OECD 414 supplementary prenatal developmental toxicity study of sodium molybdate dihydrate in the rat and benchmark dose evaluation.

In a continuing investigation of the potential for reproductive and developmental toxicity of molybdenum (Mo), consequent to the previous published OECD studies [1,2] and as directed by the European Chemicals Agency [3], a supplemental rat GLP-compliant Prenatal Developmental Toxicity (PNDT) study was conducted to investigate higher dose levels of sodium molybdate dihydrate (SMD) in an identical study design (OECD 414)[4] to Murray et al. 2014a [1], at dietary concentrations calculated to provide target Mo levels of 80 and 120 mg/kg bw/day (the maximum-tolerated dose). There was no effect on post-implantation loss, litter size, sex ratio or the incidence of external, visceral or skeletal fetal malformations or variations. Fetal weight was reduced proportionate to maternal dose. Minimal differences observed in the ossification status of some extremities of fetuses from females receiving 120 mg Mo/kg bw/day were confirmed as transient by skeletal examination of PND 21 pups from a further group of females receiving the same dose regime. There was no evidence of copper depletion in serum, placenta or liver. A benchmark dose evaluation using continuous and dichotomous approaches by combining the fetal body weight data from this study and the previous study determined that the BMD05 ranged from 47 to 57 mg Mo/kg bw/day, depending on the modelling approach and the BMDL05 estimates ranged from 37 to 47 mg Mo/kg bw/day. These levels are considered a more statistically robust point of departure for risk assessment for reproductive effects than the established NOAEL of 40 mg Mo/kg bw/day.

Financial impact of electric scooters: a review of injuries over 27 months at an urban level 1 trauma center (cost of e-scooter injuries at an urban level 1 trauma center).

BACKGROUND: Electric scooters (e-scooters) have become a widespread method of transportation due to convenience and affordability. However, the financial impact of medical care for sustained injuries is currently unknown. The purpose of this study is to characterize total billing charges associated with medical care of e-scooter injuries. METHODS: A retrospective review of patients with e-scooter injuries presenting to the trauma bay, emergency department or outpatient clinics at an urban level 1 trauma center was conducted from November 2017 to March 2020. Demographic and clinical data were collected. Primary outcomes of interest were total billing charges and billing to insurance (hospital and professional). Multivariable models were used to identify preventable risk factors associated with higher total billing charges. RESULTS: A total of 63 patients were identified consisting of 42 (66.7%) males, average age 40.19 (SD 13.29) years and 3.2% rate of helmet use. Patients sustained orthopedic (29%, n=18), facial (48%, n=30) and cranial (23%, n=15) injuries. The average total billing charges for e-scooter clinical encounters was $95 710 (SD $138 215). Average billing to insurance was $86 376 (SD $125 438) for hospital charges and $9 334 (SD $14 711) for professional charges. There were no significant differences in charges between injury categories. On multivariable regression, modifiable risk factors independently associated with higher total billing charges included any intoxication prior to injury ($231 377 increase, p=0.02), intracranial bleeds ($75 528, p=0.04) and TBI ($360 898, p=0.006). DISCUSSION: Many patients sustain high-energy injuries during e-scooter accidents with significant medical and financial consequences. Further studies may continue expanding the financial impact of e-scooter injuries on both patients and the healthcare system. LEVEL OF EVIDENCE: III.

Eye-Hand Coordination Assessment Metrics Using a Multi-Platform Haptic System with Eye-Tracking and Motion Capture Feedback.

In this paper, we discuss the possibility to determine assessment metrics for eye-hand coordination, using a mapping between a robotic haptic device to a virtual environment, and correlating it with the eye-gaze and upper arm movements. Our goal is to develop, implement and refine a system that will assess and improve eye-hand coordination in individuals with disabilities. A detailed analysis of patterns was conducted by therapists in order to select various levels of difficulty that could be included in the system, and which would yield the greatest benefit in terms of assessment of coordination as well as in training. Participants were instructed to use a haptic device (Omni) to follow the trajectories. This was completed while video data were collected using a Vicon motion capture system. Readings of traced trajectories, time, and upper limb motions were recorded for further analysis. One of the patterns was chosen to develop a multi-platform haptic system to be virtually rendered with any haptic device and a Graphic User Interface (GUI) with options to guide the user along the chosen pattern using a haptic tunnel calculated by using B-splines. Two types of haptic tunnels are presented and evaluated: one that follows the mid path of the pattern, and one that takes the smoothest path through the pattern. Finally, the Pearson coefficient was chosen as a metric to correlate the haptic device and the eye-gaze coordinates recorded simultaneously while the user traces a path.

