The financial burden of juvenile idiopathic arthritis: A Nova Scotia experience

Background: Juvenile idiopathic arthritis (JIA) is the most common childhood rheumatic illness. There is little published data on the financial burden of this illness. The primary objective of this study was to determine the annual costs borne by families of a child with JIA living in Nova Scotia (NS).Methods: All families in NS with a child followed in the Pediatric Rheumatology Clinic at the Izaak Walton Killam Health Centre (IWK) in 2009 were mailed a self-report questionnaire. The questionnaire evaluated disease related costs, gross household income and perceived financial burden. Dillman\u27s method was used to optimize return rates. Descriptive statistics were used to summarize results. Spearman\u27s correlation coefficient was used to assess the relationship of distance from the IWK and cost. The Mann-Whitney U test was used to compare median costs between groups.Results: Of 172 possible respondents, we received 54 completed questionnaires and 11 blank questionnaires (overall response rate 31.4%). Approximately one third (35.9%) of parents rated the financial burden as moderate or large and 36% rated financial resources available as poor. The median annual total cost per patient was $619.50 CAD (range 0,$5535) which was a median 0.7% (range 0, 37%) of gross household incomes. The largest expense for families was visit related costs. There was not a significant relationship between total annual costs and distance from the IWK (rs = 0.18, P = 0.2). Families of a child with oligoarthritis had significantly lower costs than the families of a child with another subtype of JIA ($359.00 CAD vs.$877.00 CAD, P = 0.02).Conclusions: The costs associated with having a child with JIA in NS are on average modest, but may be considerable for some families. Oligoarticular JIA is associated with smaller costs. Many families perceive the burden to be at least moderate and the availability of financial resources to be poor. Supports should be targeted to those families most in need. © 2013 Ens et al.; licensee BioMed Central Ltd

The financial burden of juvenile idiopathic arthritis: A Nova Scotia experience

Background: Juvenile idiopathic arthritis (JIA) is the most common childhood rheumatic illness. There is little published data on the financial burden of this illness. The primary objective of this study was to determine the annual costs borne by families of a child with JIA living in Nova Scotia (NS).Methods: All families in NS with a child followed in the Pediatric Rheumatology Clinic at the Izaak Walton Killam Health Centre (IWK) in 2009 were mailed a self-report questionnaire. The questionnaire evaluated disease related costs, gross household income and perceived financial burden. Dillman\u27s method was used to optimize return rates. Descriptive statistics were used to summarize results. Spearman\u27s correlation coefficient was used to assess the relationship of distance from the IWK and cost. The Mann-Whitney U test was used to compare median costs between groups.Results: Of 172 possible respondents, we received 54 completed questionnaires and 11 blank questionnaires (overall response rate 31.4%). Approximately one third (35.9%) of parents rated the financial burden as moderate or large and 36% rated financial resources available as poor. The median annual total cost per patient was $619.50 CAD (range 0,$5535) which was a median 0.7% (range 0, 37%) of gross household incomes. The largest expense for families was visit related costs. There was not a significant relationship between total annual costs and distance from the IWK (rs = 0.18, P = 0.2). Families of a child with oligoarthritis had significantly lower costs than the families of a child with another subtype of JIA ($359.00 CAD vs.$877.00 CAD, P = 0.02).Conclusions: The costs associated with having a child with JIA in NS are on average modest, but may be considerable for some families. Oligoarticular JIA is associated with smaller costs. Many families perceive the burden to be at least moderate and the availability of financial resources to be poor. Supports should be targeted to those families most in need. © 2013 Ens et al.; licensee BioMed Central Ltd

Descriptive epidemiology study of hand injuries sustained in Gaelic football referred to a hand therapy service over 1 year

Objectives: Gaelic football requires ball handling, such as bouncing, fist passing and catching. To date, no research has examined the types of injuries sustained to the hand in this sport. This study aims to establish the types of orthopaedic hand injuries sustained in Gaelic football. Methods: This was a retrospective descriptive epidemiology study of Gaelic football-related hand injuries treated at a hand therapy unit. The nature of injuries was categorised along with collated variables on player demographics and injury profiles. Potential correlations between injury and continuous demographic data were analysed using the Mann-Whitney U and Kruskal-Wallis tests. Pearson’s χ2 test was used for categorical data (

SmallSat Solar Axion and Activity X-ray Imager (SSAXI)

