Getting Around When You’re Just Getting By: The Travel Behavior and Transportation Expenditures of Low-Income Adults, MTI Report 10-02

How much do people with limited resources pay for cars, public transit, and other means of travel? How does their transportation behavior change during periods of falling employment and rising fuel prices? This research uses in-depth interviews with 73 adults to examine how rising transportation costs impact low-income families. The interviews examine four general areas of interest: travel behavior and transportation spending patterns; the costs and benefits of alternative modes of travel; cost management strategies; and opinions about the effect of changing transportation prices on travel behavior. Key findings include: Most low-income household are concerned about their transportation costs. Low-income individuals actively and strategically manage their household resources in order to survive on very limited means and to respond to changes in income or transportation costs. In making mode-choice decisions, low-income travelers—like higher-income travelers—carefully evaluate the costs of travel (time and out-of-pocket expenses) against the benefits of each of the modes. Some low-income individuals in our sample were willing to endure higher transportation expenditures—such as the costs of auto ownership or congestion tolls—if they believed that they currently benefit or would potentially benefit from these increased expenses. Although low-income households find ways to cover their transportation expenditures, many of these strategies had negative effects on households. The report concludes with recommendations on how to increase transportation affordability, minimize the impact that new transportation taxes or fees have on low-income people, and develop new research and data collection to support the previous two efforts

Anti-Immigrant Prejudice:Understanding the Roles of (Perceived) Values and Value Dissimilarity

Although human values and value dissimilarity play pivotal roles in the prejudiceliterature, there remain important gaps in our understanding. To address these gaps, we recruited three British samples (N=350) and presented Muslim immigrants, refugees, and economic migrants as target groups. Using polynomial regression analyses, we simultaneously tested effects of individuals’ own values, their perceptions of immigrant values, and self-immigrant value dissimilarities on prejudice. Results indicated that favorability toward immigrants is higher when individuals hold higher self-transcendence values (e.g., equality) and lower self-enhancement values (e.g., power), and when they perceive immigrants to hold higher self-transcendence values and lower self-enhancement values. In addition, prejudice toward immigrants is higher when individuals who hold higher conservation values (e.g., security) perceive immigrants to value openness (e.g., freedom) more, suggesting a value dissimilarity effect. No value dissimilarity effects emerged when immigrants were perceived to be higher in conservation, self-transcendence, or self-enhancement values. Overall, these results showed that effects of values and value dissimilarity differ depending on which value dimension is considered. Additionally, the results revealed support for a novel mechanism with the motivation to be non-prejudiced underpinning the links between individuals’ values and prejudice. Our discussion highlights the multifaceted manner in which values are linked to prejudice

The Current State of the Pediatric Emergency Medicine Workforce and Innovations to Improve Pediatric Care

Many hospitals and emergency departments lack resources to optimally care for ill and injured children, perpetuating risks of receiving fragmented and “uneven” care. In this article, we describe the present state of our pediatric emergency medicine workforce as well as the impact that different innovations could have on the future of pediatric emergency care. Many innovative initiatives, including physician and advanced practice provider education and training, pediatric readiness recognition programs, telemedicine and in-situ simulation outreach, and community paramedicine are being utilized to help bridge access gaps and augment the reach of the pediatric emergency medicine workforce. Advocacy for reimbursement for novel care delivery models, such as community paramedicine and telemedicine, and funding for outreach education programming is essential. Also, better understanding of our current training models for and utilization of advanced practice practitioners in pediatric emergency medicine is crucial to understanding the diversity of workforce growth and opportunity

Anti-immigrant prejudice: understanding the roles of (perceived) values and value dissimilarity

Although human values and value dissimilarity play pivotal roles in the prejudice literature, there remain important gaps in our understanding. To address these gaps, we recruited three British samples (N = 350) and presented Muslim immigrants, refugees, and economic migrants as target groups. Using polynomial regression analyses, we simultaneously tested effects of individuals’ own values, their perceptions of immigrant values, and self-immigrant value dissimilarities on prejudice. Results indicated that favorability toward immigrants is higher when individuals hold higher self-transcendence values (e.g., equality) and lower self-enhancement values (e.g., power), and when they perceive immigrants to hold higher self-transcendence values and lower self-enhancement values. In addition, prejudice toward immigrants is higher when individuals who hold higher conservation values (e.g., security) perceive immigrants to value openness (e.g., freedom) more, suggesting a value dissimilarity effect. No value dissimilarity effects emerged when immigrants were perceived to be higher in conservation, self-transcendence, or self-enhancement values. Overall, these results showed that effects of values and value dissimilarity differ depending on which value dimension is considered. Additionally, the results revealed support for a novel mechanism with the motivation to be nonprejudiced underpinning the links between individuals’ values and prejudice. Our discussion highlights the multifaceted manner in which values are linked to prejudic

Cost-Effectiveness Analysis of Tdap in the Prevention of Pertussis in the Elderly

