Is Less Better? Greater Efficiency With Fewer Resources Expended

Summarizes an analysis of Medicare spending to assess the relative efficiency of healthcare providers in managing patients with severe chronic illnesses in California. Highlights the need to redesign the payment system to improve healthcare efficiency

Sport gave me something to wake up for : aboriginal adults with disabilities speak about sport

The purpose of this exploratory and descriptive study was to understand the experience of disability from the perspective of Aboriginal adults and the meaning they give to the importance of sport in their communities. The experiences of 3 Aboriginal adults with physical disabilities were captured using the phenomenological methods of one-on-one interviews, artifact collection, and field notes. The co-participants were provided the opportunity for collaboration at each research stage, from clarifying the purpose to finalizing and interpreting the emerging themes, in an effort to demonstrate sensitivity and respect for their Aboriginal culture, beliefs, and community. The conceptual framework utilized was the minority group model, which provided a framework for interpreting the sport experiences of the co-participants. The thematic analysis and interpretation of the findings facilitated by the co-participants revealed four themes: (a) we have to get out first, (b) not being a priority, (c) pride through accomplishments, and (d) the gift to grab others. We Have to Get Out First expressed the co-participants’ feelings that persons with disabilities were somewhat invisible in their rural Aboriginal communities as they did not venture far from their homes. The second theme, Not Being a Priority, recognized the lack of sport opportunities for people with disabilities. However, according to the third theme, Pride through Accomplishments, for these co-participants it was their involvement in their Aboriginal community and sport that gave them a sense of self-worth and dignity. The final theme, The Gift to Grab Others, empowered them to share the richness of their experiences with other Aboriginal people with disabilities. The results reflected the need to educate and build awareness of sport opportunities for Aboriginal people with disabilities. Furthermore, the co-participants expressed the need to encourage and support people with disabilities to get out of their homes and become active, visible members of society

Frequent mild head injury promotes trigeminal sensitivity concomitant with microglial proliferation, astrocytosis, and increased neuropeptide levels in the trigeminal pain system.

BACKGROUND: Frequent mild head injuries or concussion along with the presence of headache may contribute to the persistence of concussion symptoms. METHODS: In this study, the acute effects of recovery between mild head injuries and the frequency of injuries on a headache behavior, trigeminal allodynia, was assessed using von Frey testing up to one week after injury, while histopathological changes in the trigeminal pain pathway were evaluated using western blot, ELISA and immunohistochemistry. RESULTS: A decreased recovery time combined with an increased mild closed head injury (CHI) frequency results in reduced trigeminal allodynia thresholds compared to controls. The repetitive CHI group with the highest injury frequency showed the greatest reduction in trigeminal thresholds along with greatest increased levels of calcitonin gene-related peptide (CGRP) in the trigeminal nucleus caudalis. Repetitive CHI resulted in astrogliosis in the central trigeminal system, increased GFAP protein levels in the sensory barrel cortex, and an increased number of microglia cells in the trigeminal nucleus caudalis. CONCLUSIONS: Headache behavior in rats is dependent on the injury frequency and recovery interval between mild head injuries. A worsening of headache behavior after repetitive mild head injuries was concomitant with increases in CGRP levels, the presence of astrocytosis, and microglia proliferation in the central trigeminal pathway. Signaling between neurons and proliferating microglia in the trigeminal pain system may contribute to the initiation of acute headache after concussion or other traumatic brain injuries

Nociceptive neuropeptide increases and periorbital allodynia in a model of traumatic brain injury.

