SURE Impact? An Empirical Investigation of Moral Hazard and Adverse Selection Behavior

The Supplemental Revenue Assistance Payments (SURE) program, enacted under the 2008 Farm Bill, is intended to provide indemnity payments to producers whose crop losses exceed 50% of their historical average yields. However, indemnification does not require that the farm is located in a region designated a disaster relief area -- a provision that can create significant moral hazard incentives. This study is the first to perform an empirical analysis of possible moral hazard behavior in corn, soybean, and wheat markets in response to the SURE program. Results suggest that an increase in crop insurance demand after the enactment of SURE may be due to the program's moral hazard incentives.Agricultural and Food Policy, Farm Management,

THE EFFECTS OF DIET INDUCED OBESITY ON THE FORCE-LENGTH RELATIONSHIP IN RAT SOLEUS

INTRODUCTION Obesity is associated with chronic inflammation, which has been shown to affect the integrity of musculoskeletal tissues [1]. Previous data from our group suggests that obesity can result in intramuscular fat deposition [1]. It is unclear if this structural alteration has functional consequences, as the implications of obesity on muscle mechanics are not well understood. Therefore, the purpose of this study was to quantify the active force produced by soleus muscles of obese and non-obese rats at a range of muscle lengths. As the inclusion of fat into the muscle fibers will leave less room for contractile proteins, we hypothesized that obese rats will produce lower forces normalized to muscle mass at every length than non-obese control rats.   METHODS Fourteen rats were randomly allocated to a 12-week diet: either an obesity-inducing high fat high sucrose diet (DIO, 40% fat, 45% sucrose, n=8) or a standard chow diet (chow, 12% fat 0% sucrose, n=6). Prior to surgery, body composition was evaluated using dual energy X-ray absorptiometry. Custom-made tibial nerve cuffs were surgically attached to the right tibial nerve of each animal. The soleus was exposed, mechanically isolated, and clamped to a force transducer. The muscle was then stretched to a predetermined length and electrically stimulated at 3 times the motor unit threshold (50Hz) and the force output was measured [3]. Force tracings were digitized using WINDAQ® software. Passive, active, and total forces produced by the soleus were normalized to the maximum in vivo length of each animal. Forces were averaged into 5% length intervals within each animal. Students t-tests or a two-way ANOVA were conducted between groups, and a Bonferroni correction was used as needed, α=0.05. RESULTS DIO rats had increased body mass (DIO 816.4 ± 30.1g, chow 645.0 ± 28.3g; p<0.05) and body fat (DIO 39.2 ± 1.3%, chow 21.8 ± 2.1%; p<0.05) compared to chow-fed rats. Soleus mass (DIO: 0.28 ± 0.01 g, chow: 0.26 ± 0.11 g, p=0.32), was similar between the two groups. Absolute peak isometric force was similar between the two groups (DIO: 2.58 ± 0.10 N, chow: 2.18 ± 0.34 N, p=0.23). Active isometric force normalized to soleus mass was significantly higher in DIO group rats at every muscle length (Figure 1, p<0.05). DISCUSSION AND CONCLUSIONS On average, DIO rats produced more active force at a given normalized length and soleus mass than chow rats, a finding that refutes our original hypothesis. Since optimal length occurs at the same relative muscle length for both groups, and since the decline in force from maximum is similar between groups, it appears that fascicle length, and an associated shift in the force-length relationship cannot explain our results. Results of differences in the force-velocity relationship (not shown here) suggest that the DIO rats may have a higher proportion of fast twitch fibres, but the relative force among slow and fast fibres is similar, and thus also should not affect these results. The results suggest that the force per cross-sectional area is higher in muscles from obese compared to lean rats, a finding that defies explanation at this time and needs thorough investigation in the future. Histology and tests looking at fibre and cell level muscle structures may provide more insight

Ventricular endocardial tissue geometry affects stimulus threshold and effective refractory period

