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Abstract The thermal comfort of a work glove affects wear compliance. This study investigates the thermal comfort of five types of anti-vibration gloves that use chloroprene rubber and spacer fabric as materials to isolate vibration. An evaluation of the fabric and material on the palm and dorsal of the glove, and a wear trial of the gloves were subsequently carried out. The results showed that the palm of the glove made of spacer fabric had higher air and water vapour permeabilities than chloroprene rubber. Using a thin mesh fabric for the dorsal of the glove resulted in a significantly lower skin temperature than using spacer fabric or chloroprene rubber during hand activity. The thermal sensation of the subjects showed no significant difference among the five glove samples. However, the glove wear comfort of the spacer fabric glove was the lowest. Recommendations for the fabric thickness and glove design are provided for developing anti-vibration gloves.

Studies have established that nurse practitioners (NPs) deliver primary care comparable to physicians in quality and cost, but most focus on Medicare, a program that reimburses NPs less than physicians. In this retrospective cohort study, we evaluated the quality and cost implications of receiving primary care from NPs compared to physicians in 14 states that reimburse NPs at the Medicaid fee-for-service (FFS) physician rate (i.e., pay parity). We linked national provider and practice data with Medicaid data for adults with diabetes and children with asthma (2012-2013). We attributed patients to primary care NPs and physicians based on 2012 evaluation & management claims. Using 2013 data, we constructed claims-based primary care quality measures and condition-specific costs of care for FFS enrollees. We estimated the effect of NP-led care on quality and costs using: (1) weighting to balance observable confounders and (2) an instrumental variable (IV) analysis using differential distance from patients’ residences to primary care practices. Adults with diabetes received comparable quality of care from NPs and physicians at similar cost. Weighted results showed no differences between NP- and physician-attributed patients in receipt of recommended care or diabetes-related hospitalizations. For children with asthma, costs of NP-led care were lower but quality findings were mixed: NP-led care was associated with lower use of appropriate medications and higher rates of asthma-related emergency department visits but similar rates of asthma-related hospitalization. IV analyses revealed no evidence of differences in quality between NP- and physician-led care. Our findings suggest that in states with Medicaid pay parity, NP-led care is comparable to physician-led care for adults with diabetes, while associations between NP-led care and quality were mixed for children with asthma. Increased use of NP-led primary care may be cost-neutral or cost-saving, even under pay parity.

Sustainability is one of the main concerns in the textile industry. To address this issue, three-dimensional spacer fabric bra cups are developed by using fully fashioned knitting to reduce the production of waste. Five bra cups with different types of surface yarn and shapes are proposed. The physical and compression properties of the bra cups, degree of support and subjective sensation of the resultant bra prototypes are then evaluated and compared with a conventional daily wear bra with foam cups. The results show that the proposed bra cups could provide a compression strength and support comparable to those of foam bra cups but with air resistance decreased from 0.32 kPa･sec/m to

Diffusiophoresis of a weakly charged liquid metal droplet (LMD) is investigated theoretically, motivated by its potential application in drug delivery. A general analytical formula valid for weakly charged condition is adopted to explore the droplet phoretic behavior. We determined that a liquid metal droplet, which is a special category of the conducting droplet in general, always moves up along the chemical gradient in sole chemiphoresis, contrary to a dielectric droplet where the droplet tends to move down the chemical gradient most of the time. This suggests a therapeutic nanomedicine such as a gallium LMD is inherently superior to a corresponding dielectric liposome droplet in drug delivery in terms of self-guiding to its desired destination. The droplet moving direction can still be manipulated via the polarity dependence; however, there should be an induced diffusion potential present in the electrolyte solution under consideration, which spontaneously generates an extra electrophoresis component. Moreover, the smaller the conducting liquid metal droplet is, the faster it moves in general, which means a smaller LMD nanomedicine is preferred. These findings demonstrate the superior features of an LMD nanomedicine in drug delivery.

Abstract Background A common challenge for free-access systems is that people may bypass primary care and seek secondary care through self-referral. Taiwan’s government has undertaken various initiatives to mitigate bypass; however, little is known about whether the bypass trend has decreased over time. This study examined the extent to which patients bypass primary care for treatment of common diseases and factors associated with bypass under Taiwan’s free-access system. Methods This repeated cross-sectional study analyzed data from Taiwan’s National Health Insurance Research Database. A random sample of 1 million enrollees was drawn repeatedly from the insured population during 2000–2017. To capture visits beyond the community level, the bypass rate was defined as the proportion of self-referred visits to the top two levels of providers, namely academic medical centers and regional hospitals, among all visits to all providers. Subgroup analyses were conducted for visits with a single diagnosis. Logistic regressions were used to investigate factors associated with bypass. Results The standardized bypass rate for all diseases analyzed exhibited a decreasing trend. In 2017, it was low for common cold (0.7–1.3%), moderate for hypertension (14.0–29.5%), but still high for diabetes (32.0–47.0%). Moreover, the likelihood of bypass was higher for male, patients with higher salaries or comorbidities, and in areas with more physicians practicing in large hospitals or less physicians working in primary care facilities. Conclusions Although the bypass trend has decreased over time, continuing efforts may be required to reduce bypass associated with chronic diseases. Both patient sociodemographic and market characteristics were associated with the likelihood of bypass. These results may help policymakers to develop strategies to mitigate bypass.

