Extensions and rollbacks of US unemployment insurance benefits primarily affected how long people searched for work rather than job finding.

In 2010, the US government extended unemployment insurance benefits to a maximum of 99 weeks. This extension was rolled back in 2012 and 2013, and now no state has benefits available beyond the normal duration (26 weeks in general). In new research, Henry S. Farber, Jesse Rothstein, and Robert G. Valletta examine the impact of the extension and subsequent rollback of unemployment insurance. They find that the unemployment insurance extension did not substantially reduce the rate at which people found jobs, but did keep them as active labor force participants for longer

Transition from Regular to Chaotic Circulation in Magnetized Coronae near Compact Objects

Accretion onto black holes and compact stars brings material in a zone of strong gravitational and electromagnetic fields. We study dynamical properties of motion of electrically charged particles forming a highly diluted medium (a corona) in the regime of strong gravity and large-scale (ordered) magnetic field. We start our work from a system that allows regular motion, then we focus on the onset of chaos. To this end, we investigate the case of a rotating black hole immersed in a weak, asymptotically uniform magnetic field. We also consider a magnetic star, approximated by the Schwarzschild metric and a test magnetic field of a rotating dipole. These are two model examples of systems permitting energetically bound, off-equatorial motion of matter confined to the halo lobes that encircle the central body. Our approach allows us to address the question of whether the spin parameter of the black hole plays any major role in determining the degree of the chaoticness. To characterize the motion, we construct the Recurrence Plots (RP) and we compare them with Poincar\'e surfaces of section. We describe the Recurrence Plots in terms of the Recurrence Quantification Analysis (RQA), which allows us to identify the transition between different dynamical regimes. We demonstrate that this new technique is able to detect the chaos onset very efficiently, and to provide its quantitative measure. The chaos typically occurs when the conserved energy is raised to a sufficiently high level that allows the particles to traverse the equatorial plane. We find that the role of the black-hole spin in setting the chaos is more complicated than initially thought.Comment: 21 pages, 20 figures, accepted to Ap

Steering by their own lights:Why regulators across Europe use different indicators to measure healthcare quality

Despite widespread faith that quality indicators are key to healthcare improvement and regulation, surprisingly little is known about what is actually measured in different countries, nor how, nor why. To address that gap, this article compares the official indicator sets--comprising some 1100 quality measures-- used by statutory hospital regulators in England, Germany, France, and the Netherlands. The findings demonstrate that those countries’ regulators strike very different balances in: the dimensions of quality they assess (e.g. between safety, effectiveness, and patient-centredness); the hospital activities they target (e.g. between clinical and non-clinical activities and management); and the ‘Donabedian’ measurement style of their indicators (between structure, process and outcome indicators). We argue that these contrasts reflect: i) how the distinctive problems facing each country's healthcare system create different ‘demand-side’ pressures on what national indicator sets measure; and ii) how the configuration of national healthcare systems and governance traditions create ‘supply-side’ constraints on the kinds of data that regulators can use for indicator construction. Our analysis suggests fundamental differences in the meaning of quality and its measurement across countries that are likely to impede international efforts to benchmark quality and identify best practice.</p

Intelligent Monitoring?:Assessing the ability of the Care Quality Commission's statistical surveillance tool to predict quality and prioritise NHS hospital inspections

Background The Care Quality Commission (CQC) is responsible for ensuring the quality of the health and social care delivered by more than 30000 registered providers in England. With only limited resources for conducting on-site inspections, the CQC has used statistical surveillance tools to help it identify which providers it should prioritise for inspection. In the face of planned funding cuts, the CQC plans to put more reliance on statistical surveillance tools to assess risks to quality and prioritise inspections accordingly. Objective To evaluate the ability of the CQC's latest surveillance tool, Intelligent Monitoring (IM), to predict the quality of care provided by National Health Service (NHS) hospital trusts so that those at greatest risk of providing poor-quality care can be identified and targeted for inspection. Methods The predictive ability of the IM tool is evaluated through regression analyses and Ï ‡ 2 testing of the relationship between the quantitative risk score generated by the IM tool and the subsequent quality rating awarded following detailed on-site inspection by large expert teams of inspectors. Results First, the continuous risk scores generated by the CQC's IM statistical surveillance tool cannot predict inspection-based quality ratings of NHS hospital trusts (OR 0.38 (0.14 to 1.05) for Outstanding/Good, OR 0.94 (0.80 to -1.10) for Good/Requires improvement, and OR 0.90 (0.76 to 1.07) for Requires improvement/Inadequate). Second, the risk scores cannot be used more simply to distinguish the trusts performing poorly - those subsequently rated either 'Requires improvement' or 'Inadequate' - from the trusts performing well - those subsequently rated either 'Good' or 'Outstanding' (OR 1.07 (0.91 to 1.26)). Classifying CQC's risk bandings 1-3 as high risk and 4-6 as low risk, 11 of the high risk trusts were performing well and 43 of the low risk trusts were performing poorly, resulting in an overall accuracy rate of 47.6%. Third, the risk scores cannot be used even more simply to distinguish the worst performing trusts - those subsequently rated 'Inadequate' - from the remaining, better performing trusts (OR 1.11 (0.94 to 1.32)). Classifying CQC's risk banding 1 as high risk and 2-6 as low risk, the highest overall accuracy rate of 72.8% was achieved, but still only 6 of the 13 Inadequate trusts were correctly classified as being high risk. Conclusions Since the IM statistical surveillance tool cannot predict the outcome of NHS hospital trust inspections, it cannot be used for prioritisation. A new approach to inspection planning is therefore required.</p