OBJECTIVE: This study tests the hypothesis that injury to the somatosensory cortex is associated with periorbital allodynia and increases in nociceptive neuropeptides in the brainstem in a mouse model of controlled cortical impact (CCI) injury. METHODS: Male C57BL/6 mice received either CCI or craniotomy-only followed by weekly periorbital von Frey (mechanical) sensory testing for up to 28 days post-injury. Mice receiving an incision only and naïve mice were included as control groups. Changes in calcitonin gene-related peptide (CGRP) and substance P (SP) within the brainstem were determined using enzyme-linked immunosorbent assay and immunohistochemistry, respectively. Activation of ionized calcium-binding adaptor molecule-1-labeled macrophages/microglia and glial fibrillary acidic protein (GFAP)-positive astrocytes were evaluated using immunohistochemistry because of their potential involvement in nociceptor sensitization. RESULTS: Incision-only control mice showed no changes from baseline periorbital von Frey mechanical thresholds. CCI significantly reduced mean periorbital von Frey thresholds (periorbital allodynia) compared with baseline and craniotomy-only at each endpoint, analysis of variance P \u3c .0001. Craniotomy significantly reduced periorbital threshold at 14 days but not 7, 21, or 28 days compared with baseline threshold, P \u3c .01. CCI significantly increased SP immunoreactivity in the brainstem at 7 and 14 days but not 28 days compared with craniotomy-only and controls, P \u3c .001. CGRP levels in brainstem tissues were significantly increased in CCI groups compared with controls (incision-only and naïve mice) or craniotomy-only mice at each endpoint examined, P \u3c .0001. There was a significant correlation between CGRP and periorbital allodynia (P \u3c .0001, r = -0.65) but not for SP (r = 0.20). CCI significantly increased the number of macrophage/microglia in the injured cortex at each endpoint up to 28 days, although cell numbers declined over weeks post-injury, P \u3c .001. GFAP(+) immunoreactivity was significantly increased at 7 but not 14 or 28 days after CCI, P \u3c .001. Craniotomy resulted in transient periorbital allodynia accompanied by transient increases in SP, CGRP, and GFAP immunoreactivity compared with control mice. There was no increase in the number of macrophage/microglia cells compared with controls after craniotomy. CONCLUSION: Injury to the somatosensory cortex results in persistent periorbital allodynia and increases in brainstem nociceptive neuropeptides. Findings suggest that persistent allodynia and increased neuropeptides are maintained by mechanisms other than activation of macrophage/microglia or astrocyte in the injured somatosensory cortex

Music Lessons: Exploring the Role and Meaning of Music Among Community-Dwelling Older Adults with Dementia

An aging population and increasing rates of dementia point to the need for alternative strategies to allow individuals to age in place. The purpose of this multiple case study is to explore, from an insider’s perspective, the role and meaning of music in the lives of individuals with dementia who are aging in place. The following three questions guide this exploration: What does music mean to someone with dementia and if/how has this changed, over time? How does music influence the health and wellbeing of individuals with dementia? How is music integrated into the day-to-day lives of individuals with dementia aging in place? Critical qualitative research was conducted through semi-structured interviews, observations, and videos. All three participants were in the early stages of dementia, living in the community (not in an institution), residing in Ontario, using music in their lives in a routine capacity, and not enrolled in music therapy. The partners of each of the participants were also included in the data collection process. The qualitative data was analyzed following a 10-step process that integrated the textual, auditory, and visual data. Analysis revealed that music plays a beneficial, yet complicated, role in these individuals’ lives. Analysis highlighted ‘connection’ as the central theme of the study with the various ‘connectors’ - self, partner, music and the study itself - as subthemes. Connection to self is discussed through present moment awareness, accessing memories, and self-expression. Connection to partner is explained in light of self-connection and spending time together. The connection to music acknowledges the self and partner as well as the need to keep things “ordinary”. Lastly, connection to the research is a methodological finding that speaks to the transformative nature of qualitative research. Findings from each sub-theme are described using examples from the data and discussed in relation to the literature. This study provides insight into the growing body of interdisciplinary literature dedicated to dementia, music, aging in place, and contemplative practices, as well as makes suggestions for future areas of research

Brominated Flame Retardants: Spatial and Temporal Patterns and Trends in Seabird eggs from the Nearshore Pacific Coast of Canada