Background: Understanding the biophysical processes by which electrical stimuli applied to cardiac tissue may result in local activation is important in both the experimental and clinical electrophysiology laboratory environments, as well as for gaining a more in-depth knowledge of the mechanisms of focal-trigger-induced arrhythmias. Previous computational models have predicted that local myocardial tissue architecture alone may significantly modulate tissue excitability, affecting both the local stimulus current required to excite the tissue and the local effective refractory period (ERP). In this work, we present experimental validation of this structural modulation of local tissue excitability on the endocardial tissue surface, use computational models to provide mechanistic understanding of this phenomena in relation to localized changes in electrotonic loading, and demonstrate its implications for the capture of afterdepolarizations. Methods and Results: Experiments on rabbit ventricular wedge preparations showed that endocardial ridges (surfaces of negative mean curvature) had a stimulus capture threshold that was 0.21 ± 0.03 V less than endocardial grooves (surfaces of positive mean curvature) for pairwise comparison (24% reduction, corresponding to 56.2 ± 6.4% of the energy). When stimulated at the minimal stimulus strength for capture, ridge locations showed a shorter ERP than grooves (n = 6, mean pairwise difference 7.4 ± 4.2 ms). When each site was stimulated with identical-strength stimuli, the difference in ERP was further increased (mean pairwise difference 15.8 ± 5.3 ms). Computational bidomain models of highly idealized cylindrical endocardial structures qualitatively agreed with these findings, showing that such changes in excitability are driven by structural modulation in electrotonic loading, quantifying this relationship as a function of surface curvature. Simulations further showed that capture of delayed afterdepolarizations was more likely in trabecular ridges than grooves, driven by this difference in loading. Conclusions: We have demonstrated experimentally and explained mechanistically in computer simulations that the ability to capture tissue on the endocardial surface depends upon the local tissue architecture. These findings have important implications for deepening our understanding of excitability differences related to anatomical structure during stimulus application that may have important applications in the translation of novel experimental optogenetics pacing strategies. The uncovered preferential vulnerability to capture of afterdepolarizations of endocardial ridges, compared to grooves, provides important insight for understanding the mechanisms of focal-trigger-induced arrhythmias

Umbilical hernia rupture with evisceration of omentum from massive ascites: a case report

<p>Abstract</p> <p>Introduction</p> <p>The incidence of hernias is increased in patients with alcoholic liver disease with ascites. To the best of our knowledge, this is the first report of an acute rise in intra-abdominal pressure from straining for stool as the cause of a ruptured umbilical hernia.</p> <p>Case presentation</p> <p>An 81-year-old Caucasian man with a history of alcoholic liver disease presented to our emergency department with an erythematous umbilical hernia and clear, yellow discharge from the umbilicus. On straining for stool, after initial clinical assessment, our patient noted a gush of fluid and evisceration of omentum from the umbilical hernia. An urgent laparotomy was performed with excision of the umbilicus and devitalized omentum.</p> <p>Conclusion</p> <p>We report the case of a patient with a history of alcoholic liver disease with ascites. Ascites causes a chronic increase in intra-abdominal pressure. A sudden increase in intra-abdominal pressure, such as coughing, vomiting, gastroscopy or, as in this case, straining for stool can cause rupture of an umbilical hernia. The presence of discoloration, ulceration or a rapid increase in size of the umbilical hernia signals impending rupture and should prompt the physician to reduce the intra-abdominal pressure.</p

Encounters with a future past: navigating the shifting urban atmospheres of place

There has been recent concern about the destabilizing influence of individuals' everyday encounters with managed atmospheres. This paper draws on autoethnographic data, information relating to the physical fabric, and narratives from stakeholders involved with the design and management of the Eastside area of Birmingham, UK, to demonstrate how urban atmospheres are also shaped by shifting temporal dynamics, the area's historical, cultural and regulatory context, and the prior experiences individuals can bring to spaces undergoing regeneration. The paper concludes by suggesting that this analysis has much to offer to designers, educators and stakeholders involved with improving the design and management of place

Acute Pancreatitis Secondary to Gestational Hypertriglyceridaemia

Gestational hypertriglyceridaemia is a rare cause of acute pancreatitis. Its pathophysiology is incompletely understood. Severity scoring and effective management remain challenging. We report a case of acute pancreatitis secondary to gestational hypertriglyceridaemia. We describe the use of computed tomography to provide an alternative determination of severity, as well as plasmapheresis as a means of treating the condition

