Utilisation ofpublic health services by caregivers of children from Khayelitsha presenting with acute diarrhoea

Patterns of public sector health service utilisation in relation to severity and weekday or weekend occurrence were identified for children from Khayelitsha with diarrhoeal disease. The current organisation of local services is inappropriate for the provision ofbasic primary care for these children. Given the inadequate access to appropriate care, caregivers select their health service options rationally. This paper recommends that a 24-hour rehydration unit be established in Khayelitsha to improve the effectiveness and appropriateness of the management ofthese children

Intellectual and Developmental Disability: Healthcare Financing

The World Health Organization (WHO) estimates global spending on healthcare at $6.5 trillion, approximately 10.5$2.6 trillion, essentially quadrupling since 1980. The 2010 United States Patient Protection and Affordable Care Act (PPACA), also known as Obamacare, has stimulated extensive debate over the way in which healthcare is financed, and whether or not the costs of healthcare are sustainable. Among publicly funded healthcare in the US, Medicaid and Medicare are primary sources of funding. In federal fiscal year 2012, Medicaid spending on acute health exceeded $275.4 billion, while a further$122.7 billion expended in Medicaid long term services and supports. The impact of an aging population worldwide (the so-called “wave of wisdom”), as the Baby Boomer generation reaches senior status, and attendant increases in chronic conditions, will be a substantial driver of healthcare costs in the future. Among people with intellectual and developmental disabilities (IDD), cost estimates vary depending on a range of factors. Some children with IDD, for example, are covered for at least some healthcare needs by private insurance policies held by their parents, while other children and most adults with IDD rely heavily on Medicaid and, to a lesser extent, Medicare and other publicly financed healthcare options. In many US states, certain nursing and home health services are presumed to be part of funding of home and community-based service (HCBS) medicaid waiver services (typically considered part of residential service reimbursements under these waivers), and rely on medicaid state plans for other acute health services. There are also wide ranges of estimates of uncompensated care that, when combined with other variables that are difficult to control, make accurate aggregate cost estimates difficult. Birenbaum and Cohen offer a review of healthcare utilization and costs in general for people with IDD

Quantitative Data Analysis: CRASAR Small Unmanned Aerial Systems at Hurricane Ian

This paper provides a summary of the 281 sorties that were flown by the 10 different models of small unmanned aerial systems (sUAS) at Hurricane Ian, and the failures made in the field. These 281 sorties, supporting 44 missions, represents the largest use of sUAS in a disaster to date (previously Hurricane Florence with 260 sorties). The sUAS operations at Hurricane Ian differ slightly from prior operations as they included the first documented uses of drones performing interior search for victims, and the first use of a VTOL fixed wing aircraft during a large scale disaster. However, there are substantive similarities to prior drone operations. Most notably, rotorcraft continue to perform the vast majority of flights, wireless data transmission capacity continues to be a limitation, and the lack of centralized control for unmanned and manned aerial systems continues to cause operational friction. This work continues by documenting the failures, both human and technological made in the field and concludes with a discussion summarizing potential areas for further work to improve sUAS response to large scale disasters.Comment: 6 pages, 4 figures, 3 table

Primary Care: Mental and Behavioral Health and Persons With Intellectual and Developmental Disabilities

Introduction: There are multiple ways to address the mental and behavioral health needs of people with intellectual and developmental disabilities (IDD). Method: In this paper, we do not argue for a particular approach or set of approaches, but instead review the benefits of integrating mental and behavioral health supports with primary healthcare based primarily on our experience in and understanding of healthcare systems in the United States. It is estimated that between 35 and 40% of people with IDD also live with psychiatric disorders. NADD, an association for persons with developmental disabilities and mental health needs in the US holds that coexisting IDD and a psychiatric disorder interferes with a person’s education and job readiness, and disrupts family and peer relationships. Historically, the presence of such disorders among people with IDD was not well understood or was discounted altogether. Conclusion: Over the past 15 years, however, greater attention is being paid to these comorbidities and their treatment, including the need to integrate mental and behav- ioral health treatments into primary care. Healthcare must account for multiple domains of quality of life, going beyond yearly physicals, and acute care visits, for example, to assess individuals’ healthcare goals and support them in achieving those goals. While inte- grated healthcare delivery systems can be difficult to find and access for people with IDD, such approaches are more responsive to the comprehensive needs and desires of people with IDD

Injuries in the Chinese Arena Football League: American Versus Chinese Players.