An extreme microclimate inside footwear contributes to wear discomfort and performance impairment. A thermal foot manikin system was developed to evaluate the thermal insulation of footwear. The uniqueness of this foot manikin is that it utilizes a specially designed all-in-one flexible heating sheet with uneven distribution of resistive wires to achieve a non-uniform gradient temperature distribution along the foot surface. Three flexible heating sheets with different wire distributions were developed to simulate the local skin temperature for different activity levels, suggesting more realistic measures. The heated foot manikin was enclosed by a silicone `skin' layer, which provides a soft texture. In addition, it was equipped with phalangeal joint and ankle joint for the ease of wearing various types of shoes. The local skin temperature and the power required to heat the foot manikin were recorded. Five types of footwear were compared; the results show that the leather sneaker provides the best thermal insulation performance, whereas the mesh shoe provides the worst thermal insulation performance in walking and running conditions. The findings also reveal that the toe portion is the coolest zone. This paper demonstrated that the measurements from the developed foot manikin are repeatable and versatile, which is useful for optimizing the thermal comfort of the footwear.

In this article, the impact of postural variations on hand anthropometry and distribution of skin strain ratios has been investigated. The literature suggests the glove fit directly affects hand functions. However, gloves currently manufactured based on a static posture failed to provide optimum fit. Workers often do not wear protective gloves due to discomfort caused by improper design, which increases the risk of hand injury. Full-color three-dimensional scans of the hands are captured with thirty healthy subjects (20 females, 10 males) to analyze the hand measurements and skin deformation with various postures. 42 of the 57 hand dimensions were found to have significant differences (p >0.05) related to hand posture. The skin strain ratios further suggest that the slant of the web space, dorsal-length and surface area should be increased, while the angles of the web space and length of the palm reduced to advance glove patterns. This research contributes to constructing gloves with optimum fit, performance, and comfort. Results show that in consideration of hand postures, the angle of the slant of web space between digits 2 and 5 and the finger length on the dorsal side should be increased, whilst the finger length on the palm side should be reduced in glove pattern design. Gloves currently constructed based on a splayed posture cannot provide a good fit. Consideration should be given to hand measurements in dynamic postures.

OBJECTIVE: To compare rates of fluoride varnish (FV) applications during well-child visits for children covered by Medicaid and private medical insurance in Massachusetts. METHODS: This cross-sectional study analyzed well-child visits for children aged 1 to 5 years paid by Medicaid and private insurance during 2016-18 in Massachusetts. Multivariate regression models, with all covariates interacting with insurance type, were used to calculate odds ratios and adjusted predicted probabilities of fluoride varnish during wellchild visits by calendar year and age. RESULTS: Across 957,551 well-child visits, 40.0% were paid by private insurers. Unadjusted rates of fluoride varnish were significantly lower among well-child visits paid by private insurers (6.6%) than visits paid by Medicaid (14.2%). In the fully interacted regression model, the odds of a visit including fluoride varnish were significantly lower for older children than for children aged 1 for visits paid by both insurance types. Adjusted rates of fluoride varnish increased significantly from 2016 to 2018 for both insurance types. Moreover, rates were higher among visits for children covered under Medicaid than privately insured children in all years, and the differences by insurance type declined over time (2016: 8.0% points, 95% confidence interval = -8.7 to -7.3, 2018: 5.3% points, 95% confidence interval = -6.6 to -3.9). CONCLUSIONS: Rates of fluoride varnish applications during well-child visits were low for both Medicaid and private insurance despite growth from 2016 to 2018 in Massachusetts. Low rates are concerning because this is a recommended service with the potential to help address racial, geographic, and income-based disparities in access and oral health outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Epidemiologic studies relating health outcomes to dietary patterns captured by diet quality indices have shown better quality scores associated with lower mortality and chronic disease incidence. However, changing chronic disease risk factors only alters population health over time, and initial diet quality systematically varies across the population by sociodemographic status. This study uses microsimulation to examine 30-year impacts of improved diet quality by sociodemographic group.Methods: Diet quality across 12 sex-, race/ethnicity-, and education-defined subgroups was estimated from the 2011-2012 National Health and Nutrition Examination Survey. In 2021, the Future Adults (dynamic microsimulation) Model was used to simulate population health and economic outcomes over 30 years for these subgroups and all adults. The modeled pathway was through lowering risk for heart disease by following U.S. Dietary Guidelines.Results: Diet quality varied across the sociodemographic subgroups, and half of U.S. adults had diet quality that would be classified as poor. Improving U.S. diet quality to that reported for the top 20% in 2 large health professionals' samples could reduce incidence of heart disease by 9.9% (7.6%-13.8% across the 12 sociodemographic groups) after 30 years. Year 30 would also have 37,000 fewer deaths, 694,000 more quality-adjusted life years, and healthcare cost savings of $59.6 billion (2019 U.S. dollars).Conclusions: Dynamic microsimulation enables predictions of socially important outcomes of prevention efforts, most of which are many years in the future and beyond the scope of trials. This paper estimates the 30-year population health and economic impact of poor diet quality by sociodemographic group. [ABSTRACT FROM AUTHOR]

