Kung, Shiang-Ju; Rijken, Taatske; Fontelo, Paul; Littman-Quinn, Ryan; Seymour, Anne K; Kovarik, Carrie L

2014-01-01

Objective Many mobile phone resources have been developed to increase access to health education in the developing world, yet few studies have compared these resources or quantified their performance in a resource-limited setting. This study aims to compare the performance of resident physicians in answering clinical scenarios using PubMed abstracts accessed via the PubMed for Handhelds (PubMed4Hh) website versus medical/drug reference applications (Medical Apps) accessed via software on the mobile phone. Methods A two-arm comparative study with crossover design was conducted. Subjects, who were resident physicians at the University of Botswana, completed eight scenarios, each with multi-part questions. The primary outcome was a grade for each question. The primary independent variable was the intervention arm and other independent variables included residency and question. Results Within each question type there were significant differences in ‘percentage correct’ between Medical Apps and PubMed4Hh for three of the six types of questions: drug-related, diagnosis/definitions, and treatment/management. Within each of these question types, Medical Apps had a higher percentage of fully correct responses than PubMed4Hh (63% vs 13%, 33% vs 12%, and 41% vs 13%, respectively). PubMed4Hh performed better for epidemiologic questions. Conclusions While mobile access to primary literature remains important and serves an information niche, mobile applications with condensed content may be more appropriate for point-of-care information needs. Further research is required to examine the specific information needs of clinicians in resource-limited settings and to evaluate the appropriateness of current resources in bridging location- and context-specific information gaps. PMID:23535665

Presenteeism, Absenteeism, and Lost Work Productivity among Depressive Patients from Five Cities of Colombia.

PubMed

Uribe, José Miguel; Pinto, Diana M; Vecino-Ortiz, Andres I; Gómez-Restrepo, Carlos; Rondón, Martín

2017-12-01

To estimate productivity losses due to absenteeism and presenteeism and their determinants in patients with depression from five Colombian cities. We used data from a multicenter, mixed-methods study of adult patients diagnosed with major depressive disorder or double depression (major depressive disorder plus dysthymia) during 2010. The World Health Organization's Health and Work Performance Questionnaire was used to assess absenteeism and presenteeism. We explored the determinants of productivity losses using a two-part model. We also used a costing model to calculate the corresponding monetary losses. We analyzed data from 107 patients employed in the last 4 weeks. Absenteeism was reported by 70% of patients; presenteeism was reported by all but one. Half of the patients reported a level of performance at work at least 50% below usual. Average number of hours per month lost to absenteeism and presenteeism was 43 and 51, respectively. The probability of any absenteeism was 17 percentage points lower in patients rating their mental health favorably compared with those rating it poorly (standard error [SE] 0.09; P < 0.10) and 19 percentage points higher in patients with at least one comorbidity compared with patients with none (SE 0.10; P < 0.10). All other covariates showed no significant associations on hours lost to absenteeism. Patients with favorable mental health self-ratings had 16.4 fewer hours per month of presenteeism compared with those with poor self-ratings (SE 4.52; P < 0.01). The 2015 monetary value of productivity losses amounted to US $840 million. This study in a middle-income country confirms the high economic burden of depression. Health policies and workplace interventions ensuring adequate diagnosis and treatment of depression are recommended. Copyright © 2017. Published by Elsevier Inc.

Effect of Combined Patient Decision Aid and Patient Navigation vs Usual Care for Colorectal Cancer Screening in a Vulnerable Patient Population: A Randomized Clinical Trial.

PubMed

Reuland, Daniel S; Brenner, Alison T; Hoffman, Richard; McWilliams, Andrew; Rhyne, Robert L; Getrich, Christina; Tapp, Hazel; Weaver, Mark A; Callan, Danelle; Cubillos, Laura; Urquieta de Hernandez, Brisa; Pignone, Michael P

2017-07-01

Colorectal cancer (CRC) screening is underused, especially among vulnerable populations. Decision aids and patient navigation are potentially complementary interventions for improving CRC screening rates, but their combined effect on screening completion is unknown. To determine the combined effect of a CRC screening decision aid and patient navigation compared with usual care on CRC screening completion. In this randomized clinical trial, data were collected from January 2014 to March 2016 at 2 community health center practices, 1 in North Carolina and 1 in New Mexico, serving vulnerable populations. Patients ages 50 to 75 years who had average CRC risk, spoke English or Spanish, were not current with recommended CRC screening, and were attending primary care visits were recruited and randomized 1:1 to intervention or control arms. Intervention participants viewed a CRC screening decision aid in English or Spanish immediately before their clinician encounter. The decision aid promoted screening and presented colonoscopy and fecal occult blood testing as screening options. After the clinician encounter, intervention patients received support for screening completion from a bilingual patient navigator. Control participants viewed a food safety video before the encounter and otherwise received usual care. The primary outcome was CRC screening completion within 6 months of the index study visit assessed by blinded medical record review. Characteristics of the 265 participants were as follows: their mean age was 58 years; 173 (65%) were female, 164 (62%) were Latino; 40 (15%) were white non-Latino; 61 (23%) were black or of mixed race; 191 (78%) had a household income of less than $20 000; 101 (38%) had low literacy; 75 (28%) were on Medicaid; and 91 (34%) were uninsured. Intervention participants were more likely to complete CRC screening within 6 months (68% vs 27%); adjusted-difference, 40 percentage points (95% CI, 29-51 percentage points). The intervention was more effective in women than in men (50 vs 21 percentage point increase, interaction P = .02). No effect modification was observed across other subgroups. A patient decision aid plus patient navigation increased the rate of CRC screening completion in compared with usual care invulnerable primary care patients. clinicaltrials.gov Identifier: NCT02054598.

Perceived Racial Discrimination in the Workplace and Body Weight among the Unemployed.

PubMed

Kuroki, Masanori

2017-01-01

This study investigates the association between body weight and the likelihood that people perceive that they have been the victims of racial discrimination in the workplace among the unemployed. I find that unemployed obese men and women are 8.4 percentage points and 7.7 percentage points, respectively, more likely to have experienced racial discrimination before becoming unemployed than their non-obese counterparts. For unemployed men, the relationship between body weight and perceived racial discrimination does not seem to be associated with race. For unemployed women, being black and obese significantly increases the likelihood of perceiving racial discrimination.

MEDICAL EXPENDITURE RISK AND HOUSEHOLD PORTFOLIO CHOICE

PubMed Central

Goldman, Dana

2013-01-01

Medical expenses are an increasingly important contributor to household financial risk. We examine the effect of medical expenditure risk on the willingness of Medicare beneficiaries to hold risky assets. Using a discrete factor maximum likelihood method to address the endogeneity of insurance choices, we find that having a moderately protective Medigap or employer supplemental policy increases risky asset holding by 7.1 percentage points relative to those without supplemental coverage, while participation in a highly protective Medicare HMO increases risky asset holding by 13.0 percentage points. Our results highlight an important link between the availability of health insurance and financial behavior. PMID:23997424

Oxygen in the Setting of Acute Myocardial Infarction: Is It Really a Breath of Fresh Air?

PubMed

Loomba, Rohit S; Nijhawan, Karan; Aggarwal, Saurabh; Arora, Rohit R

2016-03-01

Supplemental oxygen has been used in the setting of acute myocardial infarction (AMI). Once an official recommendation in the guidelines for the management of acute ST-segment elevation myocardial infarction, it is now mentioned as an intervention to be considered. Data for the use of supplemental oxygen or AMI are limited, and some data have suggested associated harm. We performed a systematic review of the literature and a subsequent meta-analysis of the data to determine the effect of high concentration oxygen versus titrated oxygen or room air in the setting of AMI. The following end points were studied: in-hospital mortality, opiate use, percentage of infarcted myocardium by magnetic resonance imaging (MRI), and mass of infarcted myocardium by MRI. No significant difference was noted with end points when comparing those randomized to high-concentration oxygen versus those randomized to titrated oxygen or room air in the setting of AMI. No significant publication bias was identified although this could not be assessed for all end points. High-concentration oxygen may not offer any benefit when compared to titrated oxygen or room air. A large, randomized trial is warranted to further delineate these differences with respect to multiple end points. © The Author(s) 2015.

Sifalimumab, an anti-interferon-α monoclonal antibody, in moderate to severe systemic lupus erythematosus: a randomised, double-blind, placebo-controlled study.

PubMed

Khamashta, Munther; Merrill, Joan T; Werth, Victoria P; Furie, Richard; Kalunian, Kenneth; Illei, Gabor G; Drappa, Jorn; Wang, Liangwei; Greth, Warren

2016-11-01

The efficacy and safety of sifalimumab were assessed in a phase IIb, randomised, double-blind, placebo-controlled study (NCT01283139) of adults with moderate to severe active systemic lupus erythematosus (SLE). 431 patients were randomised and received monthly intravenous sifalimumab (200 mg, 600 mg or 1200 mg) or placebo in addition to standard-of-care medications. Patients were stratified by disease activity, interferon gene-signature test (high vs low based on the expression of four genes) and geographical region. The primary efficacy end point was the percentage of patients achieving an SLE responder index response at week 52. Compared with placebo, a greater percentage of patients who received sifalimumab (all dosages) met the primary end point (placebo: 45.4%; 200 mg: 58.3%; 600 mg: 56.5%; 1200 mg 59.8%). Other improvements were seen in Cutaneous Lupus Erythematosus Disease Area and Severity Index score (200 mg and 1200 mg monthly), Physician's Global Assessment (600 mg and 1200 mg monthly), British Isles Lupus Assessment Group-based Composite Lupus Assessment (1200 mg monthly), 4-point reductions in the SLE Disease Activity Index-2000 score and reductions in counts of swollen joints and tender joints. Serious adverse events occurred in 17.6% of patients on placebo and 18.3% of patients on sifalimumab. Herpes zoster infections were more frequent with sifalimumab treatment. Sifalimumab is a promising treatment for adults with SLE. Improvement was consistent across various clinical end points, including global and organ-specific measures of disease activity. NCT01283139; Results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The 4-Item Negative Symptom Assessment (NSA-4) Instrument: A Simple Tool for Evaluating Negative Symptoms in Schizophrenia Following Brief Training.

PubMed

Alphs, Larry; Morlock, Robert; Coon, Cheryl; van Willigenburg, Arjen; Panagides, John

2010-07-01

Objective. To assess the ability of mental health professionals to use the 4-item Negative Symptom Assessment instrument, derived from the Negative Symptom Assessment-16, to rapidly determine the severity of negative symptoms of schizophrenia.Design. Open participation.Setting. Medical education conferences.Participants. Attendees at two international psychiatry conferences.Measurements. Participants read a brief set of the 4-item Negative Symptom Assessment instructions and viewed a videotape of a patient with schizophrenia. Using the 1 to 6 4-item Negative Symptom Assessment severity rating scale, they rated four negative symptom items and the overall global negative symptoms. These ratings were compared with a consensus rating determination using frequency distributions and Chi-square tests for the proportion of participant ratings that were within one point of the expert rating.Results. More than 400 medical professionals (293 physicians, 50% with a European practice, and 55% who reported past utilization of schizophrenia ratings scales) participated. Between 82.1 and 91.1 percent of the 4-items and the global rating determinations by the participants were within one rating point of the consensus expert ratings. The differences between the percentage of participant rating scores that were within one point versus the percentage that were greater than one point different from those by the consensus experts was significant (p<0.0001). Participants rating of negative symptoms using the 4-item Negative Symptom Assessment did not generally differ among the geographic regions of practice, the professional credentialing, or their familiarity with the use of schizophrenia symptom rating instruments.Conclusion. These findings suggest that clinicians from a variety of geographic practices can, after brief training, use the 4-item Negative Symptom Assessment effectively to rapidly assess negative symptoms in patients with schizophrenia.

Randomized study of washing 40- to 42-day-stored red blood cells.

PubMed

Bennett-Guerrero, Elliott; Kirby, Brett S; Zhu, Hongmei; Herman, Annadele E; Bandarenko, Nicholas; McMahon, Timothy J

2014-10-01

Pretransfusion washing of red blood cells (RBCs) stored for a longer duration may have theoretical advantages but few data exist to support this practice. In many hospital settings, use of a point-of-care cell washer could conceivably be used to quickly wash allogeneic RBCs before transfusion. The purpose of this preliminary study was to compare a point-of-care device with a common blood bank device for washing longer-stored RBCs. Forty RBC units stored for 40 to 42 days were randomized to washing with the COBE 2991 device (Terumo BCT; FDA-cleared for washing stored RBCs) or the Cell Saver Elite (Haemonetics; FDA-cleared point-of-care device for processing and washing fresh autologous shed whole blood). Supernatant and unit RBCs from unwashed (baseline) and washed blood were assayed for potassium, lactate, intracellular ATP, percentage of RBC recovery, cell-free hemoglobin, RBC microparticles, and RBCs were examined for susceptibility to hemolysis by physical stress. Both devices recovered a high percentage of RBCs and efficiently removed extracelluar potassium. Washing with the Elite resulted in significant increases in cell-free Hb, percent hemolysis, and RBC microparticle production, whereas washing with the COBE 2991 did not (fold Δ = 2.1 vs. 1.0, 4.6 vs. 1.2, 2.0 vs. 1.1, respectively; p < 0.05). Hemolysis induced by physical stress was not altered by washing. Although point-of-care washing of longer-stored RBCs is appealing, these preliminary data suggest that transfusion of washed, longer-stored units could result in potentially greater exposure to plasma free Hb. More data are needed before this practice can be routinely recommended. © 2014 AABB.

SU-E-T-167: Characterization of In-House Plastic Scintillator Detectors Array for Radiation Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhu, T; Liu, H; Dimofte, A

Purpose: To characterize basic performance of plastic scintillator detectors (PSD) array designed for dosimetry of radiation therapy. Methods: An in-house PSD array has been developed by placing single point PSD into customized 2D holder. Each point PSD is a plastic scintillating fiber-based detector designed for highly accurate measurement of small radiotherapy fields used in patient plan verification and machine commissioning and QA procedures. A parallel fiber without PSD is used for Cerenkov separation by subtracting from PSD readings. Cerenkov separation was confirmed by optical spectroscopy. Alternative Cerenkov separation approaches are also investigated. The optical signal was converted to electronic signalmore » with a photodiode and then subsequently amplified. We measured its dosimetry performance, including percentage depth dose and output factor, and compared with reference ion chamber measurements. The PSD array is then placed along the radiation beam for multiple point dose measurement, representing subsets of PDD measurements, or perpendicular to the beam for profile measurements. Results: The dosimetry results of PSD point measurements agree well with reference ion chamber measurements. For percentage depth dose, the maximal differences between PSD and ion chamber results are 3.5% and 2.7% for 6MV and 15MV beams, respectively. For the output factors, PSD measurements are within 3% from ion chamber results. PDD and profile measurement with PSD array are also performed. Conclusions: The current design of multichannel PSD array is feasible for the dosimetry measurement in radiation therapy. Dose distribution along or perpendicular to the beam path could be measured. It might as well be used as range verification in proton therapy.A PS hollow fiber detector will be investigated to eliminate the Cerenkov radiation effect so that all 32 channels can be used.« less

Sifalimumab, an anti-interferon-α monoclonal antibody, in moderate to severe systemic lupus erythematosus: a randomised, double-blind, placebo-controlled study

PubMed Central

Khamashta, Munther; Merrill, Joan T; Werth, Victoria P; Furie, Richard; Kalunian, Kenneth; Illei, Gabor G; Drappa, Jorn; Wang, Liangwei; Greth, Warren

2016-01-01

Objectives The efficacy and safety of sifalimumab were assessed in a phase IIb, randomised, double-blind, placebo-controlled study (NCT01283139) of adults with moderate to severe active systemic lupus erythematosus (SLE). Methods 431 patients were randomised and received monthly intravenous sifalimumab (200 mg, 600 mg or 1200 mg) or placebo in addition to standard-of-care medications. Patients were stratified by disease activity, interferon gene-signature test (high vs low based on the expression of four genes) and geographical region. The primary efficacy end point was the percentage of patients achieving an SLE responder index response at week 52. Results Compared with placebo, a greater percentage of patients who received sifalimumab (all dosages) met the primary end point (placebo: 45.4%; 200 mg: 58.3%; 600 mg: 56.5%; 1200 mg 59.8%). Other improvements were seen in Cutaneous Lupus Erythematosus Disease Area and Severity Index score (200 mg and 1200 mg monthly), Physician's Global Assessment (600 mg and 1200 mg monthly), British Isles Lupus Assessment Group-based Composite Lupus Assessment (1200 mg monthly), 4-point reductions in the SLE Disease Activity Index−2000 score and reductions in counts of swollen joints and tender joints. Serious adverse events occurred in 17.6% of patients on placebo and 18.3% of patients on sifalimumab. Herpes zoster infections were more frequent with sifalimumab treatment. Conclusions Sifalimumab is a promising treatment for adults with SLE. Improvement was consistent across various clinical end points, including global and organ-specific measures of disease activity. Trial registration number NCT01283139; Results. PMID:27009916

The association of percentage energy from fat and colon cancer risk among members of the US military.

PubMed

Shao, Stephanie; Kao, Tzu-Cheg; Eckhaus, Janet; Bourgeois, Jolie; Perera, Kanchana; Zhu, Kangmin

2015-05-01

Epidemiologic studies have previously reported an association between high fat intake and colon cancer risk. However, findings have generally been inconclusive. This study aimed to investigate the association between fat as a percentage of energy intake and colon cancer risk. Study subjects included 215 cases and 215 matched controls identified by the Defense Medical Surveillance System. Percentage energy from fat (Pfat) was estimated using a short dietary screener developed by the National Cancer Institute for two time periods: the year before the first blood draw and the year before colon cancer diagnosis. Conditional logistic regression analysis was used to assess the relationship between colon cancer risk and Pfat. Odds ratios and 95% confidence intervals (CIs) were calculated. Compared with the lowest quartile of Pfat, the adjusted odds of having colon cancer were 2.00 (95% CI 0.96-4.18), 2.83 (95% CI 1.41-5.66), and 3.37 (95% CI 1.58-7.17), respectively, for the second, third, and highest quartiles in the year before cancer diagnosis. Similar results were observed for Pfat at an earlier time point. Our findings suggest a positive association between Pfat and colon cancer in the US military population.

Pulse Detonation Physiochemical and Exhaust Relaxation Processes

DTIC Science & Technology

2006-05-01

based on total time to detonation and detonation percentage. Nomenclature A = Arrehenius Constant Ea = Activation Energy Ecrit = Critical...the precision uncertainties vary for each data point. Therefore, the total experimental uncertainty will vary by data point. A comprehensive bias

Recent trend in family households in Beijing.

PubMed

Guo, Z; Guo, L

1997-01-01

This study examined trends in household size and age structure in Beijing, China, in 1995. Data were reliably obtained from the 1% sample survey of China. Findings indicate that the average size of a family household was 3.15 persons, that is, 0.050 persons fewer than the 3.20 from the 1990 Census. Children aged 0-14 years in each household averaged 0.04 fewer children during 1990-95. 80% of the decline in household size was due to decreases in the number of children. The percentage of single-family and single-person households declined. Three-person households were the only size group that increased (23.2-40.7%). The household headship (HH) rate for males increased dramatically between the ages of 20 and 30 years and stabilized after 35 years. The HH rate for women grew slowly and continuously until age 50 years and then stabilized. The gender gap in HH appeared at an early age and remained thereafter. The HH rate declined at older ages. The HH rate in Beijing, compared to the national rate, suggests relative gender equity in Beijing. As a child ages, the percentage of three-generation households declines and the percentage of two-generation households rises. As a child becomes an adult, the percentages of single-person households and single-couple households increase. Single-couple households decreased among the middle-aged. 67.4% of the elderly lived in two- or three-generation households. 31.4% of elderly lived in single-person/couple households. The percentage of elderly living with their children declined by 2 points during 1990-95.

Integrating Solar into Florida's Power System: Potential Roles for Flexibility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hale, Elaine T; Stoll, Brady; Novacheck, Joshua E

Although Florida has very little photovoltaic (PV) generation to date, it is reasonable to expect significant deployment in the 2020s under a variety of future policy and cost scenarios. To understand these potential futures, we model Florida Reliability Coordinating Council operations in 2026 over a wide range of PV penetrations with various combinations of battery storage capacity, demand response, and increased operational flexibility. By calculating the value of PV under a wide range of conditions, we find that at least 5%, and more likely 10-24%, PV penetration is cost competitive in Florida within the next decade with baseline flexibility andmore » all but the most pessimistic of assumptions. For high PV penetrations, we demonstrate Florida's electrical net-load variability (duck curve) challenges, the associated reduction of PV's value to the system, and the ability of flexibility options-in particular energy-shifting resources-to preserve value and increase the economic carrying capacity of PV. A high level of demand response boosts the economic carrying capacity of PV by up to 0.5-2 percentage points, which is comparable to the impact of deploying 1 GW of battery storage. Adding 4 GW of battery storage expands the economic carrying capacity of PV by up to 6 percentage points.« less

GFam: a platform for automatic annotation of gene families.

PubMed

Sasidharan, Rajkumar; Nepusz, Tamás; Swarbreck, David; Huala, Eva; Paccanaro, Alberto

2012-10-01

We have developed GFam, a platform for automatic annotation of gene/protein families. GFam provides a framework for genome initiatives and model organism resources to build domain-based families, derive meaningful functional labels and offers a seamless approach to propagate functional annotation across periodic genome updates. GFam is a hybrid approach that uses a greedy algorithm to chain component domains from InterPro annotation provided by its 12 member resources followed by a sequence-based connected component analysis of un-annotated sequence regions to derive consensus domain architecture for each sequence and subsequently generate families based on common architectures. Our integrated approach increases sequence coverage by 7.2 percentage points and residue coverage by 14.6 percentage points higher than the coverage relative to the best single-constituent database within InterPro for the proteome of Arabidopsis. The true power of GFam lies in maximizing annotation provided by the different InterPro data sources that offer resource-specific coverage for different regions of a sequence. GFam's capability to capture higher sequence and residue coverage can be useful for genome annotation, comparative genomics and functional studies. GFam is a general-purpose software and can be used for any collection of protein sequences. The software is open source and can be obtained from http://www.paccanarolab.org/software/gfam/.

Early Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States.

PubMed

Courtemanche, Charles; Marton, James; Ukert, Benjamin; Yelowitz, Aaron; Zapata, Daniela

2017-01-01

The Affordable Care Act (ACA) aimed to achieve nearly universal health insurance coverage in the United States through a combination of insurance market reforms, mandates, subsidies, health insurance exchanges, and Medicaid expansions, most of which took effect in 2014. This paper estimates the causal effects of the ACA on health insurance coverage in 2014 using data from the American Community Survey. We utilize difference-in-difference-in-differences models that exploit cross-sectional variation in the intensity of treatment arising from state participation in the Medicaid expansion and local area pre-ACA uninsured rates. This strategy allows us to identify the effects of the ACA in both Medicaid expansion and non-expansion states. Our preferred specification suggests that, at the average pre-treatment uninsured rate, the full ACA increased the proportion of residents with insurance by 5.9 percentage points compared to 2.8 percentage points in states that did not expand Medicaid. Private insurance expansions from the ACA were due to increases in both employer-provided and non-group coverage. The coverage gains from the full ACA were largest for those without a college degree, non-whites, young adults, unmarried individuals, and those without children in the home. We find no evidence that the Medicaid expansion crowded out private coverage.

The effect of increasing the supply of skilled health providers on pregnancy and birth outcomes: evidence from the midwives service scheme in Nigeria.

PubMed

Okeke, Edward; Glick, Peter; Chari, Amalavoyal; Abubakar, Isa Sadeeq; Pitchforth, Emma; Exley, Josephine; Bashir, Usman; Gu, Kun; Onwujekwe, Obinna

2016-08-23

Limited availability of skilled health providers in developing countries is thought to be an important barrier to achieving maternal and child health-related MDG goals. Little is known, however, about the extent to which scaling-up supply of health providers will lead to improved pregnancy and birth outcomes. We study the effects of the Midwives Service Scheme (MSS), a public sector program in Nigeria that increased the supply of skilled midwives in rural communities on pregnancy and birth outcomes. We surveyed 7,104 women with a birth within the preceding five years across 12 states in Nigeria and compared changes in birth outcomes in MSS communities to changes in non-MSS communities over the same period. The main measured effect of the scheme was a 7.3-percentage point increase in antenatal care use in program clinics and a 5-percentage point increase in overall use of antenatal care, both within the first year of the program. We found no statistically significant effect of the scheme on skilled birth attendance or on maternal delivery complications. This study highlights the complexity of improving maternal and child health outcomes in developing countries, and shows that scaling up supply of midwives may not be sufficient on its own.

Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss at 5 Years Among Patients With Morbid Obesity: The SLEEVEPASS Randomized Clinical Trial.

PubMed

Salminen, Paulina; Helmiö, Mika; Ovaska, Jari; Juuti, Anne; Leivonen, Marja; Peromaa-Haavisto, Pipsa; Hurme, Saija; Soinio, Minna; Nuutila, Pirjo; Victorzon, Mikael

2018-01-16

Laparoscopic sleeve gastrectomy for treatment of morbid obesity has increased substantially despite the lack of long-term results compared with laparoscopic Roux-en-Y gastric bypass. To determine whether laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass are equivalent for weight loss at 5 years in patients with morbid obesity. The Sleeve vs Bypass (SLEEVEPASS) multicenter, multisurgeon, open-label, randomized clinical equivalence trial was conducted from March 2008 until June 2010 in Finland. The trial enrolled 240 morbidly obese patients aged 18 to 60 years, who were randomly assigned to sleeve gastrectomy or gastric bypass with a 5-year follow-up period (last follow-up, October 14, 2015). Laparoscopic sleeve gastrectomy (n = 121) or laparoscopic Roux-en-Y gastric bypass (n = 119). The primary end point was weight loss evaluated by percentage excess weight loss. Prespecified equivalence margins for the clinical significance of weight loss differences between gastric bypass and sleeve gastrectomy were -9% to +9% excess weight loss. Secondary end points included resolution of comorbidities, improvement of quality of life (QOL), all adverse events (overall morbidity), and mortality. Among 240 patients randomized (mean age, 48 [SD, 9] years; mean baseline body mass index, 45.9, [SD, 6.0]; 69.6% women), 80.4% completed the 5-year follow-up. At baseline, 42.1% had type 2 diabetes, 34.6% dyslipidemia, and 70.8% hypertension. The estimated mean percentage excess weight loss at 5 years was 49% (95% CI, 45%-52%) after sleeve gastrectomy and 57% (95% CI, 53%-61%) after gastric bypass (difference, 8.2 percentage units [95% CI, 3.2%-13.2%], higher in the gastric bypass group) and did not meet criteria for equivalence. Complete or partial remission of type 2 diabetes was seen in 37% (n = 15/41) after sleeve gastrectomy and in 45% (n = 18/40) after gastric bypass (P > .99). Medication for dyslipidemia was discontinued in 47% (n = 14/30) after sleeve gastrectomy and 60% (n = 24/40) after gastric bypass (P = .15) and for hypertension in 29% (n = 20/68) and 51% (n = 37/73) (P = .02), respectively. There was no statistically significant difference in QOL between groups (P = .85) and no treatment-related mortality. At 5 years the overall morbidity rate was 19% (n = 23) for sleeve gastrectomy and 26% (n = 31) for gastric bypass (P = .19). Among patients with morbid obesity, use of laparoscopic sleeve gastrectomy compared with use of laparoscopic Roux-en-Y gastric bypass did not meet criteria for equivalence in terms of percentage excess weight loss at 5 years. Although gastric bypass compared with sleeve gastrectomy was associated with greater percentage excess weight loss at 5 years, the difference was not statistically significant, based on the prespecified equivalence margins. clinicaltrials.gov Identifier: NCT00793143.

Time Series Analysis of Sexual Assault Case Characteristics and the 2007–2008 Period of Post-Election Violence in Kenya

PubMed Central

Anastario, Michael P.; Adhiambo Onyango, Monica; Nyanyuki, Joan; Naimer, Karen; Muthoga, Rachel; Sirkin, Susannah; Barrick, Kelle; van Hasselt, Martijn; Aruasa, Wilson; Kibet, Cynthia; Omollo, Grace

2014-01-01

Background Following the declaration that President Mwai Kibaki was the winner of the Kenyan presidential election held on December 27, 2007, a period of post-election violence (PEV) took place. In this study, we aimed to identify whether the period of PEV in Kenya was associated with systematic changes in sexual assault case characteristics. Methods and Findings Medical records of 1,615 patients diagnosed with sexual assault between 2007 and 2011 at healthcare facilities in Eldoret (n = 569), Naivasha (n = 534), and Nakuru (n = 512) were retrospectively reviewed to examine characteristics of sexual assault cases over time. Time series and linear regression were used to examine temporal variation in case characteristics relative to the period of post-election violence in Kenya. Key informant interviews with healthcare workers at the sites were employed to triangulate findings. The time series of sexual assault case characteristics at these facilities were examined, with a specific focus on the December 2007–February 2008 period of post-election violence. Prais-Winsten estimates indicated that the three-month period of post-election violence was associated with a 22 percentage-point increase in cases where survivors did not know the perpetrator, a 20 percentage-point increase in cases with more than one perpetrator, and a 4 percentage-point increase in cases that had evidence of abdominal injury. The post-election violence period was also associated with an 18 percentage-point increase in survivors waiting >1 month to report to a healthcare facility. Sensitivity analyses confirmed that these characteristics were specific to the post-election violence time period. Conclusion These results demonstrate systematic patterns in sexual assault characteristics during the PEV period in Kenya. PMID:25170917

Promotion of Healthy Eating Through Public Policy

PubMed Central

Elbel, Brian; Taksler, Glen B.; Mijanovich, Tod; Abrams, Courtney B.; Dixon, L. Beth

2013-01-01

Background To induce consumers to purchase healthier foods and beverages, some policymakers have suggested special taxes or labels on unhealthy products. The potential of such policies is unknown. Purpose In a controlled field experiment, researchers tested whether consumers were more likely to purchase healthy products under such policies. Methods From October to December 2011, researchers opened a store at a large hospital that sold a variety of healthier and less-healthy foods and beverages. Purchases (N=3680) were analyzed under five conditions: a baseline with no special labeling or taxation, a 30% tax, highlighting the phrase “less healthy” on the price tag, and combinations of taxation and labeling. Purchases were analyzed in January–July 2012, at the single-item and transaction levels. Results There was no significant difference between the various taxation conditions. Consumers were 11 percentage points more likely to purchase a healthier item under a 30% tax (95% CI=7%, 16%, <0.001) and 6 percentage points more likely under labeling (95% CI=0%, 12%, p=0.04). By product type, consumers switched away from the purchase of less-healthy food under taxation (9 percentage points decrease, p<0.001) and into healthier beverages (6 percentage point increase, p=0.001); there were no effects for labeling. Conditions were associated with the purchase of 11–14 fewer calories (9%–11% in relative terms) and 2 fewer grams of sugar. Results remained significant controlling for all items purchased in a single transaction. Conclusions Taxation may induce consumers to purchase healthier foods and beverages. However, it is unclear whether the 15%–20% tax rates proposed in public policy discussions would be more effective than labeling products as less healthy. PMID:23790988

Parents' education and child body weight in France: The trajectory of the gradient in the early years.

PubMed

Apouey, Bénédicte H; Geoffard, Pierre-Yves

2016-03-01

This paper explores the relationship between parental education and offspring body weight in France. Using two large datasets spanning the 1991-2010 period, we examine the existence of inequalities in maternal and paternal education and reported child body weight measures, as well as their evolution across childhood. Our empirical specification is flexible and allows this evolution to be non-monotonic. Significant inequalities are observed for both parents' education--maternal (respectively paternal) high education is associated with a 7.20 (resp. 7.10) percentage points decrease in the probability that the child is reported to be overweight or obese, on average for children of all ages. The gradient with respect to parents' education follows an inverted U-shape across childhood, meaning that the association between parental education and child body weight widens from birth to age 8, and narrows afterward. Specifically, maternal high education is correlated with a 5.30 percentage points decrease in the probability that the child is reported to be overweight or obese at age 2, but a 9.62 percentage points decrease at age 8, and a 1.25 percentage point decrease at age 17. The figures for paternal high education are respectively 5.87, 9.11, and 4.52. This pattern seems robust, since it is found in the two datasets, when alternative variables for parental education and reported child body weight are employed, and when controls for potential confounding factors are included. The findings for the trajectory of the income gradient corroborate those of the education gradient. The results may be explained by an equalization in actual body weight across socioeconomic groups during youth, or by changes in reporting styles of height and weight. Copyright © 2015 Elsevier B.V. All rights reserved.

Promotion of healthy eating through public policy: a controlled experiment.

PubMed

Elbel, Brian; Taksler, Glen B; Mijanovich, Tod; Abrams, Courtney B; Dixon, L B

2013-07-01

To induce consumers to purchase healthier foods and beverages, some policymakers have suggested special taxes or labels on unhealthy products. The potential of such policies is unknown. In a controlled field experiment, researchers tested whether consumers were more likely to purchase healthy products under such policies. From October to December 2011, researchers opened a store at a large hospital that sold a variety of healthier and less-healthy foods and beverages. Purchases (N=3680) were analyzed under five conditions: a baseline with no special labeling or taxation, a 30% tax, highlighting the phrase "less healthy" on the price tag, and combinations of taxation and labeling. Purchases were analyzed in January-July 2012, at the single-item and transaction levels. There was no significant difference between the various taxation conditions. Consumers were 11 percentage points more likely to purchase a healthier item under a 30% tax (95% CI=7%, 16%, p<0.001) and 6 percentage points more likely under labeling (95% CI=0%, 12%, p=0.04). By product type, consumers switched away from the purchase of less-healthy food under taxation (9 percentage point decrease, p<0.001) and into healthier beverages (6 percentage point increase, p=0.001); there were no effects for labeling. Conditions were associated with the purchase of 11-14 fewer calories (9%-11% in relative terms) and 2 fewer grams of sugar. Results remained significant controlling for all items purchased in a single transaction. Taxation may induce consumers to purchase healthier foods and beverages. However, it is unclear whether the 15%-20% tax rates proposed in public policy discussions would be more effective than labeling products as less healthy. Copyright © 2013 American Journal of Preventive Medicine.

