Adiposity and spinal cord injury

The drastic changes in body composition following spinal cord injury (SCI) have been shown to play a significant role in cardiovascular and metabolic health. The pattern of storage and distribution of different types of adipose tissue may impact metabolic health variables similar to carbohydrate, lipid and bone metabolism. The use of magnetic resonance imaging provides insights on the interplay among different regional adipose tissue compartments and their role in developing chronic diseases. Regional adipose tissue can be either distributed centrally or peripherally into subcutaneous and ectopic sites. The primary ectopic adipose tissue sites are visceral, intramuscular and bone marrow. Dysfunction in the central nervous system following SCI impacts the pattern of distribution of adiposity especially between tetraplegia and paraplegia. The current editorial is focused primarily on introducing different types of adipose tissue and establishing scientific basis to develop appropriate dietary, rehabilitation or pharmaceutical interventions to manage the negative consequences of increasing adiposity after SCI. We have also summarized the clinical implications and future recommendations relevant to study adiposity after SCI

Crop Yield Response to Precision Deep Tillage

Experimental precision deep tillage was applied at three sites in central Kentucky with relatively well-drained silt loam soils in no-till crop production. Fields were divided into 0.4 ha (1 ac) grid cells using DGPS mapping. Assessment of soil compaction by machinery traffic was made using multiple soil cone penetrometer measurements and expressed as cone index (CI). Corn, wheat, and soybean yields were depressed in grid cells with CIavg ≥ 1.5 MPa (218 psi) prior to application of tillage treatments at sites 1 and 3, whereas at site 2, where most of the highest average CI values ranged from 1.44 to 1.49 MPa (209 to 216 psi), the opposite was true. In general, deep tillage resulted in yield improvement in compacted grid cells relative to those receiving no deep tillage; however, differences were significant at the 10% level in only two of six instances. Cells tilled to 40 cm generally had higher yields than cells tilled only to the depth at which CIavg ≥ 1.5 MPa (218 psi) (precision deep tillage) at sites 1 and 3. However, the opposite was true for double-crop soybean subjected to limited rainfall. At site 2, tilled cells had higher yields than non-tilled cells, with precision tillage showing the maximum relative yield

Examination of Post-Service Health-Related Quality of Life Among Rural and Urban Military Members of the Millennium Cohort Study

Little information exists on the health-related quality of life (HRQL) of U.S. veterans based on rural (versus urban) status, especially those in younger age groups, and whether deployment influences this outcome. We addressed these questions in the Millennium Cohort Study, a prospective investigation of U.S. military personnel assessed first in 2001 and then subsequently every three years via self-administered questionnaires. Participants separated from the military at the time of the most recent survey were eligible (n = 10,738). HRQL was assessed using the SF-36V Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Rural status was assigned from zip codes using the Rural-Urban Commuting Area classification. The mean age of participants was 35 years (SD = 8.98). Compared with urban dwellers, rural residents reported significantly lower unadjusted mean PCS (49.80 vs. 50.42) and MCS (49.97 vs. 50.81) scores, but differences became nonsignificant after covariate adjustment. No interaction was seen between deployment and rural status. Rural status is not independently associated with HRQL among recent U.S. veterans

Baseline self reported functional health and vulnerability to post-traumatic stress disorder after combat deployment: prospective US military cohort study

Objective To determine if baseline functional health status, as measured by SF-36 (veterans), predicts new onset symptoms or diagnosis of post-traumatic stress disorder among deployed US military personnel with combat exposure

An Emergency Room Decision-Support Program That Increased Physician Office Visits, Decreased Emergency Room Visits, and Saved Money

