State efforts to expand health coverage: One bite at a time

For more than twenty years, health scholars and advocates have warned us about the lack of adequate health coverage among a growing number of Americans. Health insurance premiums are rising. Many employers, especially small employers who employ over half of the country’s workforce, and individuals are seeing premium increases of 30, 40, and even 50 percent. Not surprisingly, America’s uninsured population is rising— to more than 41 million people. States are feeling the budget crunch as the economy sags and more and more people turn to state Medicaid and other public health care systems. This all means that state policy makers are looking for solutions. Yet no consensus has emerged on what to do about the uninsurance problem. Conservatives propose encouraging individuals to buy private health insurance and place more reliance on market forces. Liberals continue a struggle initiated during the New Deal to provide publicly financed health coverage

Acute alcohol ingestion and sympathetic neural responses during orthostatic stress in humans

Acute alcohol consumption has been reported to decrease mean arterial pressure (MAP) during orthostatic challenge, a response that may contribute to alcohol-mediated hypotension and eventually syncope. Muscle sympathetic nerve activity (MSNA) increases during orthostatic stress to help maintain MAP, yet the influence of alcohol on MSNA during orthostatic stress has not been determined. We hypothesized that alcohol ingestion would blunt arterial blood pressure and MSNA responses to progressive lower body negative pressure (LBNP). MAP, MSNA, and heart rate (HR) were recorded during progressive LBNP (-5, -10, -15, -20, -30, and -40 mmHg; 3 min/stage) in 30 subjects(age 24 ± 1 yrs). After an initial progressive LBNP protocol (pre-treatment), subjects were randomly assigned to consume alcohol (0.8g ethanol/kg body mass; n=15) or placebo (n=15) and then repeated the progressive LBNP protocol (post-treatment). Alcohol increased (drug × treatment, P ≤ 0.05) resting HR (59 ± 2 to 65 ± 2 beats/min) and MSNA (13 ± 3 to 19 ± 4 bursts/min) when compared to placebo. While alcohol increased MAP (83 ± 2 to 87 ± 2 mmHg), these increases were also observed with placebo (82 ± 2 to 88 ± 1 mmHg; treatment, P \u3c 0.05; drug × treatment, P \u3e 0.05). During progressive LBNP, a prominent decrease in MAP was observed after alcohol (drug × time × treatment, P \u3c 0.05), but not placebo. There was also a significant attenuated response in forearm vascular resistance (FVR) during progressive LBNP (drug × time × treatment, P \u3c 0.05). MSNA and HR increased during all LBNP protocols, but there were no differences between treatments or groups (drugs). In summary, acute alcohol ingestion induces an attenuation in blood pressure response during an orthostatic challenge, possibly due to the effect that alcohol has on impairing peripheral blood vessel constriction

Interview with Kathryn Stream

An oral history interview with Kathryn Sheaffer Stream

Risky business: Effectiveness of state market-based health programs

Since the 1990s, state governments have been leaders of health care reform. Today, approximately 47 million people are without health insurance. As health care costs and uninsurance levels continue to rise, states are pursuing a variety of government- and market-based strategies to address this growing social problem. Health care research has indicated that state-based programs have proven to be successful in extending access to coverage. However, the question remains as to whether the market-based programs have had a positive impact on state health care. Advocates for market-based state health programs argue that the reforms benefit the greater good because they serve an economic development function by improving the economic productivity and overall health of state citizens. Whether market-based policies are accomplishing these goals is a matter of debate. This study examines the effects of the various market-based state policies. The evidence generated by this research sheds light on the societal effectiveness of market-based health care strategies used by state governments. The results of our analysis indicate that programs enacted by states to promote increased access to medical care have developmental effects beyond the client population directly served