Axions are a promising dark matter candidate as well as a solution to the strong charge-parity (CP) problem in quantum chromodynamics (QCD). We describe a new mission concept for SmallSat Solar Axion and Activity X-ray Imager (SSAXI) to search for solar axions or axion-like particles (ALPs) and to monitor solar activity of the entire solar disc over a wide dynamic range. SSAXI aims to unambiguously identify X-rays converted from axions in the solar magnetic field along the line of sight to the solar core, effectively imaging the solar core. SSAXI also plans to establish a statistical database of X-ray activities from Active Regions, microflares, and Quiet Sun regions to understand the origin of the solar corona heating processes. SSAXI employs Miniature lightweight Wolter-I focusing X-ray optics (MiXO) and monolithic CMOS X-ray sensors in a compact package. The wide energy range (0.5 - 6 keV) of SSAXI can easily distinguish spectra of axion-converted X-rays from typical X-ray spectra of solar activities, while encompassing the prime energy band (3 - 4.5 keV) of axion-converted X-rays. The high angular resolution (30 arcsec HPD) and large field of view (40 arcmin) in SSAXI will easily resolve the enhanced X-ray flux over the 3 arcmin wide solar core while fully covering the X-ray activity over the entire solar disc. The fast readout in the inherently radiation tolerant CMOS X-ray sensors enables high resolution spectroscopy with a wide dynamic range in a broad range of operational temperatures. SSAXI will operate in a Sun-synchronous orbit for 1 yr preferably near a solar minimum to accumulate sufficient X-ray photon statistics.Comment: 12 pages, 9 figures, 1 table, Presented at the SPIE Optics + Photonics Conference, August 2019, San Diego, C

Policy Feedback and the Politics of the Affordable Care Act

There is a large body of literature devoted to how “policies create politics” and how feedback effects from existing policy legacies shape potential reforms in a particular area. Although much of this literature focuses on self‐reinforcing feedback effects that increase support for existing policies over time, Kent Weaver and his colleagues have recently drawn our attention to self‐undermining effects that can gradually weaken support for such policies. The following contribution explores both self‐reinforcing and self‐undermining policy feedback in relationship to the Affordable Care Act, the most important health‐care reform enacted in the United States since the mid‐1960s. More specifically, the paper draws on the concept of policy feedback to reflect on the political fate of the ACA since its adoption in 2010. We argue that, due in part to its sheer complexity and fragmentation, the ACA generates both self‐reinforcing and self‐undermining feedback effects that, depending of the aspect of the legislation at hand, can either facilitate or impede conservative retrenchment and restructuring. Simultaneously, through a discussion of partisan effects that shape Republican behavior in Congress, we acknowledge the limits of policy feedback in the explanation of policy stability and change

Staff experiences of Providing Maternity Services in Rural Southern Tanzania -- A Focus on Equipment, Drug and Supply Issues.

The poor maintenance of equipment and inadequate supplies of drugs and other items contribute to the low quality of maternity services often found in rural settings in low- and middle-income countries, and raise the risk of adverse maternal outcomes through delaying care provision. We aim to describe staff experiences of providing maternal care in rural health facilities in Southern Tanzania, focusing on issues related to equipment, drugs and supplies. Focus group discussions and in-depth interviews were conducted with different staff cadres from all facility levels in order to explore experiences and views of providing maternity care in the context of poorly maintained equipment, and insufficient drugs and other supplies. A facility survey quantified the availability of relevant items. The facility survey, which found many missing or broken items and frequent stock outs, corroborated staff reports of providing care in the context of missing or broken care items. Staff reported increased workloads, reduced morale, difficulties in providing optimal maternity care, and carrying out procedures that carried potential health risks to themselves as a result. Inadequately stocked and equipped facilities compromise the health system's ability to reduce maternal and neonatal mortality and morbidity by affecting staff personally and professionally, which hinders the provision of timely and appropriate interventions. Improving stock control and maintaining equipment could benefit mothers and babies, not only through removing restrictions to the availability of care, but also through improving staff working conditions

Improving X-ray Optics Through Differential Deposition

The differential deposition technique can in theory correct shell figures to approximate arcsecond value. We have received APRA funding and are building two custom system to demonstrate the technique on full shell and segmented optics. We hope to be able to demonstrate < 5 arcsec performance in < 2 years. To go beyond this, (arcsecond level) is very difficult to judge as we have not yet discovered the problems. May necessitate in-situ metrology, stress reduction investigations, correcting for gravity effects, correcting for temperature effects. Some of this will become obvious in early parts of the investigation