Background: Arena football is an indoor version of American football played in indoor arenas on a smaller field with 8 players per team. Only 1 study has evaluated injury rates in arena football, and no study had compared 2 distinct cohorts of players. Purpose/Hypothesis: The purpose of this study was to evaluate and compare injury rates in American versus Chinese athletes in the Chinese Arena Football League. Our hypothesis was that the rate of significant injuries (≥7 days of time lost from play) would be statistically significantly higher in Chinese athletes. Study Design: Cohort study; Level of evidence, 2. Methods: Each of the 6 teams included in this study comprised 11 American and 11 Chinese athletes, for a total of 132 included athletes (66 Chinese, 66 American). All players stayed in the same hotel, trained and played in the same facilities, and were covered by the same medical staff. A total of 18 games were played consecutively in 6 cities from October 1 to November 6, 2016. At least 4 Chinese players had to be on the field for each team at all times during game play. Results: American athletes were significantly older, taller, and heavier than Chinese athletes. The total exposure was 759 athlete-hours, and there were 80 reported injuries, with 74 (92.5%) occurring during games (overall injury rate, 105.4 injuries per 1000 athlete-hours). For American athletes, the exposure was 387 athlete-hours with 38 injuries observed, and the injury rate was 98.2 injuries per 1000 athlete-hours. For Chinese athletes, the exposure was 372 athlete-hours with 42 injuries observed, and the injury rate was 112.9 injuries per 1000 athlete-hours. There was no statistically significant difference in exposure or overall injury rate between American and Chinese athletes. The rate of significant injuries was 30.3 per 1000 athlete-hours; there were 17 such injuries in Chinese athletes compared with 6 such injuries for American athletes. The rate of significant injuries was 45.7 (Chinese) and 15.5 (American) injuries per 1000 athlete-hours, and the relative risk for Chinese versus American athletes for significant injuries was 3.0 (95% CI, 1.2-7.8; Conclusion: The overall risk of injuries was similar between Chinese and American athletes, but Chinese athletes showed statistically higher rates of significant injuries than their American counterparts. Years of experience was the only factor that was associated with severe injuries. As professional sports become more global, medical personnel must take into account the distinct differences and levels of experience between the national and international professional athletes. The results of this study will be used to make recommendations to develop preventive training measures, including techniques to improve tackling

Wireless Network Demands of Data Products from Small Uncrewed Aerial Systems at Hurricane Ian

Data collected at Hurricane Ian (2022) quantifies the demands that small uncrewed aerial systems (UAS), or drones, place on the network communication infrastructure and identifies gaps in the field. Drones have been increasingly used since Hurricane Katrina (2005) for disaster response, however getting the data from the drone to the appropriate decision makers throughout incident command in a timely fashion has been problematic. These delays have persisted even as countries such as the USA have made significant investments in wireless infrastructure, rapidly deployable nodes, and an increase in commercial satellite solutions. Hurricane Ian serves as a case study of the mismatch between communications needs and capabilities. In the first four days of the response, nine drone teams flew 34 missions under the direction of the State of Florida FL-UAS1, generating 636GB of data. The teams had access to six different wireless communications networks but had to resort to physically transferring data to the nearest intact emergency operations center in order to make the data available to the relevant agencies. The analysis of the mismatch contributes a model of the drone data-to-decision workflow in a disaster and quantifies wireless network communication requirements throughout the workflow in five factors. Four of the factors-availability, bandwidth, burstiness, and spatial distribution-were previously identified from analyses of Hurricanes Harvey (2017) and Michael (2018). This work adds upload rate as a fifth attribute. The analysis is expected to improve drone design and edge computing schemes as well as inform wireless communication research and development.Comment: 6 pages, 8 figure

Traveling the past into the present : the region\u27s highways and byways

Reviews the work of Oregon\u27s first surveyors and cartographers, and compares early maps to the modern landscape

Healthcare for Persons with Intellectual and Developmental Disability in the Community

Introduction: While there has been impressive progress in creating and improving commu- nity healthcare delivery systems that support people with intellectual and developmental disabilities (IDD), there is much more that can and should be done. Methods: This paper offers a review of healthcare delivery concepts on which new models are being developed, while also establishing an historical context. We review the need for creating fully integrated models of healthcare, and at the same time offer practical consid- erations that range from specific healthcare delivery system components to the need to expand our approach to training healthcare providers. The models and delivery systems, and the areas of needed focus in their development are reviewed to set a starting point for more and greater work going forward. Conclusion: Today, we celebrate longer life spans of people with IDD, increased attention to the benefits of healthcare that is responsive to their needs, and the development of important healthcare delivery systems that are customized to their needs. We also know that the growing body of research on health status offers incentive to continue developing healthcare structures for people with IDD by training healthcare providers about the needs of people with IDD, by establishing systems of care that integrate acute healthcare with long-term services and support, by developing IDD medicine as a specialty, and by building health promotion and wellness resources to provide people with IDD a set of preventative health supports