Job-based health insurance in 2001: inflation hits double digits, managed care retreats.

Drawing on the results of a national survey of 1,907 firms with three or more workers, this paper reports on several facets of job-based health insurance, including the cost to employers and workers; plan offerings and enrollments; patient cost sharing and benefits; eligibility, coverage, and take-up rates; and results from questions about employers' knowledge of market trends and health policy initiatives. Premiums increased 11 percent from spring 2000 to spring 2001, and the percentage of Americans in health maintenance organizations (HMOs) fell six percentage points to its lowest level since 1993, while preferred provider organization (PPO) enrollment rose to 48 percent. Despite premium increases, the percentage of firms offering coverage remained statistically unchanged, and a relatively strong labor market has continued to shield workers from the higher cost of coverage.

Embraceable you: how employers influence health plan enrollment.

Based on data from a 1999 national survey of 1,939 randomly selected employers, this paper examines the policies that affect the percentage of workers eligible for and enrolled in a firm's health plan. In 1994, 14 percent of employees worked for a firm offering cash-back payments, but fewer than 1 percent worked for a firm with income-related premiums or deductibles. The strongest determinants of eligibility rates are the waiting time for new employees before they are deemed eligible, and eligibility standards for part-time workers. The primary determinants of the take-up rate are lowest monthly employee contribution for single coverage, and the percentage of the workforce earning less than $20,000 per year.

Fine mapping of Ath6, a quantitative trait locus for atherosclerosis in mice.

Ath6 is a novel quantitative trait locus associated with differences in susceptibility to atherosclerosis between C57BL/6J (B6) and C57BLKS/J (BKS) inbred mouse strains. Combining data from an intercross and a backcross (1593 meioses) between mice from B6 and BKS strains and from The Jackson Laboratory interspecific backcross panels, (C57BL/6J x Mus spretus) F1 x C57BL/6J and (C57BL/6J x SPRET/Ei) F1 x SPRET/Ei, we constructed a consensus genetic map and narrowed Ath6 to a 1.07 +/- 0.26 cM interval between the anonymous DNA marker D12Pgn4 and the gene Nmyc1. This region is near the proximal end of murine Chromosome (Chr) 12, which is homologous to the human chromosomal region 2p24-p25. Marker order in the Ath6 region was concordant among the two crosses and The Jackson Laboratory interspecific backcross panels. This high resolution map rules out candidate genes encoding apolipoprotein B, syndecan 1, and Adam17. The two Ath6 crosses have a combined potential resolution of 0.06 cM.

The diffusion of decision support systems in healthcare: are we there yet?

Clinical decision support (CDS) systems, with the potential to minimize practice variation and improve patient care, have begun to surface throughout the healthcare industry. This study reviews historic patterns of information technology (IT) in healthcare, analyzes barriers and enabling factors, and draws three lessons. First, the widespread adoption of clinical IT, including CDS systems, depends on having the right organizational and individual financial incentives in place. Second, although CDS systems and clinical IT in general are powerful tools that can be used to support the practice of medicine, they alone cannot redefine the workflow or processes within the profession. Healthcare managers counting on technology to restructure or monitor clinicians' work patterns are likely to encounter substantial resistance to CDS systems, even those that generate valuable information. Third, while the pace of implementing IT systems in healthcare has lagged behind that of other industries, many of the obstacles are gradually diminishing. However, several factors continue to inhibit their widespread diffusion, including the organizational turmoil created by large numbers of mergers and acquisitions, and the lack of uniform data standards.

Bovine acute mastitis: effects of intravenous sodium salicylate on endotoxin-induced intramammary inflammation.

Effects of the nonsteroidal antiinflammatory agent sodium salicylate on endotoxin-induced mastitis were evaluated in lactating cows. Escherichia coli endotoxin was administered to a mammary quarter 1 h after initiation of a 12-h i.v. infusion of sodium salicylate. Milk SCC, BSA concentrations in milk, mammary inflammation, rectal temperature, appetite, milk production, and plasma and lymph PGF2 alpha were monitored. Gross mammary inflammation was not reduced by salicylate infusion, nor did sodium salicylate prevent increased milk SCC or BSA concentrations in milk, although treatment tended to decrease the magnitude of these responses. Sodium salicylate decreased subcutaneous abdominal vein PGF2 alpha metabolite, and PGF2 alpha metabolite tended to be reduced in lymph during the acute phase of inflammation. The increased rectal temperature after endotoxin infusion was reduced in cows treated with sodium salicylate. Appetite was reduced after endotoxin infusion in untreated cows and those treated with sodium salicylate. Milk production declined after endotoxin challenge in all cows. Although sodium salicylate did not substantially reduce mammary inflammation, it had an antipyretic effect and reduced PGF2 alpha metabolite in mammary blood.

Economic analysis of a mastitis monitoring and control program in four dairy herds.

Mastitis monitoring and control programs were instituted in 4 Illinois dairy herds for 12 months. Two herds had high mean monthly bulk tank somatic cell counts (> 490,000 cells/ml) and 2 had low mean monthly bulk tank somatic cell counts (< 260,000 cells/ml) at the start of the study. The mastitis monitoring and control programs included mandatory mastitis control measures, as well as individualized control measures that were based on results of bacterial cultures of milk, bulk tank milk analyses, milking machine and milking procedure evaluations, and environmental inspections in each herd. Changes in mastitis prevalence, clinical mastitis incidence, milk yield, and individual cow somatic cell counts were evaluated, and an economic analysis was performed for each herd. Mastitis-associated economic losses during the study period ranged from $161.79 to $344.16/lactating cow in the 4 herds. Gross economic benefits resulted when mastitis-associated losses were lower with the monitoring and control program than predicted without it. There were no gross economic benefits in the herds with low somatic cell counts, and, when the marginal costs of the programs were added, there were large net losses ($84.06 and $113.01/lactating cow) in those herds. Gross economic benefits resulted in both of the herds with high somatic cell counts. However, in 1 of the herds, the marginal costs of the program exceeded the benefits, resulting in a net loss of $12.96/lactating cow. The net loss was attributed primarily to poor producer compliance with recommendations. There was a net economic benefit of $19.11/lactating cow in the other herd with high somatic cell counts, in which producer compliance was better.(ABSTRACT TRUNCATED AT 250 WORDS)

Designing exercise gear for zero gravity.

NASA: The authors describe the use of computer-aided software design in the development of an exercise treadmill and rowing machine for use in the space shuttle. The software allows the designer to easily reproduce frequently used details, produce complex curves, and view the design from any angle to check interferences.^ieng