Impact of emergency medical helicopter transport directly to a university hospital trauma center on mortality of severe blunt trauma patients until discharge
Source: Critical Care
The benefits of transporting severely injured patients by helicopter remains controversial. This study aimed to analyze the impact on mortality of helicopter compared to ground transport directly from the scene to a University hospital trauma center.
The French Intensive Care Research for Severe Trauma cohort study enrolled 2703 patients with severe blunt trauma requiring admission to University hospital intensive care units within 72 hours. Pre-hospital and hospital clinical data including the mode of transport, helicopter (HMICU) vs ground (GMICU), both with medical teams, were recorded. The analysis was restricted to patients admitted directly from the scene to a University hospital trauma center. The main endpoint was mortality until ICU discharge.
Of the 1958 patients analyzed, 74% were transported by GMICU, 26% by HMICU. Median ISS was 26 (IQR 19-34) for HMICU patients and 25 (IQR 18-34) for GMICU patients. Compared to GMICU, HMICU patients had a higher median time frame before hospital admission and were more intensively treated in the pre-hospital phase. Crude mortality until hospital discharge was the same regardless of pre-hospital mode of transport. After adjustment for initial status, the risk of death was significantly lower (OR: 0.68, 95% CI 0.47-0.98, p=0.035) for HMICU compared with GMICU. This result did not change after further adjustment for ISS and overall surgical procedures.
This study suggests a beneficial impact of helicopter transport on mortality in severe blunt trauma. Whether this association could be due to better management in the pre-hospital phase needs to be more thoroughly assessed.
WWC Review of the Report “The Effects of Student Coaching in College: An Evaluation of a Randomized Experiment in Student Mentoring”
Source: U.S. Department of Education
What is this study about?
The study examined whether InsideTrack, a personalized student coaching service for college students, increased rates of staying in and graduating from college. It determined InsideTrack’s effectiveness by comparing the outcomes of students who were randomly selected through one of 17 lotteries to receive InsideTrack with the outcomes of students who were not selected.
What did the study find?
For students in the seven lotteries that were well-executed, the study found that students assigned to receive InsideTrack were significantly more likely than students in the comparison group to remain enrolled at their institutions six, 12, and 18 months after random assignment. For three lotteries with longer-term follow-up data, there was no significant difference between the groups in enrollment 24 months after random assignment or college completion within four years.
For the full set of 17 lotteries, which includes both those that were well-executed and those in which random assignment was compromised, the results were similar six, 12, and 18 months after random assignment. For the 12 lotteries with longer-term follow-up data, the difference in enrollment between the groups 24 months after random assignment was significantly different.
New GAO Reports
Source: Government Accountability Office
1. Warfighter Support: DOD Should Improve Development of Camouflage Uniforms and Enhance Collaboration Among the Services. GAO-12-707, September 28.
Highlights – http://www.gao.gov/assets/650/648950.pdf
2. VA and DOD Health Care: Department-Level Actions Needed to Assess Collaboration Performance, Address Barriers, and Identify Opportunities. GAO-12-992, September 28.
Highlights – http://www.gao.gov/assets/650/648960.pdf
3. Government Contracting: Federal Efforts to Assist Small Minority Owned Businesses. GAO-12-873. September 28.
Highlights – http://www.gao.gov/assets/650/648986.pdf
4. Trade Adjustment Assistance: Changes to the Workers Program Benefited Participants, but Little Is Known about Outcomes. GAO-12-953, September 28
Highlights – http://www.gao.gov/assets/650/648979.pdf
5. Trade Adjustment Assistance: Labor Awarded Community College Grants in Accordance with Requirements, but Needs to Improve Its Process. GAO-12-954, September 28.
Highlights – http://www.gao.gov/assets/650/649003.pdf
6. Department of Homeland Security: Efforts to Assess Realignment of Its Field Office Structure. GAO-12-185R, September 28.
Source: Migration Policy Institute
With overseas employment a more permanent feature of the development strategies of a number of Asian states, predeparture orientation programs have emerged as an important tool for the protection of migrant workers. This brief examines the strengths, limitations, and areas for improvement of this intervention, based on findings from field research conducted in Indonesia, Nepal, and the Philippines.
Finding ways for a product to succeed in a beleaguered marketplace takes a mix of pragmatism and creative genius. And the winners of the 2012 Nielsen Breakthrough Innovation Award did just that. In contrast to innovation awards focused on one-year wonders, the Nielsen Breakthrough Innovation Award honors new products that succeed on multiple dimensions over multiple years.
Nielsen analyzed more than 11,000 new products in the U.S. between 2008 and 2010 to find the 2012 winners. Of the products evaluated, only 34 products met award criteria. These products totaled less than 0.5% of all new product introductions during the period.