Food insecurity and social protection in Europe: Quasi-natural experiment of Europe's great recessions 2004-2012.

PubMed

Loopstra, Rachel; Reeves, Aaron; McKee, Martin; Stuckler, David

2016-08-01

Food insecurity rose sharply in Europe after 2009, but marked variation exists across countries and over time. We test whether social protection programs protected people from food insecurity arising from economic hardship across Europe. Data on household food insecurity covering 21 EU countries from 2004 to 2012 were taken from Eurostat 2015 edition and the Organisation for Economic Cooperation and Development. Cross-national first difference models were used to evaluate how rising unemployment and declining wages related to changes in the prevalence of food insecurity and the role of social protection expenditure in modifying observed effects. Economic hardship was strongly associated with greater food insecurity. Each 1 percentage point rise in unemployment rates was associated with an estimated 0.29 percentage point rise in food insecurity (95% CI: 0.10 to 0.49). Similarly, each $1000 decreases in annual average wages was associated with a 0.62 percentage point increase in food insecurity (95% CI: 0.27 to 0.97). Greater social protection spending mitigated these risks. Each $1000 spent per capita reduced the associations of rising unemployment and declining wages with food insecurity by 0.05 percentage points (95% CI: -0.10 to -0.0007) and 0.10 (95% CI: -0.18 to -0.006), respectively. The estimated effects of economic hardship on food insecurity became insignificant when countries spent more than $10,000 per capita on social protection. Rising unemployment and falling wages are strong statistical determinants of increasing food insecurity, but at high levels of social protection, these associations could be prevented. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Impacts of overgrazing in a long term traditional grazing ecosystem on vegetation around watering points in a semi-arid rangeland of North-Eastern Iran.

PubMed

Hassani, N; Asghari, H R; Frid, A S; Nurberdief, M

2008-07-01

In this study, the effects of livestock overgrazing on vegetation of the critical area around livestock watering points in a traditional grazing ecosystem was investigated on a semi-arid rangeland in North-East of Iran. Transects were placed in 8 geographical directions around watering points and samples were taken systematically. In each experimental plot, 4 m2, percentage of canopy cover, abundance, density and species richness of vegetation were calculated. The results of this study showed that the percentage of canopy cover, density and species richness were changed with distance from watering points. Critical area immediately adjacent to watering points was dominated by unpalatable Peganum harmala and contained of ruderal species such as Sophora sp. Adjacent to this was a zone dominated by species of low palatability such as Acantholimon sp. and Hulthemia persica. In areas most distant from watering points relative importance of moderately palatable species such as Artemisia herba-alba increased. These results show the negative impacts of overgrazing on vegetation and palatability in a traditional grazing ecosystem, which may indicate the necessity of a monitoring programme, to manage livestock grazing and watering points in North-East of Iran.

A value proposition for early physical therapist management of neck pain: a retrospective cohort analysis.

PubMed

Horn, Maggie E; Brennan, Gerard P; George, Steven Z; Harman, Jeffrey S; Bishop, Mark D

2016-07-12

Neck pain is one of the most common reasons for entry into the healthcare system. Recent increases in healthcare utilization and medical costs have not correlated with improvements in health. Therefore there is a need to identify management strategies for neck pain that are effective for the patient, cost efficient for the payer and provided at the optimal time during an episode of neck pain. One thousand five hundred thirty-one patients who underwent physical therapist management with a primary complaint of non-specific neck pain from January 1, 2008 to December 31, 2012 were identified from the Rehabilitation Outcomes Management System (ROMS) database at Intermountain Healthcare. Patients reporting duration of symptoms less than 4 weeks were designated as undergoing "early" management and patients with duration of symptoms greater than 4 weeks were designated as receiving "delayed" management. These groups were compared using binary logistic regression to examine odds of achieving Minimal Clinically Important Difference (MCID) on the Neck Disability Index (NDI) and Numerical Pain Rating Scale (NPRS). Separate generalized linear modeling examined the effect of timing of physical therapist management on the metrics of value and efficiency. Patients who received early physical therapist management had increased odds of achieving MCID on the NDI (aOR = 2.01, 95 % CI 1.57, 2.56) and MCID on the NPRS (aOR = 1.82, 95 % CI 1.42, 2.38), when compared to patients receiving delayed management. Patients who received early management demonstrated the greatest value in decreasing disability with a 2.27 percentage point change in NDI score per 100 dollars, best value in decreasing pain with a 0.38 point change on the NPRS per 100 dollars. Finally, patients receiving early management were managed more efficiently with a 3.44 percentage point change in NDI score per visit and 0.57 point change in NPRS score per visit. These findings suggest that healthcare systems that provide pathways for patients to receive early physical therapist management of neck pain may realize improved patient outcomes, greater value and higher efficiency in decreasing disability and pain compared to delayed management. Further research is needed to confirm this assertion.

Comparison Between One-Point Calibration and Two-Point Calibration Approaches in a Continuous Glucose Monitoring Algorithm

PubMed Central

Mahmoudi, Zeinab; Johansen, Mette Dencker; Christiansen, Jens Sandahl

2014-01-01

Background: The purpose of this study was to investigate the effect of using a 1-point calibration approach instead of a 2-point calibration approach on the accuracy of a continuous glucose monitoring (CGM) algorithm. Method: A previously published real-time CGM algorithm was compared with its updated version, which used a 1-point calibration instead of a 2-point calibration. In addition, the contribution of the corrective intercept (CI) to the calibration performance was assessed. Finally, the sensor background current was estimated real-time and retrospectively. The study was performed on 132 type 1 diabetes patients. Results: Replacing the 2-point calibration with the 1-point calibration improved the CGM accuracy, with the greatest improvement achieved in hypoglycemia (18.4% median absolute relative differences [MARD] in hypoglycemia for the 2-point calibration, and 12.1% MARD in hypoglycemia for the 1-point calibration). Using 1-point calibration increased the percentage of sensor readings in zone A+B of the Clarke error grid analysis (EGA) in the full glycemic range, and also enhanced hypoglycemia sensitivity. Exclusion of CI from calibration reduced hypoglycemia accuracy, while slightly increased euglycemia accuracy. Both real-time and retrospective estimation of the sensor background current suggest that the background current can be considered zero in the calibration of the SCGM1 sensor. Conclusions: The sensor readings calibrated with the 1-point calibration approach indicated to have higher accuracy than those calibrated with the 2-point calibration approach. PMID:24876420

Association Between Academic Medical Center Pharmaceutical Detailing Policies and Physician Prescribing

PubMed Central

Ang, Desmond; Steinhart, Jonathan; Chao, Matthew; Patterson, Mark; Sah, Sunita; Wu, Tina; Schoenbaum, Michael; Hutchins, David; Brennan, Troyen; Loewenstein, George

2017-01-01

Importance In an effort to regulate physician conflicts of interest, some US academic medical centers (AMCs) enacted policies restricting pharmaceutical representative sales visits to physicians (known as detailing) between 2006 and 2012. Little is known about the effect of these policies on physician prescribing. Objective To analyze the association between detailing policies enacted at AMCs and physician prescribing of actively detailed and not detailed drugs. Design, Setting, and Participants The study used a difference-in-differences multivariable regression analysis to compare changes in prescribing by physicians before and after implementation of detailing policies at AMCs in 5 states (California, Illinois, Massachusetts, Pennsylvania, and New York) that made up the intervention group with changes in prescribing by a matched control group of similar physicians not subject to a detailing policy. Exposures Academic medical center implementation of policies regulating pharmaceutical salesperson visits to attending physicians. Main Outcomes and Measures The monthly within-drug class market share of prescriptions written by an individual physician for detailed and nondetailed drugs in 8 drug classes (lipid-lowering drugs, gastroesophageal reflux disease drugs, diabetes drugs, antihypertensive drugs, hypnotic drugs approved for the treatment of insomnia [sleep aids], attention-deficit/hyperactivity disorder drugs, antidepressant drugs, and antipsychotic drugs) comparing the 10- to 36-month period before implementation of the detailing policies with the 12- to 36-month period after implementation, depending on data availability. Results The analysis included 16 121 483 prescriptions written between January 2006 and June 2012 by 2126 attending physicians at the 19 intervention group AMCs and by 24 593 matched control group physicians. The sample mean market share at the physician-drug-month level for detailed and nondetailed drugs prior to enactment of policies was 19.3% and 14.2%, respectively. Exposure to an AMC detailing policy was associated with a decrease in the market share of detailed drugs of 1.67 percentage points (95% CI, −2.18 to −1.18 percentage points; P < .001) and an increase in the market share of nondetailed drugs of 0.84 percentage points (95% CI, 0.54 to 1.14 percentage points; P < .001). Associations were statistically significant for 6 of 8 study drug classes for detailed drugs (lipid-lowering drugs, gastroesophageal reflux disease drugs, antihypertensive drugs, sleep aids, attention-deficit/hyperactivity disorder drugs, and antidepressant drugs) and for 9 of the 19 AMCs that implemented policies. Eleven of the 19 AMCs regulated salesperson gifts to physicians, restricted salesperson access to facilities, and incorporated explicit enforcement mechanisms. For 8 of these 11 AMCs, there was a significant change in prescribing. In contrast, there was a significant change at only 1 of 8 AMCs that did not enact policies in all 3 areas. Conclusions and Relevance Implementation of policies at AMCs that restricted pharmaceutical detailing between 2006 and 2012 was associated with modest but significant reductions in prescribing of detailed drugs across 6 of 8 major drug classes; however, changes were not seen in all of the AMCs that enacted policies. PMID:28464141

Social networking technologies as an emerging tool for HIV prevention: a cluster randomized trial.

PubMed

Young, Sean D; Cumberland, William G; Lee, Sung-Jae; Jaganath, Devan; Szekeres, Greg; Coates, Thomas

2013-09-03

Social networking technologies are an emerging tool for HIV prevention. To determine whether social networking communities can increase HIV testing among African American and Latino men who have sex with men (MSM). Randomized, controlled trial with concealed allocation. (ClinicalTrials.gov: NCT01701206). Online. 112 MSM based in Los Angeles, more than 85% of whom were African American or Latino. Sixteen peer leaders were randomly assigned to deliver information about HIV or general health to participants via Facebook groups over 12 weeks. After participants accepted a request to join the group, participation was voluntary. Group participation and engagement were monitored. Participants could request a free, home-based HIV testing kit and completed questionnaires at baseline and 12-week follow-up. Participant acceptance of and engagement in the intervention and social network participation, rates of home-based HIV testing, and sexual risk behaviors. Almost 95% of intervention participants and 73% of control participants voluntarily communicated using the social platform. Twenty-five of 57 intervention participants (44%) requested home-based HIV testing kits compared with 11 of 55 control participants (20%) (difference, 24 percentage points [95% CI, 8 to 41 percentage points]). Nine of the 25 intervention participants (36%) who requested the test took it and mailed it back compared with 2 of the 11 control participants (18%) who requested the test. Retention at study follow-up was more than 93%. Only 2 Facebook communities were included for each group. Social networking communities are acceptable and effective tools to increase home-based HIV testing among at-risk populations. National Institute of Mental Health.

A comparative effectiveness analysis of three continuous glucose monitors.

PubMed

Damiano, Edward R; El-Khatib, Firas H; Zheng, Hui; Nathan, David M; Russell, Steven J

2013-02-01

To compare three continuous glucose monitoring (CGM) devices in subjects with type 1 diabetes under closed-loop blood glucose (BG) control. Six subjects with type 1 diabetes (age 52 ± 14 years, diabetes duration 32 ± 14 years) each participated in two 51-h closed-loop BG control experiments in the hospital. Venous plasma glucose (PG) measurements (GlucoScout, International Biomedical) obtained every 15 min (2,360 values) were paired in time with corresponding CGM glucose (CGMG) measurements obtained from three CGM devices, the Navigator (Abbott Diabetes Care), the Seven Plus (DexCom), and the Guardian (Medtronic), worn simultaneously by each subject. Errors in paired PG-CGMG measurements and data reporting percentages were obtained for each CGM device. The Navigator had the best overall accuracy, with an aggregate mean absolute relative difference (MARD) of all paired points of 11.8 ± 11.1% and an average MARD across all 12 experiments of 11.8 ± 3.8%. The Seven Plus and Guardian produced aggregate MARDs of all paired points of 16.5 ± 17.8% and 20.3 ± 18.0%, respectively, and average MARDs across all 12 experiments of 16.5 ± 6.7% and 20.2 ± 6.8%, respectively. Data reporting percentages, a measure of reliability, were 76% for the Seven Plus and nearly 100% for the Navigator and Guardian. A comprehensive head-to-head-to-head comparison of three CGM devices for BG values from 36 to 563 mg/dL revealed marked differences in performance characteristics that include accuracy, precision, and reliability. The Navigator outperformed the other two in these areas.

Improved survival of baby boomer women with early-stage uterine cancer: A Surveillance, Epidemiology and End Results (SEER) Study.

PubMed

Elshaikh, Mohamed A; Ruterbusch, Julie; Cote, Michele L; Cattaneo, Richard; Munkarah, Adnan R

2013-11-01

To study the prognostic impact of baby boomer (BB) generation on survival end-points of patients with early-stage endometrial carcinoma (EC). Data were obtained from the SEER registry between 1988-2009. Inclusion criteria included women who underwent hysterectomy for stage I-II EC. Patients were divided into two birth cohorts: BB (women born between 1946 and 1964) and pre-boomers (PB) (born between 1926 and 1945). A total of 30,956 patients were analyzed. Considering that women in the PB group were older than those of the BB generation, the statistical analysis was limited to women 50-59 years of age at the time of diagnosis (n=11,473). Baby boomers had a significantly higher percentage of endometrioid histology (p<0.0001), higher percentage of African American women (p<0.0001), lower tumor grade (p<0.0001), higher number of dissected lymph nodes (LN) (p<0.0001), and less utilization of adjuvant radiation therapy (p=0.0003). Overall survival was improved in women in the BB generation compared to the PB generation (p=0.0003) with a trend for improved uterine cancer-specific survival (p=0.0752). On multivariate analysis, birth cohort (BB vs. PB) was not a significant predictor of survival end-points. Factors predictive of survival included: tumor grade, FIGO stage, African-American race, and increased number of dissected LN. Our study suggests that the survival of BB women between 50-60 years of age is better compared to women in the PB generation. As more BB patients are diagnosed with EC, further research is warranted.

Mexico's conditional cash transfer programme increases cesarean section rates among the rural poor.

PubMed

Barber, Sarah L

2010-08-01

Caesarean section rates are increasing in Mexico and Latin America. This study evaluates the impact of a large-scale, conditional cash transfer programme in Mexico on caesarean section rates. The programme provides cash transfers to participating low income, rural households in Mexico conditional on accepting health care and nutrition supplements. The primary analyses uses retrospective reports from 979 women in poor rural communities participating in an effectiveness study and randomly assigned to incorporation into the programme in 1998 or 1999 across seven Mexican states. Using multivariate and instrumental variable analyses, we estimate the impact of the programme on caesarean sections and predict the adjusted mean rates by clinical setting. Programme participation is measured by beneficiary status, programme months and cash transfers. More than two-thirds of poor rural women delivered in a health facility. Beneficiary status is associated with a 5.1 percentage point increase in caesarean rates; this impact increases to 7.5 percentage points for beneficiaries enrolled in the programme for >or=6 months before delivery. Beneficiaries had significantly higher caesarean delivery rates in social security facilities (24.0 compared with 5.6% among non-beneficiaries) and in other government facilities (19.3 compared with 9.5%). The Oportunidades conditional cash transfer programme is associated with higher caesarean section rates in social security and government health facilities. This effect appears to be driven by the increases in disposable income from the cash transfer. These findings are relevant to other countries implementing conditional cash transfer programmes and health care requirements.

Cooking with soyabean oil increases whole-blood α-linolenic acid in school-aged children: results from a randomized trial.

PubMed

Villamor, Eduardo; Marín, Constanza; Mora-Plazas, Mercedes; Casale, Mia; Vargas, Luz N; Baylin, Ana

2015-12-01

Supply of essential n-3 PUFA is limited worldwide. While fish-oil supplementation effectively improves n-3 PUFA status, it may not be a sustainable intervention. The use of α-linolenic acid (ALA)-rich cooking oils in the household may be a suitable alternative but its effect on PUFA status is unclear. We aimed to compare the effect of providing families with soyabean oil, an ALA-rich cooking oil, v. sunflower oil on whole-blood PUFA levels of children aged 11-18 years. In a randomized, masked, parallel trial, we assigned families to receive a one-month supply of either soyabean or sunflower oil. Fatty acid concentrations were quantified in whole-blood samples obtained from the children before and at the end of the intervention. Changes in fatty acids were compared between treatment arms with use of linear regression for repeated measures. Sixty low- and middle-income families. Bogotá, Colombia. Soyabean oil significantly increased ALA concentrations by 0.05 percentage points of total serum fatty acids whereas sunflower oil decreased them by 0.12 percentage points (soyabean v. sunflower oil effect=0.17; 95% CI 0.11, 0.24). Concentrations of both n-3 and n-6 very-long-chain PUFA, including docosapentaenoic acid, DHA, dihomo-γ-linolenic acid and arachidonic acid, increased significantly in both intervention arms. Levels of oleic acid and palmitic acid decreased, irrespective of oil assignment. Total energy or energy intake from saturated fat did not change. Replacing cooking oils at the household level is an effective intervention to improve essential PUFA status of children.

The effects of price competition and reduced subsidies for uncompensated care on hospital mortality.

PubMed

Volpp, Kevin G M; Ketcham, Jonathan D; Epstein, Andrew J; Williams, Sankey V

2005-08-01

To determine whether hospital mortality rates changed in New Jersey after implementation of a law that changed hospital payment from a regulated system based on hospital cost to price competition with reduced subsidies for uncompensated care and whether changes in mortality rates were affected by hospital market conditions. State discharge data for New Jersey and New York from 1990 to 1996. Study Design. We used an interrupted time series design to compare risk-adjusted in-hospital mortality rates between states over time. We compared the effect sizes in markets with different levels of health maintenance organization penetration and hospital market concentration and tested the sensitivity of our results to different approaches to defining hospital markets. The study sample included all patients under age 65 admitted to New Jersey or New York hospitals with stroke, hip fracture, pneumonia, pulmonary embolism, congestive heart failure, hip fracture, or acute myocardial infarction (AMI). Mortality among patients in New Jersey improved less than in New York by 0.4 percentage points among the insured (p=.07) and 0.5 percentage points among the uninsured (p=.37). There was a relative increase in mortality for patients with AMI, congestive heart failure, and stroke, especially for uninsured patients with these conditions, but not for patients with the other four conditions we studied. Less competitive hospital markets were significantly associated with a relative decrease in mortality among insured patients. Market-based reforms may adversely affect mortality for some conditions but it appears the effects are not universal. Insured patients in less competitive markets fared better in the transition to price competition.

A phase 3 trial of pirfenidone in patients with idiopathic pulmonary fibrosis.

PubMed

King, Talmadge E; Bradford, Williamson Z; Castro-Bernardini, Socorro; Fagan, Elizabeth A; Glaspole, Ian; Glassberg, Marilyn K; Gorina, Eduard; Hopkins, Peter M; Kardatzke, David; Lancaster, Lisa; Lederer, David J; Nathan, Steven D; Pereira, Carlos A; Sahn, Steven A; Sussman, Robert; Swigris, Jeffrey J; Noble, Paul W

2014-05-29

In two of three phase 3 trials, pirfenidone, an oral antifibrotic therapy, reduced disease progression, as measured by the decline in forced vital capacity (FVC) or vital capacity, in patients with idiopathic pulmonary fibrosis; in the third trial, this end point was not achieved. We sought to confirm the beneficial effect of pirfenidone on disease progression in such patients. In this phase 3 study, we randomly assigned 555 patients with idiopathic pulmonary fibrosis to receive either oral pirfenidone (2403 mg per day) or placebo for 52 weeks. The primary end point was the change in FVC or death at week 52. Secondary end points were the 6-minute walk distance, progression-free survival, dyspnea, and death from any cause or from idiopathic pulmonary fibrosis. In the pirfenidone group, as compared with the placebo group, there was a relative reduction of 47.9% in the proportion of patients who had an absolute decline of 10 percentage points or more in the percentage of the predicted FVC or who died; there was also a relative increase of 132.5% in the proportion of patients with no decline in FVC (P<0.001). Pirfenidone reduced the decline in the 6-minute walk distance (P=0.04) and improved progression-free survival (P<0.001). There was no significant between-group difference in dyspnea scores (P=0.16) or in rates of death from any cause (P=0.10) or from idiopathic pulmonary fibrosis (P=0.23). However, in a prespecified pooled analysis incorporating results from two previous phase 3 trials, the between-group difference favoring pirfenidone was significant for death from any cause (P=0.01) and from idiopathic pulmonary fibrosis (P=0.006). Gastrointestinal and skin-related adverse events were more common in the pirfenidone group than in the placebo group but rarely led to treatment discontinuation. Pirfenidone, as compared with placebo, reduced disease progression, as reflected by lung function, exercise tolerance, and progression-free survival, in patients with idiopathic pulmonary fibrosis. Treatment was associated with an acceptable side-effect profile and fewer deaths. (Funded by InterMune; ASCEND ClinicalTrials.gov number, NCT01366209.).

Effect of home testing of international normalized ratio on clinical events.

PubMed

Matchar, David B; Jacobson, Alan; Dolor, Rowena; Edson, Robert; Uyeda, Lauren; Phibbs, Ciaran S; Vertrees, Julia E; Shih, Mei-Chiung; Holodniy, Mark; Lavori, Philip

2010-10-21

Warfarin anticoagulation reduces thromboembolic complications in patients with atrial fibrillation or mechanical heart valves, but effective management is complex, and the international normalized ratio (INR) is often outside the target range. As compared with venous plasma testing, point-of-care INR measuring devices allow greater testing frequency and patient involvement and may improve clinical outcomes. We randomly assigned 2922 patients who were taking warfarin because of mechanical heart valves or atrial fibrillation and who were competent in the use of point-of-care INR devices to either weekly self-testing at home or monthly high-quality testing in a clinic. The primary end point was the time to a first major event (stroke, major bleeding episode, or death). The patients were followed for 2.0 to 4.75 years, for a total of 8730 patient-years of follow-up. The time to the first primary event was not significantly longer in the self-testing group than in the clinic-testing group (hazard ratio, 0.88; 95% confidence interval, 0.75 to 1.04; P=0.14). The two groups had similar rates of clinical outcomes except that the self-testing group reported more minor bleeding episodes. Over the entire follow-up period, the self-testing group had a small but significant improvement in the percentage of time during which the INR was within the target range (absolute difference between groups, 3.8 percentage points; P<0.001). At 2 years of follow-up, the self-testing group also had a small but significant improvement in patient satisfaction with anticoagulation therapy (P=0.002) and quality of life (P<0.001). As compared with monthly high-quality clinic testing, weekly self-testing did not delay the time to a first stroke, major bleeding episode, or death to the extent suggested by prior studies. These results do not support the superiority of self-testing over clinic testing in reducing the risk of stroke, major bleeding episode, and death among patients taking warfarin therapy. (Funded by the Department of Veterans Affairs Cooperative Studies Program; ClinicalTrials.gov number, NCT00032591.).

Ultra-processed foods and added sugars in the Chilean diet (2010).

PubMed

Cediel, Gustavo; Reyes, Marcela; da Costa Louzada, Maria Laura; Martinez Steele, Euridice; Monteiro, Carlos A; Corvalán, Camila; Uauy, Ricardo

2018-01-01

To assess the consumption of ultra-processed foods and analyse its association with the content of added sugars in the Chilean diet. Cross-sectional study of national dietary data obtained through 24 h recalls and classified into food groups according to the extent and purpose of food processing (NOVA classification). Chile. A probabilistic sample of 4920 individuals (aged 2 years or above) studied in 2010 by a national dietary survey (Encuesta Nacional de Consumo Alimentario). Ultra-processed foods represented 28·6 (se 0·5) % of total energy intake and 58·6 (se 0·9) % of added sugars intake. The mean percentage of energy from added sugars increased from 7·7 (se 0·3) to 19·7 (se 0·5) % across quintiles of the dietary share of ultra-processed foods. After adjusting for several potential sociodemographic confounders, a 5 percentage point increase in the dietary share of ultra-processed foods determined a 1 percentage point increase in the dietary content of added sugars. Individuals in the highest quintile were three times more likely (OR=2·9; 95 % CI 2·4, 3·4) to exceed the 10 % upper limit for added sugars recommended by the WHO compared with those in the lowest quintile, after adjusting for sociodemographic variables. This association was strongest among individuals aged 2-19 years (OR=3·9; 95 % CI 2·7, 5·9). In Chile, ultra-processed foods are important contributors to total energy intake and to the consumption of added sugars. Actions aimed at limiting consumption of ultra-processed foods are being implemented as effective ways to achieve WHO dietary recommendations to limit added sugars and processed foods, especially for children and adolescents.

Estimating Prevalence of Overweight or Obese Children and Adolescents in Small Geographic Areas Using Publicly Available Data

PubMed Central

Davila-Payan, Carlo; DeGuzman, Michael; Johnson, Kevin; Serban, Nicoleta

2015-01-01

Introduction Interventions for pediatric obesity can be geographically targeted if high-risk populations can be identified. We developed an approach to estimate the percentage of overweight or obese children aged 2 to 17 years in small geographic areas using publicly available data. We piloted our approach for Georgia. Methods We created a logistic regression model to estimate the individual probability of high body mass index (BMI), given data on the characteristics of the survey participants. We combined the regression model with a simulation to sample subpopulations and obtain prevalence estimates. The models used information from the 2001–2010 National Health and Nutrition Examination Survey, the 2010 Census, and the 2010 American Community Survey. We validated our results by comparing 1) estimates for adults in Georgia produced by using our approach with estimates from the Centers for Disease Control and Prevention (CDC) and 2) estimates for children in Arkansas produced by using our approach with school examination data. We generated prevalence estimates for census tracts in Georgia and prioritized areas for interventions. Results In DeKalb County, the mean prevalence among census tracts varied from 27% to 40%. For adults, the median difference between our estimates and CDC estimates was 1.3 percentage points; for Arkansas children, the median difference between our estimates and examination-based estimates data was 1.7 percentage points. Conclusion Prevalence estimates for census tracts can be different from estimates for the county, so small-area estimates are crucial for designing effective interventions. Our approach validates well against external data, and it can be a relevant aid for planning local interventions for children. PMID:25764138

Self-assessment of treatment compliance with antimuscarinic drugs and lower urinary tract condition among women with urinary incontinence.

PubMed

Kosilov, Kirill; Loparev, Sergey; Kuzina, Irina; Shakirova, Olga; Zhuravskaya, Natalya; Lobodenko, Alexandra

2017-11-01

Our aim was to determine the efficiency of the Medication Compliance Self-Report Inventory (MASRI) in self-reporting antimuscarinic drug treatment compliance among women with urinary incontinence (UI). The study assessed 347 women aged 18-65 (averaging 49.7) years with more than one urinary incontinence (UI) episode per day. Treatment compliance was tested at the beginning and at weeks 4, 8, and 12 using the MASRI, the Brief Medication Questionnaire (BMQ), and visual pill counts. The MASRI's constructive, concurrent, and discriminate validity was studied in comparison with an external standard that uses the chi-square and Spearman coefficient. Receiver operating characteristic (ROC) analysis was performed to identify optimum MASRI cutoffs that would predict noncompliance. Furthermore, the functional condition of the lower urinary tract was tested using voiding diaries, uroflowmetry, and cystometry. The correlation between the percentage of noncompliant women according to the MASRI, and individuals with a belief barrier with respect to the BMQ screen was r = 0.81 (p ≤0.05), r = 0.84 (p ≤0.05), and r = 0.79 (p ≤0.05). The correlation between the percentage of noncompliant women according to the MASRI and of women who missed >20% of their doses according to the Regimen Screen of the BMQ was r = 0.79, p ≤0.05, r = 0.82, p ≤0.01, r = 0.77, and p ≤0.05 at the control points. Finally, the percentage of noncompliant patients who self-reported correctly according to the MASRI data compared with the BMQ was 95.6%, 95.7%, and 96.6% at the control points. The MASRI entails acceptable validity for accurately predicting treatment compliance with antimuscarinic drugs among women who have had UI for >3 months.

Contrast enhancement of central nervous system lesions: multicenter intraindividual crossover comparative study of two MR contrast agents.

PubMed

Maravilla, Kenneth R; Maldjian, Joseph A; Schmalfuss, Ilona M; Kuhn, Matthew J; Bowen, Brian C; Wippold, Franz J; Runge, Val M; Knopp, Michael V; Kremer, Stephane; Wolansky, Leo J; Anzalone, Nicoletta; Essig, Marco; Gustafsson, Lars

2006-08-01

To prospectively compare gadobenate dimeglumine with gadopentetate dimeglumine (0.1 mmol per kilogram body weight) for enhanced magnetic resonance (MR) imaging of central nervous system (CNS) lesions. This study was HIPAA-compliant at U.S. centers and was conducted at all centers according to the Good Clinical Practice standard. Institutional review board and regulatory approval were granted; written informed consent was obtained. Seventy-nine men and 78 women (mean age, 50.5 years +/- 14.4 [standard deviation]) were randomized to group A (n = 78) or B (n = 79). Patients underwent two temporally separated 1.5-T MR imaging examinations. In randomized order, gadobenate followed by gadopentetate was administered in group A; order of administration was reversed in group B. Contrast agent administration (volume, speed of injection), imaging parameters before and after injection, and time between injections and postinjection acquisitions were identical for both examinations. Three blinded neuroradiologists evaluated images by using objective image interpretation criteria for diagnostic information end points (lesion border delineation, definition of disease extent, visualization of internal morphologic features of the lesion, enhancement of the lesion) and quantitative parameters (percentage of lesion enhancement, contrast-to-noise ratio [CNR]). Overall diagnostic preference in terms of lesion conspicuity, detectability, and diagnostic confidence was assessed. Between-group comparisons were performed with Wilcoxon signed rank test. Readers 1, 2, and 3 demonstrated overall preference for gadobenate in 75, 89, and 103 patients, compared with that for gadopentetate in seven, 10, and six patients, respectively (P < .0001). Significant (P < .0001) preference for gadobenate was demonstrated for diagnostic information end points, percentage of lesion enhancement, and CNR. Superiority of gadobenate was significant (P < .001) in patients with intraaxial and extraaxial lesions. Gadobenate compared with gadopentetate at an equivalent dose provides significantly better enhancement and diagnostic information for CNS MR imaging. RSNA, 2006

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang, R; Bai, W

Purpose: Because of statistical noise in Monte Carlo dose calculations, effective point doses may not be accurate. Volume spheres are useful for evaluating dose in Monte Carlo plans, which have an inherent statistical uncertainty.We use a user-defined sphere volume instead of a point, take sphere sampling around effective point make the dose statistics to decrease the stochastic errors. Methods: Direct dose measurements were made using a 0.125cc Semiflex ion chamber (IC) 31010 isocentrically placed in the center of a homogeneous Cylindric sliced RW3 phantom (PTW, Germany).In the scanned CT phantom series the sensitive volume length of the IC (6.5mm) weremore » delineated and defined the isocenter as the simulation effective points. All beams were simulated in Monaco in accordance to the measured model. In our simulation using 2mm voxels calculation grid spacing and choose calculate dose to medium and request the relative standard deviation ≤0.5%. Taking three different assigned IC over densities (air electron density(ED) as 0.01g/cm3 default CT scanned ED and Esophageal lumen ED 0.21g/cm3) were tested at different sampling sphere radius (2.5, 2, 1.5 and 1 mm) statistics dose were compared with the measured does. Results: The results show that in the Monaco TPS for the IC using Esophageal lumen ED 0.21g/cm3 and sampling sphere radius 1.5mm the statistical value is the best accordance with the measured value, the absolute average percentage deviation is 0.49%. And when the IC using air electron density(ED) as 0.01g/cm3 and default CT scanned EDthe recommented statistical sampling sphere radius is 2.5mm, the percentage deviation are 0.61% and 0.70%, respectivly. Conclusion: In Monaco treatment planning system for the ionization chamber 31010 recommend air cavity using ED 0.21g/cm3 and sampling 1.5mm sphere volume instead of a point dose to decrease the stochastic errors. Funding Support No.C201505006.« less

Relation of watershed setting and stream nutrient yields at selected sites in central and eastern North Carolina, 1997-2008

USGS Publications Warehouse

Harden, Stephen L.; Cuffney, Thomas F.; Terziotti, Silvia; Kolb, Katharine R.