Objectives: Health benefits and costs of combined reduced-antigen-content tetanus, diphtheria, and pertussis (Tdap) immunization among adults ≥65 years have not been evaluated. In February 2012, the Advisory Committee on Immunization Practices (ACIP) recommended expanding Tdap vaccination (one single dose) to include adults ≥65 years not previously vaccinated with Tdap. Our study estimated the health and economic outcomes of one-time replacement of the decennial tetanus and diphtheria (Td) booster with Tdap in the 10% of individuals aged 65 years assumed eligible each year compared with a baseline scenario of continued Td vaccination. Methods: We constructed a model evaluating the cost-effectiveness of vaccinating a cohort of adults aged 65 with Tdap, by calculating pertussis cases averted due to direct vaccine effects only. Results are presented from societal and payer perspectives for a range of pertussis incidences (25–200 cases per 100,000), due to the uncertainty in estimating true annual incidence. Cases averted were accrued throughout the patient 's lifetime, and a probability tree used to estimate the clinical outcomes and costs (US$2010) for each case. Quality-adjusted life-years (QALYs) lost to acute disease were calculated by multiplying cases of mild/moderate/severe pertussis by the associated health-state disutility; QALY losses due to death and long-term sequelae were also considered. Incremental costs and QALYs were summed over the cohort to derive incremental cost-effectiveness ratios. Scenario analyses evaluated the effect of alternative plausible parameter estimates on results. Results: At incidence levels of 25, 100, 200 cases/100,000, vaccinating adults aged 65 years costs an additional$336,000, $63,000 and$17,000/QALY gained, respectively. Vaccination has a cost-effectiveness ratio less than $50,000/QALY if pertussis incidence is >116 cases/100,000 from societal and payer perspectives. Results were robust to scenario analyses. Conclusions: Tdap immunization of adults aged 65 years according to current ACIP recommendations is a cost-effective health-care intervention at plausible incidence assumptions

Cost-Effectiveness of Tdap Vaccination of Adults Aged ≥65 Years in the Prevention of Pertussis in the US: A Dynamic Model of Disease Transmission

Objectives: In February 2012, the Advisory Committee on Immunization Practices (ACIP) advised that all adults aged ≥65 years receive a single dose of reduced-antigen-content tetanus, diphtheria, and acellular pertussis (Tdap), expanding on a 2010 recommendation for adults >65 that was limited to those with close contact with infants. We evaluated clinical and economic outcomes of adding Tdap booster of adults aged ≥65 to “baseline” practice [full-strength DTaP administered from 2 months to 4–6 years, and one dose of Tdap at 11–64 years replacing decennial Td booster], using a dynamic model. Methods: We constructed a population-level disease transmission model to evaluate the cost-effectiveness of supplementing baseline practice by vaccinating 10% of eligible adults aged ≥65 with Tdap replacing the decennial Td booster. US population effects, including indirect benefits accrued by unvaccinated persons, were estimated during a 1-year period after disease incidence reached a new steady state, with consequences of deaths and long-term pertussis sequelae projected over remaining lifetimes. Model outputs include: cases by severity, encephalopathy, deaths, costs (of vaccination and pertussis care) and quality-adjusted life-years (QALYs) associated with each strategy. Results in terms of incremental cost/QALY gained are presented from payer and societal perspectives. Sensitivity analyses vary key parameters within plausible ranges. Results: For the US population, the intervention is expected to prevent >97,000 cases (>4,000 severe and >5,000 among infants) of pertussis annually at steady state. Additional vaccination costs are $4.7 million. Net cost savings, including vaccination costs, are$47.7 million (societal perspective) and $44.8 million (payer perspective). From both perspectives, the intervention strategy is dominant (less costly, and more effective by >3,000 QALYs) versus baseline. Results are robust to sensitivity analyses and alternative scenarios. Conclusions: Immunization of eligible adults aged ≥65, consistent with the current ACIP recommendation, is cost saving from both payer and societal perspectives

Getting It on Record: Issues and Strategies for Ethnographic Practice in Recording Studios

The recording studio has been somewhat neglected as a site for ethnographic fieldwork in the field of ethno-musicology and, moreover, the majority of published studies tend to overlook the specific concerns faced by the researcher within these contexts. Music recording studios can be places of creativity, artistry, and collaboration, but they often also involve challenging, intimidating, and fractious relations. Given that recording studios are, first and foremost, concerned with documenting musicians’ performances, we discuss the concerns of getting studio interactions “on record” in terms of access, social relations, and methods of data collection. This article reflects on some of the issues we faced when conducting our fieldwork within British music recording facilities and makes suggestions based on strategies that we employed to address these issues

Rhabdomyosarcoma and Wilms Tumors Contain a Subpopulation of Noggin Producing, Myogenic Cells Immunoreactive for Lens Beaded Filament Proteins

Myo/Nog cells are identified by their expression of the skeletal muscle specific transcription factor MyoD and the bone morphogenetic protein inhibitor noggin, and binding of the G8 monoclonal antibody. Their release of noggin is critical for morphogenesis and skeletal myogenesis. In the adult, Myo/Nog cells are present in normal tissues, wounds and skin tumors. Myo/Nog cells in the lens give rise to myofibroblasts that synthesize skeletal muscle proteins. The purpose of this study was to screen human lens tissue, rhabdomyosarcoma cell lines, and tissue sections from rhabdomyosarcoma, Wilms and tumors lacking features of skeletal muscle for co-localization of antibodies to Myo/Nog cell markers and the lens beaded filament proteins filensin and CP49. Immunofluorescence localization experiments revealed that Myo/Nog cells of the lens bind antibodies to beaded filament proteins. Co-localization of antibodies to G8, noggin, filensin and CP49 was observed in most RC13 and a subpopulation of RD human rhabdomyosarcoma cell lines. Western blotting with beaded filament antibodies revealed bands of similar molecular weights in RC13 and murine lens cells. Human alveolar, embryonal, pleomorphic and spindle cell rhabdomyosarcomas and Wilms tumors contained a subpopulation of cells immunoreactive for G8, noggin, MyoD and beaded filaments. G8 was also co-localized with filensin mRNA. Staining for beaded filament proteins was not detected in G8 positive cells in leiomyosarcomas, squamous and basal cell carcinomas, syringocarciomas and malignant melanomas. Lens beaded filament proteins were thought to be present only in the lens. Myo/Nog-like cells immunoreactive for beaded filaments may be diagnostic of tumors related to the skeletal muscle lineage