National critical incident reporting systems relevant to anaesthesia: a European survey

Background Critical incident reporting is a key tool in the promotion of patient safety in anaesthesia. Methods We surveyed representatives of national incident reporting systems in six European countries, inviting information on scope and organization, and intelligence on factors determining success and failure. Results Some systems are government-run and nationally conceived; others started out as small, specialty-focused initiatives, which have since acquired a national reach. However, both national co-ordination and specialty enthusiasts seem to be necessary for an optimally functioning system. The role of reporting culture, definitional issues, and dissemination is discussed. Conclusions We make recommendations for others intending to start new systems and speculate on the prospects for sharing patient safety lessons relevant to anaesthesia at European leve

Adrenoceptor sub-type involvement in Ca2+ current stimulation by noradrenaline in human and rabbit atrial myocytes

Atrial fibrillation (AF) from elevated adrenergic activity may involve increased atrial L-type Ca2+ current (ICaL) by noradrenaline (NA). However, the contribution of the adrenoceptor (AR) sub-types to such ICaL-increase is poorly understood, particularly in human. We therefore investigated effects of various broad-action and sub-type-specific α- and β-AR antagonists on NA-stimulated atrial ICaL. ICaL was recorded by whole-cell-patch clamp at 37 °C in myocytes isolated enzymatically from atrial tissues from consenting patients undergoing elective cardiac surgery and from rabbits. NA markedly increased human atrial ICaL, maximally by ~ 2.5-fold, with EC75 310 nM. Propranolol (β1 + β2-AR antagonist, 0.2 microM) substantially decreased NA (310 nM)-stimulated ICaL, in human and rabbit. Phentolamine (α1 + α2-AR antagonist, 1 microM) also decreased NA-stimulated ICaL. CGP20712A (β1-AR antagonist, 0.3 microM) and prazosin (α1-AR antagonist, 0.5 microM) each decreased NA-stimulated ICaL in both species. ICI118551 (β2-AR antagonist, 0.1 microM), in the presence of NA + CGP20712A, had no significant effect on ICaL in human atrial myocytes, but increased it in rabbit. Yohimbine (α2-AR antagonist, 10 microM), with NA + prazosin, had no significant effect on human or rabbit ICaL. Stimulation of atrial ICaL by NA is mediated, based on AR sub-type antagonist responses, mainly by activating β1- and α1-ARs in both human and rabbit, with a β2-inhibitory contribution evident in rabbit, and negligible α2 involvement in either species. This improved understanding of AR sub-type contributions to noradrenergic activation of atrial ICaL could help inform future potential optimisation of pharmacological AR-antagonism strategies for inhibiting adrenergic AF

A Profile of Biomass Stove Use in Sri Lanka

A large body of evidence has confirmed that the indoor air pollution (IAP) from biomass fuel use is a major cause of premature deaths, and acute and chronic diseases. Over 78% of Sri Lankans use biomass fuel for cooking, the major source of IAP in developing countries. We conducted a review of the available literature and data sources to profile biomass fuel use in Sri Lanka. We also produced two maps (population density and biomass use; and cooking fuel sources by district) to illustrate the problem in a geographical context. The biomass use in Sri Lanka is limited to wood while coal, charcoal, and cow dung are not used. Government data sources indicate poor residents in rural areas are more likely to use biomass fuel. Respiratory diseases, which may have been caused by cooking emissions, are one of the leading causes of hospitalizations and death. The World Health Organization estimated that the number of deaths attributable to IAP in Sri Lanka in 2004 was 4300. Small scale studies have been conducted in-country in an attempt to associate biomass fuel use with cataracts, low birth weight, respiratory diseases and lung cancer. However, the IAP issue has not been broadly researched and is not prominent in Sri Lankan public health policies and programs to date. Our profile of Sri Lanka calls for further analytical studies and new innovative initiatives to inform public health policy, advocacy and program interventions to address the IAP problem of Sri Lanka

Royal academy of medicine in Ireland

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