Health and the Revolution in Household Behavior 1880-1940: Fertility, Education and Married Female Labor Supply (previously entitled: Schooling, Fertility, and Married Female Labor Supply: What Role for Health?)

Between the latter nineteenth century and the 1930s there was a dramatic revolution in American families. Family size continued its long-term decline, the schooling of older children expanded dramatically and the proportion of married females' adulthood devoted to market-oriented activities increased. Over this same period there were significant reductions in mortality, especially among the young, and impressive reductions in morbidity. This paper considers all these trends jointly, modeling the changes in fertility, child schooling and lifetime married female labor supply as a consequence of exogenous changes in health. These interactions are then quantified using calibration techniques. The simulations suggest that reductions in child mortality alone cannot explain the transformation of the American family. Indeed, in our preferred calibration, reductions in child mortality lead to a modest decline in human capital and increase in fertility, with little effect on married female labor force involvement. In sharp contrast, reductions in morbidity are found to lower fertility and increase education. The time savings from lower fertility more than offset the increased time mothers invest in their childrens' quality, freeing some time for market work. However, lower fertility alone cannot account for the increase in market work of married women. In our framework, the majority of the increase is a consequence of a narrowing of the gender wage gap. More generally, viewing the implications of health improvements deepens our understanding of the American family transformation, complementing explanations based on skill biased technical change and improvements in household durable goods.Schooling, Fertility, Health, Human Capital Accumulation, Labor Supply.

Patient and clinician factors associated with prehospital pain treatment and outcomes: cross sectional study

Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.Objective: We aimed to identify how patient (age, sex, condition) and paramedic factors (sex, role) affected prehospital analgesic administration and pain alleviation. Methods: We used a cross-sectional design with a 7-day retrospective sample of adults aged 18 years or over requiring primary emergency transport to hospital, excluding patients with Glasgow Coma Scale below 13, in two UK ambulance services. Multivariate multilevel regression using Stata 14 analysed factors independently associated with analgesic administration and a clinically meaningful reduction in pain (≥2 points on 0–10 numerical verbal pain score [NVPS]). Results: We included data on 9574 patients. At least two pain scores were recorded in 4773 (49.9%) patients. For all models fitted there was no significant relationship between analgesic administration or pain reduction and sex of the patient or ambulance staff. Reduction in pain (NVPS ≥2) was associated with ambulance crews including at least one paramedic (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.14 to 2.04, p < 0.01), with any recorded pain score and suspected cardiac pain (OR 2.2, 95% CI 1.02 to 4.75). Intravenous morphine administration was also more likely where crews included a paramedic (OR 2.82, 95% CI 1.93 to 4.13, P < 0.01), attending patients aged 51 to 64 years (OR 2.04, 95% CI 1.21 to 3.45, p = 0.01), in moderate to severe (NVPS 4–10) compared with lower levels of pain for any clinical condition group compared with the reference condition. Conclusion: There was no association between patient sex or ambulance staff sex or grade and analgesic administration or pain reduction.Peer reviewedFinal Accepted Versio

Plant Selection for Bioretention Systems and Stormwater Treatment Practices

Landscape/Regional and Urban Planning; Water Quality/Water Pollution; Hydrology/Water Resources; Urban Ecolog

Plant Selection for Bioretention Systems and Stormwater Treatment Practices

Landscape/Regional and Urban Planning; Water Quality/Water Pollution; Hydrology/Water Resources; Urban Ecolog

In the wake of hospital inquiries : impact on staff and safety

Mishandled concerns about clinical standards resulted in whistleblowing in four Australian hospitals. Official inquiries followed with recommendations to improve patient safety. In the aftermath of the inquiries, common themes included loss of trust in management and among clinical colleagues, and loss of trust from patients and the community. Without first rebuilding trust, staff will not report mistakes or other concerns about safety. Successful implementation of patient safety procedures requires policies to stress the professional duty of staff to report concerns about colleagues when they believe there is a risk to patients.<br /

The influence of paramedic qualification level on the administration of analgesia in the prehospital setting