The study revealed that there are no easy formulas on the road to successful innovation, and many common pitfalls. Of the product launches that didn’t meet award criteria, one trap many companies fell into was losing sight of consumer needs. Often– to save time and money, attract a certain demographic group, or respond to competitors in the market– new product teams added features that consumers don’t value, or shifted product focus away from what made the original concept a fresh, viable solution.
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Source: U.S. Department of Health and Human Services, Office of Inspector General
WHY WE DID THIS STUDY
OIG is authorized to exclude certain individuals and entities (providers) from participating in federally funded health care programs, such as Medicaid managed care. These programs are generally prohibited from paying for any items or services furnished, ordered, or prescribed by an excluded provider or paying anyone who contracts with an excluded provider. In Medicaid managed care, States contract with managed care entities (MCE) to provide healthcare services to enrolled beneficiaries. The managed care entities create and manage networks of providers who deliver healthcare services to the enrolled beneficiaries. Since the providers in the Medicaid managed care networks are not under direct oversight by the States, we wanted to determine if the provider networks are vulnerable to excluded providers.
HOW WE DID THIS STUDY
This is the second of two evaluations related to excluded providers in Medicaid managed care. In the prior study, entitled Excluded Providers in Medicaid Managed Care Entities (OEI‑07‑09‑00630), we compared the provider networks of 12 selected MCEs to the List of Excluded Individuals and Entities (LEIE) to identify excluded providers. In the current study, we selected a stratified random sample of 500 hospitals, nursing facilities, home health agencies, and pharmacies from the population of providers enrolled in the 12 MCEs. From each of the 500 sampled providers, we collected rosters of employees in 2011, and responses to a survey on the safeguards they used to ensure that excluded individuals are not employed. We compared the employee rosters to the LEIE to identify excluded individuals.
WHAT WE FOUND
Of the 248,869 individuals listed on the employee rosters requested from sampled providers, we identified 16 individuals who were excluded among the employees of 14 sampled providers. Incorrect names and failure of contractors to follow procedures contributed to the employment of the excluded individuals. Most providers reported using a variety of safeguards to ensure they do not employ excluded individuals, but identified costs and resource burdens as challenges in executing those safeguards. Seven percent of providers in the 12 selected MCEs do not check the exclusions status of their employees; most of these providers lacked knowledge regarding exclusions.
This report does not contain recommendations.
Influenza Vaccination Coverage Among Health-Care Personnel — 2011–12 Influenza Season, United States
Source: Morbidity and Mortality Weekly Report (CDC)
Influenza vaccination of health-care personnel (HCP) is recommended by the Advisory Committee on Immunization Practices (ACIP) (1). Vaccination of HCP can reduce morbidity and mortality from influenza and its potentially serious consequences among HCP, their family members, and their patients (1–3). To provide timely estimates of influenza vaccination coverage and related data among HCP for the 2011–12 influenza season, CDC conducted an Internet panel survey with 2,348 HCP during April 2–20, 2012. This report summarizes the results of that survey, which found that, overall, 66.9% of HCP reported having had an influenza vaccination for the 2011–12 season. By occupation, vaccination coverage was 85.6% among physicians, 77.9% among nurses, and 62.8% among all other HCP participating in the survey. Vaccination coverage was 76.9% among HCP working in hospitals, 67.7% among those in physician offices, and 52.4% among those in long-term care facilities (LTCFs). Among HCP working in hospitals that required influenza vaccination, coverage was 95.2%; among HCP in hospitals not requiring vaccination, coverage was 68.2%. Widespread implementation of comprehensive HCP influenza vaccination strategies is needed, particularly among those who are not physicians or nurses and who work in LTCFs, to increase HCP vaccination coverage and minimize the risk for medical-care–acquired influenza illnesses.
Making Value: Integrating Manufacturing, Design, and Innovation to Thrive in the Changing Global Economy
Source: National Academy of Engineering
Manufacturing is in a period of dramatic transformation. But in the United States, public and political dialogue is simplistically focused almost entirely on the movement of certain manufacturing jobs overseas to low-wage countries. The true picture is much more complicated, and also more positive, than this dialogue implies.
After years of despair, many observers of US manufacturing are now more optimistic. A recent uptick in manufacturing employment and output in the United States is one factor they cite, but the main reasons for optimism are much more fundamental. Manufacturing is changing in ways that may favor American ingenuity. Rapidly advancing technologies in areas such as biomanufacturing, robotics, smart sensors, cloud-based computing, and nanotechnology have transformed not only the factory floor but also the way products are invented and designed, putting a premium on continual innovation and highly skilled workers. A shift in manufacturing toward smaller runs and custom-designed products is favoring agile and adaptable workplaces, business models, and employees, all of which have become a specialty in the United States. Future manufacturing will involve a global supply web, but the United States has a potentially great advantage because of our tight connections among innovations, design, and manufacturing and also our ability to integrate products and services.