2013-01-01

Data collected between 1997 and 2008 at 48 stream sites were used to characterize relations between watershed settings and stream nutrient yields throughout central and eastern North Carolina. The focus of the investigation was to identify environmental variables in watersheds that influence nutrient export for supporting the development and prioritization of management strategies for restoring nutrient-impaired streams. Nutrient concentration data and streamflow data compiled for the 1997 to 2008 study period were used to compute stream yields of nitrate, total nitrogen (N), and total phosphorus (P) for each study site. Compiled environmental data (including variables for land cover, hydrologic soil groups, base-flow index, streams, wastewater treatment facilities, and concentrated animal feeding operations) were used to characterize the watershed settings for the study sites. Data for the environmental variables were analyzed in combination with the stream nutrient yields to explore relations based on watershed characteristics and to evaluate whether particular variables were useful indicators of watersheds having relatively higher or lower potential for exporting nutrients. Data evaluations included an examination of median annual nutrient yields based on a watershed land-use classification scheme developed as part of the study. An initial examination of the data indicated that the highest median annual nutrient yields occurred at both agricultural and urban sites, especially for urban sites having large percentages of point-source flow contributions to the streams. The results of statistical testing identified significant differences in annual nutrient yields when sites were analyzed on the basis of watershed land-use category. When statistical differences in median annual yields were noted, the results for nitrate, total N, and total P were similar in that highly urbanized watersheds (greater than 30 percent developed land use) and (or) watersheds with greater than 10 percent point-source flow contributions to streamflow had higher yields relative to undeveloped watersheds (having less than 10 and 15 percent developed and agricultural land uses, respectively) and watersheds with relatively low agricultural land use (between 15 and 30 percent). The statistical tests further indicated that the median annual yields for total P were statistically higher for watersheds with high agricultural land use (greater than 30 percent) compared to the undeveloped watersheds and watersheds with low agricultural land use. The total P yields also were higher for watersheds with low urban land use (between 10 and 30 percent developed land) compared to the undeveloped watersheds. The study data indicate that grouping and examining stream nutrient yields based on the land-use classifications used in this report can be useful for characterizing relations between watershed settings and nutrient yields in streams located throughout central and eastern North Carolina. Compiled study data also were analyzed with four regression tree models as a means of determining which watershed environmental variables or combination of variables result in basins that are likely to have high or low nutrient yields. The regression tree analyses indicated that some of the environmental variables examined in this study were useful for predicting yields of nitrate, total N, and total P. When the median annual nutrient yields for all 48 sites were evaluated as a group (Model 1), annual point-source flow yields had the greatest influence on nitrate and total N yields observed in streams, and annual streamflow yields had the greatest influence on yields of total P. The Model 1 results indicated that watersheds with higher annual point-source flow yields had higher annual yields of nitrate and total N, and watersheds with higher annual streamflow yields had higher annual yields of total P. When sites with high point-source flows (greater than 10 percent of total streamflow) were excluded from the regression tree analyses (Models 2–4), the percentage of forested land in the watersheds was identified as the primary environmental variable influencing stream yields for both total N and total P. Models 2, 3 and 4 did not identify any watershed environmental variables that could adequately explain the observed variability in the nitrate yields among the set of sites examined by each of these models. The results for Models 2, 3, and 4 indicated that watersheds with higher percentages of forested land had lower annual total N and total P yields compared to watersheds with lower percentages of forested land, which had higher median annual total N and total P yields. Additional environmental variables determined to further influence the stream nutrient yields included median annual percentage of point-source flow contributions to the streams, variables of land cover (percentage of forested land, agricultural land, and (or) forested land plus wetlands) in the watershed and (or) in the stream buffer, and drainage area. The regression tree models can serve as a tool for relating differences in select watershed attributes to differences in stream yields of nitrate, total N, and total P, which can provide beneficial information for improving nutrient management in streams throughout North Carolina and for reducing nutrient loads to coastal waters.

Impact of different policies on unhealthy dietary behaviors in an urban adult population: an agent-based simulation model.

PubMed

Zhang, Donglan; Giabbanelli, Philippe J; Arah, Onyebuchi A; Zimmerman, Frederick J

2014-07-01

Unhealthy eating is a complex-system problem. We used agent-based modeling to examine the effects of different policies on unhealthy eating behaviors. We developed an agent-based simulation model to represent a synthetic population of adults in Pasadena, CA, and how they make dietary decisions. Data from the 2007 Food Attitudes and Behaviors Survey and other empirical studies were used to calibrate the parameters of the model. Simulations were performed to contrast the potential effects of various policies on the evolution of dietary decisions. Our model showed that a 20% increase in taxes on fast foods would lower the probability of fast-food consumption by 3 percentage points, whereas improving the visibility of positive social norms by 10%, either through community-based or mass-media campaigns, could improve the consumption of fruits and vegetables by 7 percentage points and lower fast-food consumption by 6 percentage points. Zoning policies had no significant impact. Interventions emphasizing healthy eating norms may be more effective than directly targeting food prices or regulating local food outlets. Agent-based modeling may be a useful tool for testing the population-level effects of various policies within complex systems.

Adults Are More Likely To Become Eligible For Medicaid During Future Recessions If Their State Expanded Medicaid.

PubMed

Jacobs, Paul D; Hill, Steven C; Abdus, Salam

2017-01-01

Eligibility for and enrollment in Medicaid can vary with economic recessions, recoveries, and changes in personal income. Understanding how Medicaid responds to such forces is important to budget analysts and policy makers tasked with forecasting Medicaid enrollment. We simulated eligibility for Medicaid for the period 2005-14 in two scenarios: assuming that each state's eligibility rules in 2009, the year before passage of the Affordable Care Act (ACA), were in place during the entire study period; and assuming that the ACA's expanded eligibility rules were in place during the entire period for all states. Then we correlated the results with unemployment rates as a measure of the economy. Each percentage-point increase in the unemployment rate was associated with an increase in the share of people eligible for Medicaid of 0.32 percentage point under the 2009 eligibility rules and 0.77 percentage point under the ACA rules. Our simulations showed that the ACA expansion increased Medicaid's responsiveness to changes in unemployment. For states that have not expanded Medicaid eligibility, our analysis demonstrates that increased responsiveness to periods of high unemployment is one benefit of expansion. Project HOPE—The People-to-People Health Foundation, Inc.

Trends in driver licensing status and driving among high school seniors in the United States, 1996–2010☆

PubMed Central

Shults, Ruth A.; Williams, Allan F.

2017-01-01

Introduction Understanding the reasons for fluctuations in teenage driver crashes over time in the United States is clouded by the lack of information on licensure rates and driving exposure. Methods We examined results from the Monitoring the Future survey to estimate the proportion of high school seniors who possessed a driver’s license and the proportion of seniors who did not drive “during an average week” during the 15-year period of 1996–2010. Results During 1996–2010, the proportion of high school seniors in United States who reported having a driver’s license declined by 12 percentage points (14%) from 85% to 73%. Two-thirds of the decline (8 percentage points) occurred during 2006–2010. During the same 15-year period, the proportion of high school seniors who did not drive during an average week increased by 7 percentage points (47%) from 15% in 1996 to 22% in 2010, with essentially all of the increase occurring during 2006–2009. Discussion Findings in this report suggest that the economic recession in recent years has reduced rates of licensure and driving among high school seniors. PMID:23932698

Does Retiree Health Insurance Encourage Early Retirement?*

PubMed Central

Nyce, Steven; Schieber, Sylvester J.; Shoven, John B.; Slavov, Sita Nataraj; Wise, David A.

2013-01-01

The strong link between health insurance and employment in the United States may cause workers to delay retirement until they become eligible for Medicare at age 65. However, some employers extend health insurance benefits to their retirees, and individuals who are eligible for such retiree health benefits need not wait until age 65 to retire with group health coverage. We investigate the impact of retiree health insurance on early retirement using employee-level data from 54 diverse firms that are clients of Towers Watson, a leading benefits consulting firm. We find that retiree health coverage has its strongest effects at ages 62 through 64. Coverage that includes an employer contribution is associated with a 6.3 percentage point (36.2 percent) increase in the probability of turnover at age 62, a 7.7 percentage point (48.8 percent) increase in the probability of turnover at age 63, and a 5.5 percentage point (38.0 percent) increase in the probability of turnover at age 64. Conditional on working at age 57, such coverage reduces the expected retirement age by almost three months and reduces the total number of person-years worked between ages 58 and 64 by 5.6 percent. PMID:24039312

Quality of care for elderly patients hospitalized for pneumonia in the United States, 2006 to 2010.

PubMed

Lee, Jonathan S; Nsa, Wato; Hausmann, Leslie R M; Trivedi, Amal N; Bratzler, Dale W; Auden, Dana; Mor, Maria K; Baus, Kristie; Larbi, Fiona M; Fine, Michael J

2014-11-01

Nearly every US acute care hospital reports publicly on adherence to recommended processes of care for patients hospitalized with pneumonia. However, it remains uncertain how much performance of these process measures has improved over time or whether performance is associated with superior patient outcomes. To describe trends in processes of care, mortality, and readmission for elderly patients hospitalized for pneumonia and to assess the independent associations between processes and outcomes of care. Retrospective cohort study conducted from January 1, 2006, to December 31, 2010, at 4740 US acute care hospitals. The cohort included 1 818 979 cases of pneumonia in elderly (≥65 years), Medicare fee-for-service patients who were eligible for at least 1 of 7 pneumonia inpatient processes of care tracked by the Centers for Medicare & Medicaid Services (CMS). Annual performance rates for 7 pneumonia processes of care and an all-or-none composite of these measures; and 30-day, all-cause mortality and hospital readmission, adjusted for patient and hospital characteristics. Adjusted annual performance rates for all 7 CMS processes of care (expressed in percentage points per year) increased significantly from 2006 to 2010, ranging from 1.02 for antibiotic initiation within 6 hours to 5.30 for influenza vaccination (P < .001). All 7 measures were performed in more than 92% of eligible cases in 2010. The all-or-none composite demonstrated the largest adjusted relative increase over time (6.87 percentage points per year; P < .001) and was achieved in 87.4% of cases in 2010. Adjusted annual mortality decreased by 0.09 percentage points per year (P < .001), driven primarily by decreasing mortality in the subgroup not treated in the intensive care unit (ICU) (-0.18 percentage points per year; P < .001). Adjusted annual readmission rates decreased significantly by 0.25 percentage points per year (P < .001). All 7 processes of care were independently associated with reduced 30-day mortality, and 5 were associated with reduced 30-day readmission. Performance of processes of care for elderly patients hospitalized for pneumonia improved substantially from 2006 to 2010. Adjusted 30-day mortality declined slightly over time primarily owing to improved survival among non-ICU patients, and all individual processes of care were independently associated with reduced mortality.

The effect of potential electronic nicotine delivery system regulations on nicotine product selection.

PubMed

Pesko, Michael F; Kenkel, Donald S; Wang, Hua; Hughes, Jenna M

2016-04-01

To estimate the effect of potential regulations of electronic nicotine delivery systems (ENDS) among adult smokers, including increasing taxes, reducing flavor availability and adding warning labels communicating various levels of risk. We performed a discrete choice experiment (DCE) among a national sample of 1200 adult smokers. We examined heterogeneity in policy responses by age, cigarette quitting interest and current ENDS use. Our experiment overlapped January 2015 by design, providing exogenous variation in cigarette quitting interest from New Year resolutions. KnowledgePanel, an online panel of recruited respondents. A total of 1200 adult smokers from the United States. Hypothetical purchase choice of cigarettes, nicotine replacement therapy and a disposable ENDS. Increasing ENDS prices from $3 to $6 was associated with a 13.6 percentage point reduction in ENDS selection (P < 0.001). Restricting flavor availability in ENDS to tobacco and menthol was associated with a 2.1 percentage point reduction in ENDS selection (P < 0.001). The proposed Food and Drug Administration (FDA) warning label was associated with a 1.1 percentage point reduction in ENDS selection (P < 0.05) and the MarkTen warning label with a 5.1 percentage point reduction (P < 0.001). We estimated an ENDS price elasticity of -1.8 (P < 0.001) among adult smokers. Statistically significant interaction terms (P < 0.001) imply that price responsiveness was higher among adult smokers 18-24 years of age, smokers who have vaped over the last month and smokers with above the median quitting interest. Young adult smokers were 3.7 percentage points more likely to choose ENDS when multiple flavors were available than older adults (P < 0.001). Young adult smokers and those with above the median cigarette quitting interest were also more likely to reduce cigarette selection and increase ENDS selection in January 2015 (P < 0.001), potentially in response to New Year's resolutions to quit smoking. Increased taxes, a proposed US Food and Drug Administration warning label for electronic nicotine delivery systems and a more severe warning label may discourage adult smokers from switching to electronic nicotine delivery systems. Reducing the availability of flavors may reduce ENDS use by young adult smokers. © 2015 Society for the Study of Addiction.

Comparative evaluation of Nabi and Beltsville extenders for cryopreservation of rooster semen.

PubMed

Nabi, Mohammad Mahdi; Kohram, Hamid; Zhandi, Mahdi; Mehrabani-Yeganeh, Hassan; Sharideh, Hossein; Zare-Shahaneh, Ahmad; Esmaili, Vahid

2016-02-01

Two experiments were conducted to evaluate the new rooster semen freezing extender which is containing a low level of glycerol and soybean lecithin as an alternative protective agent in the extender. The aim of the first experiment was to evaluate a new extender for freeze-thawing rooster semen known as "Nabi" extender compared to Beltsville. Second experiment was also performed to determine whether the Nabi extender has negative reactions on fertilization after artificial insemination (AI) or no. In the first experiment, post-thaw motion parameters, mitochondrial function and sperm apoptosis were analyzed using Sperm Class Analyzer (SCA), rhodamine-123 and Annexin-V, respectively for frozen-thawed semen in Nabi and Beltsville extender. Results showed that total motility, progressive motility, velocity parameters (VCL, VSL, VAP, LIN and STR) and live spermatozoa with active mitochondria were significantly higher in Nabi compare to Beltsville extender (P < 0.01). Also, the percentages of post-thawed live and early apoptotic spermatozoa were significantly higher in Nabi compared to Beltsville extender (14.46 ± 0.95 vs. 19.27 ± 0.95 and 14.83 ± 4.51 vs. 39.27 ± 4.51, respectively). For apoptotic spermatozoa, the percentages of post-thawed late apoptotic spermatozoa were significantly lower in Nabi (29.66 ± 3.11) compared to Beltsville extender (69.07 ± 3.11), but the type of extender had no effect on the percentages of post-thawed necrotic spermatozoa. In the second experiment, 20 broiler breeder hens (Ross 308) were inseminated with thawed semen using the new freezing diluents or fresh semen for determination of fertility rate. Fertility rate with thawed semen (with Nabi extender) was lower compared to fresh semen (by approximately 8% points). It can be concluded that Nabi extender would improve post-thawed rooster sperm in vitro quality compared to Beltsville extender. The fertility rates of insemination in hens with freeze-thaw sperm were comparable with fresh sperm. Copyright © 2015 Elsevier Inc. All rights reserved.

Primary prevention of lead exposure--blood lead results at age two years.

PubMed

Campbell, Carla; Gracely, Edward; Tran, Mary; Starkey, Naomi; Kersten, Hans; Palermo, Peter; Rothman, Nancy; Line, Laura; Hansen-Turton, Tine

2012-04-01

The Philadelphia Lead Safe Homes (LSH) Study was designed to evaluate whether educational and environmental interventions in the first year of life for families of newborns increased knowledge of lead exposure prevention and were associated with less elevation of blood lead levels (BLLs) for these children, when compared to children receiving standard care. The current study performed descriptive statistics on the second-year BLL data for both groups and compared these using chi-square tests for proportions and unpaired t-tests for means. A BLL result was found for 159 (50.6%) of the 314 LSH cohort children and 331 (52.7%) of the 628 control children (p = 0.1). Mean and standard deviation for age at draw was 23.8 (3.4) months versus 23.6 (3.1) months (P = 0.6). Geometric mean BLLs were 3.7 versus 3.5 µg/dL (P = 0.4). The percentages of the cohort group with a BLL of ≥ 20, ≥ 10 and ≥ 5 μg/dL, respectively, were 0.6%, 5% and 30%; for the controls 1.2%, 6.6%, and 25%. These percentages were not significantly different between groups. A comparison of geometric mean BLLs and percentages above several BLL cut points drawn at age two years in a group of urban newborns benefitting from study interventions versus a group of similar urban children did not yield statistically significant differences. Both groups had relatively lower lead levels when compared to historical cohort groups, which may reflect a continuing downward trend in BLLs in U.S. children. The interventions did result in benefits to the families such as an increase in parental knowledge about lead exposure prevention and in-home wet cleaning activity, and a decrease in lead dust levels in study homes.

Does the Level of Graphical Detail of a Virtual Handball Thrower Influence a Goalkeeper’s Motor Response?

PubMed Central

Vignais, Nicolas; Bideau, Benoit; Craig, Cathy; Brault, Sébastien; Multon, Franck; Delamarche, Paul; Kulpa, Richard

2009-01-01

The authors investigated how different levels of detail (LODs) of a virtual throwing action can influence a handball goalkeeper’s motor response. Goalkeepers attempted to stop a virtual ball emanating from five different graphical LODs of the same virtual throwing action. The five levels of detail were: a textured reference level (L0), a non-textured level (L1), a wire-frame level (L2), a point-light-display (PLD) representation (L3) and a PLD level with reduced ball size (L4). For each motor response made by the goalkeeper we measured and analyzed the time to respond (TTR), the percentage of successful motor responses, the distance between the ball and the closest limb (when the stopping motion was incorrect) and the kinematics of the motion. Results showed that TTR, percentage of successful motor responses and distance with the closest limb were not significantly different for any of the five different graphical LODs. However the kinematics of the motion revealed that the trajectory of the stopping limb was significantly different when comparing the L1 and L3 levels, and when comparing the L1 and L4 levels. These differences in the control of the goalkeeper’s actions suggests that the different level of information available in the PLD representations (L3 and L4) are causing the goalkeeper to adopt different motor strategies to control the approach of their limb to stop the ball. Key points Virtual reality technology can be used to analyze sport performance because it enables standardization and reproduction of sport situations. Defining a minimal graphical level of detail of a virtual action could decrease the real time calculation of a virtual reality system. A Point Light Display graphical representation of a virtual throwing motion seems to influence the regulation of action of real handball goalkeepers. PMID:24149589

Association Between Hospital Penalty Status Under the Hospital Readmission Reduction Program and Readmission Rates for Target and Non-Target Conditions

PubMed Central

Desai, Nihar R.; Ross, Joseph S.; Kwon, Ji Young; Herrin, Jeph; Dharmarajan, Kumar; Bernheim, Susannah M.; Krumholz, Harlan M.; Horwitz, Leora I.

2017-01-01

Importance Readmission rates declined after announcement of the Hospital Readmission Reduction Program (HRRP), which penalizes hospitals for excess readmissions for acute myocardial infarction (AMI), heart failure (HF), and pneumonia. Objective To compare trends in readmission rates for target and non-target conditions, stratified by hospital penalty status. Design, Setting, Participants Retrospective cohort study of 48,137,102 hospitalizations of 20,351,161 Medicare fee-for-service beneficiaries over 64 years discharged between January 1, 2008 and June 30, 2015 from 3,497 hospitals. Difference interrupted time series models were used to compare trends in readmission rates by condition and penalty status. Exposure Hospital penalty status or target condition under the HRRP. Outcome 30-day risk adjusted, all-cause unplanned readmission rates for target and non-target conditions. Results In January 2008, the mean readmission rates for AMI, HF, pneumonia and non-target conditions were 21.9%, 27.5%, 20.1%, and 18.4% respectively at hospitals later subject to financial penalties (n=2,189) and 18.7%, 24.2%, 17.4%, and 15.7% at hospitals not subject to penalties (n=1,283). Between January 2008 and March 2010, prior to HRRP announcement, readmission rates were stable across hospitals (except AMI at non-penalty hospitals). Following announcement of HRRP (March 2010), readmission rates for both target and non-target conditions declined significantly faster for patients at hospitals later subject to financial penalties compared with those at non-penalized hospitals (AMI, additional decrease of −1.24 (95% CI, −1.84, −0.65) percentage points per year relative to non-penalty discharges; HF, −1.25 (−1.64, −0.65); pneumonia, −1.37 (−0.95, −1.80); non-target, −0.27 (−0.38, −0.17); p<0.001 for all). For penalty hospitals, readmission rates for target conditions declined significantly faster compared with non-target conditions (AMI: additional decline of −0.49 (−0.81, −0.16) percentage points per year relative to non-target conditions, p=0.004; HF: −0.90 (−1.18, −0.62), p<0.001; pneumonia: −0.57 (−0.92,−0.23), p<0.001). By contrast, among non-penalty hospitals, readmissions for target conditions declined similarly or more slowly compared with non-target conditions (AMI: additional increase of 0.48 (0.01, 0.95) percentage points per year, p=0.05; HF: 0.08 (−0.30, 0.46), p=0.67; pneumonia: 0.53 (0.13, 0.93), p=0.01). After HRRP implementation in October 2012, the rate of change for readmission rates plateaued (p<0.05 for all except pneumonia at non-penalty hospitals) with the greatest relative change observed among hospitals subject to financial penalty. Conclusions Patients at hospitals subject to penalties had greater reductions in readmission rates compared with those at non-penalized hospitals. Changes were greater for target conditions at penalized hospitals, but not at non-penalized hospitals. PMID:28027367

Does Medial Meniscal Allograft Transplantation With the Bone-Plug Technique Restore the Anatomic Location of the Native Medial Meniscus?

PubMed

Kim, Nam-Ki; Bin, Seong-Il; Kim, Jong-Min; Lee, Chang-Rack

2015-12-01

Previous work has shown the importance of restoring the normal structure of the native meniscus with meniscal allograft transplantation. The purpose of this study was to compare the anatomic positions of the anterior horn and posterior horn between the preoperative medial meniscus and the postoperative meniscal allograft after medial meniscal allograft transplantation with the bone-plug technique. The hypothesis was that the bone-plug technique could restore the preoperative structure of the native medial meniscus. Case series; Level of evidence, 4. Between December 1999 and December 2013, a total of 59 patients (49 male, 10 female) underwent medial meniscal allograft transplantation by use of the bone-plug technique. The anatomic positions of both horns in the native medial meniscus and in the meniscal allograft were measured via MRI. The percentage reference method was used to measure the locations of both horns. On coronal MRI, the mean absolute distance of the posterior horn from the lateral border of the tibial plateau changed from 45.2 ± 3.3 to 48.1 ± 4.2 mm (P < .05), and the percentage distance of the posterior horn changed from 59.6% to 63.0% (P < .05). On sagittal MRI, the mean absolute distance of the posterior horn from the anterior reference point changed from 40.3 ± 3.0 to 42.0 ± 3.5 mm (P < .05), and the mean percentage distance of the posterior horn changed from 76.5% to 79.4% (P <.05). On coronal MRI, the mean absolute distance of the anterior horn from the lateral border of the tibial plateau changed from 41.3 ± 4.2 to 48.5 ± 5.6 mm (P < .05), and the mean percentage distance of the anterior horn changed from 54.5% to 63.8% (P < .05). On sagittal MRI, the mean absolute distance of the anterior horn from the anterior reference point changed from 5.5 ± 1.0 to 9.9 ± 2.9 mm (P < .05), and the mean percentage distance of the anterior horn changed from 10.6% to 19.0% (P < .05). Despite attempts to place the meniscal allograft in the same position as the native meniscus, the anatomic locations of both horns were shifted posteromedially compared with those of the native medial meniscus. There were significant differences, attributed to several limitations in the bone-plug technique, between the preoperative and postoperative values of both horns. However, the posterior horn showed a location change of <5 mm, on average, in both the coronal and sagittal planes, whereas the anterior horn showed a location change of ≥ 5 mm in the coronal plane but <5 mm in the sagittal plane. © 2015 The Author(s).

Public reporting and market area exit decisions by home health agencies.

PubMed

Jung, Kyoungrae; Feldman, Roger

2012-01-01

To examine whether home health agencies selectively discontinue services to areas with socio-economically disadvantaged people after the introduction of Home Health Compare (HHC), a public reporting program initiated by Medicare in 2003. We focused on agencies' initial responses to HHC and examined selective market-area exits by agencies between 2002 and 2004. We measured HHC effects by the percentage of quality indicators reported in public HHC data in 2003. Socio-economic status was measured by per capita income and percent college-educated at the market-area level. 2002 and 2004 Outcome and Assessment Information Set (OASIS); 2000 US Census file; 2004 Area Resource File; and 2002 Provider of Service File. WE FOUND A SMALL AND WEAK EFFECT OF PUBLIC REPORTING ON SELECTIVE EXITS: a 10-percent increase in reporting (reporting one more indicator) increased the probability of leaving an area with less-educated people by 0.3 percentage points, compared with leaving an area with high education. The small level of market-area exits under public reporting is unlikely to be practically meaningful, suggesting that HHC did not lead to a disruption in access to home health care through selective exits during the initial year of the program.

From Politics to Parity: Using a Health Disparities Index to Guide Legislative Efforts for Health Equity

PubMed Central

Simpson, Sean L.; Hairston, Kristen G.

2011-01-01

Objectives. We created an index quantifying the longitudinal burden of racial health disparities by state and compared this index to variables to guide the construction of, and validate support for, legislative efforts aimed at eliminating health disparities. Methods. We evaluated 5 focus areas of greatest racial disparities in health from 1999 to 2005 and compiled state health disparities index (HDI) scores. We compared these scores with variables representing the purported social determinants of health. Results. Massachusetts (0.35), Oklahoma (0.35), and Washington (0.39) averaged the fewest disparities. Michigan (1.22), Wisconsin (1.32), and Illinois (1.50) averaged the greatest disparities. The statistical reference point for nationwide average racial disparities was 1.00. The longitudinal mixed model procedure yielded statistically significant correlations between HDI scores and Black state population percentage as well as with the racial gap in uninsured percentages. We noted a trend for HDI correlations with median household income ratios. Conclusions. On the basis of the HDI-established trends in the extent and distribution of racial health disparities, and their correlated social determinants of health, policymakers should consider incorporating this tool to advise future efforts in minority health legislation. PMID:21233445

Home advantage in the Six Nations Rugby Union tournament.

PubMed

Thomas, Sion; Reeves, Colin; Bell, Andrew

2008-02-01

This study examined whether home advantage occurred in the Six Nations Rugby Union tournament. Data were gathered using the final championship standings from the tournament's inception in 2000 to the recently completed 2007 season. Home advantage for each championship season was defined as the number of points won by teams playing at home, expressed as a percentage of all points gained either at home or away. An analysis of home advantage for each of eight seasons of competition ranged from 53% (2005) to 70% (2006). There was an overall statistically significant home advantage of 61% for 120 matches played in the Six Nations tournament between 2000 and 2007. Also analysed were the percentage of points won at home by each country. Again, evidence supported home advantage amongst all competing nations regardless of the team's quality.

An Effective and Novel Neural Network Ensemble for Shift Pattern Detection in Control Charts.

PubMed

Barghash, Mahmoud

2015-01-01

Pattern recognition in control charts is critical to make a balance between discovering faults as early as possible and reducing the number of false alarms. This work is devoted to designing a multistage neural network ensemble that achieves this balance which reduces rework and scrape without reducing productivity. The ensemble under focus is composed of a series of neural network stages and a series of decision points. Initially, this work compared using multidecision points and single-decision point on the performance of the ANN which showed that multidecision points are highly preferable to single-decision points. This work also tested the effect of population percentages on the ANN and used this to optimize the ANN's performance. Also this work used optimized and nonoptimized ANNs in an ensemble and proved that using nonoptimized ANN may reduce the performance of the ensemble. The ensemble that used only optimized ANNs has improved performance over individual ANNs and three-sigma level rule. In that respect using the designed ensemble can help in reducing the number of false stops and increasing productivity. It also can be used to discover even small shifts in the mean as early as possible.

Secondary Behavior of Drivers on Cell Phones.

PubMed

Farmer, Charles M; Klauer, Sheila G; McClafferty, Julie A; Guo, Feng

2015-01-01

The objective of this study was to determine whether cell phone use by drivers leads to changes in the frequency of other types of potentially distracting behavior. There were 2 main questions of interest: (1) As each driver changes cell phone use, does he or she change the amount of driving time spent on other distracting behavior? (2) As each driver changes cell phone use, does he or she change the amount of driving time spent looking away from the driving task? Day-to-day driving behavior of 105 volunteer subjects was monitored over a period of 1 year. The amount of driving time during each trip spent on tasks secondary to driving (or looking away from the driving task) was correlated to the amount of time on a cell phone, taking into account the relationships among trips taken by the same driver. Drivers spent 42% of the time engaging in at least one secondary activity. Drivers were talking on a cell phone 7% of the time, interacting in some other way with a cell phone 5% of the time, and engaging in some other secondary activity (sometimes in conjunction with cell phone use) 33% of the time. Other than cell phone use, the most common secondary activities were interacting with a passenger (12% of driving time), holding but not otherwise interacting with an object (6%), and talking/singing/dancing to oneself (5%). Drivers were looking straight forward 81% of the time, forward left or right 5% of time, in a mirror 4% of the time, and elsewhere (eyes off driving task) 10% of time. On average, for each 1 percentage point increase in cell phone talking, the other secondary behavior rate decreased by 0.28 percentage points (P <.0001), and the rate of eyes off driving task decreased by 0.02 percentage points (P =.0067). For each 1 percentage point increase in the amount of other cell phone interaction per trip, the other secondary behavior rate decreased by 0.08 percentage points (P =.0558), but the rate of eyes off driving task increased by 0.06 percentage points (P <.0001). Although using a cell phone can be distracting from the driving task, other secondary activities can be equally or more distracting, at least as measured by eye glances away from the road ahead and mirrors. In this group of drivers, dialing, reaching for, and answering the cell phone were associated with increased eyes off driving task, as opposed to the decrease in eyes off driving task associated with talking on the phone. Predictions about the effect of cell phone usage on driver distraction need to consider what other behavior is being displaced by the time spent on the phone. A focus by researchers, policy-makers, and the media on the distraction of using cell phones while driving may lead drivers to disregard the risk of other secondary behavior that is even more distracting.

Mapping pyrophilic percentages across the northeastern United States using witness trees, with focus on four national forests

Treesearch

Melissa A. Thomas-Van Gundy; Gregory J. Nowacki; Charles V. Cogbill

2015-01-01

Witness trees provide information fundamental for restoration ecology, often serving as baselines for forest composition and structure. Furthermore, when categorized by fire relations, witness trees can shed light on past disturbance regimes. Kriging was applied to witness-tree point data to form a contiguous surface of pyrophilic percentage for four national forests...

The Percentage of Supported Employees with Significant Disabilities Who Would Earn More in Sheltered Workshops

ERIC Educational Resources Information Center

Cimera, Robert Evert

2017-01-01

This study examined the percentage of 21,257 supported employees served by 74 state-federal vocational rehabilitation agencies in 2013 who would have earned more wages in sheltered workshops than in the community. It found that the overwhelming majority of supported employees earned more in their communities at all wage comparison points; however,…

Effects of dietary tannins on total and extractable nutrients from manure.

PubMed

Halvorson, J J; Kronberg, S L; Hagerman, A E

2017-08-01

The effects of condensed tannins on N dynamics in ruminants have been a topic of research for some time, but much less work has focused on their impacts on other nutrients in manure. A 4 × 4 Latin square trial was used to determine if intake of sericea lespedeza (; SL; a condensed tannin source), at 0, 10, 20, or 40% of the diet (as-fed basis), would affect concentrations of nutrients in manure and patterns of total excretion when offered with alfalfa (; ALF) to sheep. With SL additions, average daily manure production increased linearly ( ≤ 0.01), from 40 to 50% of the diet mass. The concentrations of total C, total N, soluble P, total and soluble Na, total and soluble S, total and soluble Mn, and total and soluble B in feces increased ( ≤ 0.05) while soluble N, total Ca, total and soluble Mg, soluble Zn, total and soluble Fe, total and soluble Cu decreased ( ≤ 0.02). Total P, total and soluble K, soluble Ca, and total Zn were less affected ( > 0.05). Comparing diets containing 0 to 40% SL, average daily outputs of total C, total N, soluble P, soluble K, total and soluble Na, and total Mn increased linearly ( ≤ 0.01) by 42.0, 71.2, 93.3, 45.2, 111, 148, and 52.4 percentage points, respectively. Total K, total and soluble S, soluble Mn, and total and soluble B increased quadratically ( ≤ 0.02) by 26.1, 52.3, 26.7, 147, 100, and 19.5 percentage points, respectively. Conversely, outputs of soluble Zn and total Fe decreased linearly ( ≤ 0.01), by -51.5 and -24.8 percentage points, while total Ca, total and soluble Mg, soluble Fe, and soluble Cu decreased quadratically ( ≤ 0.05) by -15.7, -12.3, -40.0, -89.9, and -60.3 percentage points, respectively. Outputs of soluble N, total P, soluble Ca, total Zn, and total Cu remained unchanged ( ≥ 0.14). Ratios of manure outputs to feed inputs for C, N, K, and B increased ( ≤ 0.02) but those for P and Mg were unchanged ( ≥ 0.10). Ratios of soluble to total manure outputs (S:O) increased ( ≤ 0.01) for P, Ca, Na, Mn; decreased ( ≤ 0.05) for N, S, Mg, Zn, Fe, Cu, and B; and were unaffected by treatment ( ≤ 0.16) for K. Decreasing S:O ratios are consistent with the formation of complexes that adsorb these nutrients to insoluble fiber fractions of manure and could thus affect mineralization rates. This study suggests that dietary tannins, found in forages like SL, can alter the concentrations, total excretion rates and throughput efficiency of nutrients in manure.

Ability of dairy cows to ensure pregnancy according to breed and genetic merit for production traits under contrasted pasture-based systems.

