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Objective: This study examined family-reported ambulatory care quality and its association with emergency department and hospital utilization, and how these relationships differed across levels of medical complexity. Data sources: The 2006-2013 Medical Expenditure Panel Survey (MEPS). Study Design: Secondary analysis of MEPS data. Variables fitting the National Quality Measures Clearinghouse clinical quality measures domain framework were selected. Exploratory factor analysis grouped ambulatory quality into 12 access, experience, or process measures. Weighted negative binomial regression stratified by health status identified associations between ambulatory quality and ED visits or hospitalizations. Data Collection: 41,497 children [less than or equal to]18 years were included. The 5-item special health care needs (SHCN) screener categorized health status as complex, less complex, or noSHCN. Principal Findings: Weighted SHCN proportions were 1.6 Percent complex, 18.2 Percent less complex, and 80.0 Percent no SHCN. Mean ED visits were 130 and 335 visits/1000 children/year for no/ complex SHCN, respectively. Mean hospitalizations were 20 and 175 hospitalizations/1000 children/year for no/complex SHCN, respectively. ED visits were associated with 8 of 12 quality measures for no/less complex SHCN. For example, usually/always receiving needed care right away was associated with 22 Percent lower ED visit rate (95% CI 0.64-0.96). Hospitalizations were associated with 4 of 12 quality measures for less complex SHCN. In complex SHCN, associations between ambulatory quality and ED/hospital use were weak and inconsistent. Conclusions: Ambulatory quality may best predict ED and hospital use for children with no or less complex SHCN. Whether and how ambulatory care predicts emergency and hospital care in complex SHCN remains an important question. KEYWORDS ambulatory care, emergency service, hospitalization, quality of health care, 1 | INTRODUCTION Over $20B are spent annually on non-neonatal and nonmaternal hospitalizations for US children. (1) Hospital and emergency department (ED) visits are measures of health and chronic disease [...]

ABSTRACTMarine radiocarbon (14C) ages are an important geochronology tool for the understanding of past earthquakes and tsunamis that have impacted the coastline of New Zealand. To advance this field of research, we need an improved understanding of the radiocarbon marine reservoir correction for coastal waters of New Zealand. Here we report 170 new ΔR20(1900–1950) measurements from around New Zealand made on pre-1950 marine shells and mollusks killed by the 1931 Napier earthquake. The influence of feeding method, living depth and environmental preference on ΔR is evaluated and we find no influence from these factors except for samples living at or around the high tide mark on rocky open coastlines, which tend to have anomalously low ΔR values. We examine how ΔR varies spatially around the New Zealand coastline and identify continuous stretches of coastline with statistically similar ΔR values. We recommend subdividing the New Zealand coast into four regions with different marine reservoir corrections: A: south and western South Island, ΔR20–113 ± 33 yr, B: Cook Strait and western North Island, ΔR20–171 ± 29 yr, C: northeastern North Island, ΔR20–143 ± 18 yr, D: eastern North Island and eastern South Island, ΔR20–70 ± 39 yr.

At least two of Barth's main claims are incompatible with basic commitments of Catholic theology, though in neither case does seeing the problem in Barth depend on accepting uniquely Catholic beliefs. If carried through consistently (which Barth does not do) his claim that God has his being in his act of revelation proves incompatible with the insistence of Nicene trinitarianism that three distinct persons are one God, and that one divine person contingently became flesh as a free gift for our salvation. In soteriology, Barth's doctrine of election proves incompatible with the belief that we are participants in our own salvation, and not merely spectators of it.

For Paul Molnar, “A Catholic Appraisal” unfairly holds Barth to be inconsistent in claiming that God has his being in his act of revelation, and he shows that Barth often says the opposite of this. This does not resolve the inconsistency, but simply makes it more apparent. For Paul Hinlicky, the essay unfairly assumes that Barth needs to be consistent in the first place. Reflection on the law of identity shows how unfruitful it is for theologians to think they can dispense with basic logical truths. The essay concludes with arguments on the saving significance of baptism, the human refusal of God, and what theology can accomplish, in response to Katherine Sonderegger.

Cystic fibrosis-related diabetes (CFRD) is the most common comorbidity in people with cystic fibrosis (CF), occurring in ~20% of adolescents and 40-50% of adults (1). While it shares features of [...]

Cystic fibrosis-related diabetes (CFRD) is the most common comorbidity in subjects with cystic fibrosis (CF). A consensus conference on CFRD was cosponsored by the Cystic Fibrosis Foundation (CFF), the American [...]

Key words: bronchiectasis; comprehensive health care; cystic fibrosis; nutrition; pancreatic insufficiency Abbreviations: ADA = Americans with Disabilities Act: BMD = bone mineral density; BMI = body mass index; CBAVD = [...]

IN THE APT WORDS of one of his students, George Lindbeck had 'a life made for ecumenism.' I never heard him speak about his legacy except to say that all [...]

RationaleA previous analysis found significantly higher lung function in the US paediatric cystic fibrosis (CF) population compared with the UK with this difference apparently decreasing in adolescence and adulthood. However, the cross-sectional nature of the study makes it hard to interpret these results.ObjectivesTo compare longitudinal trajectories of lung function in children with CF between the USA and UK and to explore reasons for any differences.MethodsWe used mixed effects regression analysis to model lung function trajectories in the study populations. Using descriptive statistics, we compared early growth and nutrition (height, weight, body mass index), infections (Pseudomonas aeruginosa, Staphylococcus aureus) and treatments (rhDnase, hypertonic saline, inhaled antibiotics).ResultsWe included 9463 children from the USA and 3055 children from the UK with homozygous F508del genotype. Lung function was higher in the USA than in the UK when first measured at age six and remained higher throughout childhood. We did not find important differences in early growth and nutrition, or P.aeruginosainfection. Prescription of rhDNase and hypertonic saline was more common in the USA. Inhaled antibiotics were prescribed at similar levels in both countries, but Tobramycin was prescribed more in the USA and colistin in the UK. S. aureusinfection was more common in the USA than the UK.ConclusionsChildren with CF and homozygous F508del genotype in the USA had better lung function than UK children. These differences do not appear to be explained by early growth or nutrition, but differences in the use of early treatments need further investigation.