Brominated flame retardants (BFRs) have been widely used to reduce fire hazards. One class, the polybrominated diphenyl ethers (PBDEs), are particularly persistent bioaccumulative and toxic chemicals, now classified as POPs under the Stockholm Convention. Marine ecosystems are the ultimate sink for POPs, and thus there is a continuing need to monitor such contamination. Eggs of marine birds have proven to be an efficient and effective means of measuring and tracking xenobiotic compounds which are transferred from the female bird to the egg via yolk lipids or proteins. Here we report and discuss data from long term monitoring of and mercury in seabird eggs from the northeast Pacific. For this program, the marine system was divided, and representative species selected. The nearshore subsurface is monitored using two cormorant, Phalacrocorax, species, auritus and pelagicus, both feed on a variety of benthic and pelagic fish. The inshore and estuarine zone is monitored using the great blue heron, Adea Herodias. Nearshore data will be compared to data from the offshore subsurface monitored using the rhinoceros auklet, Cerorhinca monocerata, a feeder mainly on small pelagic fishes, and the offshore surface species, the Leach’s storm-petrel, Oceanodroma leucorhoa, which feeds mainly on surface plankton and larval fishes. At three breeding colonies each along the Pacific coast of Canada and at four year intervals 15 eggs are collected and archived. Data from a recent retrospective study, using archived samples collected from 1990 to 2011, shows, as reported for more polluted environments, that PBDEs increased in continental shelf ranging auklet eggs until the early 2000s and have declined since then, in response to restrictions on usage. In contrast, another BFR compound, HBCD (hexabromocyclododecane), increased steadily in eggs of both near and offshore species. The possible role of dietary variation, potentially related to marine regime shifts, will be examined by use of stable isotopes in variation in contaminant levels in these monitored seabirds

Operational grid and environmental impacts for a V2G-enabled electric school bus fleet using DC fast chargers

As states replace diesel school buses with electric ones, utilities will want to control charging schedules to capture potential benefits on the grid and avoid all buses charging at the same time, adding a large electric load. Vehicle-to-grid (V2G) services can provide more grid stability and reduced carbon dioxide emissions than simple controlled charging systems, yet the grid impacts of V2G school buses have not been modeled using realistic school bus schedules. This paper develops a methodology for simulating the effect of managed charging of electric school buses on peak shaving in the state of North Carolina using V2G interactions and DC fast chargers to determine potential emissions reductions by minimizing peak load periods. The V2G-Sim model is used to manage fleet-wide charging, while minimizing peak generation of electricity on the grid and flattening the load curve under different battery capacities, charger power ratings, and fleet sizes. Historic annual peak hours are examined to determine the feasibility of reducing generation capacity, and the daily peak hours are examined to determine the potential peak shaving and subsequent avoided emissions. The results demonstrate that at full electric school bus replacement, 14,000 V2G buses can aggregate and shift 2.6 GWh in North Carolina, avoiding up to 1,130 t of carbon dioxide emissions per day, assuming decreased dependence on natural gas peaker plants. An additional 1,500 t of CO2 can be avoided by replacing diesel-powered buses compared to the 320,000 t total daily CO2 emissions from all activities in North Carolina. Additional emissions are avoided by the replacement of diesel buses with electric buses. The largest greenhouse gas emission benefit is the replacement of diesel with electric school buses, and the ability to shave peak loads is maximized on weekend days in the winter. The model can be used by researchers, the utility, and states as these entities evaluate the environmental and operational grid benefits of a V2G school bus program

Editorial: Bridging the gap between policy and science in assessing the health status of marine ecosystems

Human activities,both established and emerging, increasingly affect the provision of marine ecosystem services that deliver societal and economic benefits. Monitoring the status of marine ecosystems and determining how human activities change their capacity to sustain benefits for society requires an evidence-based Integrated Ecosystem Assessment approach that incorporates knowledge of ecosystem functioning and services).Although,there are diverse methods to assess the status of individual ecosystem components, none assesses the health of marine ecosystems holistically, integrating information from multiple ecosystem components. Similarly,while acknowledging the availability of several methods to measure single pressures and assess their impacts, evaluation of cumulative effects of multiple pressures remains scarce.Therefore,an integrative assessment requires us to first understand the response of marine ecosystems to human activities and their pressures and then develop innovative, cost-effective monitoring tools that enable collection of data to assess the health status of large marine areas. Conceptually, combining this knowledge of effective monitoring methods with cost-benefit analyses will help identify appropriate management measures to improve environmental status economically and efficiently. The European project DEVOTES (DEVelopment Of innovative Tools for understanding marine biodiversity and assessing good Environmental Status) specifically addressed these topics in order to support policymakers and managers in implementing the European Marine Strategy Framework Directive. Here, we synthesize our main innovative findings, placing these within the context of recent wider research, and identifying gaps and the major future challenges

