Principles of Financing the Medical Home for Children.

A well-implemented and adequately funded medical home not only is the best approach to optimize the health of the individual patient but also can function as an effective instrument for improving population health. Key financing elements to providing quality, effective, comprehensive care in the pediatric medical home include the following: (1) first dollar coverage without deductibles, copays, or other cost-sharing for necessary preventive care services as recommended by Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents; (2) adoption of a uniform definition of medical necessity across payers that embraces services that promote optimal growth and development and prevent, diagnose, and treat the full range of pediatric physical, mental, behavioral, and developmental conditions, in accord with evidence-based science or evidence-informed expert opinion; (3) payment models that promote appropriate use of pediatric primary care and pediatric specialty services and discourage inappropriate, inefficient, or excessive use of medical services; and (4) payment models that strengthen the patient- and family-physician relationship and do not impose additional administrative burdens that will only erode the effectiveness of the medical home. These goals can be met by designing payment models that provide adequate funding of the cost of medical encounters, care coordination, population health services, and quality improvement activities; provide incentives for quality and effectiveness of care; and ease administrative burdens.

Effectiveness and optimal dosage of resistance training for chronic non-specific neck pain: a protocol for a systematic review with a qualitative synthesis and meta-analysis.

INTRODUCTION: The prevalence of neck pain is increasing rapidly with a high percentage of patients going on to experience recurrent or chronic symptoms. The resulting pain and disability are commonly managed using a variety of treatments including exercise. Resistance training exercise aimed at the neck and shoulders is advocated to treat chronic non-specific neck pain (CNSNP), however the dosage of prescribed exercise varies considerably between studies. The aim of this study is to evaluate the effectiveness of resistance training in CNSNP and to determine an optimal dosage that should be prescribed in clinical practice. METHODS AND ANALYSIS: A systematic review with qualitative synthesis and meta-analysis will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica Database, Medical Literature Analysis and Retrieval System Online, PEDro, Zetoc, Index to Chiropractic Literature ChiroAcces, PubMed, grey literature sources and key journals will be searched. Randomised clinical trials investigating resistance training exercise in adults with CNSNP using outcome measures of pain and/or disability will be eligible for inclusion. Two reviewers will independently screen for eligibility, extract data and assess risk of bias (Cochrane risk of bias tool) with a third reviewer mediating in cases of disagreement. Data will be synthesised qualitatively to investigate intervention effectiveness and to determine the effect of exercise dosage on pain and disability. Meta-analysis using a random-effects model will be conducted where sufficient clinical homogeneity exists. The strength of the overall body of evidence will be assessed and reported using Grading of Recommendations Assessment, Development and Evaluation. ETHICS AND DISSEMINATION: This study raises no ethical issues. Results will inform exercise prescription to improve management of CNSNP. Results will be published in a peer-reviewed journal and presented at conferences. PROSPERO REGISTRATION NUMBER: CRD42018096187.

Solute pools in Nikanotee Fen watershed in the Athabasca oil sands region.

Overburden and tailings materials from oil sands production were used as construction materials as part of a novel attempt to create a self-sustaining, peat accumulating fen-upland ecosystem. To evaluate the potential for elemental release from the construction materials, total elemental concentrations in the tailings sand, petroleum coke and peat used to construct a fen ecosystem were determined using microwave-assisted acid digestions and compared to a leaching experiment conducted under environmentally-relevant conditions. A comparison of solid phase to aqueous Na, Ca, S and Mg concentrations showed they were highly leachable in the materials. Given that the concentrations of these elements can affect plant community structure, it is important to understand their leachability and mobility as they migrate between materials used to construct the system. To that end, a mass balance of aqueous Na, Ca, S and Mg was conducted based on leaching experiments and materials analysis coupled with existing data from the constructed system. The data indicate that there is a large pool of leachable Na, Ca, S and Mg in the system, estimated at 27 t of Na, 14 t of Ca, 37.3 t of S and 8.8 t of Mg. Since recharge mainly drives the fen-upland system water regime, and discharge in the fen, evapo-accumulation of these solutes on the surface may occur.