The urgent need for contingency management among Tribal communities in the United States: Considerations for implementation, policy, and sovereignty.

In two randomized controlled trials, culturally adapted contingency management (i.e., incentives provided for substance-negative urine samples) was associated with reduced alcohol and drug use among geographically diverse American Indian and Alaska Native (AI/AN) adults. In response to interest in contingency management from other Tribal and AI/AN communities, our research team in collaboration with AI/AN behavioral health experts, translated the research into practice with new AI/AN community partners. Tenets of community-based participatory research were applied to develop, pilot, and refine contingency management training and implementation tools, and identify implementation challenges. In partnership with the AI/AN communities, four members of the university team developed tools and identified implementation and policy strategies to increase the successful uptake of contingency management in each location. Through our collaborative work, we identified policy barriers including inadequate federal funding of contingency management incentives and a need for further clarity regarding federal anti-kickback regulations. Adoption of contingency management is feasible and can strengthen Tribal communities' capacity to deliver evidence-based substance use disorder treatments to AI/AN people. Unfortunately, non-evidence-based limits to the use of federal funding for contingency management incentives discriminate against AI/AN communities. We recommend specific federal policy reforms, as well as other practical solutions for Tribal communities interested in contingency management.

Industry Payments to Physicians Are Kickbacks. How Should Stakeholders Respond?

Payments from the pharmaceutical industry to US physicians are common. In determining which payments rise to the level of an illegal kickback under the Anti-Kickback Statute (AKS), the Department of Health and Human Services' Office of Inspector General (OIG) has stated in nonbinding guidance that influencing or "swaying" physician prescribing is key. OIG has highlighted as a compliance standard the Pharmaceutical Research and Manufacturers of America Code on Interactions with Health Professions, which stipulates that permissible payments are those that do not interfere with prescribing. However, recent evidence has shown that most payments influence physician prescribing, driving higher prescription drug costs by increasing use of brand-name and low-value drugs. This evidence implies that many payments that are currently commonplace could be subject to prosecution under AKS. Given that these payments increase costs to patients and the health care system, there is a public interest in curtailing them. This article proposes a range of actions available to stakeholders-including industry, providers, regulators, and payers-to mitigate the cost-increasing effect of industry payments to physicians.

Electromyographic Comparison of Five Lower-Limb Muscles between Single- and Multi-Joint Exercises among Trained Men.

Resistance-training exercises can be classified as either single- or multi-joint exercises and differences in surface electromyography (EMG) amplitude between the two training methods may identify which muscles can benefit from either training modality. This study aimed to compare the surface EMG amplitude of five hip- and knee extensors during one multi-joint (leg press) and two single-joint exercises (knee extension and kickback). Fifteen resistance-trained men completed one familiarization session to determine their unilateral six repetitions maximum (6RM) in the three exercises. During the following experimental session, EMG amplitudes of the vastus lateralis, vastus medialis, rectus femoris, gluteus maximus and biceps femoris of the left leg were measured while performing three repetitions on their respective 6RM loads. The multi-joint exercise leg press produced higher EMG amplitude of the vastus lateralis (ES = 0.92, p = 0.003) than the single-joint exercise knee extension, whereas the rectus femoris demonstrated higher EMG amplitude during the knee extension (ES = 0.93, p = 0.005). The biceps femoris EMG amplitude was higher during the single-joint exercise kickback compared to the leg press (ES = 2.27, p < 0.001), while no significant differences in gluteus maximus (ES = 0.08, p = 0.898) or vastus medialis (ES = 0.056, p = 0.025 were observed between exercises. The difference in EMG amplitude between single- and multi-joint exercises appears to vary depending on the specific exercises and the muscle groups tested. Leg press is a viable and time-efficient option for targeting several hip- and knee extensors during resistance training of the lower limbs, but the single-joint exercises may be preferable for targeting the rectus femoris and biceps femoris.

Kickback risk of portable chainsaws while cutting wood of different properties: laboratory tests and deductions.

Portable chainsaws are associated with substantial risk and can cause serious injury to operators, especially during kickback. This paper presents new results from research and analyses conducted regarding the impact between the different properties of wood on this occurrence. In an open area, such differences may include: wood species, humidity, temperature and the facing angle of the wood fibres in relation to the kerf and shape of the wood surface that comes in contact with the tip of the guide bar. This paper investigates chainsaw kickback including the research results on kickback and wood-cutting energy, saw chain speed and the efficiency of the chainsaw engine. It also presents conclusions drawn from the tests that can be useful for chainsaw users, showing the dependencies between the different properties of wood and the risk of injury.

Occupational injuries in Ohio wood product manufacturing: a descriptive analysis with emphasis on saw-related injuries and associated causes.