PubMed

Bedere, N; Disenhaus, C; Ducrocq, V; Leurent-Colette, S; Delaby, L

2017-04-01

The present study aimed to assess and measure the effects of breed, genetic merit for production traits, and feeding systems (FS) on the ability of dairy cows to ensure pregnancy through its components (fertilization, embryonic losses, recalving). An experiment was conducted over 9 yr on Normande and Holstein cows assigned to contrasted FS. Diets were based on maize silage in winter and grazing plus concentrate in spring in the high FS group, and on grass silage in winter and grazing with no concentrate during spring in the low FS group. Within breeds, cows were classified into 2 groups with similar estimated breeding values (EBV) for milk solids: cows with high EBV for milk yield were included in a milk group and those with high EBV for fat and protein contents were included in a content group. Holstein cows produced more milk throughout lactation than Normande cows (the differential was greater in the high FS group, +2,294 kg, compared with +1,280 kg in the low FS group) and lost more body condition to nadir (the differential was greater in the high FS group, -1.00 point, compared with -0.80 point in the low FS group). Within breeds, milk solids production was similar between genetic groups. Cows in the high FS group produced more milk (+2,495 kg for Holstein and +1,481 kg for Normande cows) and had a higher body condition score at nadir (+0.40 point for Holstein and +0.60 point for Normande) than cows in the low FS group. Holstein cows had a lower recalving rate than Normande cows (-19 percentage units). We found no effect of genetic group and FS on fertility of Normande cows. However, according to FS, Holstein cows in the content group exhibited different fertility failure patterns. In the low FS group, Holstein cows in the content group had more nonfertilizations or early embryo mortality (+26 percentage units at first and second services) than Holstein cows in the milk group. In the high FS group, Holstein cows in the content group had a higher proportion of late embryo mortality than in the milk group (+10 percentage units at first and second services). We observed no effect of FS on recalving rate; however, indicators of energy balance (protein content or body condition score) were positively associated with successful conception and pregnancy. This suggested a link between genetic merit for fat and protein content and lower ability of dairy cows to ensure pregnancy because of more nonfertilizations and early or late embryo mortality. Copyright © 2017 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Effect of biotin supplementation on meat quality of F1 Wagyu/Black Angus feedlot steers of known genotype.

PubMed

Lawrence, R J; Doyle, J C; Elliott, R; Norton, B W; Loxton, I

2007-10-01

Biotin (D-biotin) was supplemented to F1 Wagyu/Black Angus steers fed a wheat-based ration to evaluate the effect on meat quality. One hundred and eight steers of known Wagyu sire lines were assigned to three biotin treatments (0, 10 and 20mg/head/day) with each treatment replicated four times using an unfasted liveweight of 410.5kg (±24.42 SD). Biotin supplementation had no effect (P>0.05) on beef marbling standard at either the 5/6th or 10/11th rib quartering site, 10/11th rib intra-muscular fat percentage, intra-muscular fat fatty acid composition or adipose melting points. Wagyu genotype had an effect (P<0.05) on beef marbling standard and intra-muscular fat percentage at the 10/11th rib, inter-muscular and intra-muscular melting point and fatty acid composition of intra-muscular fat. A significant (P<0.001) but poor correlation existed between beef marbling standard and intra-muscular fat percentage (R(2)=0.198). Total conjugated linoleic acid had a highly significantly (P<0.0001) positive correlation to intra-muscular fat percentage (R(2)=0.446).

Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome.

PubMed

Devinsky, Orrin; Cross, J Helen; Laux, Linda; Marsh, Eric; Miller, Ian; Nabbout, Rima; Scheffer, Ingrid E; Thiele, Elizabeth A; Wright, Stephen

2017-05-25

The Dravet syndrome is a complex childhood epilepsy disorder that is associated with drug-resistant seizures and a high mortality rate. We studied cannabidiol for the treatment of drug-resistant seizures in the Dravet syndrome. In this double-blind, placebo-controlled trial, we randomly assigned 120 children and young adults with the Dravet syndrome and drug-resistant seizures to receive either cannabidiol oral solution at a dose of 20 mg per kilogram of body weight per day or placebo, in addition to standard antiepileptic treatment. The primary end point was the change in convulsive-seizure frequency over a 14-week treatment period, as compared with a 4-week baseline period. The median frequency of convulsive seizures per month decreased from 12.4 to 5.9 with cannabidiol, as compared with a decrease from 14.9 to 14.1 with placebo (adjusted median difference between the cannabidiol group and the placebo group in change in seizure frequency, -22.8 percentage points; 95% confidence interval [CI], -41.1 to -5.4; P=0.01). The percentage of patients who had at least a 50% reduction in convulsive-seizure frequency was 43% with cannabidiol and 27% with placebo (odds ratio, 2.00; 95% CI, 0.93 to 4.30; P=0.08). The patient's overall condition improved by at least one category on the seven-category Caregiver Global Impression of Change scale in 62% of the cannabidiol group as compared with 34% of the placebo group (P=0.02). The frequency of total seizures of all types was significantly reduced with cannabidiol (P=0.03), but there was no significant reduction in nonconvulsive seizures. The percentage of patients who became seizure-free was 5% with cannabidiol and 0% with placebo (P=0.08). Adverse events that occurred more frequently in the cannabidiol group than in the placebo group included diarrhea, vomiting, fatigue, pyrexia, somnolence, and abnormal results on liver-function tests. There were more withdrawals from the trial in the cannabidiol group. Among patients with the Dravet syndrome, cannabidiol resulted in a greater reduction in convulsive-seizure frequency than placebo and was associated with higher rates of adverse events. (Funded by GW Pharmaceuticals; ClinicalTrials.gov number, NCT02091375 .).

The Relationship Between Heart Rate Reserve and Oxygen Uptake Reserve in Heart Failure Patients on Optimized and Non-Optimized Beta-Blocker Therapy

PubMed Central

Carvalho, Vitor Oliveira; Guimarães, Guilherme Veiga; Bocchi, Edimar Alcides

2008-01-01

BACKGROUND The relationship between the percentage of oxygen consumption reserve and percentage of heart rate reserve in heart failure patients either on non-optimized or off beta-blocker therapy is known to be unreliable. The aim of this study was to evaluate the relationship between the percentage of oxygen consumption reserve and percentage of heart rate reserve in heart failure patients receiving optimized and non-optimized beta-blocker treatment during a treadmill cardiopulmonary exercise test. METHODS A total of 27 sedentary heart failure patients (86% male, 50±12 years) on optimized beta-blocker therapy with a left ventricle ejection fraction of 33±8% and 35 sedentary non-optimized heart failure patients (75% male, 47±10 years) with a left ventricle ejection fraction of 30±10% underwent the treadmill cardiopulmonary exercise test (Naughton protocol). Resting and peak effort values of both the percentage of oxygen consumption reserve and percentage of heart rate reserve were, by definition, 0 and 100, respectively. RESULTS The heart rate slope for the non-optimized group was derived from the points 0.949±0.088 (0 intercept) and 1.055±0.128 (1 intercept), p<0.0001. The heart rate slope for the optimized group was derived from the points 1.026±0.108 (0 intercept) and 1.012±0.108 (1 intercept), p=0.47. Regression linear plots for the heart rate slope for each patient in the non-optimized and optimized groups revealed a slope of 0.986 (almost perfect) for the optimized group, but the regression analysis for the non-optimized group was 0.030 (far from perfect, which occurs at 1). CONCLUSION The relationship between the percentage of oxygen consumption reserve and percentage of heart rate reserve in patients on optimized beta-blocker therapy was reliable, but this relationship was unreliable in non-optimized heart failure patients. PMID:19060991

A comparison of four-sample slope-intercept and single-sample 51Cr-EDTA glomerular filtration rate measurements.

PubMed

Porter, Charlotte A; Bradley, Kevin M; McGowan, Daniel R

2018-05-01

The aim of this study was to verify, with a large dataset of 1394 Cr-EDTA glomerular filtration rate (GFR) studies, the equivalence of slope-intercept and single-sample GFR. Raw data from 1394 patient studies were used to calculate four-sample slope-intercept GFR in addition to four individual single-sample GFR values (blood samples taken at 90, 150, 210 and 270 min after injection). The percentage differences between the four-sample slope-intercept and each of the single-sample GFR values were calculated, to identify the optimum single-sample time point. Having identified the optimum time point, the percentage difference between the slope-intercept and optimal single-sample GFR was calculated across a range of GFR values to investigate whether there was a GFR value below which the two methodologies cannot be considered equivalent. It was found that the lowest percentage difference between slope-intercept and single-sample GFR was for the third blood sample, taken at 210 min after injection. The median percentage difference was 2.5% and only 6.9% of patient studies had a percentage difference greater than 10%. Above a GFR value of 30 ml/min/1.73 m, the median percentage difference between the slope-intercept and optimal single-sample GFR values was below 10%, and so it was concluded that, above this value, the two techniques are sufficiently equivalent. This study supports the recommendation of performing single-sample GFR measurements for GFRs greater than 30 ml/min/1.73 m.

Setting capitation payments in markets for health services

PubMed Central

Ellis, Randall P.; McGuire, Thomas G.

1987-01-01

Health maintenance organizations (HMO's) are paid a capitated amount for enrolled Medicare beneficiaries that is 95 percent of what these enrollees would be expected to cost in the fee-for-service sector. However, it appears that HMO enrollees are less costly than other Medicare beneficiaries. With a simulation model, we demonstrate that with a 95-percent pricing rule, any significant degree of biased selection leads to increased cost to the payer, even when HMO's are cost effective compared with the fee-for-service sector. Optimal pricing percentages from the point of view of cost minimization are considerably less than 95 percent. PMID:10312188

Changes in consumption of food away from home and intakes of energy and other nutrients among US working-age adults, 2005-2014.

PubMed

Todd, Jessica E

2017-12-01

To document changes in consumption of food away from home (FAFH) and intakes of selected nutrients by working-age adults between 2005-06 and 2013-14, covering the most recent recessionary period and recovery. Means were compared across survey rounds relative to 2005-06. Multivariate regression was used to account for changes in demographic characteristics over time. National Health and Nutrition Examination Survey (NHANES), 2005-2014. Working-age adults born in 1951-80 (n 12 129) and adolescents and young adults born in 1981-90 (n 5197) who reported day 1 dietary intake data. Approximately 34 % of energy consumed by working-age adults came from FAFH (14 % from fast foods) in 2005-06. Levels of FAFH consumption were lowest in 2009-10, at 28 and 11 % of energy from FAFH and fast foods, respectively. Percentage of energy from fast foods was 1·9 percentage points higher in 2013-14. Percentage of energy from saturated fat and total mg of cholesterol consumed were lower in 2009-14, while intake of fibre was higher in 2011-14. At-home foods had less saturated fat and more fibre in 2009-14. The greater the percentage of energy from FAFH in the day, the greater the intakes of fat and cholesterol. Percentage of energy from FAFH was highest among those born in 1981-90 and lowest among those born in 1951-60. FAFH is a significant source of energy, fat and cholesterol among working-age adults. Menu labelling may lower FAFH's energy content and make it easier for consumers to choose more healthful items.

Determination of heat capacity of ionic liquid based nanofluids using group method of data handling technique

NASA Astrophysics Data System (ADS)

Sadi, Maryam

2018-01-01

In this study a group method of data handling model has been successfully developed to predict heat capacity of ionic liquid based nanofluids by considering reduced temperature, acentric factor and molecular weight of ionic liquids, and nanoparticle concentration as input parameters. In order to accomplish modeling, 528 experimental data points extracted from the literature have been divided into training and testing subsets. The training set has been used to predict model coefficients and the testing set has been applied for model validation. The ability and accuracy of developed model, has been evaluated by comparison of model predictions with experimental values using different statistical parameters such as coefficient of determination, mean square error and mean absolute percentage error. The mean absolute percentage error of developed model for training and testing sets are 1.38% and 1.66%, respectively, which indicate excellent agreement between model predictions and experimental data. Also, the results estimated by the developed GMDH model exhibit a higher accuracy when compared to the available theoretical correlations.

Emergency Department Profits Are Likely To Continue As The Affordable Care Act Expands Coverage

PubMed Central

Wilson, Michael; Cutler, David

2014-01-01

To better understand the financial viability of hospital emergency departments (EDs), we created national estimates of the cost to hospitals of providing ED care and the associated hospital revenue using hospital financial reports and patient claims data from 2009. We then estimated the effect the Affordable Care Act (ACA) will have on the future profitability of providing ED care. We estimated that hospital revenue from ED care exceeded costs for that care by $6.1 billion in 2009, representing a profit margin of 7.8 percent (net revenue expressed as a percentage of total revenue). However, this is primarily because hospitals make enough profit on the privately insured ($17 billion) to cover underpayment from all other payer groups, such as Medicare, Medicaid, and unreimbursed care. Assuming current payer reimbursement rates, ACA reforms could result in an additional 4.4-percentage-point increase in profit margins for hospital-based EDs compared to what could be the case without the reforms. PMID:24799576

QRS slopes for assessment of myocardial damage in chronic chagasic patients

NASA Astrophysics Data System (ADS)

Pueyo, E.; Laciar, E.; Anzuola, E.; Laguna, P.; Jané, R.

2007-11-01

In this study the slopes of the QRS complex are evaluated for determination of the degree of myocardial damage in chronic chagasic patients. Previous studies have demonstrated the ability of the slope indices to reflect alterations in the conduction velocity of the cardiac impulse. Results obtained in the present study show that chronic chagasic patients have significantly flatter QRS slopes as compared to healthy subjects. Not only that but the extent of slope lessening turns out to be proportional to the degree of myocardial damage caused by the disease. Additionally, when incorporating the slope indices into a classification analysis together with other indices indicative of the presence of ventricular late potentials obtained from high resolution electrocardiography, results show that the percentages of correct classification increase up to 62.5%, which means eight points above the percentages obtained prior to incorporation of the slope indices. It can be concluded that QRS slopes have great potential for assessing the degree of severity associated with Chagas' disease.

Force-displacement differences in the lower extremities of young healthy adults between drop jumps and drop landings.

PubMed

Hackney, James M; Clay, Rachel L; James, Meredith

2016-10-01

We measured ground reaction force and lower extremity shortening in ten healthy, young adults in order to compare five trials of drop jumps to drop landings. Our dependent variable was the percentage of displacement (shortening) between the markers on the ASIS and second metatarsal heads on each LE, relative to the maximum shortening (100% displacement) for that trial at the point of greatest ground reaction force. We defined this as "percent displacement at maximum force" (%dFmax). The sample mean %dFmax was 0.73%±0.14% for the drop jumps, and 0.47%±0.09% for the drop landings. The mean within-subject difference score was 0.26%±0.20%. Two-tailed paired t test comparing %dFmax between the drop jump and drop landing yielded P=0.002. For all participants in this study, the %dFmax was greater in drop jumps than in drop landings. This indicates that in drop jumps, the point of maximum force and of maximum shortening was nearly simultaneous, compared to drop landings, where the point of maximum shortening followed that of maximum force by a greater proportion. This difference in force to displacement behavior is explained by linear spring behavior in drop jumps, and linear damping behavior in drop landings. Copyright © 2016 Elsevier B.V. All rights reserved.

34 CFR 200.16 - Starting points.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) Using data from the 2001-2002 school year, each State must establish starting points in reading/language... of proficient students in the school that represents 20 percent of the State's total enrollment among all schools ranked by the percentage of students at the proficient level. The State must determine...

40 CFR 63.652 - Emissions averaging provisions.

Code of Federal Regulations, 2012 CFR

2012-07-01

...; and (3) Emission points from which emissions are reduced by pollution prevention measures. Percentages... this section. (i) For a Group 1 emission point, the pollution prevention measure must reduce emissions...)(3)(ii) of this section. (ii) If a pollution prevention measure is used in conjunction with other...

Local and Cumulative Impervious Cover of Massachusetts Stream Basins

USGS Publications Warehouse

Brandt, Sara L.; Steeves, Peter A.

2009-01-01

Impervious surfaces such as paved roads, parking lots, and building roofs can affect the natural streamflow patterns and ecosystems of nearby streams. This dataset summarizes the percentage of impervious area for watersheds across Massachusetts by using a newly available statewide 1-m binary raster dataset of impervious surface for 2005. In order to accurately capture the wide spatial variability of impervious surface, it was necessary to delineate a new set of finely discretized basin boundaries for Massachusetts. This new set of basins was delineated at a scale finer than that of the existing 12-digit Hydrologic Unit Code basins (HUC-12s) of the national Watershed Boundary Dataset. The dataset consists of three GIS shapefiles. The Massachusetts nested subbasins and the hydrologic units data layers consist of topographically delineated boundaries and their associated percentage of impervious cover for all of Massachusetts except Cape Cod, the Islands, and the Plymouth-Carver region. The Massachusetts groundwater-contributing areas data layer consists of groundwater contributing-area boundaries for streams and coastal areas of Cape Cod and the Plymouth-Carver region. These boundaries were delineated by using groundwater-flow models previously published by the U.S. Geological Survey. Subbasin and hydrologic unit boundaries were delineated statewide with the exception of Cape Cod and the Plymouth-Carver Region. For the purpose of this study, a subbasin is defined as the entire drainage area upstream of an outlet point. Subbasins draining to multiple outlet points on the same stream are nested. That is, a large downstream subbasin polygon comprises all of the smaller upstream subbasin polygons. A hydrologic unit is the intervening drainage area between a given outlet point and the outlet point of the next upstream unit (Fig. 1). Hydrologic units divide subbasins into discrete, nonoverlapping areas. Each hydrologic unit corresponds to a subbasin delineated from the same outlet point; the hydrologic unit and the subbasin share the same unique identifier attribute. Because the same set of outlet points was used for the delineation of subbasins and hydrologic units, the linework for both data layers is identical; however, polygon attributes differ because for a given outlet point, the subbasin polygon area is the sum of all the upstream hydrologic units. Impervious surface summarized for a subbasin represents the percentage of impervious surface area of the entire upstream watershed, whereas the impervious surface for a hydrologic unit represents the percentage of impervious surface area for the intervening drainage area between two outlet points.

Dissolved-solids sources, loads, yields, and concentrations in streams of the conterminous United States

USGS Publications Warehouse

Anning, David W.; Flynn, Marilyn E.

2014-01-01

Results from the trend analysis and from the SPARROW model indicate that, compared to monitoring stations with no trends or decreasing trends, stations with increasing trends are associated with a smaller percentage of the predicted dissolved-solids load originating from geologic sources, and a larger percentage originating from urban lands and road deicers. Conversely, compared to stations with increasing trends or no trends, stations with decreasing trends have a larger percentage of the predicted dissolved-solids load originating from geologic sources and a smaller percentage originating from urban lands and road deicers. Stations with decreasing trends also have larger percentages of predicted dissolved-solids load originating from cultivated lands and pasture lands, compared to stations with increasing trends or no trends.

Uncertainty of exploitation estimates made from tag returns

USGS Publications Warehouse

Miranda, L.E.; Brock, R.E.; Dorr, B.S.

2002-01-01

Over 6,000 crappies Pomoxis spp. were tagged in five water bodies to estimate exploitation rates by anglers. Exploitation rates were computed as the percentage of tags returned after adjustment for three sources of uncertainty: postrelease mortality due to the tagging process, tag loss, and the reporting rate of tagged fish. Confidence intervals around exploitation rates were estimated by resampling from the probability distributions of tagging mortality, tag loss, and reporting rate. Estimates of exploitation rates ranged from 17% to 54% among the five study systems. Uncertainty around estimates of tagging mortality, tag loss, and reporting resulted in 90% confidence intervals around the median exploitation rate as narrow as 15 percentage points and as broad as 46 percentage points. The greatest source of estimation error was uncertainty about tag reporting. Because the large investments required by tagging and reward operations produce imprecise estimates of the exploitation rate, it may be worth considering other approaches to estimating it or simply circumventing the exploitation question altogether.

Reforming Access: Trends in Medicaid Enrollment for New Medicare Beneficiaries, 2008-2011.

PubMed

Keohane, Laura M; Rahman, Momotazur; Mor, Vincent

2016-04-01

To evaluate whether aligning the Part D low-income subsidy and Medicaid program enrollment pathways in 2010 increased Medicaid participation among new Medicare beneficiaries. Medicare enrollment records for years 2007-2011. We used a multinomial logistic model with state fixed effects to examine the annual change in limited and full Medicaid enrollment among new Medicare beneficiaries for 2 years before and after the reforms (2008-2011). We identified new Medicare beneficiaries in the years 2008-2011 and their participation in Medicaid based on Medicare enrollment records. The percentage of beneficiaries enrolling in limited Medicaid at the start of Medicare coverage increased in 2010 by 0.3 percentage points for individuals aging into Medicare and by 1.3 percentage points for those qualifying due to disability (p < .001). There was no significant difference in the size of enrollment increases between states with and without concurrent limited Medicaid eligibility expansions. Our findings suggest that streamlining financial assistance programs may improve Medicare beneficiaries' access to benefits. © Health Research and Educational Trust.

States With Medically Needy Pathways: Differences in Long-Term and Temporary Medicaid Entry for Low-Income Medicare Beneficiaries.

PubMed

Keohane, Laura M; Trivedi, Amal; Mor, Vincent

2017-10-01

Medically needy pathways may provide temporary catastrophic coverage for low-income Medicare beneficiaries who do not otherwise qualify for full Medicaid benefits. Between January 2009 and June 2010, states with medically needy pathways had a higher percentage of low-income beneficiaries join Medicaid than states without such programs (7.5% vs. 4.1%, p < .01). However, among new full Medicaid participants, living in a state with a medically needy pathway was associated with a 3.8 percentage point (adjusted 95% confidence interval [1.8, 5.8]) increase in the probability of switching to partial Medicaid and a 4.5 percentage point (adjusted 95% confidence interval [2.9, 6.2]) increase in the probability of exiting Medicaid within 12 months. The predicted risk of leaving Medicaid was greatest when new Medicaid participants used only hospital services, rather than nursing home services, in their first month of Medicaid benefits. Alternative strategies for protecting low-income Medicare beneficiaries' access to care could provide more stable coverage.

Accessibility to editorial information in Oral and Maxillofacial Surgery journals: The authors' point of view.

PubMed

Castelo-Baz, Pablo; Leira-Feijoo, Yago; Seoane-Romero, Juan Manuel; Varela-Centelles, Pablo; Seoane, Juan

2015-09-01

To evaluate the accessibility to editorial information in Oral & Maxillofacial Surgery journals. A cross-sectional study using the WOS-Web of Science database in three categories: "Surgery," "Otorhinolaryngology," and "Dentistry, Oral Surgery & Medicine" was designed. Journals were filtered by title and classified under three headings: OMFS specialty; OMFS subspecialty and related sciences; and multidisciplinary journals. Specialty scope (OMFS vs. other); impact factor; path for the manuscript; blinding policy; accessibility to reviewers' criteria; and percentage of acceptance. Only 46 of 330 journals met the inclusion criteria. All OMFS journals provided comprehensive information about the review process, compared to 5 of 27 (18.5%) of Oral Surgery and related sciences periodicals. Most specialty journals do not inform about the blind review mode used (20 of 33; 60.6%). Generally, information about the reviewers' assessment criteria is scarce, but is available from all OMFS journals, which also state the percentage of manuscript acceptance (100% vs. 14.8%). OMFS JCR journals provide adequate information about their editorial process in terms of path for the manuscript, accessibility to reviewers' criteria, and percentage of acceptance. Additional efforts are needed to increase accessibility to information about blinding policy and average time from submission to acceptance. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

The effect of wheelchair propulsion style on changes in time spent in extreme wrist orientations after a bout of fatiguing propulsion.

PubMed

Zukowski, Lisa A; Hass, Chris J; Shechtman, Orit; Christou, Evangelos A; Tillman, Mark D

2017-10-01

This study compared how wheelchair propulsion styles affect changes in percentage of time spent in extreme wrist orientations, which have been associated with median nerve injury, after a fatiguing bout of propulsion. Twenty novice, non-disabled adult males learned arcing (ARC) and semicircular (SEMI) propulsion styles and utilised each to perform a wheelchair fatigue protocol. ARC and SEMI did not significantly differ in terms of changes after the fatigue protocol in percentage of time spent in extreme flexion/extension or radial/ulnar deviation at the push phase beginning or end. A pattern was observed, although not significant, of greater increases in percentage of time spent in extreme wrist extension and ulnar deviation during the push phase beginning and ulnar deviation during the push phase end while utilising SEMI relative to ARC. This study evinces that individual differences are greater than observed changes in extreme wrist orientations for both propulsion styles. Practitioner Summary: How wheelchair propulsion styles change with fatigue in terms of extreme wrist orientations was examined. This study evinces that individual differences are greater than observed changes in extreme wrist orientations for both propulsion styles and point towards the need for future research on individual differences utilising propulsion styles.

Breastfeeding policy: a globally comparative analysis.

PubMed

Heymann, Jody; Raub, Amy; Earle, Alison

2013-06-01

To explore the extent to which national policies guaranteeing breastfeeding breaks to working women may facilitate breastfeeding. An analysis was conducted of the number of countries that guarantee breastfeeding breaks, the daily number of hours guaranteed, and the duration of guarantees. To obtain current, detailed information on national policies, original legislation as well as secondary sources on 182 of the 193 Member States of the United Nations were examined. Regression analyses were conducted to test the association between national policy and rates of exclusive breastfeeding while controlling for national income level, level of urbanization, female percentage of the labour force and female literacy rate. Breastfeeding breaks with pay are guaranteed in 130 countries (71%) and unpaid breaks are guaranteed in seven (4%). No policy on breastfeeding breaks exists in 45 countries (25%). In multivariate models, the guarantee of paid breastfeeding breaks for at least 6 months was associated with an increase of 8.86 percentage points in the rate of exclusive breastfeeding (P < 0.05). A greater percentage of women practise exclusive breastfeeding in countries where laws guarantee breastfeeding breaks at work. If these findings are confirmed in longitudinal studies, health outcomes could be improved by passing legislation on breastfeeding breaks in countries that do not yet ensure the right to breastfeed.

Elongation measurement using 1-dimensional image correlation method

NASA Astrophysics Data System (ADS)

Phongwisit, Phachara; Kamoldilok, Surachart; Buranasiri, Prathan

2016-11-01

Aim of this paper was to study, setup, and calibrate an elongation measurement by using 1- Dimensional Image Correlation method (1-DIC). To confirm our method and setup correctness, we need calibration with other methods. In this paper, we used a small spring as a sample to find a result in terms of spring constant. With a fundamental of Image Correlation method, images of formed and deformed samples were compared to understand the difference between deformed process. By comparing the location of reference point on both image's pixel, the spring's elongation were calculated. Then, the results have been compared with the spring constants, which were found from Hooke's law. The percentage of 5 percent error has been found. This DIC method, then, would be applied to measure the elongation of some different kinds of small fiber samples.

Wheat Ear Detection in Plots by Segmenting Mobile Laser Scanner Data

NASA Astrophysics Data System (ADS)

Velumani, K.; Oude Elberink, S.; Yang, M. Y.; Baret, F.

2017-09-01

The use of Light Detection and Ranging (LiDAR) to study agricultural crop traits is becoming popular. Wheat plant traits such as crop height, biomass fractions and plant population are of interest to agronomists and biologists for the assessment of a genotype's performance in the environment. Among these performance indicators, plant population in the field is still widely estimated through manual counting which is a tedious and labour intensive task. The goal of this study is to explore the suitability of LiDAR observations to automate the counting process by the individual detection of wheat ears in the agricultural field. However, this is a challenging task owing to the random cropping pattern and noisy returns present in the point cloud. The goal is achieved by first segmenting the 3D point cloud followed by the classification of segments into ears and non-ears. In this study, two segmentation techniques: a) voxel-based segmentation and b) mean shift segmentation were adapted to suit the segmentation of plant point clouds. An ear classification strategy was developed to distinguish the ear segments from leaves and stems. Finally, the ears extracted by the automatic methods were compared with reference ear segments prepared by manual segmentation. Both the methods had an average detection rate of 85 %, aggregated over different flowering stages. The voxel-based approach performed well for late flowering stages (wheat crops aged 210 days or more) with a mean percentage accuracy of 94 % and takes less than 20 seconds to process 50,000 points with an average point density of 16  points/cm2. Meanwhile, the mean shift approach showed comparatively better counting accuracy of 95% for early flowering stage (crops aged below 225 days) and takes approximately 4 minutes to process 50,000 points.

Paid maternity leave and breastfeeding practice before and after California's implementation of the nation's first paid family leave program.

PubMed

Huang, Rui; Yang, Muzhe

2015-01-01

California was the first state in the United States to implement a paid family leave (PFL) program in 2004. We use data from the Infant Feeding Practices Study to examine the changes in breastfeeding practices in California relative to other states before and after the implementation of PFL. We find an increase of 3-5 percentage points for exclusive breastfeeding and an increase of 10-20 percentage points for breastfeeding at several important markers of early infancy. Our study supports the recommendation of the Surgeon General to establish paid leave policies as a strategy for promoting breastfeeding. Copyright © 2014 Elsevier B.V. All rights reserved.

Effectiveness of vaccination recommendations versus mandates: Evidence from the hepatitis A vaccine.

PubMed

Lawler, Emily C

2017-03-01

I provide novel evidence on the effectiveness of two vaccination policies - simple non-binding recommendations to vaccinate versus mandates requiring vaccination prior to childcare or kindergarten attendance - in the context of the only disease whose institutional features permit a credible examination of both: hepatitis A. Using provider-verified immunization data I find that recommendations significantly increased hepatitis A vaccination rates among young children by at least 20 percentage points, while mandates increase rates by another 8 percentage points. These policies also significantly reduced population hepatitis A incidence. My results suggest a range of policy options for addressing suboptimally low population vaccination rates. Copyright © 2017 Elsevier B.V. All rights reserved.

Physical characteristics of stream subbasins in the Pomme de Terre River Basin, west-central Minnesota

USGS Publications Warehouse

Lorenz, D.L.; Payne, G.A.

1994-01-01

Data describing the physical characteristics of stream subbasins upstream from selected points on streams in the Pomme de Terre River Basin, located in west-central Minnesota, are presented in this report. The physical characteristics are the drainage area of the subbasin, the percentage area of the subbasin covered only by lakes, the percentage area of the subbasin covered by both lakes and wetlands, the main-channel length, and the main-channel slope. The points on the stream include outlets of subbasins of at least 5 square miles, outfalls of sewage treatment plants, and locations of U.S. Geological Survey low-flow, high-flow, and continuous-record gaging stations.

Using provider performance incentives to increase HIV testing and counseling services in Rwanda.

PubMed

de Walque, Damien; Gertler, Paul J; Bautista-Arredondo, Sergio; Kwan, Ada; Vermeersch, Christel; de Dieu Bizimana, Jean; Binagwaho, Agnès; Condo, Jeanine

2015-03-01

Paying for performance provides financial rewards to medical care providers for improvements in performance measured by utilization and quality of care indicators. In 2006, Rwanda began a pay for performance scheme to improve health services delivery, including HIV/AIDS services. Using a prospective quasi-experimental design, this study examines the scheme's impact on individual and couples HIV testing. We find a positive impact of pay for performance on HIV testing among married individuals (10.2 percentage points increase). Paying for performance also increased testing by both partners by 14.7 percentage point among discordant couples in which only one of the partners is an AIDS patient. Copyright © 2014. Published by Elsevier B.V.

Prenatal drug use and the production of infant health.

PubMed

Noonan, Kelly; Reichman, Nancy E; Corman, Hope; Dave, Dhaval

2007-04-01

We estimate the effect of illicit drug use during pregnancy on two measures of poor infant health: low birth weight and abnormal infant health conditions. We use data from a national longitudinal study of urban parents that includes postpartum interviews with mothers, hospital medical record data on the mothers and their newborns, and information about the neighborhood in which the mother resides. We address the potential endogeneity of prenatal drug use. Depending on how prenatal drug use is measured, we find that it increases low birth weight by 4-6 percentage points and that it increases the likelihood of an abnormal infant health condition by 7-12 percentage points. Copyright (c) 2006 John Wiley & Sons, Ltd.

Endovascular Therapy after Intravenous t-PA versus t-PA Alone for Stroke

PubMed Central

Broderick, Joseph P.; Palesch, Yuko Y.; Demchuk, Andrew M.; Yeatts, Sharon D.; Khatri, Pooja; Hill, Michael D.; Jauch, Edward C.; Jovin, Tudor G.; Yan, Bernard; Silver, Frank L.; von Kummer, Rüdiger; Molina, Carlos A.; Demaerschalk, Bart M.; Budzik, Ronald; Clark, Wayne M.; Zaidat, Osama O.; Malisch, Tim W.; Goyal, Mayank; Schonewille, Wouter J.; Mazighi, Mikael; Engelter, Stefan T.; Anderson, Craig; Spilker, Judith; Carrozzella, Janice; Ryckborst, Karla J.; Janis, L. Scott; Martin, Renée H.; Foster, Lydia D.; Tomsick, Thomas A.

2013-01-01

BACKGROUND Endovascular therapy is increasingly used after the administration of intravenous tissue plasminogen activator (t-PA) for patients with moderate-to-severe acute ischemic stroke, but whether a combined approach is more effective than intravenous t-PA alone is uncertain. METHODS We randomly assigned eligible patients who had received intravenous t-PA within 3 hours after symptom onset to receive additional endovascular therapy or intravenous t-PA alone, in a 2:1 ratio. The primary outcome measure was a modified Rankin scale score of 2 or less (indicating functional independence) at 90 days (scores range from 0 to 6, with higher scores indicating greater disability). RESULTS The study was stopped early because of futility after 656 participants had undergone randomization (434 patients to endovascular therapy and 222 to intravenous t-PA alone). The proportion of participants with a modified Rankin score of 2 or less at 90 days did not differ significantly according to treatment (40.8% with endovascular therapy and 38.7% with intravenous t-PA; absolute adjusted difference, 1.5 percentage points; 95% confidence interval [CI], −6.1 to 9.1, with adjustment for the National Institutes of Health Stroke Scale [NIHSS] score [8–19, indicating moderately severe stroke, or ≥20, indicating severe stroke]), nor were there significant differences for the predefined subgroups of patients with an NIHSS score of 20 or higher (6.8 percentage points; 95% CI, −4.4 to 18.1) and those with a score of 19 or lower (−1.0 percentage point; 95% CI, −10.8 to 8.8). Findings in the endovascular-therapy and intravenous t-PA groups were similar for mortality at 90 days (19.1% and 21.6%, respectively; P = 0.52) and the proportion of patients with symptomatic intracerebral hemorrhage within 30 hours after initiation of t-PA (6.2% and 5.9%, respectively; P = 0.83). CONCLUSIONS The trial showed similar safety outcomes and no significant difference in functional independence with endovascular therapy after intravenous t-PA, as compared with intravenous t-PA alone. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT00359424.) PMID:23390923

Online versus Live Delivery of Education to Pharmacists in a Large Multicentre Health Region: A Non-inferiority Assessment of Learning Outcomes.