Show Me My Health Plans: a study protocol of a randomized trial testing a decision support tool for the federal health insurance marketplace in Missouri.

BACKGROUND: The implementation of the ACA has improved access to quality health insurance, a necessary first step to improving health outcomes. However, access must be supplemented by education to help individuals make informed choices for plans that meet their individual financial and health needs. METHODS/DESIGN: Drawing on a model of information processing and on prior research, we developed a health insurance decision support tool called Show Me My Health Plans. Developed with extensive stakeholder input, the current tool (1) simplifies information through plain language and graphics in an educational component; (2) assesses and reviews knowledge interactively to ensure comprehension of key material; (3) incorporates individual and/or family health status to personalize out-of-pocket cost estimates; (4) assesses preferences for plan features; and (5) helps individuals weigh information appropriate to their interests and needs through a summary page with "good fit" plans generated from a tailored algorithm. The current study will evaluate whether the online decision support tool improves health insurance decisions compared to a usual care condition (the healthcare.gov marketplace website). The trial will include 362 individuals (181 in each group) from rural, suburban, and urban settings within a 90 mile radius around St. Louis. Eligibility criteria includes English-speaking individuals 18-64 years old who are eligible for the ACA marketplace plans. They will be computer randomized to view the intervention or usual care condition. DISCUSSION: Presenting individuals with options that they can understand tailored to their needs and preferences could help improve decision quality. By helping individuals narrow down the complexity of health insurance plan options, decision support tools such as this one could prepare individuals to better navigate enrollment in a plan that meets their individual needs. The randomized trial was registered in clinicaltrials.gov (NCT02522624) on August 6, 2015.

The toxicity of molybdate to freshwater and marine organisms. II. Effects assessment of molybdate in the aquatic environment under REACH.

The REACH Molybdenum Consortium initiated an extensive research program in order to generate robust PNECs, based on the SSD approach, for both the freshwater and marine environments. This activity was part of the REACH dossier preparation and to form the basis for scientific dialogues with other national and international regulatory authorities. Chronic ecotoxicity data sets for the freshwater and marine environments served as starting point for the derivation of PNECs for both compartments, in accordance with the recommended derivation procedures established by the European Chemicals Agency (ECHA). The HC(5,50%)s that were derived from the generated Species Sensitivity Distributions were 38.2 mg Mo/L and 5.75 mg Mo/L for the freshwater and marine water compartment, respectively. Uncertainty analysis on both data sets and available data on bioaccumulation at high exposure levels justified an assessment factor of 3 on both HC(5,50%) leading to a PNEC(freshwater) of 12.7 mg Mo/L and a PNEC(marine) of 1.92 mg Mo/L. As there are currently insufficient ecotoxicological data available for the derivation of PNECs in the sediment compartment, the equilibrium partitioning method was applied; typical K(D)-values for both the freshwater and marine compartments were identified and combined with the respective PNEC, leading to a PNEC(sediment) of 22,600 mg/kg dry weight and 1980 mg/kg dry weight for freshwater and marine sediments, respectively. The chronic data sets were also used for the derivation of final chronic values using the procedures that are outlined by the US Environmental Protection Agency for deriving such water benchmarks. Comparing PNECs with FCVs showed that both methodologies result in comparable protective concentration levels for molybdenum in the environment.

The nursing shortage as a community transformational opportunity: an update.

In the 2002 original work discussing some of our professional issues that have contributed to the current nursing shortage, I concluded that until the profession examines and addresses some of the troublesome and paradoxical areas of our workplaces, we will continue to remain locked in our current cyclical strange loop of nursing shortages and a dissatisfied nursing working force. While the nursing shortage seems to have taken on a new context, given current global economic issues and healthcare reformation efforts, many of the professional issues I addressed in my original article remain pertinent to our professional growth and the future of an autonomous workforce of nurses. In this article, the writer will briefly review the current literature around the nursing shortage, reexplore our own role in contributing to the cyclical or strange loop shortage of professional nurses, and further discuss possible solutions for the growth of nursing as a profession. The aim of this article is to explore how we can address our professional identity issues in ways that will serve to manage the current challenges we face of attracting and retaining a stable workforce.