BACKGROUND: Stationary sawing machinery is often a basic tool in the wood product manufacturing industry and was the source for over 2,500 injury/illness events that resulted in days away from work in 2010. METHODS: We examined 9 years of workers' compensation claims for the state of Ohio in wood product manufacturing with specific attention to saw-related claims. For the study period, 8,547 claims were evaluated; from this group, 716 saw-related cases were examined. RESULTS: The sawmills and wood preservation sub-sector experienced a 71% reduction in average incidence rate and an 87% reduction in average lost-time incidence rate from 2001 to 2009. The top three injury category descriptions for lost-time incidents within saw-related claims were fracture (35.8%), open wounds (29.6%), and amputation (14.8%). CONCLUSIONS: For saw-related injuries, preventing blade contact remains important but securing the work piece to prevent kickback is also important.

Radiology quick cash? Kickbacks, compliance, and consequences.

The Anti-Kickback Statute was passed by Congress in the 1970s to reduce the overuse of government-reimbursed medical services. It attempts to eliminate fraud, abuse, and waste of medical services by outlawing the incentive of personal gain when referring patients for government-funded services. Although safe harbors were written into the law to maintain transactions beneficial to society, they require strict adherence. Anti-Kickback Statute violations are subject to the whistleblower provision of the False Claims Act, and violations can yield significant civil and criminal penalties.

False Claims Act and Anti-Kickback Statute: Avoiding Legal Landmines.

Health care entities doing business with the federal government may run afoul of the False Claims Act and Anti-Kickback Statute not only when they directly submit fraudulent claims for government reimbursement but also when they create schemes that manipulate others into submitting (whether knowingly or unknowingly) illegal claims. In recent years, the Department of Justice is deploying these statutes to ensure that electronic health records are built and maintained with appropriate cybersecurity protections.

Investigation of abrasive saw kickback.

Saw kickback can cause fatal injuries, but only woodcutting saws have regulations and assessment methodologies for kickback. These regulations do not apply to abrasive cutting saws, as their cutting mechanism and dominant kickback mode differ from those of woodcutting saws. This work combines theoretical and experimental tools to investigate abrasive saw kickback. A theoretical model based on frictional engagement during a pinch-based kickback event is shown to predict resultant kickback energy in good agreement with experimental measurements. These measurements were obtained using a specialized machine that generates pinch-based kickback events and measures resultant kickback energy. Upon validating the model, two representative saws, a circular cutoff saw and a chainsaw, were tested using the prototype machine to evaluate their comparative kickback risk. This work demonstrates that pinch-based kickback is a potential safety risk for abrasive cutting saw operators and provides a testing machine design and analytical framework for evaluating this risk.

Do Not Cut Wood with an Angle Grinder, or You Might Lose a Finger: A Retrospective Study.

Background: Angle grinders are a handheld power tool used for grinding and polishing stone, metal, and concrete. Some people, however, use them with a circular saw blade attachment for cutting wood and consequently, suffer injuries. We aimed to investigate the underlying cause and mechanisms of injuries caused by cutting wood with an angle grinder. Methods: We conducted a retrospective study using medical records from our trauma center and identified 15 patients treated for angle grinder injury between 2017 and 2018. Moreover, we contacted the National Consumer Affairs Center of Japan for further information about angle grinder injuries. Results: Nine of the 15 patients used angle grinders improperly, of which only three patients were aware of the risk of injury. The details of the nine patients were as follows: the types of injuries: complete finger amputation (n = 2), partial finger amputation (n = 1), tendon injury with phalangeal fracture (n = 5), and tendon injury alone, (n = 1); the causes of accidents: kickback (n = 7) and glove entanglement (n = 2); and the accident situations: on-the-job (n = 5) and do-it-yourself (n = 4). Conclusions: The primary cause of angle grinder injury caused by cutting wood was a lack of user knowledge that an angle grinder cannot be used as a cutting tool. Appropriate feedback from hand surgeons are necessary to urge manufacturers to take safety measures.

Influence of the milling tool setup on occupational safety in furniture making.

One of the most serious causes of accidents in furniture making is kickback of machined material. The aim of this study was to determine the influence of the milling tool setup on hazards associated with kickback in furniture making. The speed of kickback was accepted as the measure of these hazards. The experiment involved controlled changes in milling tool setup, projection of cutting knives over the body of the milling tool, number of cutting knives and clearance angle. Multifactor analysis of variance was applied to the results of individual experiments, showing statistically significant factors and their interactions. Inspection and analysis of traces left by the cutting knives of the tools on the test pieces made of wood materials supported inferential statistics. The obtained results verified some common opinions and ideas on the impact of the milling tool setup on the hazards resulting from kickback in furniture making.