The National Academy of Engineering has been concerned about the issues surrounding manufacturing and is excited by the prospect of dramatic change. On June 11-12, 2012, it hosted a workshop in Washington, DC, to discuss the new world of manufacturing and how to position the United States to thrive in this world. The workshop steering committee focused on two particular goals. First, presenters and participants were to examine not just manufacturing but the broad array of activities that are inherently associated with manufacturing, including innovation and design. Second, the committee wanted to focus not just on making things but on making value, since value is the quality that will underlie high-paying jobs in America’s future. Making Value: Integrating Manufacturing, Design, and Innovation to Thrive in the Changing Global Economy summarizes the workshop and the topics discussed by participants.
Bisphenol A and Peripheral Arterial Disease: Results from the NHANES
Source: Environmental Health Perspectives
Background: Bisphenol A (BPA) is a common chemical used in the manufacture of polycarbonate
plastics and epoxy resins, and > 93% of U.S. adults have detectable levels of urinary BPA. Recent animal studies have suggested that BPA exposure may have a role in several mechanisms involved in the development of cardiovascular disease (CVD), including weight gain, insulin resistance, thyroid dysfunction, endothelial dysfunction, and oxidative stress. However, few human studies have examined
the association between markers of BPA exposure and CVD. Peripheral arterial disease (PAD) is a subclinical measure of atherosclerotic vascular disease and a strong independent risk factor for CVD and mortality.
Objective: We examined the association between urinary BPA levels and PAD in a nationally representative sample of U.S. adults.
Methods: We analyzed data from 745 participants in the National Health and Nutritional Examination Survey 2003–2004. We estimated associations between urinary BPA levels (in tertiles) and PAD (ankle–brachial index < 0.9, n = 63) using logistic regression models adjusted for potentialconfounders (age, sex, race/ethnicity, education, smoking, body mass index, diabetes mellitus, hypertension, urinary creatinine, estimated glomerular filtration rate, and serum cholesterol levels).
Results: We observed a significant, positive association between increasing levels of urinary BPA and PAD before and after adjusting for confounders. The multivariable-adjusted odds ratio for PAD associated with the highest versus lowest tertile of urinary BPA was 2.69 (95% confidence interval: 1.02, 7.09; p-trend = 0.01).
Conclusions: Urinary BPA levels were significantly associated with PAD, independent of traditional CVD risk factors.
New GAO Reports
Source: Government Accountability Office
1. Human Capital: DOD Needs Complete Assessments to Improve Future Civilian Strategic Workforce Plans. GAO-12-1014, September 27.
Highlights – http://www.gao.gov/assets/650/648918.pdf
2. Commonwealth of the Northern Mariana Islands: Additional DHS Actions Needed on Foreign Worker Permit Program. GAO-12-975, September 27.
Highlights – http://www.gao.gov/assets/650/648908.pdf
3. Civilian Service Contract Inventories: Opportunities Exist to Improve Agency Reporting and Review Efforts. GAO-12-1007, September 27.
Highlights – http://www.gao.gov/assets/650/648940.pdf
4. Community Reinvestment Act: Challenges in Quantifying Its Effect on Low-Income Housing Tax Credit Investment. GAO-12-869R, August 28.
5. Managing for Results: Key Considerations for Implementing Interagency Collaborative Mechanisms. GAO-12-1022, September 27.
Highlights – http://www.gao.gov/assets/650/648935.pdf
6. Medical Devices: FDA Should Expand Its Consideration of Information Security for Certain Types of Devices. GAO-12-816, August 31.
Highlights – http://www.gao.gov/assets/650/647766.pdf
Source: U.S. Census Bureau
The U.S. Census Bureau today released a 2010 Census special report, The Emergency and Transitional Shelter Population: 2010, providing information on people counted at emergency and transitional shelters (with sleeping facilities) for people experiencing homelessness.
In the 2010 Census, emergency and transitional shelters were defined as places where people experiencing homelessness stay overnight. Examples include missions; hotels and motels used to shelter people experiencing homelessness; shelters for children who are runaways, neglected or experiencing homelessness; and similar places known to shelter people experiencing homelessness.
The emergency and transitional shelter population is one of many types that make up the total group quarters population. People in emergency and transitional shelters were enumerated in the 2010 Census as part of the Service-Based Enumeration Operation, which also included enumeration at soup kitchens, regularly scheduled mobile food vans and targeted nonsheltered outdoor locations.