The objective of this study was to evaluate an Emergency Room having a Decision-Support (ERDS) program designed to appropriately reduce ER use among frequent users, defined as 3 or more visits within a 12-month period. To achieve this, adults with an AARP Medicare Supplement Insurance plan insured by UnitedHealthcare Insurance Company (for New York residents, UnitedHealthcare Insurance Company of New York) were eligible to participate in the program. These included 7070 individuals who elected to enroll in the ERDS program and an equal number of matched nonparticipants who were eligible but either declined or were unreachable. Program-related benefits were estimated by comparing the difference in downstream health care utilization and expenditures between engaged and not engaged individuals after using propensity score matching to adjust for case mix differences between these groups. As a result, compared with the not engaged, engaged individuals experienced better care coordination, evidenced by a greater reduction in ER visits (P=0.033) and hospital admissions (P=0.002) and an increase in office visits (P<0.001). The program was cost-effective, with a return on investment (ROI) of 1.24, which was calculated by dividing the total program savings ($3.41 million) by the total program costs ($2.75 million). The ROI implies that for every dollar invested in this program, $1.24 was saved, most of which was for the federal Medicare program. In conclusion, the decrease in ER visits and hospital admissions and the increase in office visits may indicate the program helped individuals to seek the appropriate levels of care. (Population Health Management 2014;17:257?264)Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140184/1/pop.2013.0117.pd

Oral rivaroxaban versus standard therapy for the treatment of symptomatic venous thromboembolism : a pooled analysis of the EINSTEIN-DVT and PE randomized studies

Background: Standard treatment for venous thromboembolism (VTE) consists of a heparin combined with vitamin K antagonists. Direct oral anticoagulants have been investigated for acute and extended treatment of symptomatic VTE; their use could avoid parenteral treatment and/or laboratory monitoring of anticoagulant effects. Methods: A prespecified pooled analysis of the EINSTEIN-DVT and EINSTEIN-PE studies compared the efficacy and safety of rivaroxaban (15 mg twice-daily for 21 days, followed by 20 mg once-daily) with standard-therapy (enoxaparin 1.0 mg/kg twice-daily and warfarin or acenocoumarol). Patients were treated for 3, 6, or 12 months and followed for suspected recurrent VTE and bleeding. The prespecified noninferiority margin was 1.75. Results: 8282 patients were enrolled. 4151 received rivaroxaban and 4131 received standard-therapy. The primary efficacy outcome occurred in 86 rivaroxaban-treated patients (2.1%) compared with 95 (2.3%) standard-therapy-treated patients (hazard ratio, 0.89; 95% confidence interval [CI], 0.66-1.19; pnoninferiority<0.001). Major bleeding was observed in 40 (1.0%) and 72 (1.7%) patients in the rivaroxaban and standard-therapy groups, respectively (hazard ratio, 0.54; 95% CI, 0.37-0.79; p=0.002). In key subgroups, including fragile patients, cancer patients, patients presenting with large clots and those with a history of recurrent VTE, the efficacy and safety of rivaroxaban was similar compared with standard-therapy. Conclusion: The single-drug approach with rivaroxaban resulted in similar efficacy to standard-therapy and was associated with a significantly lower rate of major bleeding. Efficacy and safety results were consistent among key patient subgroups

Unsupervised Home Exercises Versus Formal Physical Therapy After Primary Total Hip Arthroplasty: A Systematic Review

Historically, postoperative exercise and physical therapy (PT) have been viewed as crucial to a successful outcome following primary total hip arthroplasty (THA). This systematic review and meta-analysis aimed to assess differences in both short- and long-term objective and self-reported measures between primary THA patients with formal supervised physical therapy versus unsupervised home exercises after discharge. A search was conducted of six electronic databases from inception to December 14, 2020, for randomized controlled trials (RCTs) comparing changes from baseline in lower extremity strength (LES), aerobic capacity, and self-reported physical function and quality of life (QoL) between supervised and unsupervised physical therapy/exercise regimens following primary THA. Outcomes were separated into short-term (surgery, closest to 3 months) and long-term (≥6 months from surgery, closest to 12 months) measures. Meta-analyses were performed when possible and reported in standardized mean differences (SMDs) with 95% confidence intervals (CI). Seven studies (N=398) were included for review. No significant differences were observed with regard to lower extremity strength (p=0.85), aerobic capacity (p=0.98), or short-term quality of life scores (p=0.18). Although patients in supervised physical therapy demonstrated improved short-term self-reported outcomes compared to those performing unsupervised exercises, this was represented by a small effect size (SMD 0.23 [95% CI, 0.02-0.44]; p=0.04). No differences were observed between groups regarding long-term lower extremity strength (p=0.24), physical outcome scores (p=0.37), or quality of life (p=0.14). The routine use of supervised physical therapy may not provide any clinically significant benefit over unsupervised exercises following primary THA. These results suggest that providers should reconsider the routine use of supervised physical therapy after discharge

