How Primary Care Practice Affects Medicaid Patients’ use of Emergency Services

The use of emergency departments (EDs) in the U.S. continues to rise. Some of these ED visits may reflect limited access to primary care, even among patients with a primary care provider. Payers and policymakers have tried to restrain ED use, because of concern over high charges and discontinuity of care. But most of these attempts have involved erecting financial and administrative barriers to going to the ED, rather than expanding access to primary care. Is it possible to reduce excessive use of EDs by making primary care practices more “user-friendly”? This Issue Brief summarizes research that identifies primary care characteristics associated with ED use in a Medicaid managed care population. It suggests a strategy to simultaneously improve access to primary care and reduce costs of ED care

Does Managed Care Gatekeeping Affect African Americans’ Access to Emergency Care?

A number of national initiatives have focused attention on persistent racial and ethnic disparities in health and health care. The rising tide of improvements in health has not raised all boats; in some cases, the health gap between whites and minorities has widened. Although many social and economic forces contribute to this gap, inequitable access to health care also plays a part. This Issue Brief examines a common strategy that managed care organizations use to reduce emergency department visits—gatekeeping—and describes a study of the differential impact it may have on African Americans

Additive and synergistic relations of early mother-child and caregiver-child interactions for predicting later achievement.

This study examines associations between stimulating-responsive social interactions with mothers and nonparental childcare providers during the first 3 years of life and children's vocabulary and mathematics skills through age 15 (N = 1,364). Additive relations were found in which more stimulating-responsive interactions with mothers and with caregivers were linked to higher mathematics achievement in childhood and adolescence. More stimulating-responsive early interactions with mothers were also associated with larger child vocabularies through age 15. Synergistic relations, consistent with the dual-risk hypothesis, also were found. Children whose early interactions with both mothers and caregivers were low in stimulation and responsivity had substantially lower mathematics skills. Implications for early childhood interventions and policies are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved)

Middle east centre: annual report 2010-2011

The LSE Middle East Centre opened in October 2010. It builds on LSE’s long engagement with the Middle East and provides a central hub for the wide range of research on the region carried out at LSE. The Middle East Centre works to develop research and teaching on the societies, economies, polities and international relations of the region. LSE is one of the world’s leading social science institutions and comprises departments covering all branches of the social sciences. The Middle East Centre taps into that expertise to promote innovative interdisciplinary research and training on the region. The Centre places special emphasis on active collaboration with colleagues in the Middle East, with international scholars, policy-makers and civil society, and on speaking to a global audience about the region’s strengths and challenges. The Middle East Centre was established with support from the Emirates Foundation for Philanthropy and the Aman Trust

Introduction to the new usability

This paper introduces the motivation for and concept of the "new usability" and positions it against existing approaches to usability. It is argued that the contexts of emerging products and systems mean that traditional approaches to usability engineering and evaluation are likely to prove inappropriate to the needs of "digital consumers." The paper briefly reviews the contributions to this special issue in terms of their relation to the idea of the "new usability" and their individual approaches to dealing with contemporary usability issues. This helps provide a background to the "new usability" research agenda, and the paper ends by posing what are argued to be the central challenges facing the area and those which lie at the heart of the proposed research agenda

Listening to Consumer Perspectives to Inform Addictions and Housing-Related Practice and Research

The study, funded by the Northwest Health Foundation of Portland, Oregon and the National Institute on Drug Abuse (NIDA), was conducted as part of the HEARTH collaborative (Housing, Employment and Recovery Together for Health). HEARTH, established in 2010, is a community-academic partnership involving partners from Portland State University (PSU), Oregon Health and Science University (OHSU), and Central City Concern (CCC). Using the approaches of community-based participatory research (CBPR), these diverse stakeholders collaborated to co-develop research of direct relevance to the local community and to national academic and policy communities. This study employed qualitative methods and community-based participatory research principles to solicit personal experiences with housing, employment, and recovery programs. We recruited interview participants via CCC-operated housing programs, including Alcohol and Drug Free Community Housing (ADFC), family housing, transitional housing, and non-ADFC (low barrier) housing units. The manuscript presents interview themes based on the five broad categories of interview questions: housing, employment programs, recovery programs, definitions of recovery, and definitions of success. Co-authors describe recommendations for practice and research protocol based on our findings. Our results highlight the importance of involving consumers in the development, data collection, and analysis of research, and present the unique perspectives of those who experience homelessness, recovery, and the programs designed to assist them

Novel DNA methylation profiles associated with key gene regulation and transcription pathways in blood and placenta of growth-restricted neonates

BB/H012494/1/ Biotechnology and Biological Sciences Research Counci

Effects Of A 4-week Vibration-induced Hamstrings Fatigue Intervention On Quadriceps Weakness After ACL Reconstruction

Arthrogenic muscle inhibition (AMI) results from an inability to voluntarily activate all motor units in the quadriceps due to ongoing neuronal inhibition. This may be due to changes in small diameter afferent activity that increase the excitability of the flexor withdrawal pathway, causing over-excitation of the hamstrings and reciprocal inhibition of the quadriceps. Reciprocal inhibition of the quadriceps from Ia afferents of the hamstrings may be reduced with prolonged muscle vibration of the hamstrings via fatigue of the intrafusal muscle fibers. PURPOSE: To determine the effects of vibration-induced hamstring fatigue on AMI after ACL reconstruction (ACLr). METHODS: Seven adults (28.7 ± 8.2 yrs) with unilateral ACLr (time since surgery: 19.4 ± 9.7 months) were recruited. Participants received a 4-week long (3x/week) training program. Vibration-induced fatigue of the hamstrings consisted of 20 minutes of prolonged vibration applied directly to the hamstrings. Then, a cuff was placed on the proximal thigh and inflated to 150 mmHg to trap the metabolites in the muscle, and maintain hamstrings fatigue; during which participants performed four sets of 15 reps at 30% RM unilateral knee extension (KE). Quadriceps strength and quadriceps inhibition were assessed before and after the intervention using KE 1-repitition maximum (RM) normalized to body weight, and the central activation ratio (CAR) measured by a superimposed burst. The co-activation of the hamstrings was assessed using hamstring EMG during KE. Paired t-tests were used to examine the effect of prolong vibration on KE strength, quadriceps CAR, and hamstrings co-activation before and after the intervention. RESULTS: KE strength increased significantly by 38.5% (from 0.45 ± 0.1 to 0.62 ± 0.2 %BW, P =0.004); quadriceps CAR also increased significantly by 5.8% (from 93 ± 0.1% to 98 ± 0.8%, P=0.02). Finally, co-activation decreased by 34% (from 12 ± 1.3% to 8 ± 0.9%, P=0.03). CONCLUSION: These results suggest that quadriceps weakness may be due to over excitation of the hamstrings which results in reciprocal inhibition of the quadriceps. Vibration-induced hamstrings fatigue can be used as a rehabilitation strategy to restore normal quadriceps function following ACLr by reducing the hamstrings over-excitability and restoring full quadriceps activation