Healthcare utilization and costs among older adult female drivers and former drivers

PurposeThis study compared the healthcare utilization and costs for specific types of medical services among older adult women who currently drive and those who no longer drive.MethodsThis study included 347 women aged 65 or older who were either former (had stopped driving) or current drivers, randomly sampled from a large U.S. health plan to participate in a telephone survey, and who had automated health records with healthcare utilization and cost data. Bivariate analyses and generalized linear modeling were used to examine associations between driving status and healthcare utilization and costs.ResultsAdjusting for age, income, and marital status, former drivers were more likely than current drivers to use mental health care services (RR = 3.37; 95% CI: 1.03, 10.98). Former drivers also tended to use more inpatient (RR = 1.85; 95% CI: 0.88, 3.87) and emergency services (RR = 1.89; 95% CI: 0.96, 3.70), but results did not reach statistical significance. Total annual healthcare costs in 2005 were almost twice as high for former drivers compared with current drivers ($13,046 vs. $7,054; mean difference = $5,992; 95% CI: -$360, $12,344), although this relationship was not statistically significant (CR = 1.61; 95% CI: 0.88, 2.96).Impact on IndustryFormer drivers were more than three times as likely as current drivers to use mental health services, and tended to use more emergency and inpatient services. Further research on factors that potentially mediate the relationship between driving status and health service use is warranted.     

Mortality in rural locations after severe injuries from motor vehicle crashes

BackgroundMortality from traffic crashes is often higher in rural regions, and this may be attributable to decreased survival probability after severe injury.MethodsData were obtained from the National Automotive Sampling System – General Estimates System (NASS-GES) for 2002–2008. Using weighted survey logistic regression, three injury outcomes were analyzed: (a) Death overall, (b) Severe injury (incapacitating or fatal), and (c) Death, after severe injury. Models controlled for (pre-crash) person, event, and county level factors.ResultsThe sample included 883,473 motorists. Applying weights, this represented a population of 98,411,993. Only 2% of the weighted sample sustained a severe injury, and 9% of these severely injured motorists died. The probability of death overall and the probability of severe injury increased with older age, safety belt nonuse, vehicle damage, high speed, and early morning crashes . Males were less likely to be severely injured, but more likely to die if severely injured. Motorists in southern states were more likely to have severe injuries, but not more likely to die if severely injured. Motorists who crashed in very rural counties were significantly more likely to die overall, and were more likely to die if severely injured.ConclusionsMotorists with severe injury are more likely to die in rural areas, after controlling for person- and event-specific factors.     

Degradation of extracellular genomic,plasmid DNA and specific antibiotic resistance genes by chlorination

Extracellular DNA structure damaged by chlorination was characterized. Integrity of extracellular ARG genetic information after chlorination was determined. Typical chlorine doses will likely effectively diminish extracellular DNA and ARGs. Plasmid DNA/ARGs were less readily broken down than genomic DNA. The Bioanalyzer methodology effectively documented damage incurred to DNA. There is a need to improve understanding of the effect of chlorine disinfection on antibiotic resistance genes (ARGs) in order to advance relevant drinking water, wastewater, and reuse treatments. However, few studies have explicitly assessed the physical effects on the DNA. Here we examined the effects of free chlorine (1–20 mg Cl₂/L) on extracellular genomic, plasmid DNA and select ARGs. Chlorination was found to decrease the fluorometric signal of extracellular genomic and plasmid DNA (ranging from 0.005 to 0.05 mg/mL) by 70%, relative to a no-chlorine control. Resulting DNA was further subject to a fragment analysis using a Bioanalyzer, indicating that chlorination resulted in fragmentation. Moreover, chlorine also effectively deactivated both chromosomal- and plasmid-borne ARGs, mecA and tetA, respectively. For concentrations >2 mg Cl₂//L × 30 min, chlorine efficiently reduced the qPCR signal when the initial concentration of ARGs was 10⁵ copies/mL or less. Notably, genomic DNA and mecA gene signals were more readily reduced by chlorine than the plasmid-borne tetA gene (by ~2 fold). Based on the results of qPCR with short (~200 bps) and long amplicons (~1200 bps), chlorination could destroy the integrity of ARGs, which likely reduces the possibility of natural transformation. Overall, our findings strongly illustrate that chlorination could be an effective method for inactivating extracellular chromosomal- and plasmid-borne DNA and ARGs.     

Designing the next generation of climate adaptation research for development

Adaptation research has changed significantly in recent years as funders and researchers seek to encourage greater impact, ensure value for money and promote interdisciplinarity across the natural and social sciences. While these developments are inherently positive, they also bring fresh challenges. With this in mind, this paper presents an agenda for the next generation of climate adaptation research for development. The agenda is based on insights from a dialogue session held at the 2016 Adaptation Futures conference as well as drawing on the collective experience of the authors. We propose five key areas that need to be changed in order to meet the needs of future adaptation research, namely: increasing transparency and consultation in research design; encouraging innovation in the design and delivery of adaptation research programmes; demonstrating impact on the ground; addressing incentive structures; and promoting more effective brokering, knowledge management and learning. As new international funding initiatives start to take shape, we underscore the importance of learning from past experiences and scaling-up of successful innovations in research funding models.

     

Muskox status,recent variation,and uncertain future

Ambio - Muskoxen (Ovibos moschatus) are an integral component of Arctic biodiversity. Given low genetic diversity, their ability to respond to future and rapid Arctic change is unknown, although...     

Leisure/Labor Tradeoffs: The Backward-Bending Labor Supply in Fisheries

Economists have understood that the open-access nature of fishing grounds can cause the long-run fishery supply to bend backward. There is also increasing speculation that fishermen respond to falling output price either by increasing or decreasing effort, depending on the circumstances. This suggests a short-run backward-bending supply of fishing labor. A dynamic, utility-theoretic model of fishermen's behavior is developed to address this possibility. The model highlights both contemporaneous and intertemporal trade-offs between labor and leisure. The model is tested and the results indicate that the short-run labor supply in fisheries may exhibit backward-bending properties. In addition, changes in current prices may trigger changes in expectations of future prices, causing potentially greater counterintuitive behavior. These results challenge many traditional regulatory strategies (e.g., output taxes) that address problems of open access.     

Systemic retention of ingested cantharidin by frogs

Summary Frogs(Rana pipiens) fed on blister beetles (Meloidae) or cantharidin, retain cantharidin systemically. After cessation of feeding, they void the compound relatively quickly. Systemic cantharidin does not protect frogs against ectoparasitic feeding by leeches(Hirudo medicinalis) or predation by snakes(Nerodia sipedon). As suggested by our data, and from reports in the early literature, ingestion of cantharidin-containing frogs can pose a health threat to humans.Paper no. 95 of the seriesDefense Mechanisms of Arthropods; no. 94 is LaMunyon & Eisner, Psyche (in press)     

Congenital myotonic dystrophy: An often unsuspected cause of severe polyhydramnios

Two cases of severe polyhydramnios are presented in which the unsuspected diagnosis of myotonic dystrophy was made in the patient and the fetus.