Accessibility of Medical Diagnostic Equipment - Implications for People with Disability

Under Attorney General Jeff Sessions, the U.S. Department of Justice (DOJ) has inactivated or rescinded numerous rules and guidelines issued by prior administrations, sometimes attracting considerable public attention in the process. Little noticed, however, was a decision by the DOJ on December 26, 2017, to formally withdraw four Advance Notices of Proposed Rulemaking related to Titles II and III of the Americans with Disabilities Act (ADA), including rulemaking that addressed making medical diagnostic equipment accessible to people with disability. For now, this step halts efforts on a national level to ensure accessibility of such equipment, which includes exam tables, weight scales, mammography equipment, and other diagnostic ­imaging technologies. It also forestalls explicit guidance for providers on what constitutes accessible medical diagnostic equipment and perpetuates existing confusion about this issue at many health care facilities. As we approach 30 years since the passage of the ADA in 1990, the absence of a clear federal rule in this area raises questions about how to improve access to medical diagnostic equipment for millions of Americans with disability, many of whom face considerable difficulty getting care because of inaccessible equipment in public and private health care settings

The Role of Law and Policy in Achieving Healthy People\u27s Disability and Health Goals Around Access to Health Care, Activities Promoting Health and Wellness, Independent Living and Participation, and Collecting Data in the United States

Ensuring that the almost 60 million Americans with disabilities live as healthy and independent lives as possible is an important goal for our nation. This evidence-based report highlights efforts to better use law and policy to support and protect people with disabilities. Specifically, it examines how existing federal laws and policies could be leveraged by states, communities, and other sectors to reduce barriers to primary and preventive care; reduce barriers to local health and wellness programs; increase access to leisure, social, or community activities (and indirectly, to religious activities) for individuals with disabilities; and generate better disability data needed to inform and support efforts to reach these and other disability and health objectives. This report also features specific, real-world examples of legal community strategies or interventions, or Laws and Policies in Action, to illustrate how law and policy is used to make progress on each of these objectives

Use and cost of disease-modifying therapies by Sonya Slifka Study participants: has anything really changed since 2000 and 2009?

Background:Disease-modifying therapies benefit individuals with relapsing forms of multiple sclerosis, but their utility remains unclear for those without relapses. Objective:To determine disease-modifying therapy use and costs in 2009, compare use in 2009 and 2000, and examine compliance with evidence-based guidelines. Methods:We determined the extent and characteristics of disease-modifying therapy use by participants in the Sonya Slifka Longitudinal Multiple Sclerosis Study (Slifka) in 2000 (n=2156) and 2009 (n=2361) and estimated out-of-pocket and total (payer) costs for 2009. Two multivariable logistic regressions predicted disease-modifying therapy use. Results:Disease-modifying therapy use increased from 55.3% in 2000 to 61.5% in 2009. In 2009, disease-modifying therapy use was reported by 76.5% of participants with relapsing-remitting multiple sclerosis, 73.2% with progressive-relapsing multiple sclerosis, 62.5% with secondary progressive multiple sclerosis, and 41.8% with primary progressive multiple sclerosis. Use was significantly associated with relapsing-remitting multiple sclerosis, shorter duration of illness, one to two relapses per year, non-ambulatory symptoms, using a cane, younger age, higher family income, and having health insurance. Average annual costs in 2009 were US$939-3101 for patients and US$16,302-18,928 for payers. Conclusion:Use rates were highest for individuals with relapsing-remitting multiple sclerosis, but substantial for those with progressive courses although clinical trials have not demonstrated significant benefits for them

Genetic Dissection of Bloom Time in Low Chilling Sweet Cherry (Prunus avium L.) Using a Multi-Family QTL Approach

Bloom time in sweet cherry (Prunus avium L.) is a highly heritable trait that varies between genotypes and depends on the environmental conditions. Bud-break occurs after chill and heat requirements of each genotype are fulfilled, and dormancy is released. Bloom time is a critical trait for fruit production as matching cultivar adaptation to the growing area is essential for adequate fruit set. Additionally, low chilling cultivars are of interest to extend sweet cherry production to warmer regions, and for the crop adaptation to increasing winter and spring temperatures. The aim of this work is to investigate the genetic control of this trait by analyzing multiple families derived from the low chilling and extra-early flowering local Spanish cultivar ‘Cristobalina’ and other cultivars with higher chilling requirements and medium to late bloom times. Bloom time evaluation in six related sweet cherry populations confirmed a high heritability of this trait, and skewed distribution toward late flowering, revealing possible dominance of the late bloom alleles. SNP genotyping of the six populations (n = 406) resulted in a consensus map of 1269 SNPs. Quantitative trait loci (QTL) analysis using the Bayesian approach implemented by FlexQTL™ software revealed two major QTLs on linkage groups 1 and 2 (qP-BT1.1m and qP-BT2.1m) that explained 47.6% of the phenotypic variation. The QTL on linkage group 1 was mapped to a 0.26 Mbp region that overlaps with the DORMANCY ASSOCIATED MADS-BOX (DAM) genes. This finding is consistent with peach results that indicate that these genes are major determinants of chilling requirement in Prunus. Haplotype analysis of the linkage group 1 and 2 QTL regions showed that ‘Cristobalina’ was the only cultivar tested that contributed early bloom time alleles for these two QTLs. This work contributes to knowledge of the genetic control of chilling requirement and bloom date and will enable marker-assisted selection for low chilling in sweet cherry breeding programs

Accommodating Medical School Faculty with Disabilities

More than ten years have passed since the Americans with Disabilities Act (ADA) mandated that all employers provide “reasonable accommodations” for employees with disabilities. This mandate applies to medical schools, but no systematic information is available to assess the accommodations provided to medical school faculty with disabilities. This Issue Brief summarizes anecdotal evidence from several medical schools about the experiences of faculty with disabilities, and the barriers they face in establishing and maintaining their careers. It also recommends practical steps medical schools can take to provide a welcoming and accessible academic medical environment

Calibration of Capacitance Sensors for Use in Nonisothermal Applications

This study investigates how temperature affects the response of capacitance sensors. These sensors are used to measure the dielectric permittivity of unsaturated soils, which is strongly related to the volumetric water content. The volumetric water content is frequently used in the analyses of water flow through soils. Capacitance sensors have been used in experiments intended to characterize thermally-induced flow of water in unsaturated soils during geothermal heat exchange processes. Water flow is an important process in the design of thermally-active geotechnical systems such as energy piles and thermally-active retaining walls. To date, no studies have characterized the effect of temperature on capacitance sensor output from a geotechnical perspective (where soils are typically dense). An understanding of this topic is necessary to obtain an accurate estimate of thermally-induced changes in volumetric water content in thermally active geotechnical systems. This paper describes the heating experiments performed on compacted soil layers with constant water content that indicated changes in temperature can lead to changes in the measured dielectric permittivity of up to 40%. The capacitance sensor's response to changing temperatures was observed to be sensitive to the initial density of the soil, and the initial volumetric water content. A calibration equation to consider the soil-specific relationship between volumetric water content and dielectric permittivity was defined, along with a correction equation to account for temperature effects in unsaturated soils having different dry density values

Knowledge of Practicing Physicians about Their Legal Obligations When Caring for Patients with Disability

doi: 10.1377/hlthaff.2018.05060 HEALTH AFFAIRS 38, NO. 4 (2019): 545–55