PubMed

Taylor, Robert; Jung, Joanne; Loewen, Peter; Spencer, Carrie; Dossa, Anar; de Lemos, Jane

2013-07-01

The prevalence of online modules for continuing education in the health professions has been increasing in recent years. However, the effectiveness of online modules for pharmacist learning has not been thoroughly studied. The primary aim of this study was to determine if providing education to pharmacists through a self-paced enhanced online module was non-inferior to a face-to-face learning module with respect to knowledge application on the topic of postoperative insulin dosing. Secondary aims were to determine pharmacists' knowledge gain and retention, as well as their satisfaction with the modules. The participants in this prospective, randomized, parallel-group non-inferiority trial were pharmacists in a large multicentre health region. Outcomes were measured by comparing scores obtained on pre- and post-module knowledge-assessment questionnaires. A between-group difference in change on knowledge application scores of less than 25 percentage points was the predetermined non-inferiority margin. A total of 74 pharmacists consented to participate, 38 randomly assigned to use the enhanced online module and 36 to attend the face-to-face learning session. For questions examining knowledge application, the mean improvement achieved by the online learning group was 26 percentage points greater than that achieved by the face-to-face learning group (95% confidence interval [CI] 25 to 27; p < 0.001). For questions testing knowledge gain, the improvement achieved by the online learning group was 7 percentage points less than that achieved by the face-to-face learning group (95% CI 2 to 12; p = 0.008). Therefore, the enhanced online module was deemed to be non-inferior to the face-to-face learning session in terms of knowledge application and knowledge gain. Insufficient data were available to analyze the secondary outcome of knowledge retention over time. Participant satisfaction was similar for the 2 groups (p = 0.62). The self-paced enhanced online module was non-inferior to facilitated face-to-face learning in terms of improving application and knowledge of insulin dosing. Pharmacists had similar levels of satisfaction with the 2 modes of learning.

Impact of health insurance for tertiary care on postoperative outcomes and seeking care for symptoms: quasi-experimental evidence from Karnataka, India.

PubMed

Sood, Neeraj; Wagner, Zachary

2016-01-06

To evaluate the effects of a government insurance programme covering tertiary care for the poor in Karnataka, India--Vajpayee Arogyashree Scheme (VAS)--on treatment seeking and postoperative outcomes. Geographic regression discontinuity. 572 villages in Karnataka, India. 3478 households in 300 villages where VAS was implemented and 3486 households in 272 neighbouring matched villages ineligible for VAS. A government insurance programme that provided free tertiary care to households below the poverty line in half of villages in Karnataka from February 2010 to August 2012. Seeking treatment for symptoms, posthospitalisation well-being, occurrence of infections during hospitalisation and need for rehospitalisation. The prevalence of symptoms was nearly identical for households in VAS-eligible villages compared with households in VAS-ineligible villages. However, households eligible for VAS were 4.96 percentage points (95% CI 1 to 8.9; p=0.014) more likely to seek treatment for their symptoms. The increase in treatment seeking was more pronounced for symptoms of cardiac conditions, the condition most frequently covered by VAS. Respondents from VAS-eligible villages reported greater improvements in well-being after a hospitalisation in all categories assessed and they were statistically significant in 3 of the 6 categories (walking ability, pain and anxiety). Respondents eligible for VAS were 9.4 percentage points less likely to report any infection after their hospitalisation (95% CI -20.2 to 1.4; p=0.087) and 16.5 percentage points less likely to have to be rehospitalised after the initial hospitalisation (95% CI -28.7 to -4.3; p<0.01). Insurance for tertiary care increased treatment seeking among eligible households. Moreover, insured patients experienced better posthospitalisation outcomes, suggesting better quality of care received. These results suggest that there are several pathways through which tertiary care insurance could improve health, aside from increasing utilisation of the services that the programme directly subsidises. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

False positive rate of carbon monoxide saturation by pulse oximetry of emergency department patients.

PubMed

Weaver, Lindell K; Churchill, Susan K; Deru, Kayla; Cooney, Darryl

2013-02-01

Symptoms of carbon monoxide (CO) poisoning are non-specific. Diagnosis requires suspicion of exposure, confirmed by measuring ambient CO levels or carboxyhemoglobin (COHb). An FDA-approved pulse oximeter (Rad-57) can measure CO saturation (S(pCO)). The device accuracy has implications for clinical decision-making. From April 1 to August 15, 2008, study personnel measured S(pCO) and documented demographic factors at time of clinical blood draw, in a convenience sample of 1,363 subjects presenting to the emergency department at Intermountain Medical Center, Murray, Utah. The technician then assayed COHb. COHb and S(pCO) values were compared by subject; false positive or negative values were defined as S(pCO) at least 3 percentage points greater or less than COHb level, reported by the manufacturer to be ± 1 SD in performance. In 1,363 subjects, 613 (45%) were male, 1,141 (84%) were light-skinned, 14 in shock, 4 with CO poisoning, and 122 (9%) met the criteria for a false positive value (range 3-19 percentage points), while 247 (18%) met the criteria for a false negative value (-13 to -3 percentage points). Risks for a false positive S(pCO) reading included being female and having a lower perfusion index. Methemoglobin, body temperature, and blood pressure also appear to influence the S(pCO) accuracy. There was variability among monitors, possibly related to technician technique, as rotation of monitors among technicians was not enforced. While the Rad-57 pulse oximeter functioned within the manufacturer's specifications, clinicians using the Rad-57 should expect some S(pCO) readings to be significantly higher or lower than COHb measurements, and should not use S(pCO) to direct triage or patient management. An elevated S(pCO) could broaden the diagnosis of CO poisoning in patients with non-specific symptoms. However, a negative S(pCO) level in patients suspected of having CO poisoning should never rule out CO poisoning, and should always be confirmed by COHb. © 2013 Daedalus Enterprises.

Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest.

PubMed

Kudenchuk, Peter J; Brown, Siobhan P; Daya, Mohamud; Rea, Thomas; Nichol, Graham; Morrison, Laurie J; Leroux, Brian; Vaillancourt, Christian; Wittwer, Lynn; Callaway, Clifton W; Christenson, James; Egan, Debra; Ornato, Joseph P; Weisfeldt, Myron L; Stiell, Ian G; Idris, Ahamed H; Aufderheide, Tom P; Dunford, James V; Colella, M Riccardo; Vilke, Gary M; Brienza, Ashley M; Desvigne-Nickens, Patrice; Gray, Pamela C; Gray, Randal; Seals, Norman; Straight, Ron; Dorian, Paul

2016-05-05

Antiarrhythmic drugs are used commonly in out-of-hospital cardiac arrest for shock-refractory ventricular fibrillation or pulseless ventricular tachycardia, but without proven survival benefit. In this randomized, double-blind trial, we compared parenteral amiodarone, lidocaine, and saline placebo, along with standard care, in adults who had nontraumatic out-of-hospital cardiac arrest, shock-refractory ventricular fibrillation or pulseless ventricular tachycardia after at least one shock, and vascular access. Paramedics enrolled patients at 10 North American sites. The primary outcome was survival to hospital discharge; the secondary outcome was favorable neurologic function at discharge. The per-protocol (primary analysis) population included all randomly assigned participants who met eligibility criteria and received any dose of a trial drug and whose initial cardiac-arrest rhythm of ventricular fibrillation or pulseless ventricular tachycardia was refractory to shock. In the per-protocol population, 3026 patients were randomly assigned to amiodarone (974), lidocaine (993), or placebo (1059); of those, 24.4%, 23.7%, and 21.0%, respectively, survived to hospital discharge. The difference in survival rate for amiodarone versus placebo was 3.2 percentage points (95% confidence interval [CI], -0.4 to 7.0; P=0.08); for lidocaine versus placebo, 2.6 percentage points (95% CI, -1.0 to 6.3; P=0.16); and for amiodarone versus lidocaine, 0.7 percentage points (95% CI, -3.2 to 4.7; P=0.70). Neurologic outcome at discharge was similar in the three groups. There was heterogeneity of treatment effect with respect to whether the arrest was witnessed (P=0.05); active drugs were associated with a survival rate that was significantly higher than the rate with placebo among patients with bystander-witnessed arrest but not among those with unwitnessed arrest. More amiodarone recipients required temporary cardiac pacing than did recipients of lidocaine or placebo. Overall, neither amiodarone nor lidocaine resulted in a significantly higher rate of survival or favorable neurologic outcome than the rate with placebo among patients with out-of-hospital cardiac arrest due to initial shock-refractory ventricular fibrillation or pulseless ventricular tachycardia. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov number, NCT01401647.).

Impact of a personalised active labour market programme for persons with disabilities.

PubMed

Adamecz-Völgyi, Anna; Lévay, Petra Zsuzsa; Bördős, Katalin; Scharle, Ágota

2018-02-01

The paper estimates the impact of a supported employment programme implemented in Hungary. This is a non-experimental evaluation using a matching identification strategy supported by rich data on individual characteristics, personal employment and unemployment history and the local labour market situation. We use a time-window approach to ensure that programme participants and matched controls entered unemployment at the same point in time, and thus faced very similar labour market conditions. We find that the programme had a positive effect of 16 percentage points on the probability of finding a job among men and 25 percentage points among women. The alternative outcome indicator of not re-entering the unemployment registry shows somewhat smaller effects in the case of women. In comparison to similarly costly programmes that do not facilitate employment in the primary labour market, rehabilitation services represent a viable alternative.

Incidence of Molds on Pecan Nuts at Different Points During Harvesting

PubMed Central

Beuchat, L. R.

1975-01-01

Pecan nuts were selected at various points during routine harvesting, and nutmeats were analyzed for gross and internal fungal contamination and for the presence of Aspergillus flavus and A. parasiticus. Fungi were isolated from a large percentage of the nutmeats at all points of examination. No correlations could be made between increased incidence of fungi and particular harvesting procedures. PMID:808170

Effects of breastfeeding on postpartum weight loss among U.S. women

PubMed Central

Jarlenski, Marian P.; Bennett, Wendy L.; Bleich, Sara N.; Barry, Colleen L.; Stuart, Elizabeth A.

2014-01-01

Objective To evaluate the effects of breastfeeding on maternal weight loss in the 12 months postpartum among U.S. women. Methods Using data from a national cohort of U.S. women conducted in 2005-2007 (N=2,102), we employed propensity scores to match women who breastfed exclusively and non-exclusive for at least three months to comparison women who had not breastfed or breastfed for less than three months. Outcomes included postpartum weight loss at 3, 6, 9, and 12 months postpartum; and the probability of returning to pre-pregnancy body mass index (BMI) category and the probability of returning to pre-pregnancy weight. Results Compared to women who did not breastfeed or breastfed non-exclusively, exclusive breastfeeding for at least 3 months resulted in 3.2 pounds (95% CI: 1.4,4.7) greater weight loss at 12 months postpartum, a 6.0-percentage-point increase (95% CI: 2.3,9.7) in the probability of returning to the same or lower BMI category postpartum; and a 6.1-percentage-point increase (95% CI: 1.0,11.3) in the probability of returning to pre-pregnancy weight or lower postpartum. Non-exclusive breastfeeding did not significantly affect any outcomes. Conclusion Our study provides evidence that exclusive breastfeeding for at least three months has a small effect on postpartum weight loss among U.S. women. PMID:25284261

Effects of breastfeeding on postpartum weight loss among U.S. women.

PubMed

Jarlenski, Marian P; Bennett, Wendy L; Bleich, Sara N; Barry, Colleen L; Stuart, Elizabeth A

2014-12-01

The aim of this study is to evaluate the effects of breastfeeding on maternal weight loss in the 12months postpartum among U.S. women. Using data from a national cohort of U.S. women conducted in 2005-2007 (N=2102), we employed propensity scores to match women who breastfed exclusively and non-exclusive for at least three months to comparison women who had not breastfed or breastfed for less than three months. Outcomes included postpartum weight loss at 3, 6, 9, and 12months postpartum; and the probability of returning to pre-pregnancy body mass index (BMI) category and the probability of returning to pre-pregnancy weight. Compared to women who did not breastfeed or breastfed non-exclusively, exclusive breastfeeding for at least 3months resulted in 3.2 pound (95% CI: 1.4,4.7) greater weight loss at 12months postpartum, a 6.0-percentage-point increase (95% CI: 2.3,9.7) in the probability of returning to the same or lower BMI category postpartum; and a 6.1-percentage-point increase (95% CI: 1.0,11.3) in the probability of returning to pre-pregnancy weight or lower postpartum. Non-exclusive breastfeeding did not significantly affect any outcomes. Our study provides evidence that exclusive breastfeeding for at least three months has a small effect on postpartum weight loss among U.S. women. Copyright © 2014 Elsevier Inc. All rights reserved.

Changes in smoking prevalence in 16-17-year-old versus older adults following a rise in legal age of sale: findings from an English population study.

PubMed

Fidler, Jennifer A; West, Robert

2010-11-01

To assess smoking prevalence before and after the rise in legal age of sale of cigarettes in England and Wales from age 16 to age 18 in October 2007. A series of monthly cross-sectional household surveys: the 'Smoking Toolkit Study'. England. A total of 53, 322 adults aged 16 and over interviewed between October 2006 and May 2009, 1136 of whom were aged 16 or 17 years. Change in smoking prevalence from pre- to post-legislation, assessed by self-reported smoking status, among the 16-17-year-old group and older adults. The prevalence change following the legislation among those aged 16 and 17 was 7.1 percentage points (denominator=1136) compared with 2.4 percentage points (denominator=52,186) for older adults (odds ratio 1.36, P=0.024, 95% confidence interval=1.04-1.77 for the interaction). There was no difference within older age categories. There was a greater fall in prevalence in 16-17-year-olds following an increase in age of sale than in older age groups. This provides some support to the view that raising the age of sale can, at least in some circumstances, reduce smoking prevalence in younger age groups. © 2010 The Authors. Journal compilation © 2010 Society for the Study of Addiction.

Medicaid Adult Dental Benefits Increase Use Of Dental Care, But Impact Of Expansion On Dental Services Use Was Mixed.

PubMed

Singhal, Astha; Damiano, Peter; Sabik, Lindsay

2017-04-01

Dental coverage for adult enrollees is an optional benefit under Medicaid. Thirty-one states and the District of Columbia have expanded eligibility for Medicaid under the Affordable Care Act. Millions of low-income adults have gained health care coverage and, in states offering dental benefits, oral health coverage as well. Using data for 2010 and 2014 from the Behavioral Risk Factor Surveillance System, we examined the impact of Medicaid adult dental coverage and eligibility expansions on low-income adults' use of dental care. We found that low-income adults in states that provided dental benefits beyond emergency-only coverage were more likely to have had a dental visit in the past year, compared to low-income adults in states without such benefits. Among states that provided dental benefits and expanded their Medicaid program, regression-based estimates suggest that childless adults had a significant increase (1.8 percentage points) in the likelihood of having had a dental visit, while parents had a significant decline (8.1 percentage points). One possible explanation for the disparity is that after expansion, newly enrolled childless adults might have exhausted the limited dental provider capacity that was available to parents before expansion. Additional policy-level efforts may be needed to expand the dental care delivery system's capacity. Project HOPE—The People-to-People Health Foundation, Inc.

The Effect of the MassHealth Hospital Pay-for-Performance Program on Quality

PubMed Central

Ryan, Andrew M; Blustein, Jan

2011-01-01

Objective To test the effect of Massachusetts Medicaid's (MassHealth) hospital-based pay-for-performance (P4P) program, implemented in 2008, on quality of care for pneumonia and surgical infection prevention (SIP). Data Hospital Compare process of care quality data from 2004 to 2009 for acute care hospitals in Massachusetts (N = 62) and other states (N = 3,676) and American Hospital Association data on hospital characteristics from 2005. Study Design Panel data models with hospital fixed effects and hospital-specific trends are estimated to test the effect of P4P on composite quality for pneumonia and SIP. This base model is extended to control for the completeness of measure reporting. Further sensitivity checks include estimation with propensity-score matched control hospitals, excluding hospitals in other P4P programs, varying the time period during which the program was assumed to have an effect, and testing the program effect across hospital characteristics. Principal Findings Estimates from our preferred specification, including hospital fixed effects, trends, and the control for measure completeness, indicate small and nonsignificant program effects for pneumonia (−0.67 percentage points, p>.10) and SIP (−0.12 percentage points, p>.10). Sensitivity checks indicate a similar pattern of findings across specifications. Conclusions Despite offering substantial financial incentives, the MassHealth P4P program did not improve quality in the first years of implementation. PMID:21210796

Early Medicaid Expansion in Connecticut Stemmed the Growth in Hospital Uncompensated Care

PubMed Central

Nikpay, Sayeh; Buchmueller, Thomas; Levy, Helen

2015-01-01

As states continue to debate whether or not to expand Medicaid under the Affordable Care Act (ACA), a key consideration is the impact of expansion on the financial position of hospitals, including their burden of uncompensated care. Conclusive evidence from coverage expansions that occurred in 2014 is several years away. In the meantime, we analyzed the experience of hospitals in Connecticut, which expanded Medicaid coverage to a large number of childless adults in April 2010 under the ACA. With hospital-level panel data from Medicare cost reports, we used difference-in-differences analyses to compare the change in Medicaid volume and uncompensated care in the period 2007–13 in Connecticut to changes in other Northeastern states. We found that early Medicaid expansion in Connecticut was associated with an increase in Medicaid discharges of 7 to 9 percentage points, relative to a baseline rate of 11 percent, and 7 to 8 percentage point increase in Medicaid revenue as a share of total revenue, relative to baseline share of 9.5 percent.. Also, in contrast to the national and regional trends of increasing uncompensated care during this period, hospitals in Connecticut experienced no increase in uncompensated care. We conclude that uncompensated care in Connecticut was roughly one-third lower than what it would have been without early Medicaid expansion. The results suggest that ACA Medicaid expansions could reduce hospitals’ uncompensated care burden. PMID:26153312

Risk of iron overload is decreased in beating heart coronary artery surgery compared to conventional bypass.

PubMed

Mumby, S; Koh, T W; Pepper, J R; Gutteridge, J M

2001-11-29

Conventional cardiopulmonary bypass surgery (CCPB) increases the iron loading of plasma transferrin often to a state of plasma iron overload, with the presence of low molecular mass iron. Such iron is a potential risk factor for oxidative stress and microbial virulence. Here we assess 'off-pump' coronary artery surgery on the beating heart for changes in plasma iron chemistry. Seventeen patients undergoing cardiac surgery using the 'Octopus' myocardial wall stabilisation device were monitored at five time points for changes in plasma iron chemistry. This group was further divided into those (n=9) who had one- or two- (n=8) vessel grafts, and compared with eight patients undergoing conventional coronary artery surgery. Patients undergoing beating heart surgery had significantly lower levels of total plasma non-haem iron, and a decreased percentage saturation of their transferrin at all time points compared to conventional bypass patients. Plasma iron overload occurred in only one patient undergoing CCPB. Beating heart surgery appears to decrease red blood cell haemolysis, and tissue damage during the operative procedures and thereby significantly decreases the risk of plasma iron overload associated with conventional bypass.

A Prospective Observational Comparison Between Arm and Wrist Blood Pressure During Scheduled Cesarean Delivery.

PubMed

Sebbag, Ilana; Massey, Simon R; Albert, Arianne Y K; Dube, Alison; Gunka, Vit; Douglas, M Joanne

2015-09-01

Shivering is common during cesarean delivery (CD) under neuraxial anesthesia and may disrupt the measurement of noninvasive blood pressure (BP). BP measured at the wrist may be less affected by shivering. There have been no studies comparing trends in BP measured on the upper arm and wrist. We hypothesized that wrist systolic blood pressure (sBP) would accurately trend with upper arm sBP measurements (agree within a limit of ±10%) in parturients undergoing elective CD under spinal anesthesia or combined spinal-epidural anesthesia. After initiation of spinal anesthesia, BP measurements were obtained simultaneously from the upper arm and wrist on opposite arms. The interval between measurements was 1 to 2 minutes, and data were collected for 20 minutes or until delivery. The primary outcome was agreement in dynamic changes in sBP measurements between the upper arm and the wrist. Bland-Altman plots indicating the levels of agreement between the methods were drawn for baseline measurements, over multiple measurements, and over multiple measurements on percentage change from baseline. Forty-nine patients were recruited and completed the study. The wrist sBP tended to overestimate the upper sBP for both baseline data (sBP bias = 13.4 mm Hg; 95% confidence interval = +10.4 to +16.4 mm Hg) and data obtained over multiple measurements (sBP bias = 12.8 mm Hg; 95% confidence interval = +9.3 to +16.3 mm Hg). For change in sBP from baseline over multiple measurements, the mean difference between the wrist and the arm sBP was -0.2 percentage points (99% limits of agreement -25 to +25 percentage points). The wrist measurement overestimated the reading relative to the upper arm measurement for multiple measurements over time. However, when the time series for each subject was examined for percentage change from baseline, the 2 methods mirrored each other in most cases. Nevertheless, our hypothesis was rejected as the limits of agreement were higher than ±10%. This finding suggests that wrist BP may not be an accurate method of detecting hypotension or hypertension during spinal or combined spinal-epidural anesthesia for CD.

[Correlation between body fat percentage and general obesity indexes in middle aged and old people in Guangzhou].

PubMed

Hu, Q; Jiang, C Q; Zhang, W S; Cheng, J J; Xu, L; Jin, Y L; Rao, S L; Zheng, H Q; Lam, D Q

2016-10-10

Objective: To examine the correlation between body fat percentage (BFP) and general obesity indexes, including body mass index (BMI), waist circumference (WC) and waist to hip ratio (WHR) and calculate the corresponding BFP cutoff values in the middle aged and old people in Guangzhou. The corresponding cut-point of optimal body fat percentage for Guangzhou older population. Methods: Based on the Guangzhou Biobank Cohort Study (GBCS), 3 490 relatively healthy Guangzhou residents aged ≥50 years were selected and were randomly divided into 2 groups. The equations between BFP and BMI, WC, WHR were set up with Curve fitting analysis in one group. The multiple regression analysis was undertaken to establish predictive equations between BFP and BMI, WC, WHR with stepwise model for adding gender, age, physical activity, drinking and smoking. Then, the optimal cut-points of BFP corresponding to BMI, WC and WHR to reflect the degree of obesity were calculated. The equations were then validated with another group. Results: BFP increased with the increase of WHR, WC and BMI. BMI was a better predictor of body fat percentage than WC and WHR. The final regression equation was BFP=(-23.47 -8.87×sex) +2.94× (BMI) - 0.024 × (BMI) 2 ,the coefficient of determination was 0.805. Based on the equation, the BFP corresponding to overweight/obesity (24 kg/m 2 ≤BMI<28 kg/m 2 ) were 24.3 % ≤BFP<31.1 % in men and 33.2 % ≤BFP<40.0 % in women, respectively. BMI had a better consistency with BFP in identify obesity compared with WC and WHR, obtained the area of ROC 0.909 in men and 0.919 in women respectively. The sensitivity and specificity were 70.3 % and 85.5 % in men; and 75.2 % and 93.0 % in women respectively. Conclusion: BFP has a better correlation with BMI. The study results indicated that BFP for middle aged and old males and females in Guangzhou corresponding to overweight/obesity (BMI≥24 kg/m 2 ) were <24.0 % and <33.0 % respectively.

Plain cigarette packs do not exert Pavlovian to instrumental transfer of control over tobacco-seeking

PubMed Central

Hogarth, Lee; Maynard, Olivia M; Munafò, Marcus R

2015-01-01

Aims To gain insight into the potential impact of plain tobacco packaging policy, two experiments were undertaken to test whether ‘prototype’ plain compared with branded UK cigarette pack stimuli would differentially elicit instrumental tobacco-seeking in a nominal Pavlovian to instrumental transfer (PIT) procedure. Design, Setting and Participants Two experiments were undertaken at the University of Bristol UK, with a convenience sample of adult smokers (experiment 1, n = 23, experiment 2, n = 121). Measurement In both experiments, smokers were trained on a concurrent choice procedure in which two responses earned points for cigarettes and chocolate, respectively, before images of branded and plain packs were tested for capacity to elicit the tobacco-seeking response in extinction. The primary outcome was percentage choice of the tobacco- over the chocolate-seeking response in plain pack, branded pack and no-stimulus conditions. Findings Both experiments found that branded packs primed a greater percentage of tobacco-seeking (overall mean = 62%) than plain packs (overall mean = 53%) and the no-stimulus condition (overall mean = 52%; Ps ≤ 0.01, ŋp2s ≥ 0.16), and that there was no difference in percentage tobacco-seeking between plain packs and the no-stimulus condition (Ps ≥ 0.17, ŋp2s ≤ 0.04). Plain tobacco packs showed an overall 9% reduction in the priming of a tobacco choice response compared to branded tobacco packs. Conclusions Plain packaging may reduce smoking in current smokers by degrading cue-elicited tobacco-seeking. PMID:25292280

Subprimal purchasing and merchandising decisions for pork: relationship to retail value.

PubMed

Lorenzen, C L; Walter, J P; Dockerty, T R; Griffin, D B; Johnson, H K; Savell, J W

1996-01-01

To assess retail value and profitability, cutting test data were obtained in a simulated retail cutting room for boxed pork subprimals, bone-in loins (n = 180), boneless loins (n = 94), Boston butts (n = 148), fresh hams (n = 28), and boneless hams (n = 23). Processing times (seconds) and retail weights (kilograms) were used to determine relative value. Cutting style affected (P < .05) value differential (US$/subprimal) for bone-in and boneless loins. When cutting styles within subprimals were pooled, value differential was affected (P < .05) by purchasing specification for bone-in loins, boneless loins, Boston butts, and inside fresh hams. Processing bone-in loins to a boneless end point produced a greater (P < .05) value differential and percentage of gross margin than a bone-in retail end point. Bone-in loins fabricated to a boneless retail end point produced a greater (P < .05) value differential and percentage of gross margin than boneless loins fabricated to the same end point. The increase in retail value can be attributed to the increased number and weight of retail cuts produced from bone-in loins. The thick, boneless loin cutting style produced a greater (P < .05) value differential and percentage of gross margin as a result of a lower (P < .05) cost of fabrication and increased value of retail cuts than the thin, boneless cutting style. In general, boneless pork cutting methods were more profitable than bone-in cutting methods regardless of subprimal.

The double burden of malnutrition in indigenous and nonindigenous Guatemalan populations.

PubMed

Ramirez-Zea, Manuel; Kroker-Lobos, Maria F; Close-Fernandez, Regina; Kanter, Rebecca

2014-12-01

As the prevalence of obesity increases in developing countries, the double burden of malnutrition (DBM) has become a public health problem, particularly in countries such as Guatemala with a high concentration of indigenous communities where the prevalence of stunting remains high. The aim was to describe and analyze the prevalence of DBM over time (1998-2008) in indigenous and nonindigenous Guatemalan populations. We used 3 National Maternal and Child Health Surveys conducted in Guatemala between 1998 and 2008 that include anthropometric data from children aged 0-60 mo and women of reproductive age (15-49 y). We assessed the prevalence of childhood stunting and both child and adult female overweight and obesity between 1998 and 2008. For the year 2008, we assessed the prevalence of DBM at the household (a stunted child and an overweight mother) and individual (stunting/short stature and overweight or anemia and overweight in the same individual) levels and compared the expected and observed prevalence rates to test if the coexistence of the DBM conditions corresponded to expected values. Between 1998 and 2008, the prevalence of childhood stunting decreased in both indigenous and nonindigenous populations, whereas overweight and obesity in women increased faster in indigenous populations than in nonindigenous populations (0.91% compared with 0.38%/y; P-trend < 0.01). In 2008, the prevalence of stunted children was 28.8 percentage points higher and of overweight women 4.6 percentage points lower in indigenous compared with nonindigenous populations (63.7% compared with 34.9% and 46.7% compared with 51.3%, respectively). DBM at the household and individual levels was higher in indigenous populations and was higher in geographic areas in which most of the population was indigenous, where there was also a greater prevalence of stunting and DBM at the individual level, both in women and children. In Guatemala, DBM is more prevalent in indigenous than in nonindigenous populations at the household and individual levels. To enhance effectiveness, current strategies of national policies and programs should consider DBM and focus on indigenous populations. © 2014 American Society for Nutrition.

Does Medicaid Managed Care Help Equalize Racial and Ethnic Disparities in Utilization?

PubMed

Marton, James; Yelowitz, Aaron; Shores, Meredith; Talbert, Jeffery C

2016-06-01

To estimate the impact of different forms of Medicaid managed care (MMC) delivery on racial and ethnic disparities in utilization. Longitudinal, administrative data on 101,649 children in Kentucky continuously enrolled in Medicaid between January 1997 and June 1999. Outcomes considered are monthly professional, outpatient, and inpatient utilization. We apply an intent-to-treat, instrumental variables analysis using the staggered geographic implementation of MMC to create treatment and control groups of children. The implementation of MMC reduced monthly professional visits by a smaller degree for non-whites than whites (3.8 percentage points vs. 6.2 percentage points), thereby helping to equalize the initial racial/ethnic disparity in utilization. The Passport MMC program in the Louisville-centered region statistically significantly reduced disparities for professional visits (closing the gap by 8.0 percentage points), while the Kentucky Health Select MMC program in the Lexington-centered region did not. No substantive impact on disparities was found for either outpatient or inpatient utilization in either program. We find evidence that MMC has the possibility to reduce racial/ethnic disparities in professional utilization. More work is needed to determine which managed care program characteristics drive this result. © 2015 The Authors. Health Services Research published by Wiley Periodicals, Inc. on behalf of Health Research and Educational Trust.

Children's health insurance program premiums adversely affect enrollment, especially among lower-income children.

PubMed

Abdus, Salam; Hudson, Julie; Hill, Steven C; Selden, Thomas M

2014-08-01

Both Medicaid and the Children's Health Insurance Program (CHIP), which are run by the states and funded by federal and state dollars, offer health insurance coverage for low-income children. Thirty-three states charged premiums for children at some income ranges in CHIP or Medicaid in 2013. Using data from the 1999-2010 Medical Expenditure Panel Surveys, we show that the relationship between premiums and coverage varies considerably by income level and by parental access to employer-sponsored insurance. Among children with family incomes above 150 percent of the federal poverty level, a $10 increase in monthly premiums is associated with a 1.6-percentage-point reduction in Medicaid or CHIP coverage. In this income range, the increase in uninsurance may be higher among those children whose parents lack an offer of employer-sponsored insurance than among those whose parents have such an offer. Among children with family incomes of 101-150 percent of poverty, a $10 increase in monthly premiums is associated with a 6.7-percentage-point reduction in Medicaid or CHIP coverage and a 3.3-percentage-point increase in uninsurance. In this income range, the increase in uninsurance is even larger among children whose parents lack offers of employer coverage. Project HOPE—The People-to-People Health Foundation, Inc.

Three-Year Impacts Of The Affordable Care Act: Improved Medical Care And Health Among Low-Income Adults.

PubMed

Sommers, Benjamin D; Maylone, Bethany; Blendon, Robert J; Orav, E John; Epstein, Arnold M

2017-06-01

Major policy uncertainty continues to surround the Affordable Care Act (ACA) at both the state and federal levels. We assessed changes in health care use and self-reported health after three years of the ACA's coverage expansion, using survey data collected from low-income adults through the end of 2016 in three states: Kentucky, which expanded Medicaid; Arkansas, which expanded private insurance to low-income adults using the federal Marketplace; and Texas, which did not expand coverage. We used a difference-in-differences model with a control group and an instrumental variables model to provide individual-level estimates of the effects of gaining insurance. By the end of 2016 the uninsurance rate in the two expansion states had dropped by more than 20 percentage points relative to the nonexpansion state. For uninsured people gaining coverage, this change was associated with a 41-percentage-point increase in having a usual source of care, a $337 reduction in annual out-of-pocket spending, significant increases in preventive health visits and glucose testing, and a 23-percentage-point increase in "excellent" self-reported health. Among adults with chronic conditions, we found improvements in affordability of care, regular care for those conditions, medication adherence, and self-reported health. Project HOPE—The People-to-People Health Foundation, Inc.

Impact of Different Policies on Unhealthy Dietary Behaviors in an Urban Adult Population: An Agent-Based Simulation Model

PubMed Central

Giabbanelli, Philippe J.; Arah, Onyebuchi A.; Zimmerman, Frederick J.

2014-01-01

Objectives. Unhealthy eating is a complex-system problem. We used agent-based modeling to examine the effects of different policies on unhealthy eating behaviors. Methods. We developed an agent-based simulation model to represent a synthetic population of adults in Pasadena, CA, and how they make dietary decisions. Data from the 2007 Food Attitudes and Behaviors Survey and other empirical studies were used to calibrate the parameters of the model. Simulations were performed to contrast the potential effects of various policies on the evolution of dietary decisions. Results. Our model showed that a 20% increase in taxes on fast foods would lower the probability of fast-food consumption by 3 percentage points, whereas improving the visibility of positive social norms by 10%, either through community-based or mass-media campaigns, could improve the consumption of fruits and vegetables by 7 percentage points and lower fast-food consumption by 6 percentage points. Zoning policies had no significant impact. Conclusions. Interventions emphasizing healthy eating norms may be more effective than directly targeting food prices or regulating local food outlets. Agent-based modeling may be a useful tool for testing the population-level effects of various policies within complex systems. PMID:24832414

Zinc lozenges and the common cold: a meta-analysis comparing zinc acetate and zinc gluconate, and the role of zinc dosage.