Benefits of the Comprehensive Child Development Program as a function of AFDC receipt and SES.

The benefits for children at the Pittsburgh site of the federal Comprehensive Child Development Program (CCDP) were examined as a function of family welfare status (Aid to Families with Dependent Children; AFDC) and SES. The CCDP was the largest attempt by the federal government to provide two-generation, case-managed, comprehensive services to low-income families. Participating families could set their own goals and choose services to achieve them, but relatively few services were directed specifically at children. Results showed that more Pittsburgh families in the CCDP treatment group (N = 120) left AFDC than in the control group (N = 120), consistent with results from a national evaluation of the CCDP. Children whose families were on AFDC regardless of treatment group had lower mental test scores, even after controlling for family SES, a result suggesting that AFDC receipt over and above income level was associated with poorer child mental performance. The CCDP was associated with higher children's mental scores plus improvements over time in achievement scores only for children in families who were not on AFDC, even after controlling for SES. Such parents were more likely to choose parenting and child goals and services, which in turn were associated with higher child mental scores. In contrast, parents who were on AFDC tended to choose adult-centered goals and services, which did not benefit children. Therefore, in contrast to the national evaluation, which found no benefits of the CCDP for children, these analyses showed that the CCDP did produce benefits for children whose parents were not on AFDC, who tended to choose parenting and child services.

The nursing shortage as a community transformational opportunity.

The nursing shortage is continuing toward its projected peak in 2010. As a profession we seem unable to devise effective strategies to enhance growth and overcome this looming crisis. By focusing on predictable barriers using methods of reductionism, nurses may have forgotten the biggest barrier: the challenge of creating a holistic professional group presence and inclusive nursing stance. Without first addressing and solving internal paradoxical identity struggles, nursing will continue to try to overcome the multiple internal and external barriers that resulted in the current shortage. This article discusses the group dynamics that have fostered the cyclic loop of nursing shortage situations and explores the reflection and inquiry needed to formulate a cohesive national nursing group posture.

Benefit-cost analysis of community residential versus institutional services for adults with severe mental retardation and challenging behaviors.

A benefit-cost analysis was conducted to compare services in community residences versus an institution for 11 individuals with severe mental retardation and challenging behaviors who had been moved from an institution to a community setting. Effects that were not readily quantifiable in economic terms also were examined. Overall, the community-based program costs represented slight public savings over costs of the state institution. However, community living netted significant increases in variables such as resident's social networks, opportunities for integrated activities, and income.

A collaborative case management program: the Crawford Long Hospital of Emory University model.

At Crawford Long Hospital of Emory University, a new system of patient care delivery, defined as collaborative case management, was developed as the organization struggled with implementation of the Deming management method. At the onset of the change process, an evaluation system was established to measure and document specific outcomes for patients, families, providers of care, and the organization. This article traces the development and implementation of the collaborative case management program and describes the evaluation system. Findings highlighting improved patient care outcomes, changes in patient and provider perceptions of care, and benefits to the organization are summarized.

Utilization of dental services and its relation to the periodontal status in a group of South Australian employees.

The pattern of dental service utilization, the perception of periodontal disease, and the oral hygiene habits among 642 industrial employees were evaluated using a self-administered questionnaire against background variables of age, sex, and socioeconomic strata. Of the study population, 50.5% had their most recent dental visit within the previous 12 months and 42.5% claimed to seek regular check ups. There was no significant association between time intervals since the last dental visit and age, sex, occupation, income or education. Regular visits were made more often by subjects in the higher occupation and income level. Multivariate analyses of the number of missing teeth simultaneously considering age, sex, socioeconomic level, regularity and frequency of dental visits revealed that except for age and sex, no other factors were significant. The most common reason for not seeing a dentist in the previous 12 months was an assumption that "nothing was wrong". A large majority of the group surveyed were unaware of the presence of periodontal disease or the need for its treatment, despite the high prevalence in all subgroups. Periodontal status was not significantly associated with sex, socioeconomic levels, regularity of frequency of dental visits, but there was a significant regression on age. The study population's pattern of service utilization was found to be similar to that reported for the general population, and it was anticipated that the hygiene habits of the group was representative of the total community. If that assumption is true the high prevalence of periodontal disease of the study population probably exists in the general community.