El hombre, con el paso del tiempo, ha incentivado nuevas vías que le permiten comunicarse y así superar las dificultades que aparecen en la vida cotidiana. Dicho en otras palabras, la comunicación es el elemento esencial del proceso de formación de los profesionales, de manera particular y el proceso de enseñanza-aprendizaje, de manera general. El proceso de comprensión lectora y desarrollo de las habilidades idiomáticas desempeña un importante papel, por lo que demanda de los docentes un trabajo minucioso desde que el estudiante universitario comienza el proceso de aprendizaje, al ser la herramienta fundamental para la adquisición de conocimientos y trasmisión de ideas y sentimientos. La utilización de la bibliografía impresa y digital se convierte en medios necesarios para un profesional de perfil amplio, que permiten el aprendizaje y la comunicación, para mantenerse informado en un mundo cambiante en los momentos actuales. Este trabajo tiene como objetivo orientar a los estudiantes universitarios de la carrera Licenciatura en Educación. Primaria en la comprensión de textos escritos, donde se favorece un aprendizaje activo, reflexivo y desarrollador.

Actualmente en Cuba se desarrolla la Tercera Revolución Educacional, etapa de perfeccionamiento superior a la etapa anterior, la que ha sido el resultado de las diversas investigaciones y aportes realizados por investigadores cubanos a todo lo largo y ancho del país. Como elemento particular para cada etapa ha predominado un enfoque educativo basado en las ideas de nuestro Héroe Nacional José Martí, combinado por el carácter humanista que se le concede a la educación. Con ello, se perfeccionan todos los sistemas educativos, en el que la Educación Primaria es la base para el aprendizaje de todos los educandos. El propósito fundamental es ofrecer una educación de calidad a la diversidad, condicionado por las estrategias que se diseñen a partir de los resultados del diagnóstico integral. De aquí la importancia de esta investigación que se traza como objetivo ofrecer sugerencias didácticas acerca de cómo enseñar a leer y escribir atendiendo las diferencias individuales de cada uno de los educandos con y sin necesidades educativas especiales que asisten a un mismo grupo clase.

The metagenome embedded in urban sewage is an attractive new data source to understand urban ecology and assess human health status at scales beyond a single host. Analyzing the viral fraction of wastewater in the ongoing COVID-19 pandemic has shown the potential of wastewater as aggregated samples for early detection, prevalence monitoring, and variant identification of human diseases in large populations. However, using census-based population size instead of real-time population estimates can mislead the interpretation of data acquired from sewage, hindering assessment of representativeness, inference of prevalence, or comparisons of taxa across sites. Here, we show that taxon abundance and sub-species diversisty in gut-associated microbiomes are new feature space to utilize for human population estimation. Using a population-scale human gut microbiome sample of over 1,100 people, we found that taxon-abundance distributions of gut-associated multi-person microbiomes exhibited generalizable relationships with respect to human population size. Here and throughout this paper, the human population size is essentially the sample size from the wastewater sample. We present a new algorithm, MicrobiomeCensus, for estimating human population size from sewage samples. MicrobiomeCensus harnesses the inter-individual variability in human gut microbiomes and performs maximum likelihood estimation based on simultaneous deviation of multiple taxa's relative abundances from their population means. MicrobiomeCensus outperformed generic algorithms in data-driven simulation benchmarks and detected population size differences in field data. New theorems are provided to justify our approach. This research provides a mathematical framework for inferring population sizes in real time from sewage samples, paving the way for more accurate ecological and public health studies utilizing the sewage metagenome.