PubMed

Hemilä, Harri

2017-05-01

To compare the efficacy of zinc acetate lozenges with zinc gluconate lozenges in common cold treatment and to examine the dose-dependency of the effect. Meta-analysis. Placebo-controlled zinc lozenge trials, in which the zinc dose was > 75 mg/day. The pooled effect of zinc lozenges on common cold duration was calculated by using inverse-variance random-effects method. Seven randomised trials with 575 participants with naturally acquired common colds. Duration of the common cold. The mean common cold duration was 33% (95% CI 21% to 45%) shorter for the zinc groups of the seven included trials. Three trials that used lozenges composed of zinc acetate found that colds were shortened by 40% and four trials that used zinc gluconate by 28%. The difference between the two salts was not significant: 12 percentage points (95% CI: -12 to + 36). Five trials used zinc doses of 80-92 mg/day, common cold duration was reduced by 33%, and two trials used zinc doses of 192-207 mg/day and found an effect of 35%. The difference between the high-dose and low-dose zinc trials was not significant: 2 percentage points (95% CI: -29 to + 32). Properly composed zinc gluconate lozenges may be as effective as zinc acetate lozenges. There is no evidence that zinc doses over 100 mg/day might lead to greater efficacy in the treatment of the common cold. Common cold patients may be encouraged to try zinc lozenges for treating their colds. The optimal lozenge composition and dosage scheme need to be investigated further.

Agreement Between Institutional Measurements and Treatment Planning System Calculations for Basic Dosimetric Parameters as Measured by the Imaging and Radiation Oncology Core-Houston

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kerns, James R.; Followill, David S.; Imaging and Radiation Oncology Core-Houston, The University of Texas Health Science Center-Houston, Houston, Texas

Purpose: To compare radiation machine measurement data collected by the Imaging and Radiation Oncology Core at Houston (IROC-H) with institutional treatment planning system (TPS) values, to identify parameters with large differences in agreement; the findings will help institutions focus their efforts to improve the accuracy of their TPS models. Methods and Materials: Between 2000 and 2014, IROC-H visited more than 250 institutions and conducted independent measurements of machine dosimetric data points, including percentage depth dose, output factors, off-axis factors, multileaf collimator small fields, and wedge data. We compared these data with the institutional TPS values for the same points bymore » energy, class, and parameter to identify differences and similarities using criteria involving both the medians and standard deviations for Varian linear accelerators. Distributions of differences between machine measurements and institutional TPS values were generated for basic dosimetric parameters. Results: On average, intensity modulated radiation therapy–style and stereotactic body radiation therapy–style output factors and upper physical wedge output factors were the most problematic. Percentage depth dose, jaw output factors, and enhanced dynamic wedge output factors agreed best between the IROC-H measurements and the TPS values. Although small differences were shown between 2 common TPS systems, neither was superior to the other. Parameter agreement was constant over time from 2000 to 2014. Conclusions: Differences in basic dosimetric parameters between machine measurements and TPS values vary widely depending on the parameter, although agreement does not seem to vary by TPS and has not changed over time. Intensity modulated radiation therapy–style output factors, stereotactic body radiation therapy–style output factors, and upper physical wedge output factors had the largest disagreement and should be carefully modeled to ensure accuracy.« less

Social networking technologies as emerging tools for HIV prevention: A Cluster Randomized Trial

PubMed Central

Young, Sean D.; Cumberland, William G.; Lee, Sung-Jae; Jaganath, Devan; Szekeres, Greg; Coates, Thomas

2013-01-01

Background Social networking technologies are an emerging tool for HIV prevention. Objective To determine whether social networking communities can increase HIV testing among African American and Latino men who have sex with men (MSM). Design Randomized; controlled trial with concealed allocation (ClinicalTrials.gov: NCT01701206). Setting Online. Patients 112 MSM based in Los Angeles, more than 85% of whom were African American or Latino. Intervention Sixteen peer leaders were randomly assigned to deliver information about HIV or general health to participants via Facebook groups over 12 weeks. After participants accepted a request to join the group, participation was voluntary. Group participation and engagement was monitored. Participants could request a free home-based HIV testing kit and completed questionnaires at baseline and 12-week follow-up. Measurements Participant acceptance of and engagement in the intervention and social network participation, rates of home-based HIV testing, and sexual risk behaviors. Results Almost 95% of intervention participants and 73% of control participants voluntarily communicated using the social platform. Twenty-five of the 57 intervention participants (44%) requested home-based HIV testing kits compared with 11 of 55 control participants (20%) (difference, 24 percentage points [95% CI, 8 to 41 percentage points]). Nine of the 25 intervention participants (36%) who requested the test took it and mailed it back compared with 2 of the 11 control participants (18%) who requested the test. Retention at study follow-up was more 93%. Limitations Only 2 Facebook communities were included for each group. Conclusions Social networking communities are acceptable and effective tools to increase home-based HIV testing among at-risk populations. Primary funding source National Institute of Mental Health ClinicalTrials.gov Identifier (NCT01701206) PMID:24026317

Effect of the Affordable Care Act Medicaid Expansion on Emergency Department Visits: Evidence From State-Level Emergency Department Databases.

PubMed

Nikpay, Sayeh; Freedman, Seth; Levy, Helen; Buchmueller, Tom

2017-08-01

We assess whether the expansion of Medicaid under the Patient Protection and Affordable Care Act (ACA) results in changes in emergency department (ED) visits or ED payer mix. We also test whether the size of the change in ED visits depends on the change in the size of the Medicaid population. Using all-capture, longitudinal, state data from the Agency for Healthcare Research and Quality's Fast Stats program, we implemented a difference-in-difference analysis, which compared changes in ED visits per capita and the share of ED visits by payer (Medicaid, uninsured, and private insurance) in 14 states that did and 11 states that did not expand Medicaid in 2014. Analyses controlled for state-level demographic and economic characteristics. We found that total ED use per 1,000 population increased by 2.5 visits more in Medicaid expansion states than in nonexpansion states after 2014 (95% confidence interval [CI] 1.1 to 3.9). Among the visit types that could be measured, increases in ED visits were largest for injury-related visits and for states with the largest changes in Medicaid enrollment. Compared with nonexpansion states, in expansion states the share of ED visits covered by Medicaid increased 8.8 percentage points (95% CI 5.0 to 12.6), whereas the uninsured share decreased by 5.3 percentage points (95% CI -1.7 to -8.9). The ACA's Medicaid expansion has resulted in changes in payer mix. Contrary to other studies of the ACA's effect on ED visits, our study found that the expansion also increased use of the ED, consistent with polls of emergency physicians. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

State Variation in Increased ADHD Prevalence: Links to NCLB School Accountability and State Medication Laws.

PubMed

Fulton, Brent D; Scheffler, Richard M; Hinshaw, Stephen P

2015-10-01

The study's objective was to investigate whether attention-deficit hyperactivity disorder (ADHD) diagnoses from 2003 to 2011 were associated with either public school consequential accountability reforms initiated by the No Child Left Behind (NCLB) Act, particularly for low-income children, or with state psychotropic medication laws that prohibit public schools from recommending or requiring medication use. Logistic regression difference-in-differences models were estimated with repeated U.S. and state-representative cross-sections of responses to the 2003, 2007, and 2011 National Survey of Children's Health. Each wave included approximately 35,000 public school children between ages six and 13. From 2003 to 2007, the change in adjusted diagnostic prevalence was 2.8 percentage points higher for children ages six to 13 in households with incomes ≤185% of the federal poverty level residing in states first exposed to consequential accountability through NCLB (from 8.5% to 13.2%), compared with demographically similar children residing in other states (from 10.2% to 12.1%). From 2003 to 2011, the change in adjusted diagnostic prevalence was 2.2 percentage points lower for children ages six to 13 residing in states with a psychotropic medication law (from 8.1% to 7.8%), compared with children residing in other states (from 8.1% to 10.1%). NCLB-initiated consequential accountability reforms were associated with more ADHD diagnoses among low-income children, consistent with increased academic pressures from NCLB for this subgroup. In contrast, psychotropic medication laws were associated with fewer ADHD diagnoses, because they may indirectly reduce diagnoses via restrictions on recommending or requiring medication use. Future research should investigate whether children most affected by these policies are receiving appropriate diagnoses.

The Impact of the Affordable Care Act's Dependent Coverage Mandate on Use of Dental Treatments and Preventive Services.

PubMed

Shane, Dan M; Wehby, George L

2017-09-01

Oral health problems are the leading chronic conditions among children and younger adults. Lack of dental coverage is thought to be an important barrier to care but little empirical evidence exists on the causal effect of private dental coverage on use of dental services. We explore the relationship between dental coverage and dental services utilization with an analysis of a natural experiment of increasing private dental coverage stemming from the Affordable Care Act's (ACA)-dependent coverage mandate. To evaluate whether increased private dental insurance due to the spillover effect of the ACA-dependent coverage health insurance mandate affected utilization of dental services among a group of affected young adults. 2006-2013 Medical Expenditure Panel Surveys. We used a difference-in-difference regression approach comparing changes in dental care utilization for 25-year olds affected by the policy to unaffected 27-year olds. We evaluate effects on dental treatments and preventive services RESULTS:: Compared to 27-year olds, 25-year olds were 8 percentage points more likely to have private dental coverage in the 3 years following the mandate. We do not find compelling evidence that young adults increased their use of preventive dental services in response to gaining insurance. We do find a nearly 5 percentage point increase in the likelihood of dental treatments among 25-year olds following the mandate, an effect that appears concentrated among women. Increases in private dental coverage due to the ACA's-dependent coverage mandate do not appear to be driving significant changes in overall preventive dental services utilization but there is evidence of an increase in restorative care.

Distribution of essential medicines to primary care institutions in Hubei of China: effects of centralized procurement arrangements.

PubMed

Yang, Lianping; Huang, Cunrui; Liu, Chaojie

2017-11-14

Poor distribution of essential medicines to primary care institutions has attracted criticism since China adopted provincial centralized regional tendering and procurement systems. This study evaluated the impact of new procurement arrangements that limit the number of distributors at the county level in Hubei province, China. Procurement ordering and distribution data were collected from four counties that pioneered a new distribution arrangement (commencing September 2012) compared with six counties that continued the existing arrangement over the period from August 2011 to September 2013. The new arrangement allowed primary care institutions and/or suppliers to select a local distributor from a limited panel (from 3 to 5) of government nominated distributors. Difference-in-differences analyses were performed to assess the impact of the new arrangements on delivery and receipt of essential medicines. Overall, the new distribution arrangement has not improved distribution of essential medicines to primary care institutions. On the contrary, we found a 7.78-19.85 percentage point (p < 0.01) decrease in distribution rates to rural primary care institutions. Similar results were demonstrated using the indicator of received rates, with a 7.89-19.65 percentage point (p < 0.01) decrease. Simply limiting the number of distributors does not offer a solution to the poor performance of delivery of essential medicines for primary care institutions, especially those located in rural areas. Procurement arrangements need to consider the special characteristics of rural facilities. In a county, there are more rural primary care institutions than urban ones. On average, rural primary care institutions demand more and are more geographically dispersed compared to their urban counterparts, which may impose increased distribution costs.

Not All Insurance Is Equal: Differential Treatment and Health Outcomes by Insurance Coverage Among Nonelderly Adult Patients With Heart Attack.

PubMed

Niedzwiecki, Matthew J; Hsia, Renee Y; Shen, Yu-Chu

2018-06-05

The Affordable Care Act has provided health insurance to a large portion of the uninsured in the United States. However, different types of health insurance provide varying amounts of reimbursements to providers, which may lead to different types of treatment, potentially worsening health outcomes in patients covered by low-reimbursement insurance plans, such as Medicaid. The objective was to determine differences in access, treatment, and health outcomes by insurance type, using hospital fixed effects. We conducted a multivariate regression analysis using patient-level data for nonelderly adult patients with acute myocardial infarction in California from January 1, 2001, to December 31, 2014, as well as hospital-level information to control for differences between hospitals. The probability of Medicaid-insured and uninsured patients having access to catheterization laboratory was higher by 4.50 and 3.75 percentage points, respectively, relative to privately insured patients. When controlling for access to percutaneous coronary intervention facilities, however, Medicaid-insured and uninsured patients had a 4.24- and 0.85-percentage point lower probability, respectively, in receiving percutaneous coronary intervention treatment compared with privately insured patients. They also had higher mortality and readmission rates relative to privately insured patients. Although Medicaid-insured and uninsured patients with acute myocardial infarction had better access to catheterization laboratories, they had significantly lower probabilities of receiving percutaneous coronary intervention treatment and a higher likelihood of death and readmission compared with privately insured patients. This provides empirical evidence that treatment received and health outcomes strongly vary between Medicaid-insured, uninsured, and privately insured patients, with Medicaid-insured patients most disproportionately affected, despite having better access to cardiac technology. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Trends in Special Education Eligibility Among Children With Autism Spectrum Disorder, 2002-2010.

PubMed

Rubenstein, Eric; Daniels, Julie; Schieve, Laura A; Christensen, Deborah L; Van Naarden Braun, Kim; Rice, Catherine E; Bakian, Amanda V; Durkin, Maureen S; Rosenberg, Steven A; Kirby, Russell S; Lee, Li-Ching

Although data on publicly available special education are informative and offer a glimpse of trends in autism spectrum disorder (ASD) and use of educational services, using these data for population-based public health monitoring has drawbacks. Our objective was to evaluate trends in special education eligibility among 8-year-old children with ASD identified in the Autism and Developmental Disabilities Monitoring Network. We used data from 5 Autism and Developmental Disabilities Monitoring Network sites (Arizona, Colorado, Georgia, Maryland, and North Carolina) during 4 surveillance years (2002, 2006, 2008, and 2010) and compared trends in 12 categories of special education eligibility by sex and race/ethnicity. We used multivariable linear risk regressions to evaluate how the proportion of children with a given eligibility changed over time. Of 6010 children with ASD, more than 36% did not receive an autism eligibility in special education in each surveillance year. From surveillance year 2002 to surveillance year 2010, autism eligibility increased by 3.6 percentage points ( P = .09), and intellectual disability eligibility decreased by 4.6 percentage points ( P < .001). A greater proportion of boys than girls had an autism eligibility in 2002 (56.3% vs 48.8%). Compared with other racial/ethnic groups, Hispanic children had the largest increase in proportion with autism eligibility from 2002 to 2010 (15.4%, P = .005) and the largest decrease in proportion with intellectual disability (-14.3%, P = .004). Although most children with ASD had autism eligibility, many received special education services under other categories, and racial/ethnic disparities persisted. To monitor trends in ASD prevalence, public health officials need access to comprehensive data collected systematically, not just special education eligibility.

Effects of covert subject actions on percent body fat by air-displacement plethsymography.

PubMed

Tegenkamp, Michelle H; Clark, R Randall; Schoeller, Dale A; Landry, Greg L

2011-07-01

Air-displacement plethysmography (ADP) is used for estimation of body composition, however, some individuals, such as athletes in weight classification sports, may use covert methods during ADP testing to alter their apparent percent body fat. The purpose of this study was to examine the effect of covert subject actions on percent body fat measured by ADP. Subjects underwent body composition analysis in the Bod Pod following the standard procedure using the manufacturer's guidelines. The subjects then underwent 8 more measurements while performing the following intentional manipulations: 4 breathing patterns altering lung volume, foot movement to disrupt air, hand cupping to trap air, and heat and cold exposure before entering the chamber. Increasing and decreasing lung volume during thoracic volume measurement and during body density measurement altered the percent body fat assessment (p < 0.001). High lung volume during thoracic gas measures overestimated fat by 3.7 ± 2.1 percentage points. Lowered lung volume during body volume measures overestimated body fat by an additional 2.2 ± 2.1 percentage points. The heat and cold exposure, tapping, and cupping treatments provided similar estimates of percent body fat when compared with the standard condition. These results demonstrate the subjects were able to covertly change their estimated ADP body composition value by altering breathing when compared with the standard condition. We recommend that sports conditioning coaches, athletic trainers, and technicians administering ADP should be aware of the potential effects of these covert actions. The individual responsible for administering ADP should remain vigilant during testing to detect deliberate altered breathing patterns by athletes in an effort to gain a competitive advantage by manipulating their body composition assessment.

Noninvasive Determination of Anaerobic Threshold Based on the Heart Rate Deflection Point in Water Cycling.

PubMed

Pinto, Stephanie S; Brasil, Roxana M; Alberton, Cristine L; Ferreira, Hector K; Bagatini, Natália C; Calatayud, Joaquin; Colado, Juan C

2016-02-01

This study compared heart rate (HR), oxygen uptake (VO2), percentage of maximal HR (%HRmax), percentage of maximal VO2, and cadence (Cad) related to the anaerobic threshold (AT) during a water cycling maximal test between heart rate deflection point (HRDP) and ventilatory (VT) methods. In addition, the correlations between both methods were assessed for all variables. The test was performed by 27 men in a cycle ergometer in an aquatic environment. The protocol started at a Cad of 100 b · min(-1) for 3 minutes with subsequent increments of 15 b · min(-1) every 2 minutes until exhaustion. A paired two-tailed Student's t-test was used to compare the variables between the HRDP and VT methods. The Pearson product-moment correlation test was used to correlate the same variables determined by the 2 methods. There was no difference in HR (166 ± 13 vs. 166 ± 13 b · min(-1)), VO2 (38.56 ± 6.26 vs. 39.18 ± 6.13 ml · kg(-1) · min(-1)), %HRmax (89.24 ± 3.84 vs. 89.52 ± 4.29%), VO2max (70.44 ± 7.99 vs. 71.64 ± 8.32%), and Cad (174 ± 14 b · min(-1) vs. 171 ± 8 b · min(-1)) related to AT between the HRDP and VT methods. Moreover, significant relationships were found between the methods to determine the AT for all variables analyzed (r = 0.57-0.97). The estimation of the HRDP may be a noninvasive and easy method to determine the AT, which could be used to adapt individualized training intensities to practitioners during water cycling classes.

Feeding behaviors during home-based treatment of moderate acute malnutrition using corn-soy blends or lipid-based nutrient supplements.

PubMed

Iuel-Brockdorf, Ann-Sophie; Ouedraogo, Albertine; Ritz, Christian; Draebel, Tania Aase; Ashorn, Per; Filteau, Suzanne; Michaelsen, Kim F

2017-10-01

Feeding behaviors have an important impact on children's nutritional status and are essential to consider when implementing nutrition programs. The objective of this study was to explore and compare feeding behaviors related to supplementary feeding with corn-soy blends (CSB) and lipid-based nutrient supplements (LNS) based on best practice feeding behaviors. The study was conducted as part of a randomized controlled trial assessing the effectiveness of new formulations of CSB and LNS and comprised 1,546 children from 6 to 23 months. The study included a mixed methods approach using questionnaires, focus group discussions and home visits and interviews with a subsample of 20 caretakers of trial participants. We found that LNS, compared to CSB, were more likely to be mixed into other foods (OR [95% CI] 1.7 [1.3-2.2], p = <.001), served with a meal (OR [95% CI] 1.6 [1.1-2.3], p = <.018)or between meals (OR [95% CI] 1.5 [1.1-1.9], p = <.005), and fed using an encouraging feeding style (mean difference in percentage points [95% CI] 23% [6%:40%], p = .01). CSB were more likely to be fed using a forced feeding style (mean difference in percentage points [95% CI] 18% [3%:33%], p = .02) and were often observed to be served unprepared. The main differences in feeding behaviors between the two diet groups were linked to how and when supplements were served. Educational instructions should therefore be adapted according to the supplement provided; when providing CSB, efforts should be made to promote an encouraging feeding style, and emphasis should be made to ensure preparations are made according to recommendations. © 2016 John Wiley & Sons Ltd.

Option A improved HIV-free infant survival and mother to child HIV transmission at 9-18 months in Zimbabwe.

PubMed

Buzdugan, Raluca; Kang Dufour, Mi-Suk; McCoy, Sandra I; Watadzaushe, Constancia; Dirawo, Jeffrey; Mushavi, Angela; Mujuru, Hilda Angela; Mahomva, Agnes; Kangwende, Rugare Abigail; Hakobyan, Anna; Mugurungi, Owen; Cowan, Frances M; Padian, Nancy S

2016-06-19

We evaluated the impact of Option A on HIV-free infant survival and mother-to-child transmission (MTCT) in Zimbabwe. Serial cross-sectional community-based serosurveys. We analyzed serosurvey data collected in 2012 and 2014 among mother-infant pairs from catchment areas of 132 health facilities from five of 10 provinces in Zimbabwe. Eligible infants (alive or deceased) were born 9-18 months before each survey to mothers at least 16 years old. We randomly selected mother-infant pairs and conducted questionnaires, verbal autopsies, and collected blood samples. We estimated the HIV-free infant survival and MTCT rate within each catchment area and compared the 2012 and 2014 estimates using a paired t test and number of HIV infections averted because of the intervention. We analyzed 7249 mother-infant pairs with viable maternal specimens collected in 2012 and 8551 in 2014. The mean difference in the catchment area level MTCT between 2014 and 2012 was -5.2 percentage points (95% confidence interval = -8.1, -2.3, P < 0.001). The mean difference in the catchment area level HIV-free survival was 5.5 percentage points (95% confidence interval = 2.6, 8.5, P < 0.001). Between 2012 and 2014, 1779 infant infections were averted compared with the pre-Option A regimen. The association between HIV-free infant survival and duration of Option A implementation was NS at the multivariate level (P = 0.093). We found a substantial and statistically significant increase in HIV-free survival and decrease in MTCT among infants aged 9-18 months following Option A rollout in Zimbabwe. This is the only evaluation of Option A and shows the effectiveness of Option A and Zimbabwe's remarkable progress toward eMTCT.

Utility of a near real-time emergency department syndromic surveillance system to track injuries in New York City.

PubMed

Seil, Kacie; Marcum, Jennifer; Lall, Ramona; Stayton, Catherine

2015-12-01

The New York City emergency department (ED) syndromic surveillance (SS) system provides near real-time data on the majority of ED visits. The utility of ED SS for injury surveillance has not been thoroughly evaluated. We created injury syndromes based on ED chief complaint information and evaluated their utility compared to administrative billing data. Six injury syndromes were developed: traffic-related injuries to pedal cyclists, pedestrians, and motor vehicle occupants; fall-related injuries; firearm-related injuries; and assault-related stabbings. Daily injury counts were compared for ED SS and the administrative billing data for years 2008-2010. We examined characteristics of injury trends and patterns between the two systems, calculating descriptive statistics for temporal patterns and Pearson correlation coefficients (r) for temporal trends. We also calculated proportions of demographic and geospatial patterns for both systems. Although daily volume of the injuries varied between the two systems, the temporal patterns were similar (all r values for daily volume exceeded 0.65). Comparisons of injuries by time of day, day of week, and quarter of year demonstrated high agreement between the two systems-the majority had an absolute percentage point difference of 2.0 or less. Distributions of injury by sex and age group also aligned well. Distribution of injury by neighborhood of residence showed mixed results-some neighborhood comparisons showed a high level of agreement between systems, while others were less successful. As evidenced by the strong positive correlation coefficients and the small absolute percentage point differences in our comparisons, we conclude that ED SS captures temporal trends and patterns of injury-related ED visits effectively. The system could be used to identify changes in injury patterns, allowing for situational awareness during emergencies, timely response, and public messaging.

Ulipristal acetate versus leuprolide acetate for uterine fibroids.

PubMed

Donnez, Jacques; Tomaszewski, Janusz; Vázquez, Francisco; Bouchard, Philippe; Lemieszczuk, Boguslav; Baró, Francesco; Nouri, Kazem; Selvaggi, Luigi; Sodowski, Krzysztof; Bestel, Elke; Terrill, Paul; Osterloh, Ian; Loumaye, Ernest

2012-02-02

The efficacy and side-effect profile of ulipristal acetate as compared with those of leuprolide acetate for the treatment of symptomatic uterine fibroids before surgery are unclear. In this double-blind noninferiority trial, we randomly assigned 307 patients with symptomatic fibroids and excessive uterine bleeding to receive 3 months of daily therapy with oral ulipristal acetate (at a dose of either 5 mg or 10 mg) or once-monthly intramuscular injections of leuprolide acetate (at a dose of 3.75 mg). The primary outcome was the proportion of patients with controlled bleeding at week 13, with a prespecified noninferiority margin of -20%. Uterine bleeding was controlled in 90% of patients receiving 5 mg of ulipristal acetate, in 98% of those receiving 10 mg of ulipristal acetate, and in 89% of those receiving leuprolide acetate, for differences (as compared with leuprolide acetate) of 1.2 percentage points (95% confidence interval [CI], -9.3 to 11.8) for 5 mg of ulipristal acetate and 8.8 percentage points (95% CI, 0.4 to 18.3) for 10 mg of ulipristal acetate. Median times to amenorrhea were 7 days for patients receiving 5 mg of ulipristal acetate, 5 days for those receiving 10 mg of ulipristal acetate, and 21 days for those receiving leuprolide acetate. Moderate-to-severe hot flashes were reported for 11% of patients receiving 5 mg of ulipristal acetate, for 10% of those receiving 10 mg of ulipristal acetate, and for 40% of those receiving leuprolide acetate (P<0.001 for each dose of ulipristal acetate vs. leuprolide acetate). Both the 5-mg and 10-mg daily doses of ulipristal acetate were noninferior to once-monthly leuprolide acetate in controlling uterine bleeding and were significantly less likely to cause hot flashes. (Funded by PregLem; ClinicalTrials.gov number, NCT00740831.).

Evaluating the impact of the Baby-Friendly Hospital Initiative on breast-feeding rates: a multi-state analysis

PubMed Central

Hawkins, Summer Sherburne; Stern, Ariel Dora; Baum, Christopher F; Gillman, Matthew W

2014-01-01

Objective To evaluate the impact of the Baby-Friendly Hospital Initiative (BFHI) on breast-feeding initiation and duration overall and according to maternal education. Design Quasi-experimental study using data from five states (Alaska, Maine, Nebraska, Ohio, Washington) that participated in the Pregnancy Risk Assessment Monitoring System from 1999 to 2009. Using differences-in-differences models that included year and hospital fixed effects, we compared rates of breast-feeding initiation and duration (any and exclusive breast-feeding for ≥4 weeks) before and after BFHI accreditation between mothers who gave birth in hospitals that were accredited or became accredited and mothers from matched non-BFHI facilities. We stratified analyses into lower and higher education groups. Setting Thirteen BFHI hospitals and nineteen matched non-BFHI facilities across five states in the USA. Subjects Mothers (n 11723) who gave birth in BFHI hospitals and mothers (n 13604) from nineteen matched non-BFHI facilities. Results Although we did not find overall differences in breast-feeding initiation between birth facilities that received BFHI accreditation compared with non-Baby-Friendly facilities (adjusted coefficient = 0.024; 95 % CI −0.00, 0.51), breast-feeding initiation increased by 3.8 percentage points among mothers with lower education who delivered in Baby-Friendly facilities (P = 0.05), but not among mothers with higher education (adjusted coefficient = 0.002; 95 % CI −0.04, 0.05). BFHI accreditation also increased exclusive breast-feeding for ≥4 weeks by 4.5 percentage points (P=0.02) among mothers with lower education who delivered in BFHI facilities. Conclusions By increasing breast-feeding initiation and duration among mothers with lower education, the BFHI may reduce socio-economic disparities in breast-feeding. PMID:24625787

Evaluating the impact of the Baby-Friendly Hospital Initiative on breast-feeding rates: a multi-state analysis.

PubMed

Hawkins, Summer Sherburne; Stern, Ariel Dora; Baum, Christopher F; Gillman, Matthew W

2015-02-01

To evaluate the impact of the Baby-Friendly Hospital Initiative (BFHI) on breast-feeding initiation and duration overall and according to maternal education. Quasi-experimental study using data from five states (Alaska, Maine, Nebraska, Ohio, Washington) that participated in the Pregnancy Risk Assessment Monitoring System from 1999 to 2009. Using differences-in-differences models that included year and hospital fixed effects, we compared rates of breast-feeding initiation and duration (any and exclusive breast-feeding for ≥4 weeks) before and after BFHI accreditation between mothers who gave birth in hospitals that were accredited or became accredited and mothers from matched non-BFHI facilities. We stratified analyses into lower and higher education groups. Thirteen BFHI hospitals and nineteen matched non-BFHI facilities across five states in the USA. Mothers (n 11 723) who gave birth in BFHI hospitals and mothers (n 13 604) from nineteen matched non-BFHI facilities. Although we did not find overall differences in breast-feeding initiation between birth facilities that received BFHI accreditation compared with non-Baby-Friendly facilities (adjusted coefficient = 0·024; 95 % CI -0·00, 0·51), breast-feeding initiation increased by 3·8 percentage points among mothers with lower education who delivered in Baby-Friendly facilities (P = 0·05), but not among mothers with higher education (adjusted coefficient = 0·002; 95 % CI -0·04, 0·05). BFHI accreditation also increased exclusive breast-feeding for ≥4 weeks by 4·5 percentage points (P = 0·02) among mothers with lower education who delivered in BFHI facilities. By increasing breast-feeding initiation and duration among mothers with lower education, the BFHI may reduce socio-economic disparities in breast-feeding.

Feasibility of distributing rapid diagnostic tests for malaria in the retail sector: evidence from an implementation study in Uganda.

PubMed

Cohen, Jessica; Fink, Günther; Berg, Katrina; Aber, Flavia; Jordan, Matthew; Maloney, Kathleen; Dickens, William

2012-01-01

Despite the benefits of malaria diagnosis, most presumed malaria episodes are never tested. A primary reason is the absence of diagnostic tests in retail establishments, where many patients seek care. Malaria rapid diagnostic tests (RDTs) in drug shops hold promise for guiding appropriate treatment. However, retail providers generally lack awareness of RDTs and training to administer them. Further, unsubsidized RDTs may be unaffordable to patients and unattractive to retailers. This paper reports results from an intervention study testing the feasibility of RDT distribution in Ugandan drug shops. 92 drug shops in 58 villages were offered subsidized RDTs for sale after completing training. Data on RDT purchases, storage, administration and disposal were collected, and samples were sent for quality testing. Household surveys were conducted to capture treatment outcomes. Estimated daily RDT sales varied substantially across shops, from zero to 8.46 RDTs per days. Overall compliance with storage, treatment and disposal guidelines was excellent. All RDTs (100%) collected from shops passed quality testing. The median price charged for RDTs was 1000USH ($0.40), corresponding to a 100% markup, and the same price as blood slides in local health clinics. RDTs affected treatment decisions. RDT-positive patients were 23 percentage points more likely to buy Artemisinin Combination Therapies (ACTs) (p = .005) and 33.1 percentage points more likely to buy other antimalarials (p<.001) than RDT-negative patients, and were 5.6 percentage points more likely to buy ACTs (p = .05) and 31.4 percentage points more likely to buy other antimalarials (p<.001) than those not tested at all. Despite some heterogeneity, shops demonstrated a desire to stock RDTs and use them to guide treatment recommendations. Most shops stored, administered and disposed of RDTs properly and charged mark-ups similar to those charged on common medicines. Results from this study suggest that distributing RDTs through the retail sector is feasible and can reduce inappropriate treatment for suspected malaria.

A multicenter randomized controlled trial of a plant-based nutrition program to reduce body weight and cardiovascular risk in the corporate setting: the GEICO study.

PubMed

Mishra, S; Xu, J; Agarwal, U; Gonzales, J; Levin, S; Barnard, N D

2013-07-01

To determine the effects of a low-fat plant-based diet program on anthropometric and biochemical measures in a multicenter corporate setting. Employees from 10 sites of a major US company with body mass index ≥ 25 kg/m(2) and/or previous diagnosis of type 2 diabetes were randomized to either follow a low-fat vegan diet, with weekly group support and work cafeteria options available, or make no diet changes for 18 weeks. Dietary intake, body weight, plasma lipid concentrations, blood pressure and glycated hemoglobin (HbA1C) were determined at baseline and 18 weeks. Mean body weight fell 2.9 kg and 0.06 kg in the intervention and control groups, respectively (P<0.001). Total and low-density lipoprotein (LDL) cholesterol fell 8.0 and 8.1 mg/dl in the intervention group and 0.01 and 0.9 mg/dl in the control group (P<0.01). HbA1C fell 0.6 percentage point and 0.08 percentage point in the intervention and control group, respectively (P<0.01).Among study completers, mean changes in body weight were -4.3 kg and -0.08 kg in the intervention and control groups, respectively (P<0.001). Total and LDL cholesterol fell 13.7 and 13.0 mg/dl in the intervention group and 1.3 and 1.7 mg/dl in the control group (P<0.001). HbA1C levels decreased 0.7 percentage point and 0.1 percentage point in the intervention and control group, respectively (P<0.01). An 18-week dietary intervention using a low-fat plant-based diet in a corporate setting improves body weight, plasma lipids, and, in individuals with diabetes, glycemic control.