One year after Katrina: Tragedy of the Crescent City

One year after Katrina, New Orleans and the surrounding area are slowly showing signs of growth and a return to normalcy. Two recent studies provide excellent overviews of the economic impacts the hurricane had on the area as well as the efforts New Orleans has made to recover from the storm’s devastation. The first study which was published in August of 2006 was done by the Brookings Institution. A “Special Edition of the Katrina Index: A One-Year Review of Key Indicators of Recovery in Post-Storm New Orleans” by Amy Liu, Matt Fellowes and Mia Mabanta, provides an overview of key social and economic indicators on New Orleans’ progress since the storm. The other study, published in June 2006, “Advancing in the Aftermath II: Tracking the Recovery from Katrina and Rita,” by Dr. Loren C. Scott, provides an extremely detailed account on the progress of recovery in the four MSAs along the Gulf Coast. In this brief article, we summarize key economic indicators and look at how the city and region’s economy has been impacted by the storm and its progress since. We rely heavily on these two studies and recommend them as outstanding sources for the economic impact the hurricane had on New Orleans

Methods of Restraint in Boar Castration

Recently the ambulatory clinic was called to the Veterinary Research Farm to castrate seven boars. Since the boars ranged in weight from 400 to 700 lbs., it was a good opportunity to demonstrate various methods of restraint. Four different methods were used

A mass-balance approach to estimate in-stream processes in a large river

A mass-balance approach was used to estimate in-stream processes related to inorganic nitrogen species (NH4 C, NO2 and NO3 ) in a large river characterized by highly variable hydrological conditions, the Garonne River (south-west France). Studies were conducted in two consecutive reaches of 30 km located downstream of the Toulouse agglomeration (population 760 000, seventh order), impacted by modification of discharge regime and high nitrogen concentrations. The mass-balance was calculated by two methods: the first is based on a variable residence time (VRT) simulated by a one-dimensional (1-D) hydraulic model; the second is a based on a calculation using constant residence time (CRT) evaluated according to hydrographic peaks. In the context of the study, removal of dissolved inorganic nitrogen (DIN) for a reach of 30 km is underestimated by 11% with the CRT method. In sub-reaches, the discrepancy between the two methods led to a 50% overestimation of DIN removal in the upper reach (13 km) and a 43% underestimation in the lower reach (17 km) using the CRT method. The study highlights the importance of residence time determination when using modelling approaches in the assessment of whole stream processes in short-duration mass-balance for a large river under variable hydrological conditions

Colorado River Basin Study Comments--New Mexico Interstate Stream Commission

Comments on the Colorado River Basin Study prepared by the the Western Water Policy Review Advisory Commission

Trends in adoption of electronic health records by family physicians in Washington State

Objective Electronic health record (EHR) adoption is encouraged by health plans, government agencies, and both the American Academy of Family Physicians and the Washington Academy of Family Physicians (WAFP), but rates of EHR adoption by family physicians in Washington were previously unknown. This study measured current rates of EHR adoption by family physicians in Washington State, as well as perceived barriers to adoption and what physicians identify as possible means to overcome those barriers. Design A survey of medical practices in Washington State was performed. One physician per practice was selected to respond on behalf of their practice for all practices where family physicians work and for which contact information was available in the databases of the Washington State Medical Association (WSMA) and WAFP. The survey was distributed either electronically or in print form depending on availability of an email address. Measurements Rates of EHR adoption, plans for adoption for those not yet using EHRs, perceived barriers to EHR adoption and perceived means to overcome those barriers. Results Response rate was 43.8%. EHR adoption by this group is relatively high at 57.9%and did not vary by practice location. Although solo practices had a relatively high rate of adoption (43.5%), EHR adoption remains strongly associated with practice size. Identified barriers to implementation are primarily financial, as are the means to overcome those barriers. If current trends continue, adoption will plateau at approximately 68% in the next four years. Conclusions Adoption rate appears to have peaked in this group given current constraints and barriers. Increased outreach efforts and assistance programs will be necessary to achieve EHR adoption in the remaining practices, particularly solo and small group practices

The oyster industry in Oregon

Aquaculture of oysters has never obtained the economic importance in Oregon as it has in other coastal states. There are at present seven commercial culturists in Oregon. The two oysters cultured are the Crassostrea gigas and the Ostrea lurida. Since oysters do not naturally spawn in Oregon waters the spat, seed, must be produced elsewhere to be planted in the tidewaters. Many problems in the culture of oysters result after the larvae has attached itself to a permanent growing site, It is then easy prey for other sea life, starfish and oyster drills. In today's environment a greater danger is water pollution. The pollution changes the chemical balance of the water as well as the temperature, both of which the oyster is sensitive to