The impact of COVID-19 restrictions on perceived health and wellbeing of adult Australian sport and physical activity participants

Individuals’ access to sport and physical activity has been hampered due to COVID-19 lockdown restrictions. In Australia participation in community sport was cancelled during lockdowns. There is limited research on the impact of sport participation restrictions on the health and wellbeing of adults. Aim The aim of this study was to investigate the perceived health and wellbeing of a sample of predominantly active Australian adults, both during COVID-19 and in comparison with one year earlier (pre COVID-19). Methods A survey was conducted during the first COVID-19 restrictions and lockdowns in Australia in May–June 2020. It was distributed by national and state sporting organisations and through researchers’ social media accounts. This particular paper focuses on adults aged 18–59 years. The survey collected information on participant demographics, the sport and physical activity patterns pre- COVID-19, and health and wellbeing outcomes during COVID-19 lockdown and compared to one year earlier. The health measures were cross-tabulated against the demographic and sport and physical activity variables, and group profiles compared with chi-square tests. Scales were derived from three wellbeing questions, and group differences were analysed by t-tests and F-tests. Results The survey sample included 1279 men and 868 women aged 18–59 years. Most (67%) resided in metropolitan cities. The great majority (83%) were sport participants. During COVID-19 lockdown men were significantly more likely than women to report worse or much worse general (p = 0.014), physical (p = 0.015) and mental health (p = 0.038) and lower life satisfaction (p = 0.016). The inactive adults were significantly more likely to report poorer general health (p = 0.001) and physical health (p = 0.001) compared to active adults. The younger age cohort (18–29 years) were significantly more likely to report poorer general wellbeing (p < 0.001), and lower life satisfaction (p < 0.001) compared to the older age groups. Conclusion It seems that the absence of playing competitive sport and training with friends, teams and within clubs has severely impacted males and younger adults in particular. Sports clubs provide an important setting for individuals’ health and wellbeing which is why clubs require the capacity to deliver sport and individuals may need to regain the motivation to return. © 2022, The Author(s)

Acute effects of a selective cannabinoid-2 receptor agonist on neuroinflammation in a model of traumatic brain injury.

Proposed therapeutic strategies for attenuating secondary traumatic brain injury (TBI) include modulation of acute neuroimmune responses. The goal of this study was to examine the acute effects of cannabinoid-2 receptor (CB(2)R) modulation on behavioral deficits, cerebral edema, perivascular substance P, and macrophage/microglial activation in a murine model of TBI. Thirty male C57BL/6 mice underwent sham surgery, or cortical contusion impact injury (CCI). CCI mice received vehicle or the CB(2)R agonist 0-1966 at 1 and 24 h after injury. Performance on the rotarod, forelimb cylinder, and open-field tests were evaluated before and at 48 h after sham or CCI surgery. Cerebral edema was evaluated using the wet-dry weight technique. Immunohistochemical analysis was used to examine changes in substance P and macrophage/microglia-specific Iba1 protein immunoreactivity. Locomotor performance and exploratory behavior were significantly improved in mice receiving 0-1966 (CB(2)R agonist) compared to vehicle-treated mice. Significant reductions were found for cerebral edema, number of perivascular areas of substance P immunoreactivity, and number of activated macrophages/microglial cells in the injured brains of 0-1966-treated mice compared to vehicle-treated mice. The findings show that the effects of the CB(2)R agonist 0-1966 on edema, substance P immunoreactivity, and macrophage/microglial activation, were associated with recovery of acute motor and exploratory deficits. This study provides evidence of acute neuroprotective effects derived from selective CB(2)R activation that may represent an avenue for further development of novel therapeutic agents in the treatment of TBI