Effect of Spironolactone and Amiloride on Thiazolidinedione-Induced Fluid Retention in South Indian Patients with Type 2 Diabetes

PubMed Central

Viswanathan, Vijay; Mohan, Viswanathan; Subramani, Poongothai; Parthasarathy, Nandakumar; Subramaniyam, Gayathri; Manoharan, Deepa; Sundaramoorthy, Chandru; Gnudi, Luigi; Viberti, Giancarlo

2013-01-01

Summary Background and objectives Thiazolidinediones (pioglitazone and rosiglitazone) induce renal epithelial sodium channel (ENaC)–mediated sodium reabsorption, resulting in plasma volume (PV) expansion. Incidence and long-term management of fluid retention induced by thiazolidinediones remain unclear. Design, setting, participants, & measurements In a 4-week run-in period, rosiglitazone, 4 mg twice daily, was added to a background anti-diabetic therapy in 260 South Indian patients with type 2 diabetes mellitus. Patients with PV expansion (absolute reduction in hematocrit in run-in, ≥1.5 percentage points) entered a randomized, placebo-controlled study to evaluate effects of amiloride and spironolactone on attenuating rosiglitazone-induced fluid retention. Primary endpoint was change in hematocrit in each diuretic group versus placebo (control group). Results Of the 260 patients, 70% (n=180) had PV expansion. These 180 patients (70% male; mean age, 47.8 years [range, 30–80 years]) were randomly assigned to rosiglitazone, 4 mg twice daily, plus spironolactone, 50 mg once daily; rosiglitazone, 4 mg twice daily, plus amiloride, 10 mg once daily; or rosiglitazone, 4 mg twice daily, plus placebo for 24 weeks. Hematocrit continued to decrease significantly in control and spironolactone groups (mean absolute change, −1.2 [P=0.01] and −0.7 [P=0.02] percentage points, respectively), suggesting continued PV expansion. No change occurred with amiloride (mean change, 0.0 percentage points). Amiloride, but not spironolactone, was superior to control (mean hematocrit difference [95% confidence interval] relative to control, 1.27 [0.21–2.55] and 0.49 [−0.79–1.77] percentage points [P=0.04 and P=0.61], respectively). Conclusions Prevalence of rosiglitazone-induced fluid retention in South Indian patients with type 2 diabetes is high. Amiloride, a direct ENaC blocker, but not spironolactone, prevented protracted fluid retention in these patients. PMID:23184569

Using standard and institutional mentorship models to implement SLMTA in Kenya

PubMed Central

Mwalili, Samuel; Basiye, Frank L.; Zeh, Clement; Emonyi, Wilfred I.; Langat, Raphael; Luman, Elizabeth T.; Mwangi, Jane

2014-01-01

Background Kenya is home to several high-performing internationally-accredited research laboratories, whilst most public sector laboratories have historically lacked functioning quality management systems. In 2010, Kenya enrolled an initial eight regional and four national laboratories into the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme. To address the challenge of a lack of mentors for the regional laboratories, three were paired, or ‘twinned’, with nearby accredited research laboratories to provide institutional mentorship, whilst the other five received standard mentorship. Objectives This study examines results from the eight regional laboratories in the initial SLMTA group, with a focus on mentorship models. Methods Three SLMTA workshops were interspersed with three-month periods of improvement project implementation and mentorship. Progress was evaluated at baseline, mid-term, and exit using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) audit checklist and scores were converted into a zero- to five-star scale. Results At baseline, the mean score for the eight laboratories was 32%; all laboratories were below the one-star level. At mid-term, all laboratories had measured improvements. However, the three twinned laboratories had increased an average of 32 percentage points and reached one to three stars; whilst the five non-twinned laboratories increased an average of 10 percentage points and remained at zero stars. At exit, twinned laboratories had increased an average 12 additional percentage points (44 total), reaching two to four stars; non-twinned laboratories increased an average of 28 additional percentage points (38 total), reaching one to three stars. Conclusion The partnership used by the twinning model holds promise for future collaborations between ministries of health and state-of-the-art research laboratories in their regions for laboratory quality improvement. Where they exist, such laboratories may be valuable resources to be used judiciously so as to accelerate sustainable quality improvement initiated through SLMTA. PMID:29043191

A multicenter randomized controlled trial of a plant-based nutrition program to reduce body weight and cardiovascular risk in the corporate setting: the GEICO study

PubMed Central

Mishra, S; Xu, J; Agarwal, U; Gonzales, J; Levin, S; Barnard, N D

2013-01-01

Background/objectives: To determine the effects of a low-fat plant-based diet program on anthropometric and biochemical measures in a multicenter corporate setting. Subjects/methods: Employees from 10 sites of a major US company with body mass index ⩾25 kg/m2 and/or previous diagnosis of type 2 diabetes were randomized to either follow a low-fat vegan diet, with weekly group support and work cafeteria options available, or make no diet changes for 18 weeks. Dietary intake, body weight, plasma lipid concentrations, blood pressure and glycated hemoglobin (HbA1C) were determined at baseline and 18 weeks. Results: Mean body weight fell 2.9 kg and 0.06 kg in the intervention and control groups, respectively (P<0.001). Total and low-density lipoprotein (LDL) cholesterol fell 8.0 and 8.1 mg/dl in the intervention group and 0.01 and 0.9 mg/dl in the control group (P<0.01). HbA1C fell 0.6 percentage point and 0.08 percentage point in the intervention and control group, respectively (P<0.01). Among study completers, mean changes in body weight were −4.3 kg and −0.08 kg in the intervention and control groups, respectively (P<0.001). Total and LDL cholesterol fell 13.7 and 13.0 mg/dl in the intervention group and 1.3 and 1.7 mg/dl in the control group (P<0.001). HbA1C levels decreased 0.7 percentage point and 0.1 percentage point in the intervention and control group, respectively (P<0.01). Conclusions: An 18-week dietary intervention using a low-fat plant-based diet in a corporate setting improves body weight, plasma lipids, and, in individuals with diabetes, glycemic control. PMID:23695207

Impact of tobacco control policies on adolescent smokeless tobacco and cigar use: a difference-in-differences approach.

PubMed

Hawkins, Summer Sherburne; Bach, Nicoline; Baum, Christopher F

2018-02-15

While increasing cigarette taxes has been a major policy driver to decrease smoking, taxes on other tobacco products have received less attention. Our aims were to evaluate the impact of chewing tobacco/cigar taxes, cigarette taxes, and smoke-free legislation on adolescent male and female use of smokeless tobacco and cigars. We analyzed data on 499,381 adolescents age 14-18 years from 36 US states in the Youth Risk Behavior Surveys (1999-2013) linked to state-level tobacco control policies. We conducted difference-in-differences regression models to assess whether changes in taxes and the enactment of smoke-free legislation were associated with smokeless tobacco use and, separately, cigar use. Models were stratified by adolescent sex. We found that chewing tobacco taxes had no effect on smokeless tobacco use and cigar taxes had no effect on cigar use. In contrast, among males a 10% increase in cigarette taxes was associated with a 1.0 percentage point increase (0.0010, 95% CI 0.0003-0.0017) in smokeless tobacco use. A 10% increase in cigarette taxes was also associated with a 1.5 percentage point increase (0.0015, 95% CI 0.0006-0.0024) in cigar use among males and a 0.7 percentage point increase (0.0007, 95% CI 0.0001-0.0013) in cigar use among females. There was some evidence that smoke-free legislation was associated with an 1.1 percentage point increase (0.0105, 95% CI 0.0015-0.0194) in smokeless tobacco use among males only, but no effect of smoke-free legislation on cigar use for males or females. Higher state cigarette taxes are associated with adolescents' use of cheaper, alternative tobacco products such as smokeless tobacco and cigars. Reducing tobacco use will require comprehensive tobacco control policies that are applied equally to and inclusive of all tobacco products.

Reducing the CP content in broiler feeds: impact on animal performance, meat quality and nitrogen utilization.

PubMed

Belloir, P; Méda, B; Lambert, W; Corrent, E; Juin, H; Lessire, M; Tesseraud, S

2017-11-01

Reducing the dietary CP content is an efficient way to limit nitrogen excretion in broilers but, as reported in the literature, it often reduces performance, probably because of an inadequate provision in amino acids (AA). The aim of this study was to investigate the effect of decreasing the CP content in the diet on animal performance, meat quality and nitrogen utilization in growing-finishing broilers using an optimized dietary AA profile based on the ideal protein concept. Two experiments (1 and 2) were performed using 1-day-old PM3 Ross male broilers (1520 and 912 for experiments 1 and 2, respectively) using the minimum AA:Lys ratios proposed by Mack et al. with modifications for Thr and Arg. The digestible Thr (dThr): dLys ratio was increased from 63% to 68% and the dArg:dLys ratio was decreased from 112% to 108%. In experiment 1, the reduction of dietary CP from 19% to 15% (five treatments) did not alter feed intake or BW, but the feed conversion ratio was increased for the 16% and 15% CP diets (+2.4% and +3.6%, respectively), while in experiment 2 (three treatments: 19%, 17.5% and 16% CP) there was no effect of dietary CP on performance. In both experiments, dietary CP content did not affect breast meat yield. However, abdominal fat content (expressed as a percentage of BW) was increased by the decrease in CP content (up to +0.5 and +0.2 percentage point, in experiments 1 and 2, respectively). In experiment 2, meat quality traits responded to dietary CP content with a higher ultimate pH and lower lightness and drip loss values for the low CP diets. Nitrogen retention efficiency increased when reducing CP content in both experiments (+3.5 points/CP percentage point). The main consequence of this higher efficiency was a decrease in nitrogen excretion (-2.5 g N/kg BW gain) and volatilization (expressed as a percentage of excretion: -5 points/CP percentage point). In conclusion, this study demonstrates that with an adapted AA profile, it is possible to reduce dietary CP content to at least 17% in growing-finishing male broilers, without altering animal performance and meat quality. Such a feeding strategy could therefore help improving the sustainability of broiler production as it is an efficient way to reduce environmental burden associated with nitrogen excretion.

Effect of fast pyrolysis bio-oil from palm oil empty fruit bunch on bitumen properties

NASA Astrophysics Data System (ADS)

Poh, Chia Chin; Hassan, Norhidayah Abdul; Raman, Noor Azah Abdul; Shukry, Nurul Athma Mohd; Warid, Muhammad Naqiuddin Mohd; Satar, Mohd Khairul Idham Mohd; Ros Ismail, Che; Asmah Hassan, Sitti; Mashros, Nordiana

2018-04-01

Bitumen shortage has triggered the exploration of another alternative waste material that can be blended with conventional bitumen. This study presents the performance of pyrolysis bio-oil from palm oil empty fruit bunch (EFB) as an alternative binder in modified bitumen mixtures. The palm oil EFB was first pyrolyzed using auger pyrolyzer to extract the bio-oil. Conventional bitumen 80/100 penetration grade was used as a control sample and compared with samples that were modified with different percentages, i.e., 5% and 10%, of pyrolysis EFB bio-oil. The physical and rheological properties of the control and modified bitumen samples were investigated using penetration, softening point, viscosity and dynamic shear rheometer (DSR) tests. Results showed that the addition of EFB bio-oil softened the bitumen with high penetration and a reduction in softening point, penetration index, and viscosity. However, the DSR results showed a comparable rutting resistance between the bitumen samples containing EFB bio-oil and virgin bitumen with a failure temperature achieved greater than 64°C.

Modeling fortification of corn masa flour with folic acid: the potential impact on exceeding the tolerable upper intake level for folic acid, NHANES 2001–2008

PubMed Central

Hamner, Heather C.; Tinker, Sarah C.; Berry, R.J.; Mulinare, Joe

2013-01-01

Background The Institute of Medicine set a tolerable upper intake level (UL) for usual daily total folic acid intake (1,000 µg). Less than 3% of US adults currently exceed the UL. Objective The objective of this study was to determine if folic acid fortification of corn masa flour would increase the percentage of the US population who exceed the UL. Design We used dietary intake data from NHANES 2001–2008 to estimate the percentage of adults and children who would exceed the UL if corn masa flour were fortified at 140 µg of folic acid/100 g. Results In 2001–2008, 2.5% of the US adult population (aged≥19 years) exceeded the UL, which could increase to 2.6% if fortification of corn masa flour occurred. With corn masa flour fortification, percentage point increases were small and not statistically significant for US adults exceeding the UL regardless of supplement use, sex, race/ethnicity, or age. Children aged 1–8 years, specifically supplement users, were the most likely to exceed their age-specific UL. With fortification of corn masa flour, there were no statistically significant increases in the percentage of US children who were exceeding their age-specific UL, and the percentage point increases were small. Conclusions Our results suggest that fortification of corn masa flour would not significantly increase the percentage of individuals who would exceed the UL. Supplement use was the main factor related to exceeding the UL with or without fortification of corn masa flour and within all strata of sex, race/ethnicity, and age group. PMID:23316130

Evaluation of body weight, body mass index, and body fat percentage changes in early stages of fixed orthodontic therapy.

PubMed

Sandeep, K Sai; Singaraju, Gowri Sankar; Reddy, V Karunakar; Mandava, Prasad; Bhavikati, Venkata N; Reddy, Rohit

2016-01-01

The aim of this study was to evaluate and compare the changes in body weight, body mass index (BMI), and body fat percentage (BFP) during the initial stages of fixed orthodontic treatment. The sample for this observational prospective study included 68 individuals with fixed orthodontic appliance in the age group of 18-25 years of both the sexes (25 males and 43 females). The control group consisted of 60 individuals (24 males and 36 females). The weight, BMI, and BFP were measured using a Body Composition Monitor at three points of time "T1" initial; "T2" after 1 month; and "T2" after 3 months. The results were tabulated and analyzed with the Statistical Package for the Social Sciences software. The mean changes between different parameters in both the study and control groups and between males and females in the study group was compared by using two-tailed unpaired student's t-test. The statistical significance is set atP ≤ 0.05. There was an overall decrease in the body weight, BMI, and BFP after 1 month in the study cohort, which was statistically significant compared to the control group (P < 0.0001). This was followed by an increase in the parameters after the end of the 3(rd) month. Comparison of the parameters between the study and control group at the start of the treatment and at the end of the 3(rd) month had no statistical significance. There was a marked variation in the changes of these parameters between males and females of the study group, which is statistically significant (<0.0001). There is a definite reduction in the weight, BMP, and BMI at the end of the first month followed by a gain of weight, but not at the initial point by the end of the 3(rd) month.

An Observational Study of Antibiotic Prescribing Behavior and the Hawthorne Effect

PubMed Central

Mangione-Smith, Rita; Elliott, Marc N; McDonald, Laurie; McGlynn, Elizabeth A

2002-01-01

Objectives To assess whether prospective, observational study procedures, including questionnaires and audio recording, are associated with different patterns of physician diagnostic decision making and antibiotic prescribing. Data Sources/Setting (1) Survey data from a prospective observational study of treatment patterns for children with acute upper respiratory illnesses (10/96–3/97) and (2) retrospective medical record abstraction data of nonobserved encounters for the same problems occurring during (10/96–3/97) and one year after (10/97–3/98) the observational study period. Ten pediatricians in two community practices were studied. Study Design Patterns of diagnoses recorded in the medical record and antibiotics ordered for visits occurring outside of the observational study (same time period and one year later) were compared with the pattern of diagnoses and antibiotics ordered during the observational study. Data Collection/Extraction Methods For the observational study (10/96–2/97), diagnosis and treatment choices were obtained from questionnaires completed by physicians immediately following the visit. For the nonstudy encounters (10/96–3/97 and 10/97–3/98), data were abstracted from medical records one year after the observational study was completed. Principal Findings The proportion of viral cases in which an antibiotic was prescribed was 29 percentage points lower for the observational study compared to the retrospective analysis (p <.05). In one of two study sites, the proportion of cases assigned a bacterial diagnosis was 29 percentage points lower in the observational study period compared to the retrospective study (p <.05). Conclusions Observational study procedures including questionnaires and audio recording can affect antibiotic prescribing behavior. Future observational studies aimed at examining the frequency of inappropriate antibiotic prescribing should measure and adjust for the Hawthorne effect; without such adjustments, the results will likely underestimate the true degree of the problem. Future interventions aimed at decreasing inappropriate antibiotic prescribing should consider “harnessing” the Hawthorne effect through performance feedback to participating physicians. PMID:12546288

Optimal Timing for Early Excision in a Deep Partial Thickness Porcine Burn Model.

PubMed

Toussaint, Jimmy; Chung, Won Taek; Mc Clain, Steve; Raut, Vivek; Singer, Adam J

Many deep partial thickness burns require more than 3 weeks to heal resulting in disfiguring and dysfunctional scarring. Early excision of the eschar has been shown to improve outcomes in deep burns; however, the optimal timing of the excision remains controversial. We compared wound healing and scarring of deep partial thickness burns that were excised at different time points in a porcine model. Deep partial thickness burns (2.5 by 2.5 cm each) were created on the backs of six anesthetized pigs using a previously validated model. The burns were randomly assigned to excision at days 2, 4, or 7 using an electric dermatome. Full thickness 4-mm punch biopsies were obtained at several time points for determination of re-epithelialization and at day 28 for determination of scar depth. Digital imaging was used to calculate percentage wound contraction at day 28. There were no statistically significant differences in wound re-epithelialization at any of the studied time points. Scar depth and percentage wound contraction were also similar among the wounds excised at 2, 4, and 7 days (4.4 ± 1.1 mm vs 3.9 ± 1.1 mm vs 4.1 ± 1.2 mm and 52.9 ± 17.9% vs 52.6 ± 15.6% vs 52.5 ± 13.8%, respectively). Timing of eschar excision (at 2, 4, or 7 days) does not affect the rates of re-epithelialization and scarring in a deep partial thickness porcine burn model. Timing of eschar excision may not change outcomes if performed within the first 2 to 7 days after injury.

Delayed manipulation after collagenase clostridium histolyticum injection for Dupuytren contracture.

PubMed

Kaplan, F Thomas D; Badalamente, Marie A; Hurst, Lawrence C; Merrell, Gregory A; Pahk, Raymond

2015-09-01

Collagenase clostridium histolyticum (CCH) injection for Dupuytren contracture was approved in the USA in 2010. Current FDA guidelines stipulate that finger manipulation occurs the day following injection. To investigate the safety and efficacy of delaying manipulation to 2 or 4 days following CCH injection, we conducted a prospective, randomized trial at two sites. Patients with Dupuytren contracture involving the metacarpophalangeal (MCP) joint ≥20° caused by a palpable cord participated. All patients received one dose of CCH (0.58 mg/0.25 ml) and were followed for 90 days. The primary end point was the percent of patients maintaining clinical success (reduction of contracture to 0°-5°) at 90 days post-injection. Adverse events and change in Michigan Hand Questionnaire (MHQ) score were recorded as secondary end points. Thirty-seven patients enrolled; 13 were manipulated on day 1, 11 on day 2, and 13 on day 4. At 30 days after injection, the percentage of patients obtaining reduction of contracture to <0°-5° extension was 92, 82, and 85 % in groups 1, 2, and 3, respectively, with no significant difference. At 90 days follow-up, the percentage of patients maintaining 0°-5° extension was 91, 82, and 83 % in groups 1, 2, and 3, respectively, with no significant difference. Adverse events were comparable to rates in prior studies. There were no serious adverse events. There was no statistical difference in MHQ scores between groups at any time point. Delaying manipulation to day 2 or 4 following CCH injection for MCP joint contractures does not increase adverse events or result in loss of efficacy. Therapeutic, Level II.

[Iodine intake in Portuguese school children].

PubMed

Limbert, Edward; Prazeres, Susana; São Pedro, Márcia; Madureira, Deolinda; Miranda, Ana; Ribeiro, Manuel; Carrilho, Francisco; Jácome de Castro, J; Lopes, Maria Santana; Cardoso, João; Carvalho, Andre; Oliveira, Maria João; Reguengo, Henrique; Borges, Fátima

2012-01-01

The aim of the present study was to evaluate iodine intake in portuguese school children in order to inform health authorities of eventual measures to be implemented. Iodine is the key element for thyroid hormone synthesis and its deficiency even mild, as found in other European countries, may have deleterious effects in pregnancy resulting in cognitive problems of offsprings. In Portugal there are no recent data on iodine intake in schoolchildren. 3680 children aged 6-12 years of both sexes, from 78 different schools were studied. Iodine intake was evaluated trough urine iodine (UI) determinations using a colorimetic method. The global median UI value was 105.5 µg/L; the percentage of children with UI <100 µg/L was 47.1%, corresponding to 41% of the studied schools. The percentage of values <50 µg/L was 11.8%. The male gender, the south region of the country and the distribution of milk in school were significantly linked with a higher iodine elimination. Our global results point to a borderline/ mildly insufficient iodine intake in the portuguese school population. However 47% of the children had UI under 100 µg /L. The comparison of our results with the available data from 30 years ago, point to a considerable improvement, due to silent prophylaxis. Male gender, geographical area and milk distribution influenced positively iodine intake.The importance of milk has been referred in numerous papers. The study of UI in the Portuguese school population points to a borderline iodine intake. However, in 47% of children iodine intake was inadequate. Compared with data from the eighties, a considerable increase in iodine elimination was found. Taking into account the potencial deleterious effects of inadequate iodine intake, a global prophylaxis with salt iodization has to be considered.

Cognitive impairment associated with locomotive syndrome in community-dwelling elderly women in Japan.

PubMed

Nakamura, Misa; Tazaki, Fumie; Nomura, Kazuki; Takano, Taeko; Hashimoto, Masashi; Hashizume, Hiroshi; Kamei, Ichiro

2017-01-01

In our worldwide aging society, elderly people should maintain cognitive and physical function to help avoid health problems. Dementia is a major brain disease among elderly people, and is caused by cognitive impairment. The locomotive syndrome (LS) refers to a condition in which people require healthcare services because of problems associated with locomotion. The purpose of this study was to determine the association between cognitive impairment and LS. Study participants were 142 healthy elderly female volunteers living in a rural area in Japan. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). A score of ≤26 points on the MMSE was used to indicate categorically defined poor cognitive performance (cognitive impairment). The LS was defined by a score ≥16 points, and non-LS as <16 points, on the 25-question Geriatric Locomotive Function Scale (GLFS-25). Twenty-one participants (14.8%) had an MMSE score ≤26, and 19.0% were found to have LS. Compared with the MMSE >26 group, the ≤26 group was significantly older, had a higher percentage of body fat, and a higher GLFS-25 score. Those with LS were significantly older, had a higher body mass index, a higher percentage of body fat, and a lower MMSE score. Participants in the LS group had higher odds of cognitive impairment than those without LS [odds ratio (OR) =3.08] by logistic regression analysis adjusted for age. Furthermore, participants with GLFS-25 scores ≥6 had higher odds of cognitive impairment than those with a GLFS-25 score <6 by logistic regression analysis adjusted for both age (OR =4.44), and age and percent body fat (OR =4.12). These findings suggest that a strong relationship exists between the early stage of decreased motor function and cognitive impairment.

Occupational Gender Desegregation in the 1980s.

ERIC Educational Resources Information Center

Cotter, David A.; And Others

1995-01-01

Analysis of 1980 and 1990 Public Use Microdata Samples showed that, among full-time workers, occupational sex segregation declined 6.5 percentage points, less than the 8.5 point decline in the 1970s. Three-quarters of the desegregation was due to changed gender composition of occupations, one-quarter due to faster growth in more integrated…

When is a "free" registrar in clinic not free?

PubMed

Lota, Amrit S; Manisty, Charlotte H; Sutton, Richard; Francis, Darrel P

2011-12-20

To investigate whether using registrars (doctors undergoing higher specialist training, whose salary is reimbursed) rather than consultants in outpatient clinics saves money Development of a formula calculating the economic breakeven point and application to retrospective audit data from 273 outpatient consultations. General cardiology outpatient clinic in a secondary and tertiary referral NHS hospital. Outcomes Difference in probability of a registrar and a consultant making a diagnostic decision that completes a clinical episode. Use of UK costings for consultant salaries and outpatient attendances to determine the economic breakeven point. The formula showed that if a registrar's episode completing probability is 12 percentage points lower than that of a consultant, then using a registrar costs the hospital more. Real life data showed that episode completion probabilities are 43 percentage points lower for registrars than for consultants (26% versus 69%, 95% CI 32% to 54%, P<0.0001). It is wrong to assume that external reimbursement of registrar salaries makes them a money saving option for staffing clinics. The apparent service role of a registrar can be a disservice.

Does lemon juice increase radioiodine reaccumulation within the parotid glands more than if lemon juice is not administered?

PubMed

Kulkarni, Kanchan; Van Nostrand, Douglas; Atkins, Francis; Mete, Mihriye; Wexler, Jason; Wartofsky, Leonard

2014-02-01

The protective effect of sialagogues following I therapy became controversial after a study proposed that sialagogues increase the reaccumulation of I in the parotid glands (PGs) to a level higher than when sialagogues are not administered ('rebound effect'). The present study examined PG radiopharmacokinetics within 2-4 h after radioiodine administration to evaluate whether sialagogues cause a 'rebound effect'. This prospective study was conducted at the Medstar Washington Hospital Center. The study patients had (i) differentiated thyroid cancer, (ii) no history of salivary gland disease or medications affecting the salivary glands, (iii) a clinical salivary scan (SS) with lemon juice (LJ) (SSwLJ) that was performed before I therapy, and (iv) a second SS performed without LJ (SSwoLJ) performed prior to I therapy after giving informed consent. Each PG was assessed for I uptake using time-activity curves (TACs) that were (i) corrected for background and decay, (ii) smoothed using a seven-point unweighted moving average, and (iii) normalized to the administered I activity. TACs of the SSwLJ and SSwoLJ were compared with activity at each time point over 120 min. Areas under the TACs for the PGs were calculated for each gland's SSwLJ and SSwoLJ, and the relative percentage change in potential radiation absorbed dose (PRAD) was calculated. A total of 2100 time points were analyzed in nine patients (18 PGs). I activity in the PGs on SSwLJ exceeded activity seen on the SSwoLJ at 134 time points (6.3%), and 98 (73%) of these were on the basis of spontaneous salivation during SSwoLJ. Mean percentage decrease in relative PRAD was 34.2±17.4% (range, 3.1-66.1%). During the time period studied, LJ administration did not result in a 'rebound effect' but resulted in mean relative decrease of 34.2% in PRAD to the PGs.

Comparative study of attitudes to eating between male and female students in the People's Republic of China.

PubMed

Makino, M; Hashizume, M; Tsuboi, K; Yasushi, M; Dennerstein, L

2006-09-01

This study was conducted to compare eating attitudes and lifestyles of male and female college students in China (Beijing). The subjects of this study consisted of 217 male and 177 female college students. They were asked to fill out the Eating Attitudes Test-26 (EAT-26) and a lifestyle questionnaire. The percentages of those above the cutoff point on the EAT-26 for abnormal eating attitudes were 4.7% of male and 6.2% of female students. Body perception of being fat (distorted body image) was the factor most associated with abnormal eating attitudes. Weight related concern was prevalent amongst the Chinese students. This suggests that the culture of the beauty of thinness is common among young students in Beijing, particularly female students.

Design and Off-design Performance of 100 Kwe-class Brayton Power Conversion Systems

NASA Technical Reports Server (NTRS)

Johnson, Paul K.; Mason, Lee S.

2005-01-01

The NASA Glenn Research Center in-house computer model Closed Cycle Engine Program (CCEP) was used to explore the design trade space and off-design performance characteristics of 100 kWe-class recuperated Closed Brayton Cycle (CBC) power conversion systems. Input variables for a potential design point included the number of operating units (1, 2, 4), cycle peak pressure (0.5, 1, 2 MPa), and turbo-alternator shaft speed (30, 45, 60 kRPM). The design point analysis assumed a fixed turbine inlet temperature (1150 K), compressor inlet temperature (400 K), working-fluid molecular weight (40 g/mol), compressor pressure ratio (2.0), recuperator effectiveness (0.95), and a Sodium-Potassium (NaK) pumped-loop radiator. The design point options were compared on the basis of thermal input power, radiator area, and mass. For a nominal design point with defined Brayton components and radiator area, off-design cases were examined by reducing turbine inlet temperature (as low as 900 K), reducing shaft speed (as low as 50% of nominal), and circulating a percentage (up to 20%) of the compressor exit flow back to the gas cooler. The off-design examination sought approaches to reduce thermal input power without freezing the radiator.

The effects of HMO ownership on hospital costs and revenues: is there a difference between for-profit and nonprofit plans?

PubMed

Shen, Yu-Chu; Melnick, Glenn

2004-01-01

We conducted multivariate analyses to examine whether high health maintenance organization (HMO) penetration and large share of for-profit health plans in a market reduced hospital cost and revenue growth rates between 1989 and 1998. We found that hospitals in high HMO areas experienced revenue and cost growth rates that were 21 and 18 percentage points, respectively, below hospitals in low HMO areas. We also found that, conditional on overall HMO penetration level, hospitals in areas with high for-profit HMO penetration experienced revenue and cost growth rates that were 10 percentage points below hospitals in areas with low for-profit penetration areas; the difference was especially evident within high HMO penetration areas.

Mental health and retirement savings: Confounding issues with compounding interest.

PubMed

Bogan, Vicki L; Fertig, Angela R

2018-02-01

The questionable ability of the U.S. pension system to provide for the growing elderly population combined with the rising number of people affected by depression and other mental health issues magnifies the need to understand how these household characteristics affect retirement. Mental health problems have a large and significant negative effect on retirement savings. Specifically, psychological distress is associated with decreasing the probability of holding retirement accounts by as much as 24 percentage points and decreasing retirement savings as a share of financial assets by as much as 67 percentage points. The magnitude of these effects underscores the importance of employer management policy and government regulation of these accounts to help ensure households have adequate retirement savings. Copyright © 2017 John Wiley & Sons, Ltd.

Effect of a hypocaloric diet with a commercial formula in weight loss and quality of life in obese patients with chronic osteoarthritis.

PubMed

de Luis, D A; Izaola, O; García Alonso, M; Aller, R; Cabezas, G; de la Fuente, B

2012-01-01

The aim of our study was to evaluate in patients with obesity and chronic osteoarthritis the impact on quality of life and metabolic control of a dietary intervention with a hypocaloric commercial formula. A sample of 55 obese patients with chronic osteoarthritis was enrolled. The study consisted of a 12-week weight reduction program where the participants received an oral diet replaced with 2 bricks of Optisource Plus®. In order to assess the effect of weight loss on different parameters, patients were divided in two groups by the median of weight loss percentage (9%); group 1 (< 9%) and group 2 (> 9%). In group 2, patients showed an improvement in total SF-36 score (4.0 ± 6.1 points), physical function domain of SF 36 (1.8 ± 3.4 points), role physical domain of SF 36 (0.6 ± 1.6 points) and vitality domain of SF 36 (2.7 ± 4.6 points) improved. Total score of WOMAC test (- 8.2 ± 15.0 points), function domain of WOMAC test (- 6.5 ± 10.6 points) and stiffness domain of WOMAC test (-0.7 ± 2.1 points) improved, too. The effect on metabolic response, functionality and quality of life was better in patients with a percentage of weight loss > 9% than patients with a lower weight loss.

Histologic assessment of thermal injury to tonsillectomy specimens: a comparison of electrocautery, coblation, harmonic scalpel, and tonsillotome.

PubMed

Modi, Vikash K; Monforte, Hector; Geller, Kenneth A; Koempel, Jeffrey A

2009-11-01

To determine the extent of thermal injury to the tonsillar tissue following the use of various types of instrumentation. To determine if tonsillectomy specimens routinely contain tissue other than lymphoid tissue. Retrospective histologic analysis. A histologic analysis performed on 228 tonsillectomy specimens removed by use of an electrocautery in 132 specimens, harmonic scalpel in 46, coblation device in 24, and a tonsillotome in 26. The specimens were evaluated for presence and percentage of skeletal muscle and depth of thermal tissue injury. The mean percentage of skeletal muscle present in the specimens was 0.79% for electrocautery, 1.74% for harmonic scalpel, 0.97% for coblation device, and 1.66% for the tonsillotome. Skeletal muscle was absent in only 8 of 228 specimens (3.5%). Electrocautery has a statistically significant (P < .05) lower percentage of muscle tissue compared to harmonic scalpel and the tonsillotome. There was no statistically significant difference in the mean depth of thermal injury among the harmonic scalpel (0.68 mm), electrocautery (0.58 mm), and coblation device (0.71 mm) specimens. The tonsillotome specimens had no thermal injury. Attempts to remove the entire tonsil results in a similar depth of thermal injury to tonsillectomy specimens when using the harmonic scalpel, electrocautery, and coblation device. Skeletal muscle is a nearly ubiquitous finding in routine tonsillectomy specimens. The use of an electrocautery with a needle point may allow for a more precise dissection as it results in tonsillectomy specimens with a smaller percentage of muscle present.

Latanoprostene Bunod 0.024% versus Timolol Maleate 0.5% in Subjects with Open-Angle Glaucoma or Ocular Hypertension: The APOLLO Study.

PubMed

Weinreb, Robert N; Scassellati Sforzolini, Baldo; Vittitow, Jason; Liebmann, Jeffrey

2016-05-01

To compare the diurnal intraocular pressure (IOP)-lowering effect of latanoprostene bunod (LBN) ophthalmic solution 0.024% every evening (qpm) with timolol maleate 0.5% twice daily (BID) in subjects with open-angle glaucoma (OAG) or ocular hypertension (OHT). Phase 3, randomized, controlled, multicenter, double-masked, parallel-group clinical study. Subjects aged ≥18 years with a diagnosis of OAG or OHT in 1 or both eyes. Subjects were randomized (2:1) to a 3-month regimen of LBN 0.024% qpm or timolol 0.5% 1 drop BID. Intraocular pressure was measured at 8 am, 12 pm, and 4 pm of each postrandomization visit (week 2, week 6, and month 3). Adverse events were recorded throughout the study. The primary efficacy end point was IOP in the study eye measured at each of the 9 assessment time points. Secondary efficacy end points included the proportion of subjects with IOP ≤18 mmHg consistently at all 9 time points and the proportion of subjects with IOP reduction ≥25% consistently at all 9 time points. Of 420 subjects randomized, 387 completed the study (LBN 0.024%, n = 264; timolol 0.5%, n = 123). At all 9 time points, the mean IOP in the study eye was significantly lower in the LBN 0.024% group than in the timolol 0.5% group (P ≤ 0.002). At all 9 time points, the percentage of subjects with mean IOP ≤18 mmHg and the percentage with IOP reduction ≥25% were significantly higher in the LBN 0.024% group versus the timolol 0.5% group (mean IOP ≤18 mmHg: 22.9% vs. 11.3%, P = 0.005; IOP reduction ≥25%: 34.9% vs. 19.5%, P = 0.001). Adverse events were similar in both treatment groups. In this phase 3 study, LBN 0.024% qpm demonstrated significantly greater IOP lowering than timolol 0.5% BID throughout the day over 3 months of treatment. Latanoprostene bunod 0.024% was effective and safe in these adults with OAG or OHT. Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Have we progressed in the surgical literature? Thirty-year trends in clinical studies in 3 surgical journals.