When ‘Must’ Means ‘Maybe’:Varieties of Risk Regulation and the Problem of Trade-offs in Europe. HowSAFE Working Paper, No. 1

This paper explains how the inevitable trade-offs between risk and cost in occupational health and safety (OHS) regulation are managed across EU member states. While trade-offs are explicitlysanctioned in UK law, many continental countries mandate ambitious goals of safety. This contrast in statutory goals appears to reflect cleavages identified in the risk regulation literature between European precaution and Anglo-Saxon neoliberal risk-taking, as well as in the Varieties of literature which suggests workers are better protected in co-ordinated than in liberal market economies. However, we challenge those claims through adetailed analysis of OHS regimes in the UK, Netherlands, Germany and France, which shows that a narrow focus on headline regulatory goals misses how each country makes cost-benefit trade-offs on safety. In particular, we show how the nature and outcome of those trade-offs substantially vary according to the degree of coupling between regulation and welfare regimes, and to national traditions of common and civil law. As such, we offer a novel explanation for risk regulation and governance variety that emphasises deep institutional differences among welfare states in the organization of the political economy and their philosophies of regulation

Glial contribution to excitatory and inhibitory synapse loss in neurodegeneration

Synapse loss is an early feature shared by many neurodegenerative diseases, and it represents the major correlate of cognitive impairment. Recent studies reveal that microglia and astrocytes play a major role in synapse elimination, contributing to network dysfunction associated with neurodegeneration. Excitatory and inhibitory activity can be affected by glia-mediated synapse loss, resulting in imbalanced synaptic transmission and subsequent synaptic dysfunction. Here, we review the recent literature on the contribution of glia to excitatory/inhibitory imbalance, in the context of the most common neurodegenerative disorders. A better understanding of the mechanisms underlying pathological synapse loss will be instrumental to design targeted therapeutic interventions, taking in account the emerging roles of microglia and astrocytes in synapse remodeling

Predictive value of neurological examination for early cortical responses to somatosensory evoked potentials in patients with postanoxic coma

Bilateral absence of cortical N20 responses of median nerve somatosensory evoked potentials (SEP) predicts poor neurological outcome in postanoxic coma after cardiopulmonary resuscitation (CPR). Although SEP is easy to perform and available in most hospitals, it is worthwhile to know how neurological signs are associated with SEP results. The aim of this study was to investigate whether specific clinical neurological signs are associated with either an absent or a present median nerve SEP in patients after CPR. Data from the previously published multicenter prospective cohort study PROPAC (prognosis in postanoxic coma, 2000–2003) were used. Neurological examination, consisting of Glasgow Coma Score (GCS) and brain stem reflexes, and SEP were performed 24, 48, and 72 h after CPR. Positive predictive values for predicting absent and present SEP, as well as diagnostic accuracy were calculated. Data of 407 patients were included. Of the 781 SEPs performed, N20 s were present in 401, bilaterally absent in 299, and 81 SEPs were technically undeterminable. The highest positive predictive values (0.63–0.91) for an absent SEP were found for absent pupillary light responses. The highest positive predictive values (0.71–0.83) for a present SEP were found for motor scores of withdrawal to painful stimuli or better. Multivariate analyses showed a fair diagnostic accuracy (0.78) for neurological examination in predicting an absent or present SEP at 48 or 72 h after CPR. This study shows that neurological examination cannot reliably predict absent or present cortical N20 responses in median nerve SEPs in patients after CPR

Implementation of rapid genomic sequencing in safety-net neonatal intensive care units: protocol for the VIrtual GenOme CenteR (VIGOR) proof-of-concept study.

INTRODUCTION: Rapid genomic sequencing (rGS) in critically ill infants with suspected genetic disorders has high diagnostic and clinical utility. However, rGS has primarily been available at large referral centres with the resources and expertise to offer state-of-the-art genomic care. Critically ill infants from racial and ethnic minority and/or low-income populations disproportionately receive care in safety-net and/or community settings lacking access to state-of-the-art genomic care, contributing to unacceptable health equity gaps. VIrtual GenOme CenteR is a \u27proof-of-concept\u27 implementation science study of an innovative delivery model for genomic care in safety-net neonatal intensive care units (NICUs). METHODS AND ANALYSIS: We developed a virtual genome centre at a referral centre to remotely support safety-net NICU sites predominantly serving racial and ethnic minority and/or low-income populations and have limited to no access to rGS. Neonatal providers at each site receive basic education about genomic medicine from the study team and identify eligible infants. The study team enrols eligible infants (goal n of 250) and their parents and follows families for 12 months. Enrolled infants receive rGS, the study team creates clinical interpretive reports to guide neonatal providers on interpreting results, and neonatal providers return results to families. Data is collected via (1) medical record abstraction, (2) surveys, interviews and focus groups with neonatal providers and (3) surveys and interviews with families. We aim to examine comprehensive implementation outcomes based on the Proctor Implementation Framework using a mixed methods approach. ETHICS AND DISSEMINATION: This study is approved by the institutional review board of Boston Children\u27s Hospital (IRB-P00040496) and participating sites. Participating families are required to provide electronic written informed consent and neonatal provider consent is implied through the completion of surveys. The results will be disseminated via peer-reviewed publications and data will be made accessible per National Institutes of Health (NIH) policies. TRIAL REGISTRATION NUMBER: NCT05205356/clinicaltrials.gov