Managed Care, Technology Adoption, and Health Care: The Adoption of Neonatal Intensive Care

Managed care activity may alter the incentives associated with the acquisition and use of new medical technologies, with potentially important implications for health care costs, patient care, and outcomes. This paper discusses mechanisms by which managed care could influence the adoption of new technologies and empirically examines the relationship between HMO market share and the diffusion of neonatal intensive care, a collection of technologies for the care of high risk newborns. We find that managed care slowed the adoption of NICUs, primarily by slowing the adoption of mid-level NICUs rather than the most advanced high-level units. Slowing the adoption of mid-level units would likely have generated savings. Moreover, opposite the frequent supposition that slowing technology growth is uniformly harmful to patients, in this case reduced adoption of mid-level units could have benefitted patients, since health outcomes for seriously ill newborns are better in higher-level NICUs and reductions in the availability of mid-level units appear to increase the chance of receiving care in a high-level center.

The effect of physical contact on changes in fatigue markers following rugby union field-based training.

Repeated physical contact in rugby union is thought to contribute to post-match fatigue; however, no evidence exists on the effect of contact activity during field-based training on fatigue responses. Therefore, the purpose of this study was to examine the effect of contact during training on fatigue markers in rugby union players. Twenty academy rugby union players participated in the cross-over study. The magnitude of change in upper- and lower-body neuromuscular function (NMF), whole blood creatine kinase concentration [CK] and perception of well-being was assessed pre-training (baseline), immediately and 24 h post-training following contact and non-contact, field-based training. Training load was measured using mean heart rate, session rating of perceived exertion (sRPE) and microtechnology (Catapult Optimeye S5). The inclusion of contact during field-based training almost certainly increased mean heart rate (9.7; ±3.9%) and sRPE (42; ±29.2%) and resulted in likely and very likely greater decreases in upper-body NMF (-7.3; ±4.7% versus 2.7; ±5.9%) and perception of well-being (-8.0; ±4.8% versus  -3.4; ±2.2%) 24 h post-training, respectively, and almost certainly greater elevations in [CK] (88.2; ±40.7% versus 3.7; ±8%). The exclusion of contact from field-based training almost certainly increased running intensity (19.8; ±5%) and distance (27.5; ±5.3%), resulting in possibly greater decreases in lower-body NMF (-5.6; ±5.2% versus 2.3; ±2.4%). Practitioners should be aware of the different demands and fatigue responses of contact and non-contact, field-based training and can use this information to appropriately schedule such training in the weekly microcycle

Strategic planning, ‘city deals’ and affordable housing

This study examines how local and international funding interventions focussed on specific regions, such as City Deals, deliver affordable rental housing for low income households to enhance urban productivity. Such strategic policy interventions offer some promise in creating new economic opportunities, however explicit policies are needed to ensure low income households can access affordable housing close to employment opportunities

Changes in undergraduates’ marijuana, heavy alcohol and cigarette use following legalization of recreational marijuana use in Oregon

Background and AimsRecreational marijuana legalization (RML) went into effect in Oregon in July 2015. RML is expected to influence marijuana use by adolescents and young adults in particular, and by those with a propensity for substance use. We sought to quantify changes in rates of marijuana use among college students in Oregon from pre‐ to post‐RML relative to college students in other states across the same time period.DesignRepeated cross‐sectional survey data from the 2012–16 administrations of the Healthy Minds Study.SettingSeven 4‐year universities in the United States.ParticipantsThere were 10 924 undergraduate participants. One large public Oregon university participated in 2014 and 2016 (n = 588 and 1115, respectively); six universities in US states where recreational marijuana use was illegal participated both in 2016 and at least once between 2012 and 2015.MeasurementsSelf‐reported marijuana use in the past 30 days (yes/no) was regressed on time (pre/post 2015), exposure to RML (i.e. Oregon students in 2016) and covariates using mixed‐effects logistic regression. Moderation of RML effects by recent heavy alcohol use was examined.FindingsRates of marijuana use increased from pre‐ to post‐2015 at six of the seven universities, a trend that was significant overall. Increases in rates of marijuana use were significantly greater in Oregon than in comparison institutions, but only among students reporting recent heavy alcohol use.ConclusionsRates of Oregon college students’ marijuana use increased (relative to that of students in other states) following recreational marijuana legislation in 2015, but only for those who reported recent heavy use of alcohol. Such alcohol misuse may be a proxy for vulnerabilities to substance use or lack of prohibitions (e.g. cultural) against it.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138912/1/add13906_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138912/2/add13906.pd

Objective sleep patterns and validity of self-reported sleep monitoring across different playing levels in rugby union

Background: Growing evidence highlights that elite rugby union players experience poor sleep quality and quantity which can be detrimental for performance. Objectives: This study aimed to i) compare objective sleep measures of rugby union players between age categories over a one week period, and ii) compare self-reported measures of sleep to wristwatch actigraphy as the criterion. Methods: Two hundred and fifty-three nights of sleep were recorded from 38 players representing four different age groups (i.e. under 16, under 18, senior academy, elite senior) in a professional rugby union club in the United Kingdom (UK). Linear mixed models and magnitude-based decisions were used for analysis. Results: The analysis of sleep schedules showed that U16 players went to bed and woke up later than their older counterparts (small differences). In general, players obtained seven hours of sleep per night, with trivial or unclear differences between age groups. The validity analysis highlighted a large relationship between objective and subjective sleep measures for bedtime (r = 0.56 [0.48 to 0.63]), and get up time (r = 0.70 [0.63 to 0.75]). A large standardised typical error (1.50 [1.23 to 1.88]) was observed for total sleep time. Conclusion: This study highlights that differences exist in sleep schedules between rugby union players in different age categories that should be considered when planning training. Additionally, self-reported measures overestimated sleep parameters. Coaches should consider these results to optimise sleep habits of their players and should be careful with self-reported sleep measures