The approval of aztreonam lysine for inhalation solution (AZLI) raised concerns that additional antibiotic exposure would potentially affect the susceptibility profiles of Pseudomonas aeruginosaisolates from cystic fibrosis (CF) patients. This 5-year, prospective, observational study tracked susceptibility changes and clinical outcomes in CF patients in the United States with chronic P. aeruginosainfection.

We performed a study to better understand the long-term impact of treatment with a drug called ivacaftor for patients with cystic fibrosis (CF). Our study used data from CF patient registries in the United Kingdom and the United States. These registries collect information about patients with CF, their health, and the treatments they receive. Using data from these registries, we compared patients treated with ivacaftor with a similar group of patients (similar age, sex, and disease severity) who did not receive ivacaftor. We looked at the clinical outcomes of each group every year for up to 5 years. In the final analysis from our study, we found no new safety concerns associated with ivacaftor treatment. Additionally, we found that patients treated with ivacaftor tended to have lower risks of death, organ transplant, pulmonary exacerbations, and hospitalizations. Overall, these results demonstrate the favorable impact of ivacaftor treatment on long-term outcomes of patients with CF.

We regularly tow a Toyota Prius on a Tow Master Dolly. We found ours sitting at an RV dealer, which was part of a trade-in. Apparently this happens quite often. [...]

A Training Success Story On October 24, 1981, most of Alaska's firefighters were spending their Saturday night glued to their television sets watching Big Bird, the Cookie Monster, and the [...]

•50,000 artisanal tin miners work in precarious conditions in Bangka and Belitung, Indonesia.•More than 60% of tin produced in Indonesia (approximately 27% of the global tin) comes from artisanal miners.•High incidence of fatalities, with more than 70 miners dying per year.•Government and electronic industries should step forward and assist the artisanal miners to evolve.•Simple procedures and education are badly needed to reduce dramatic occupational and environmental impacts.

The article discusses Baptism as an invitation to martyrdom and a promise of suffering at the hands of the world. It mentions that every book of the New Testament speaks of the persecution and suffering Christians should expect to undergo for their faith in Jesus and for living as he commanded. It reveals that some books, like the Revelation to John, are suffused with this theme.

•Indigenous Peoples are vulnerable to boomtown impacts.•Barriers prevent Indigenous Peoples from benefiting from large resource developments.•Most sectors feel First Nations education, training and employment is most important.•First Nations feel socioeconomic issues is most important for their sustainability.•Socioeconomic cumulative effects are best managed by a multi-stakeholder group.

•Bureaucracy involved in formalization of artisanal miners creates more informality and more illegality.•Some government sectors believe that more laws and restrictions will eliminate informality and therefore pollution.•The Colombian Government announced that gold production declined in 2017, but gold exports increased.•Informality in Colombia is increasing in all sectors, particularly in mining.•Without training, capital and law enforcement, artisanal miners will not change their polluting techniques.

BackgroundIvacaftor is the first cystic fibrosis transmembrane conductance regulator (CFTR) modulator demonstrating clinical benefit in patients with cystic fibrosis (CF). As ivacaftor is intended for chronic, lifelong use, understanding long-term effects is important for patients and healthcare providers.ObjectiveThis ongoing, observational, postapproval safety study evaluates clinical outcomes and disease progression in ivacaftor-treated patients using data from the US and the UK CF registries following commercial availability.MethodsAnnual analyses compare ivacaftor-treated and untreated matched comparator patients for: risks of death, transplantation, hospitalisation, pulmonary exacerbation; prevalence of CF-related complications and microorganisms and lung function changes in a subset of patients who initiated ivacaftor in the first year of commercial availability. Results from the 2014 analyses (2 and 3 years following commercial availability in the UK and USA, respectively) are presented here.ResultsAnalyses included 1256 ivacaftor-treated and 6200 comparator patients from the USA and 411 ivacaftor-treated and 2069 comparator patients from the UK. No new safety concerns were identified based on the evaluation of clinical outcomes included in the analyses. As part of safety evaluations, ivacaftor-treated US patients were observed to have significantly lower risks of death (0.6% vs 1.6%, p=0.0110), transplantation (0.2% vs 1.1%, p=0.0017), hospitalisation (27.5% vs 43.1%, p<0.0001) and pulmonary exacerbation (27.8% vs 43.3%, p<0.0001) relative to comparators; trends were similar in the UK. In both registries, ivacaftor-treated patients had a lower prevalence of CF-related complications and select microorganisms and had better preserved lung function.ConclusionsWhile general limitations of observational research apply, analyses revealed favourable results for clinically important outcomes among ivacaftor-treated patients, adding to the growing body of literature supporting disease modification by CFTR modulation with ivacaftor.EU PAS registration numberEUPAS4270

•Poor effectiveness of policies to persuade artisanal gold miners to eliminate the use of mercury.•Poor role of governments and the futile regulation are creating more health effects.•Music can be used as an effective way to engage miners into an education process.•Music parodies are used to exemplify the educational method.

•Artisanal gold mining is increasing in developing countries.•Artisanal miners are now invading more companies’ concessions.•The formalized miners (processors) are the largest polluters.•Confusing legislations and poor policies are not helping the situation.•Without Education and Organization, formalization is useless.