Evaluation of a High-Risk Case Management Pilot Program for Medicare Beneficiaries with Medigap Coverage

The objective was to evaluate the 3-year experience of a high-risk case management (HRCM) pilot program for adults with an AARP Medicare Supplement (Medigap) Insurance Plan. Participants were provided in-person visits as well as telephonic and mailed services to improve care coordination from December 1, 2008, to December 31, 2011. Included were adults who had an AARP Medigap Insurance Plan, resided in 1 of 5 pilot states, and had a Hierarchical Condition Category score>3.74, or were referred into the program. Propensity score weighting was used to adjust for case-mix differences among 2015 participants and 7626 qualified but nonparticipating individuals. Participants were in the program an average of 15.4 months. After weighting, multiple regression analyses were used to estimate differences in quality of care and health care expenditures between participants and nonparticipants. Increased duration in the program was associated with fewer hospital readmissions. Additionally, participants were significantly more likely to have recurring office visits and recommended laboratory tests. The program demonstrated $7.7 million in savings over the 3 years, resulting in a return on investment of$1.40 saved for every dollar spent on the program. Savings increased each year from 2009 to 2011 and with longer length of engagement. The majority of savings were realized by the federal Medicare program. This study focused on quality of care and savings for an HRCM program designed solely for Medicare members with Medicare Supplement coverage. This program had a favorable impact on quality of care and demonstrated savings over a 3-year period. (Population Health Management 2015;18:93?103)Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140185/1/pop.2014.0035.pd

Leveraging Telematics and Weather Data to Study the Productivity of Roadside Mowers

The Indiana Department of Transportation (INDOT) is responsible for the construction and maintenance of approximately 11,000 centerline miles of state roads, US routes and interstates. Mowing operations along the state rights-of-way to manage vegetation consume considerable resources. Mowing activities are usually reported by daily work orders and it is difficult to obtain quantitative information characterizing the utilization and productivity of the mowing operations. This research uses telematics data from commercial sensors to track the daily activity of seven mowers in the Fort Wayne district. Weather data from NOAA was also captured to estimate the weather related delays. During a one-month period, the mowers collectively covered a total of around 1170 miles and an area of nearly 1800 acres of mowing. Crews worked alternative work schedules with extended hours four days a week. On an average 9.5 hour work day approximately 50% of the time is spent actively mowing. The simple telematics based metrics and visualization graphics proposed in this paper can be used by agencies to evaluate the efficiency of their mowing operations to provide guidance on resource allocation, scheduling, and comparison with alternative contract mowing. The proposed utilization graphics may be of particular interest to agencies as they provide a concise way of communicating to stakeholders the overall efficiency of the mowing operations and can be used to identify opportunities for efficiency improvements

Alcohol, No Ordinary Commodity: policy implications for Canada

Alcohol is a favorite psychoactive substance of Canadians. It is also a leading risk factor for death and disability, playing a causal role in a broad spectrum of health and social issues. Alcohol: No Ordinary Commodity is a collaborative, integrative review of the scientific literature. This paper describes the epidemiology of alcohol use and current state of alcohol policy in Canada, best practices in policy identified by the third edition of Alcohol: No Ordinary Commodity, and the implications for the development of effective alcohol policy in Canada. Best practices – strongly supported by the evidence, highly effective in reducing harm, and relatively low-cost to implement – have been identified. Measures that control affordability, limit availability, and restrict marketing would reduce population levels of alcohol consumption and the burden of disease attributable to it