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 rugby training on indirect markers of gut permeability and gut damage in academy level rugby players.

PURPOSE: To assess indirect markers of intestinal endothelial cell damage and permeability in academy rugby players in response to rugby training at the beginning and end of preseason. METHODS: Blood and urinary measures (intestinal fatty acid binding protein and lactulose:rhamnose) as measures of gastrointestinal cell damage and permeability were taken at rest and after a standardised collision-based rugby training session in 19 elite male academy rugby players (age: 20 ± 1 years, backs: 89.3 ± 8.4 kg; forwards: 111.8 ± 7.6 kg) at the start of preseason. A subsample (n = 5) repeated the protocol after six weeks of preseason training. Gastrointestinal symptoms (GIS; range of thirteen standard symptoms), aerobic capacity (30-15 intermittent fitness test), and strength (1 repetition maximum) were also measured. RESULTS: Following the rugby training session at the start of preseason, there was an increase (median; interquartile range) in intestinal fatty acid binding protein (2140; 1260-2730 to 3245; 1985-5143 pg/ml, p = 0.003) and lactulose:rhamnose (0.31; 0.26-0.34 to 0.97; 0.82-1.07, p < 0.001). After six weeks of preseason training players physical qualities improved, and the same trends in blood and urinary measures were observed within the subsample. Overall, the frequency and severity of GIS were low and not correlated to markers of endothelial damage. CONCLUSIONS: Rugby training resulted in increased intestinal endothelial cell damage and permeability compared to rest. A similar magnitude of effect was observed after six weeks of pre-season training. This was not related to the experience of GIS

Housing assistance: exploring benefits beyond shelter

In Australia, an increasing number of households face problems of access to suitable housing in the private market. In response, the Federal and State Governments share responsibility for providing housing assistance to these, mainly low-income, households. A broad range of policy instruments are used to provide and maintain housing assistance across all housing tenures, for example, assisting entry into homeownership, providing affordability assistance in the private rental market, and the provision of socially owned and managed housing options. Underlying each of these interventions is the premise that secure, affordable, and appropriate housing provides not only shelter but also a number of nonshelter benefits to individuals and their households. Although the nonshelter outcomes of housing are well acknowledged in Australia, the understanding of the nonshelter outcomes of housing assistance is less clear. This paper explores nonshelter outcomes of three of the major forms of housing assistance provided by Australian governments—low-income mortgage assistance, social housing, and private rent assistance. It is based upon analysis of a survey of 1,353 low-income recipients of housing assistance, and specifically measures the formulation of health and well-being, financial stress, and housing satisfaction outcomes across these three assistance types. We find clear evidence that health, finance, and housing satisfaction outcomes are associated with quite different factors for individuals in these three major housing assistance types. Emma Baker, Laurence Lester and Andrew Bee

Revealing Repton: bringing landscape to life at Sheringham Park

The year 2012 marked 200 years since Humphry Repton (1752–1818) produced his design for Sheringham Park in north Norfolk, bound as one of his Red Books. On paper, Repton is England’s best-known and most influential landscape gardener. On the ground, his work is much harder to identify, focused as it was on light touches that equated more to landscape makeover than the landscape making of his predecessor Lancelot “Capability” Brown. This paper documents and evaluates a project that celebrated this bicentenary through a temporary exhibition within the visitor centre of Sheringham Park, whilst also making reference to the commemoration of his work in other places and on paper. In attempting to reveal Repton at Sheringham, we explore the context of the 1812 commission and the longer landscape history of the site, as well as the different methods of representing Repton on site that are open to site owners and managers

Comparison of distance measures in spatial analytical modeling for health service planning

<p>Abstract</p> <p>Background</p> <p>Several methodological approaches have been used to estimate distance in health service research. In this study, focusing on cardiac catheterization services, Euclidean, Manhattan, and the less widely known Minkowski distance metrics are used to estimate distances from patient residence to hospital. Distance metrics typically produce less accurate estimates than actual measurements, but each metric provides a single model of travel over a given network. Therefore, distance metrics, unlike actual measurements, can be directly used in spatial analytical modeling. Euclidean distance is most often used, but unlikely the most appropriate metric. Minkowski distance is a more promising method. Distances estimated with each metric are contrasted with road distance and travel time measurements, and an optimized Minkowski distance is implemented in spatial analytical modeling.</p> <p>Methods</p> <p>Road distance and travel time are calculated from the postal code of residence of each patient undergoing cardiac catheterization to the pertinent hospital. The Minkowski metric is optimized, to approximate travel time and road distance, respectively. Distance estimates and distance measurements are then compared using descriptive statistics and visual mapping methods. The optimized Minkowski metric is implemented, via the spatial weight matrix, in a spatial regression model identifying socio-economic factors significantly associated with cardiac catheterization.</p> <p>Results</p> <p>The Minkowski coefficient that best approximates road distance is 1.54; 1.31 best approximates travel time. The latter is also a good predictor of road distance, thus providing the best single model of travel from patient's residence to hospital. The Euclidean metric and the optimal Minkowski metric are alternatively implemented in the regression model, and the results compared. The Minkowski method produces more reliable results than the traditional Euclidean metric.</p> <p>Conclusion</p> <p>Road distance and travel time measurements are the most accurate estimates, but cannot be directly implemented in spatial analytical modeling. Euclidean distance tends to underestimate road distance and travel time; Manhattan distance tends to overestimate both. The optimized Minkowski distance partially overcomes their shortcomings; it provides a single model of travel over the network. The method is flexible, suitable for analytical modeling, and more accurate than the traditional metrics; its use ultimately increases the reliability of spatial analytical models.</p

The effects of traditional, superset, and tri-set resistance training structures on perceived intensity and physiological responses.

PURPOSE: Investigate the acute and short-term (i.e., 24 h) effects of traditional (TRAD), superset (SS), and tri-set (TRI) resistance training protocols on perceptions of intensity and physiological responses. METHODS: Fourteen male participants completed a familiarisation session and three resistance training protocols (i.e., TRAD, SS, and TRI) in a randomised-crossover design. Rating of perceived exertion, lactate concentration ([Lac]), creatine kinase concentration ([CK]), countermovement jump (CMJ), testosterone, and cortisol concentrations was measured pre, immediately, and 24-h post the resistance training sessions with magnitude-based inferences assessing changes/differences within/between protocols. RESULTS: TRI reported possible to almost certainly greater efficiency and rate of perceived exertion, although session perceived load was very likely lower. SS and TRI had very likely to almost certainly greater lactate responses during the protocols, with changes in [CK] being very likely and likely increased at 24 h, respectively. At 24-h post-training, CMJ variables in the TRAD protocol had returned to baseline; however, SS and TRI were still possibly to likely reduced. Possible increases in testosterone immediately post SS and TRI protocols were reported, with SS showing possible increases at 24-h post-training. TRAD and SS showed almost certain and likely decreases in cortisol immediately post, respectively, with TRAD reporting likely decreases at 24-h post-training. CONCLUSIONS: SS and TRI can enhance training efficiency and reduce training time. However, acute and short-term physiological responses differ between protocols. Athletes can utilise SS and TRI resistance training, but may require additional recovery post-training to minimise effects of fatigue