Supporting affordable housing supply: inclusionary planning in new and renewing communities, AHURI Final Report No. 297

This study examined recent Australian and international practice in planning for affordable housing within new and renewing communities, focusing on South Australia’s 15 per cent inclusionary housing target and voluntary incentives for affordable housing in NSW, as well as recent practice in the UK and the US. * Key data sources included policy documents, government reports, and development approval data as well as 23 interviews with planners and affordable housing developers and consultants

The Interplay of Climate and Disaster in Men's Stories of the 2016 Kaikōura Earthquake in Aotearoa New Zealand

This paper contributes to the emerging field of men, masculinities, and disasters by drawing on narratives of men's accounts of the 2016 Kaikōura earthquake, including how stories of the earthquake intersect with experiences and understandings of extreme weather and climate change. A qualitative methodology was employed, and semi-structured interviews were conducted with 19 men who experienced the 7.8 magnitude earthquake. This article offers an examination of the complexity of disaster experiences and recovery, as well as how people make sense of hazards and risks. We argue that ongoing exposure to climate hazards informed participant's responses to other infrequent natural hazard events, such as the Kaikōura earthquake. The research identified that men construct their own understandings and responses to natural hazards through a hierarchy of risk perception and probability based on personal experience.fals

Addressing the needs of children with disabilities experiencing disaster or terrorism

Purpose of review: This paper reviews the empirical literature on psychosocial factors relating to children with disabilities in the context of disaster or terrorism. Recent findings: Research indicates individuals with disabilities experience increased exposure to hazards due to existing social disparities and barriers associated with disability status. However, studies on the psychological effects of disaster/terrorism on children with preexisting disabilities are exceedingly few and empirical evidence of the effectiveness of trauma-focused therapies for this population is limited. Secondary adversities, including social stigma and health concerns, also compromise the recovery of these children post-disaster/terrorism. Schools and teachers appear to be particularly important in the recovery of children with disabilities to disaster. Disasters, terrorism, and war all contribute to the incidence of disability, as well as disproportionately affect children with preexisting disabilities. Summary: Disaster preparedness interventions and societal changes are needed to decrease the disproportionate environmental and social vulnerability of children with disabilities to disaster and terrorism

First Report of Soybean Vein Necrosis Disease Caused by Soybean vein necrosis-associated virus in Wisconsin and Iowa

Several viral diseases of soybean (Glycine max) have been identified in the north-central U.S. soybean production area, which includes Wisconsin and Iowa (2). Previously, Soybean vein necrosis disease (SVND) caused by Soybean vein necrosis-associated virus was reported in Arkansas, Tennessee, and other southern states (4). In September 2012, soybean plants with symptoms similar to those reported for SVND (4) were observed in fields across Wisconsin and Iowa. Symptoms included leaf-vein and leaf chlorosis, followed by necrosis of the leaf veins and eventually necrosis of the entire leaf. Six samples with symptoms indicative of SVNaV were collected from research plots located at the West Madison Agricultural Research Station located in Madison, WI. An additional three samples were collected from three locations in central Iowa. Total RNA extracted from each sample using the Trizol Plus RNA purification kit (Invitrogen, Carlsbad, CA) was used to generate complementary DNA (cDNA) using the iScript cDNA synthesis kit (Bio-Rad Laboratories, Hercules, CA) following the manufacturers\u27 suggested protocols. The resulting cDNA was used as template in a PCR with SVNaV-specific primers, SVNaV-f1 and SVNaV-r1 (3). PCRs of two of the six Wisconsin samples and two Iowa samples were positive. Amplification products were not detected in the other five samples. The amplification products from the four strongly positive samples were purified using the Wizard SV Gel and PCR Purification Kit (Promega, Madison, WI) following the manufacturer\u27s suggested protocol and were subjected to automated sequencing (University of Wisconsin Biotechnology Center or Iowa State University, DNA Sequencing Facilities). BLASTn (1) alignments of the 915-bp consensus sequence revealed 98% and \u3e99% identity of the Wisconsin and Iowa samples, respectively, with the ‘S’ segment of the SVNaV ‘TN’ isolate (GenBank Accession No. GU722319.1). Samples from the same leaf tissue used above, were subjected to serological tests for SVNaV using antigen coated-indirect ELISA (3). Asymptomatic soybeans grown in the greenhouse were used as a source of leaves for negative controls. These tests confirmed the presence of SVNaV in eight symptomatic soybean leaflets collected in Wisconsin and Iowa. The asymptomatic control and one Iowa sample, which was also PCR-negative, were also negative by serological testing. Six additional samples from soybean fields in as many Wisconsin counties (Fond Du Lac, Grant, Green, Juneau, Richland, Rock) tested positive for SVNaV using specific primers that amplify the ‘L’ segment (4). The sequenced amplification products (297-bp) showed 99 to 100% homology to the L segment of the TN isolate (GU722317.1). To our knowledge, this is the first report of SVNaV associated with soybean and the first report of SVND in Wisconsin and Iowa. Considering that little is known about SVNaV, it is assumed that it is like other Tospoviruses and can cause significant yield loss (4). Soybean is a major cash crop for Wisconsin and Iowa, and infection by SVNaV could result in potential yield loss in years where epidemics begin early and at a high initial inoculum level