PubMed

Shawhan, Robert R; Hatch, Quinton M; Bingham, Jason R; Nelson, Daniel W; Fitzpatrick, Emile B; McLeod, Robin; Johnson, Eric K; Maykel, Justin A; Steele, Scott R

2015-01-01

We practice in an era of evidence-based medicine. In 1993, Solomon and McLeod published an article examining study designs in 3 surgical journals from 1980 and 1990. The purpose of this study was to evaluate subsequent 30-year trends in the quality of selected literature. All of the articles from Diseases of the Colon & Rectum, Surgery, and the British Journal of Surgery during 2000 and 2010 were classified by study design. Nonclinical studies were substratified by animal/laboratory, surgical technique, editorial/review, or miscellaneous articles. Clinical articles were categorized as case or comparative studies, further categorized by study design, and rated on a 10-point scale to determine strength. We compared interobserver reliability using a random sample. This study was conducted at 3 North American medical centers. Patients described in the scope of the literature were included in this study. Frequency, type, and strength of study design were measured. We evaluated 1911 articles (967 clinical; 17% comparative). There was a significant increase in multicenter clinical studies (from 12% to 27%; p < 0.0001) and mean study population (from 326 to 6775; p < 0.05). Studies using administrative data increased from 14% to 43% (p < 0.0001). Case reports decreased from 16% to 7% of all clinical studies (p < 0.001), whereas the percentage of comparative studies increased from 14% to 21% (p = 0.001). The percentage of randomized controlled trials did not increase significantly (8.5% in 2000; 10.0% in 2010; p = 0.44). The mean 10-point score for comparative studies was 6.7 for both years (p = 0.50). There was good interobserver agreement in the classification of studies (κ = 0.70) and moderate agreement in scoring comparative studies (κ = 0.47). This descriptive study cannot fully account for the reasons behind the identified differences. Comparative and multicenter studies, mean study population, and the use of administrative data increased from 2000 to 2010. This suggests that increased use of administrative databases has allowed larger populations of patients from more institutions to be studied and may be more generalizable. Researchers should strive toward improving the level of evidence (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A167).

Accuracy of body mass index for age to diagnose obesity in Mexican schoolchildren.

PubMed

Mendoza Pablo, Pedro A; Valdés, Jesús; Ortiz-Hernández, Luis

2015-06-01

To compare the accuracy of three BMI-forage references (World Health Organization reference, WHO; the updated International Obesity Task Force reference, IOTF; and Centers for Disease Control and Prevention (CDC) growth charts) to diagnose obesity in Mexican children. A convenience sample of Mexican schoolchildren (n = 218) was assessed. The gold standard was the percentage of body fat estimated by deuterium dilution technique. Sensitivity and specificity of the classical cutoff point of BMI-for-age to identify obesity (i.e. > 2.00 standard deviation, SD) were estimated. The accuracy (i.e. area under the curve, AUC) of three BMI-for-age references for the diagnosis of obesity was estimated with the receiver operating characteristic (ROC) curves method. The optimal cutoff point (OCP) was determined. The cutoff points to identify obesity had low (WHO reference: 57.6%, CDC: 53.5%) to very low (IOTF reference: 40.4%) sensitivities, but adequate specificities (91.6%, 95.0%, and, 97.5%, respectively). The AUC of the three references were adequate (0.89). For the IOTF reference, the AUC was lower among the older children. The OCP for the CDC reference (1.24 SD) was lower than the OCP for WHO (1.53 SD) and IOTF charts (1.47 SD). The classical cutoff point for obesity has low sensitivity--especially for the IOTF reference. The accuracy of the three references was similar. However, to obtain comparable diagnosis of obesity different cutoff points should be used depending of the reference. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Motor adaptation in complex sports - the influence of visual context information on the adaptation of the three-point shot to altered task demands in expert basketball players.

PubMed

Stöckel, Tino; Fries, Udo

2013-01-01

We examined the influence of visual context information on skilled motor behaviour and motor adaptation in basketball. The rules of basketball in Europe have recently changed, such that that the distance for three-point shots increased from 6.25 m to 6.75 m. As such, we tested the extent to which basketball experts can adapt to the longer distance when a) only the unfamiliar, new three-point line was provided as floor markings (NL group), or b) the familiar, old three-point line was provided in addition to the new floor markings (OL group). In the present study 20 expert basketball players performed 40 three-point shots from 6.25 m and 40 shots from 6.75 m. We assessed the percentage of hits and analysed the landing position of the ball. Results showed better adaptation of throwing performance to the longer distance when the old three-point line was provided as a visual landmark, compared to when only the new three-point line was provided. We hypothesise that the three-point line delivered relevant information needed to successfully adapt to the greater distance in the OL group, whereas it disturbed performance and ability to adapt in the NL group. The importance of visual landmarks on motor adaptation in basketball throwing is discussed relative to the influence of other information sources (i.e. angle of elevation relative to the basket) and sport practice.

Randomised clinical trial of five ear acupuncture points for the treatment of overweight people.

PubMed

Yeo, Sujung; Kim, Kang Sik; Lim, Sabina

2014-04-01

To evaluate the efficacy of the five ear acupuncture points (Shen-men, Spleen, Stomach, Hunger, Endocrine), generally used in Korean clinics for treating obesity, and compare them with the Hunger acupuncture point. A randomised controlled clinical trial was conducted in 91 Koreans (16 male and 75 female, body mass index (BMI)≥23), who had not received any other weight control treatment within the past 6 months. Subjects were divided randomly into treatment I, treatment II or sham control groups and received unilateral auricular acupuncture with indwelling needles replaced weekly for 8 weeks. Treatment I group received acupuncture at the five ear acupuncture points, treatment II group at the Hunger acupuncture point only and the sham control group received acupuncture at the five ear acupuncture points used in treatment I, but the needles were removed immediately after insertion. BMI, waist circumference, weight, body fat mass (BFM), percentage body fat and blood pressure were measured at baseline and at 4 and 8 weeks after treatment. For the 58 participants who provided data at 8 weeks, significant differences in BMI, weight and BFM were found between the treatment and control groups. Treatment groups I and II showed 6.1% and 5.7% reduction in BMI, respectively (p<0.004). There were no significant differences between the two treatment groups. This finding suggests that the five ear acupuncture points, generally used in Korean clinics, and the Hunger point alone treatment are both effective for treating overweight people.

National health spending in 2013: growth slows, remains in step with the overall economy.

PubMed

Hartman, Micah; Martin, Anne B; Lassman, David; Catlin, Aaron

2015-01-01

In 2013 US health care spending increased 3.6 percent to $2.9 trillion, or $9,255 per person. The share of gross domestic product devoted to health care spending has remained at 17.4 percent since 2009. Health care spending decelerated 0.5 percentage point in 2013, compared to 2012, as a result of slower growth in private health insurance and Medicare spending. Slower growth in spending for hospital care, investments in medical structures and equipment, and spending for physician and clinical care also contributed to the low overall increase. Project HOPE—The People-to-People Health Foundation, Inc.

The effect of a hay grid feeder on feed consumption and measurement of the gastric pH using an intragastric electrode device in horses: a preliminary report.

PubMed

Aristizabal, F; Nieto, J; Yamout, S; Snyder, J

2014-07-01

Obesity and gastric ulceration are highly prevalent in horses. Management modifications for preventing squamous gastric ulceration include frequent feeding and free access to pasture; however, these practices may predispose horses to obesity. To compare the percentage of hay consumed, intragastric pH and horse activity between feeding from the ground and a hay grid feeder. Crossover experimental study. A pH electrode was inserted into the stomach to record the intragastric pH for 48 h. Horses received 1% of their body weight in grass hay twice a day. Horses were assigned to be fed from the ground or a commercial hay grid feeder for 24 h and then switched to the opposite protocol for an additional 24 h. Horses were continuously video-recorded and the percentage of time spent eating or drinking, walking or standing, and lying down were calculated. Two point data were compared by paired t test and pH over time was compared by repeated measures ANOVA. Horses consumed significantly greater amounts of grass hay when fed on the ground compared with a hay grid feeder (n = 9; P<0.001). There were no significant differences between the groups for mean intragastric pH values (n = 6; P = 0.97), mean intragastric pH over time (n = 6; P = 0.45) the length of time the pH was below 4.0 (n = 6; P = 0.54), and the percentage of time horses spent eating or drinking (n = 9; P = 0.52), walking or standing (n = 9; P = 0.3), or lying down (n = 9; P = 0.4). Within each group horses spent more time eating during the day compared with the night (n = 9; hay grid feeder P = 0.003; ground feeding P = 0.007). The hay grid feeder studied may be used to reduce the amount of hay ingested by horses without reducing the time horses spend eating. © 2013 EVJ Ltd.

ABCs and AYP Results, Wake County Public School System (WCPSS): 2009-10. Measuring Up. E&R Report No. 10.20

ERIC Educational Resources Information Center

Haynie, Glenda

2011-01-01

In 2009-10, 92% of WCPSS schools met Expected or High Growth as measured by the North Carolina ABCs program, a 3.5 percentage point increase from 2008-09. Fifty-four percent of the schools made High Growth and 38% made Expected Growth. All subgroups saw their percentages of students meeting growth increase to above 55% in 2009-10; with the…

Orthodontic camouflage versus orthognathic surgery for class III deformity: comparative cephalometric analysis.

PubMed

Martinez, P; Bellot-Arcís, C; Llamas, J M; Cibrian, R; Gandia, J L; Paredes-Gallardo, V

2017-04-01

The objective of this study was to compare different cephalometric variables in adult patients with class III malocclusions before and after treatment, in order to determine which variables are indicative of orthodontic camouflage or orthognathic surgery. The cases of 156 adult patients were assessed: 77 treated with orthodontic camouflage and 79 treated with orthodontics and orthognathic surgery. The following cephalometric variables were measured on pre-treatment (T1) and post-treatment (T2) lateral cephalograms: sella-nasion-A-point (SNA), sella-nasion-B-point (SNB), and A-point-nasion-B-point (ANB) angles, Wits appraisal, facial axis angle, mandibular plane angle, upper and lower incisor inclination, and inter-incisal angle. There were statistically significant differences in cephalometric variables before and after treatment between the two groups. The percentage of normal pre-treatment measurements in the camouflage orthodontics group was 30.7%, which worsened slightly to 28.4% post-treatment. However in the group receiving surgery, this was 24.5% pre-treatment, improving to 33.5% after surgery. SNA, SNB, Wits appraisal, lower incisor inclination, and inter-incisal angle showed differences between the two groups before and after treatment. Wits appraisal, lower incisor inclination, and inter-incisal angle were indicative of one or other treatment. Upper and lower incisor decompensation in both groups did not reach ideal values, which impeded complete skeletal correction in 52% of surgical cases. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Randomized clinical trial of treatments for symptomatic convergence insufficiency in children.

PubMed

2008-10-01

To compare home-based pencil push-ups (HBPP), home-based computer vergence/accommodative therapy and pencil push-ups (HBCVAT+), office-based vergence/accommodative therapy with home reinforcement (OBVAT), and office-based placebo therapy with home reinforcement (OBPT) as treatments for symptomatic convergence insufficiency. In a randomized clinical trial, 221 children aged 9 to 17 years with symptomatic convergence insufficiency were assigned to 1 of 4 treatments. Convergence Insufficiency Symptom Survey score after 12 weeks of treatment. Secondary outcomes were near point of convergence and positive fusional vergence at near. After 12 weeks of treatment, the OBVAT group's mean Convergence Insufficiency Symptom Survey score (15.1) was statistically significantly lower than those of 21.3, 24.7, and 21.9 in the HBCVAT+, HBPP, and OBPT groups, respectively (P < .001). The OBVAT group also demonstrated a significantly improved near point of convergence and positive fusional vergence at near compared with the other groups (P

Human hydatid disease: evaluation of an ELISA for diagnosis, population screening and monitoring of control programmes.

PubMed

Biffin, A H; Jones, M A; Palmer, S R

1993-07-01

The routine use of ELISA and complement fixation tests in the diagnosis of suspected clinical cases of hydatid disease was evaluated. In the ELISA test, dialysed and filtered sheep cyst fluid was used as antigen and two positive cut-off points--+3SD and +2SD of the mean absorbance values of the control sera--were evaluated. The predictive values of ELISA tests were 82% and 90% for positive tests, and 86% and 82% for negative tests, respectively with the two cut-off points. In a population survey of blood donors and veterinary workers in Powys, 4% and 8%, respectively, had ELISA values above the lower cut-off point. However, it would not be appropriate to use the same test for diagnostic population screening in Wales since the predictive value of the test is likely to be very low in this setting. Serological surveys with the ELISA may be of use in monitoring the progress of the South Powys Hydatid Control Programme. The use of cumulative percentages was found to be a useful method of comparing whole distributions of results in different populations.

Four-month moxifloxacin-based regimens for drug-sensitive tuberculosis.

PubMed

Gillespie, Stephen H; Crook, Angela M; McHugh, Timothy D; Mendel, Carl M; Meredith, Sarah K; Murray, Stephen R; Pappas, Frances; Phillips, Patrick P J; Nunn, Andrew J

2014-10-23

Early-phase and preclinical studies suggest that moxifloxacin-containing regimens could allow for effective 4-month treatment of uncomplicated, smear-positive pulmonary tuberculosis. We conducted a randomized, double-blind, placebo-controlled, phase 3 trial to test the noninferiority of two moxifloxacin-containing regimens as compared with a control regimen. One group of patients received isoniazid, rifampin, pyrazinamide, and ethambutol for 8 weeks, followed by 18 weeks of isoniazid and rifampin (control group). In the second group, we replaced ethambutol with moxifloxacin for 17 weeks, followed by 9 weeks of placebo (isoniazid group), and in the third group, we replaced isoniazid with moxifloxacin for 17 weeks, followed by 9 weeks of placebo (ethambutol group). The primary end point was treatment failure or relapse within 18 months after randomization. Of the 1931 patients who underwent randomization, in the per-protocol analysis, a favorable outcome was reported in fewer patients in the isoniazid group (85%) and the ethambutol group (80%) than in the control group (92%), for a difference favoring the control group of 6.1 percentage points (97.5% confidence interval [CI], 1.7 to 10.5) versus the isoniazid group and 11.4 percentage points (97.5% CI, 6.7 to 16.1) versus the ethambutol group. Results were consistent in the modified intention-to-treat analysis and all sensitivity analyses. The hazard ratios for the time to culture negativity in both solid and liquid mediums for the isoniazid and ethambutol groups, as compared with the control group, ranged from 1.17 to 1.25, indicating a shorter duration, with the lower bounds of the 95% confidence intervals exceeding 1.00 in all cases. There was no significant difference in the incidence of grade 3 or 4 adverse events, with events reported in 127 patients (19%) in the isoniazid group, 111 (17%) in the ethambutol group, and 123 (19%) in the control group. The two moxifloxacin-containing regimens produced a more rapid initial decline in bacterial load, as compared with the control group. However, noninferiority for these regimens was not shown, which indicates that shortening treatment to 4 months was not effective in this setting. (Funded by the Global Alliance for TB Drug Development and others; REMoxTB ClinicalTrials.gov number, NCT00864383.).

Assets among low-income families in the Great Recession

PubMed Central

Garfinkel, Irwin

2018-01-01

This paper examines the association between the Great Recession and real assets among families with young children. Real assets such as homes and cars are key indicators of economic well-being that may be especially valuable to low-income families. Using longitudinal data from the Fragile Families and Child Wellbeing Study (N = 4,898), we investigate the association between the city unemployment rate and home and car ownership and how the relationship varies by family structure (married, cohabiting, and single parents) and by race/ethnicity (White, Black, and Hispanic mothers). Using mother fixed-effects models, we find that a one percentage point increase in the unemployment rate is associated with a -0.5 percentage point decline in the probability of home ownership and a -0.7 percentage point decline in the probability of car ownership. We also find that the recession was associated with lower levels of home ownership for cohabiting families and for Hispanic families, as well as lower car ownership among single mothers and among Black mothers, whereas no change was observed among married families or White households. Considering that homes and cars are the most important assets among middle and low-income households in the U.S., these results suggest that the rise in the unemployment rate during the Great Recession may have increased household asset inequality across family structures and race/ethnicities, limiting economic mobility, and exacerbating the cycle of poverty. PMID:29401482

Smoking ban policies in Italy and the potential impact of the so-called Sirchia Law: state of the art after eight years.

PubMed

Gualano, Maria Rosaria; Bert, Fabrizio; Scaioli, Giacomo; Passi, Stefano; La Torre, Giuseppe; Siliquini, Roberta

2014-01-01

The aim of the present work is to describe the state of the art of tobacco habits in Italy, eight years after the law was introduced. Time series analyses, based on estimates of smoking prevalence/consumption derived from the openly available data of national surveys performed during the 2001-2013 period, were performed. Data have been expressed in percentage of smokers and daily cigarettes consumption. Time changes are expressed as expected annual percentage change (EAPC). Over time, the percentage of Italian smokers shows a constant and statistically significant decrease (from 28.9% in 2001 to 20.6% in 2013, EAPC = -2.6%, and P < 0.001). Regarding data stratified by gender, we found a stronger reduction among men (EAPC = -2.9%, P < 0.001) than in women (EAPC = -2.5%, P < 0.001). Similarly, the consumption of tobacco smoking, measured as the number of daily cigarettes smoked, registered a downward trend (P < 0.001). No join point (time point when a significant trend change is detected) resulted from the trend analysis. Data show a constant decrease of tobacco consumption in Italy, with no join point related to the introduction of the banning law. These findings require to reflect on the priorities of the smoking banning policies that may be focused on other intervention activities such as to increase the price of cigarettes.

Assets among low-income families in the Great Recession.

PubMed

Duque, Valentina; Pilkauskas, Natasha V; Garfinkel, Irwin

2018-01-01

This paper examines the association between the Great Recession and real assets among families with young children. Real assets such as homes and cars are key indicators of economic well-being that may be especially valuable to low-income families. Using longitudinal data from the Fragile Families and Child Wellbeing Study (N = 4,898), we investigate the association between the city unemployment rate and home and car ownership and how the relationship varies by family structure (married, cohabiting, and single parents) and by race/ethnicity (White, Black, and Hispanic mothers). Using mother fixed-effects models, we find that a one percentage point increase in the unemployment rate is associated with a -0.5 percentage point decline in the probability of home ownership and a -0.7 percentage point decline in the probability of car ownership. We also find that the recession was associated with lower levels of home ownership for cohabiting families and for Hispanic families, as well as lower car ownership among single mothers and among Black mothers, whereas no change was observed among married families or White households. Considering that homes and cars are the most important assets among middle and low-income households in the U.S., these results suggest that the rise in the unemployment rate during the Great Recession may have increased household asset inequality across family structures and race/ethnicities, limiting economic mobility, and exacerbating the cycle of poverty.

The Effect of Introducing a Smaller and Lighter Basketball on Female Basketball Players’ Shot Accuracy

PubMed Central

Podmenik, Nadja; Leskošek, Bojan; Erčulj, Frane

2012-01-01

Our study examined whether the introduction of a smaller and lighter basketball (no. 6) affected the accuracy of female basketball players’ shots at the basket. The International Basketball Federation (FIBA) introduced a size 6 ball in the 2004/2005 season to improve the efficiency and accuracy of technical elements, primarily shots at the basket. The sample for this study included 573 European female basketball players who were members of national teams that had qualified for the senior women’s European championships in 2001, 2003, 2005 and 2007. A size 7 (larger and heavier) basketball was used by 286 players in 1,870 matches, and a size 6 basketball was used by 287 players in 1,966 matches. The players were categorised into three playing positions: guards, forwards and centres. The results revealed that statistically significant changes by year occurred only in terms of the percentage of successful free throws. With the size 6 basketball, this percentage decreased. Statistically significant differences between the playing positions were observed in terms of the percentage of field goals worth three points (between guards and forwards) and two points (between guards and centres). The results show that the introduction of the size 6 basketball did not lead to improvement in shooting accuracy (the opposite was found for free throws), although the number of three-point shots increased. PMID:23486286

Changing healthcare capital-to-labor ratios: evidence and implications for bending the cost curve in Canada and beyond.

PubMed

Nauenberg, Eric

2014-12-01

Healthcare capital-to-labor ratios are examined for the 10 provincial single-payer health care plans across Canada. The data show an increasing trend-particularly during the period 1997-2009 during which the ratio as much as doubled from 3 to 6 %. Multivariate analyses indicate that every percentage point uptick in the rate of increase in this ratio is associated with an uptick in the rate of increase of real per capita provincial government healthcare expenditures by approximately $31 ([Formula: see text] 0.01). While the magnitude of this relationship is not large, it is still substantial enough to warrant notice: every percentage point decrease in the upward trend of the capital-to-labor ratio might be associated with a one percentage point decrease in the upward trend of per capita government healthcare expenditures. An uptick since 1997 in the rate of increase in per capita prescription drug expenditures is also associated with a decline in the trend of increasing per capita healthcare costs. While there has been some recent evidence of a slowing in the rate of health care expenditure increase, it is still unclear whether this reflects just a pause, after which the rate of increase will return to its baseline level, or a long-term shift; therefore, it is important to continue to explore various policy avenues to affect the rate of change going forward.

Cytogenetic toxicity of vincristine.

PubMed

Choudhury, R C; Das, B; Misra, S; Jagdale, M B

2000-01-01

The anticancer drugs vincristine sulphate (VCR) and cyclophosphamide (CTX) were tested for their cytogenetic effects in the bone marrow cells of Swiss mice. The end points investigated were chromosomal aberrations and mitotic index at 24 hours posttreatment and micronuclei (MN) at 30 hours posttreatment in bone marrow cells of male and female mice after a single intraperitoneal exposure. The doses tested were VCR 0.25, 0.5, and 1.0 mg/kg and CTX 40 mg/kg b.w. of mice. Significant percentages of chromosomal aberrations and significant numbers of micronuclei per thousand polychromatic erythrocytes (PCEs) that were induced were recorded from bone marrow of each of the VCR-treated groups of mice. There were no significant differences between the percentages of dividing cells in the VCR-treated group and the vehicle control groups of mice. Peculiarly, in the chromosomal aberration study, the male mice were found to be more responsive to VCR than the females, and the aberrations per hundred metaphases were found to be decreased when the dose of VCR was increased. The percentage of dividing cells was also higher with the lowest dose of VCR tested. However, there was a dose-dependent, but nonlinear, increase in MN per thousand PCEs. The results were compared with the already available fragmentary and self-contradictory data on the genotoxicity of VCR in mice and in other mammalian test systems.

A double-blind, randomized, comparative study of the use of a combination of uridine triphosphate trisodium, cytidine monophosphate disodium, and hydroxocobalamin, versus isolated treatment with hydroxocobalamin, in patients presenting with compressive neuralgias.

PubMed

Goldberg, Henrique; Mibielli, Marco Antonio; Nunes, Carlos Pereira; Goldberg, Stephanie Wrobel; Buchman, Luiz; Mezitis, Spyros Ge; Rzetelna, Helio; Oliveira, Lisa; Geller, Mauro; Wajnsztajn, Fernanda

2017-01-01

This paper reports on the results of treatment of compressive neuralgia using a combination of nucleotides (uridine triphosphate trisodium [UTP] and cytidine monophosphate disodium [CMP]) and vitamin B 12 . To assess the safety and efficacy of the combination of nucleotides (UTP and CMP) and vitamin B 12 in patients presenting with neuralgia arising from neural compression associated with degenerative orthopedic alterations and trauma, and to compare these effects with isolated administration of vitamin B 12 . A randomized, double-blind, controlled trial, consisting of a 30-day oral treatment period: Group A (n=200) receiving nucleotides + vitamin B 12, and Group B (n=200) receiving vitamin B 12 alone. The primary study endpoint was the percentage of subjects presenting pain visual analog scale (VAS) scores ≤20 at end of study treatment period. Secondary study endpoints included the percentage of subjects presenting improvement ≥5 points on the patient functionality questionnaire (PFQ); percentage of subjects presenting pain reduction (reduction in VAS scores at study end in relation to pretreatment); and number of subjects presenting adverse events. The results of this study showed a more expressive improvement in efficacy evaluations among subjects treated with the combination of nucleotides + vitamin B 12 , with a statistically significant superiority of the combination in pain reduction (evidenced by VAS scores). There were adverse events in both treatment groups, but these were transitory and no severe adverse event was recorded during the study period. Safety parameters were maintained throughout the study in both treatment groups. The combination of uridine, cytidine, and vitamin B 12 was safe and effective in the treatment of neuralgias arising from neural compression associated with degenerative orthopedic alterations and trauma.

How well do route survey areas represent landscapes at larger spatial extents? An analysis of land cover composition along Breeding Bird Survey routes

USGS Publications Warehouse

Veech, Joseph A.; Pardieck, Keith L.; Ziolkowski, David

2017-01-01

The occurrence of birds in a survey unit is partly determined by the habitat present. Moreover, some bird species preferentially avoid some land cover types and are attracted to others. As such, land cover composition within the 400 m survey areas along a Breeding Bird Survey (BBS) route clearly influences the species available to be detected. Ideally, to extend survey results to the larger landscape, land cover composition within the survey area should be similar to that at larger spatial extents defining the landscape. Such representativeness helps minimize possible roadside effects (bias), here defined as differences in bird species composition and abundance along a roadside as compared to a larger surrounding landscape. We used land cover data from the 2011 National Land Cover Database to examine representativeness of land cover composition along routes. Using ArcGIS, the percentages of each of 15 land cover types within 400 m buffers along 2,696 U.S. BBS routes were calculated and compared to percentages in 2 km, 5 km, and 10 km buffers surrounding each route. This assessment revealed that aquatic cover types and highly urbanized land tend to be slightly underrepresented in the survey areas. Two anthropogenic cover types (pasture/hay and cropland) may be slightly overrepresented in the survey areas. Over all cover types, 92% of the 2,696 routes exhibited “good” representativeness, with <5 percentage points per cover type difference in proportional cover between the 400 m and 10 km buffers. This assessment further supports previous research indicating that any land-cover-based roadside bias in the bird data of the BBS is likely minimal.

Active transportation and public transportation use to achieve physical activity recommendations? A combined GPS, accelerometer, and mobility survey study.

PubMed

Chaix, Basile; Kestens, Yan; Duncan, Scott; Merrien, Claire; Thierry, Benoît; Pannier, Bruno; Brondeel, Ruben; Lewin, Antoine; Karusisi, Noëlla; Perchoux, Camille; Thomas, Frédérique; Méline, Julie

2014-09-27

Accurate information is lacking on the extent of transportation as a source of physical activity, on the physical activity gains from public transportation use, and on the extent to which population shifts in the use of transportation modes could increase the percentage of people reaching official physical activity recommendations. In 2012-2013, 234 participants of the RECORD GPS Study (French Paris region, median age = 58) wore a portable GPS receiver and an accelerometer for 7 consecutive days and completed a 7-day GPS-based mobility survey (participation rate = 57.1%). Information on transportation modes and accelerometry data aggregated at the trip level [number of steps taken, energy expended, moderate to vigorous physical activity (MVPA), and sedentary time] were available for 7,644 trips. Associations between transportation modes and accelerometer-derived physical activity were estimated at the trip level with multilevel linear models. Participants spent a median of 1 h 58 min per day in transportation (8.2% of total time). Thirty-eight per-cent of steps taken, 31% of energy expended, and 33% of MVPA over 7 days were attributable to transportation. Walking and biking trips but also public transportation trips with all four transit modes examined were associated with greater steps, MVPA, and energy expenditure when compared to trips by personal motorized vehicle. Two simulated scenarios, implying a shift of approximately 14% and 33% of all motorized trips to public transportation or walking, were associated with a predicted 6 point and 13 point increase in the percentage of participants achieving the current physical activity recommendation. Collecting data with GPS receivers, accelerometers, and a GPS-based electronic mobility survey of activities and transportation modes allowed us to investigate relationships between transportation modes and physical activity at the trip level. Our findings suggest that an increase in active transportation participation and public transportation use may have substantial impacts on the percentage of people achieving physical activity recommendations.

Financial accessibility and user fee reforms for maternal healthcare in five sub-Saharan countries: a quasi-experimental analysis.

PubMed

Leone, Tiziana; Cetorelli, Valeria; Neal, Sarah; Matthews, Zoë

2016-01-28

Evidence on whether removing fees benefits the poorest is patchy and weak. The aim of this paper is to measure the impact of user fee reforms on the probability of giving birth in an institution or undergoing a caesarean section (CS) in Ghana, Burkina Faso, Zambia, Cameroon and Nigeria for the poorest strata of the population. Women's experience of user fees in 5 African countries. Using quasi-experimental regression analysis we tested the impact of user fee reforms on facilities' births and CS differentiated by wealth, education and residence in Burkina Faso and Ghana. Mapping of the literature followed by key informant interviews are used to verify details of reform implementation and to confirm and support our countries' choice. We analysed data from consecutive surveys in 5 countries: 2 case countries that experienced reforms (Ghana and Burkina Faso) by contrast with 3 that did not experience reforms (Zambia, Cameroon, Nigeria). User fee reforms are associated with a significant percentage of the increase in access to facility births (27 percentage points) and to a much lesser extent to CS (0.7 percentage points). Poor (but not the poorest), and non-educated women, and those in rural areas benefitted the most from the reforms. User fees reforms have had a higher impact in Burkina Faso compared with Ghana. Findings show a clear positive impact on access when user fees are removed, but limited evidence for improved availability of CS for those most in need. More women from rural areas and from lower socioeconomic backgrounds give birth in health facilities after fee reform. Speed and quality of implementation might be the key reason behind the differences between the 2 case countries. This calls for more research into the impact of reforms on quality of care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Financial accessibility and user fee reforms for maternal healthcare in five sub-Saharan countries: a quasi-experimental analysis

PubMed Central

Leone, Tiziana; Cetorelli, Valeria; Neal, Sarah; Matthews, Zoë

2016-01-01

Objectives Evidence on whether removing fees benefits the poorest is patchy and weak. The aim of this paper is to measure the impact of user fee reforms on the probability of giving birth in an institution or undergoing a caesarean section (CS) in Ghana, Burkina Faso, Zambia, Cameroon and Nigeria for the poorest strata of the population. Setting Women's experience of user fees in 5 African countries. Primary and secondary outcome measures Using quasi-experimental regression analysis we tested the impact of user fee reforms on facilities’ births and CS differentiated by wealth, education and residence in Burkina Faso and Ghana. Mapping of the literature followed by key informant interviews are used to verify details of reform implementation and to confirm and support our countries’ choice. Participants We analysed data from consecutive surveys in 5 countries: 2 case countries that experienced reforms (Ghana and Burkina Faso) by contrast with 3 that did not experience reforms (Zambia, Cameroon, Nigeria). Results User fee reforms are associated with a significant percentage of the increase in access to facility births (27 percentage points) and to a much lesser extent to CS (0.7 percentage points). Poor (but not the poorest), and non-educated women, and those in rural areas benefitted the most from the reforms. User fees reforms have had a higher impact in Burkina Faso compared with Ghana. Conclusions Findings show a clear positive impact on access when user fees are removed, but limited evidence for improved availability of CS for those most in need. More women from rural areas and from lower socioeconomic backgrounds give birth in health facilities after fee reform. Speed and quality of implementation might be the key reason behind the differences between the 2 case countries. This calls for more research into the impact of reforms on quality of care. PMID:26823178

Government health insurance for people below poverty line in India: quasi-experimental evaluation of insurance and health outcomes.

PubMed

Sood, Neeraj; Bendavid, Eran; Mukherji, Arnab; Wagner, Zachary; Nagpal, Somil; Mullen, Patrick

2014-09-11

To evaluate the effects of a government insurance program covering tertiary care for people below the poverty line in Karnataka, India, on out-of-pocket expenditures, hospital use, and mortality. Geographic regression discontinuity study. 572 villages in Karnataka, India. 31,476 households (22,796 below poverty line and 8680 above poverty line) in 300 villages where the scheme was implemented and 28,633 households (21,767 below poverty line and 6866 above poverty line) in 272 neighboring matched villages ineligible for the scheme. A government insurance program (Vajpayee Arogyashree scheme) that provided free tertiary care to households below the poverty line in about half of villages in Karnataka from February 2010 to August 2012. Out-of-pocket expenditures, hospital use, and mortality. Among households below the poverty line, the mortality rate from conditions potentially responsive to services covered by the scheme (mostly cardiac conditions and cancer) was 0.32% in households eligible for the scheme compared with 0.90% among ineligible households just south of the eligibility border (difference of 0.58 percentage points, 95% confidence interval 0.40 to 0.75; P<0.001). We found no difference in mortality rates for households above the poverty line (households above the poverty line were not eligible for the scheme), with a mortality rate from conditions covered by the scheme of 0.56% in eligible villages compared with 0.55% in ineligible villages (difference of 0.01 percentage points, -0.03 to 0.03; P=0.95). Eligible households had significantly reduced out-of-pocket health expenditures for admissions to hospitals with tertiary care facilities likely to be covered by the scheme (64% reduction, 35% to 97%; P<0.001). There was no significant increase in use of covered services, although the point estimate of a 44.2% increase approached significance (-5.1% to 90.5%; P=0.059). Both reductions in out-of-pocket expenditures and potential increases in use might have contributed to the observed reductions in mortality. Insuring poor households for efficacious but costly and underused health services significantly improves population health in India. © Sood et al 2014.