BackgroundUndertreatment of pain has been reported in the paramedic literature, and reasons for these disparities are not well understood.AimsAs the qualification level of the paramedic may affect analgesia administration, the primary aim of this study was to determine the impact of paramedic qualification on the provision of any analgesia for patients reporting pain.MethodsRetrospective study of de-identified patient care records from one Australian ambulance service over a period of 6 months. Inclusion criteria were age was &gt; 17 years, initial pain severity score was &gt; 3/10 and Glasgow Coma Score &gt;13. Data were descriptively analysed for analgesia administration and type of analgesic by predictor variables: age, sex, pain score and case nature. Pearson’s chi-square test was used to test for associations between the outcome of interest and predictor variables. Adjusted logged odds of patients receiving analgesia was tested with binomial logistic regression.Findings3173 patient records met the inclusion criteria. ICP treated 86% of the sample population. Of those treated by an AP, 76.2% (n=340) received analgesia, whereas 71.6% (n=1952) of patients treated by an ICP received analgesia (p=0.042). Methoxyflurane was the most frequently administered analgesic, with 39.9% of the patients (n=1,264) receiving this agent; 31.1% of patients (n=988) received morphine, and 14.2% (n=452) received fentanyl. The unadjusted regression model found that AP have higher odds of administering analgesia than ICP paramedics (OR 1.264, p &lt;0.05). However, once other covariates are included in the logistic regression, the significance no longer exists.ConclusionParamedic qualification is not associated with the administration of analgesia in this setting. This study contributes to the gap in knowledge regarding disparities in analgesia for adults experiencing pain and may inform future research that aims to identify and reduce barriers to appropriate pain management in the paramedic practice setting

Expert in my pocket: creating first person POV videos to enhance mobile learning

Worldwide, there has been a rapid increase in both the use of mobile technologies as a conduit for student learning and the use of wearable cameras to record sporting and recreational activities. The Expert in My Pocket project (EiMP) has combined these two technologies to produce a repository of freely available short videos and supporting materials to enhance student development of psychomotor clinical skills. The videos are presented from a first person point of view (1PPOV) with expert health professionals &lsquo;thinking aloud&rsquo; as they demonstrate selected skills. Research indicates that students and educators overwhelmingly support the concept of EiMP videos and more importantly value the 1PPOV as an authentic view. This paper demonstrates the techniques and equipment employed to produce these videos, which consisted of a chest or head mounted GoPro camera operated via an iPad. Additionally, the paper explains another innovative feature, Quick Response (QR) Codes, that when linked to the videos placed on equipment assists with &ldquo;just in time&rdquo; mobile learning

236 Developing a Young Persons Advisory Group (YPAG) to inform the design of a study to improve pre-hospital pain management for Children and Young People (CYP)

Background Patient and public involvement is an integral component of clinical research. A YPAG is group of young people with active involvement in the design and conduct of clinical research aimed at CYP.1 2 Active collaboration with a YPAG can be mutually beneficial and can have a positive impact on study design and conduct.2 3 We report on the involvement of young people, their influence on study design and the perceived benefits to members. Method A UK secondary school was approached and ten 16–17 year old students agreed to form a YPAG. Three 1-hour sessions were planned involving arts-based activities to explore key challenges, predetermined iteratively by the research team. Activities involved group work to explore and propose solutions for effective CYP recruitment and data collection, produce a study logo and review the plain English summary. Results YPAG members produced insightful arts-based posters containing important ideas and concepts that were incorporated into the study design. A study logo was created, diaries and electronic communication methods to collect data were added and a variety of age-based leaflets were added to the recruitment strategy. Members reported several benefits from the sessions, including enhanced creative and problem-solving skills and members enjoyed the teamwork and collaborative approach. Conclusion YPAG involvement resulted in meaningful improvements to research design and members gained new knowledge, transferrable skills and improved confidence. This experience should help inform YPAG involvement in future research

Glutathione pathway gene variation and risk of autism spectrum disorders

Despite evidence that autism is highly heritable with estimates of 15 or more genes involved, few studies have directly examined associations of multiple gene interactions. Since inability to effectively combat oxidative stress has been suggested as a mechanism of autism, we examined genetic variation 42 genes (308 single-nucleotide polymorphisms (SNPs)) related to glutathione, the most important antioxidant in the brain, for both marginal association and multi-gene interaction among 318 case–parent trios from The Autism Genetic Resource Exchange. Models of multi-SNP interactions were estimated using the trio Logic Regression method. A three-SNP joint effect was observed for genotype combinations of SNPs in glutaredoxin, glutaredoxin 3 (GLRX3), and cystathione gamma lyase (CTH); OR = 3.78, 95% CI: 2.36, 6.04. Marginal associations were observed for four genes including two involved in the three-way interaction: CTH, alcohol dehydrogenase 5, gamma-glutamylcysteine synthetase, catalytic subunit and GLRX3. These results suggest that variation in genes involved in counterbalancing oxidative stress may contribute to autism, though replication is necessary