The Census Bureau stresses that this special report presents statistics for people enumerated at emergency and transitional shelters only, and should not be misconstrued as a count of the entire population experiencing homelessness. The Census Bureau does not produce or publish a total count of the homeless population. Further, it is important to recognize that there is no standard or agreed upon definition of what constitutes homelessness. Also, people experiencing homelessness can be counted and included in the census through various operations, but those operations do not separately identify, or even collect information to separately identify, people who might be experiencing homelessness.
Source: PLoS ONE
Adaptation aftereffects have been found for low-level visual features such as colour, motion and shape perception, as well as higher-level features such as gender, race and identity in domains such as faces and biological motion. It is not yet clear if adaptation effects in humans extend beyond this set of higher order features. The aim of this study was to investigate whether objects highly associated with one gender, e.g. high heels for females or electric shavers for males can modulate gender perception of a face. In two separate experiments, we adapted subjects to a series of objects highly associated with one gender and subsequently asked participants to judge the gender of an ambiguous face. Results showed that participants are more likely to perceive an ambiguous face as male after being exposed to objects highly associated to females and vice versa. A gender adaptation aftereffect was obtained despite the adaptor and test stimuli being from different global categories (objects and faces respectively). These findings show that our perception of gender from faces is highly affected by our environment and recent experience. This suggests two possible mechanisms: (a) that perception of the gender associated with an object shares at least some brain areas with those responsible for gender perception of faces and (b) adaptation to gender, which is a high-level concept, can modulate brain areas that are involved in facial gender perception through top-down processes.
In U.S., Trust in State, Local Governments Up
Americans’ trust in their state and local governments has increased this year, with 74% expressing a great deal or fair amount of trust in local government and 65% in state government. Trust in state government has now essentially returned to levels seen before the financial crisis, after falling to as low as 51% in 2009.
The results are based on Gallup’s annual Governance survey, conducted Sept. 6-9. Americans’ trust in the federal government’s ability to handle international and domestic issues and their trust in the three branches of the federal government are all up at least marginally this year.
Americans typically trust local government more than state government, but a majority have expressed trust in each every time Gallup has measured trust. The public’s trust in local government has been more stable over time, and thus appears to be affected less by state or national political and economic factors than trust in state government is.
State government trust dipped to 53% in 2003 amid the California recall of Gov. Gray Davis, largely due to the influence of Californians’ trust on the national numbers. Trust quickly rebounded to 67% in 2004, then held steady at that level through 2008. Then the 2008-2009 financial crisis caused state governments to face financial hardships of their own, with many struggling to pay their obligations, and trust sank to 51% in 2009.
But with the economy improving somewhat and states apparently on better financial footing after making cutbacks in recent years, trust in state government has improved, a total of 14 percentage points since 2009.
Source: Pew Social & Demographic Trends
About one out of five (19%) of the nation’s households owed student debt in 2010, more than double the share two decades earlier1 and a significant rise from the 15% that owed such debt in 2007, just prior to the onset of the Great Recession, according to a Pew Research Center analysis of newly available government data.
The Pew Research analysis also finds that a record 40% of all households headed by someone younger than age 35 owe such debt, by far the highest share among any age group.
It also finds that, whether computed as a share of household income or assets, the relative burden of student loan debt is greatest for households in the bottom fifth of the income spectrum, even though members of such households are less likely than those in other groups to attend college in the first place.
Since 2007 the incidence of student debt has increased in nearly every demographic and economic category, as has the size of that debt.
Consumer Financial Protection Bureau Study Finds Credit Scores Used by Consumers and Lenders Can Differ
Consumer Financial Protection Bureau Study Finds Credit Scores Used by Consumers and Lenders Can Differ
Source: Consumer Financial Protection Bureau
The Consumer Financial Protection Bureau (CFPB) released a study comparing credit scores sold to creditors and those sold to consumers. The study found that about one out of five consumers would likely receive a meaningfully different score than would a lender.
The Dodd-Frank Wall Street Reform and Consumer Protection Act directed the CFPB to compare credit scores sold to creditors and those sold to consumers by nationwide credit bureaus and to determine whether differences between those scores harm consumers. Today’s study analyzes credit scores from 200,000 credit files from each of the following credit bureaus: TransUnion, Equifax, and Experian. It is a follow up to a study the Bureau released in July 2011 that described the credit scoring industry, the types of credit scores, and the potential problems for consumers that could result from differences between the scores they purchase and the scores creditors use.
The study released today determined:
- One out of five consumers would likely receive a meaningfully different score than would a creditor: When consumers purchase their score from a credit bureau, the score they receive may be meaningfully different from the score that a lender would consult in making a decision. A meaningful difference means that the consumer would be likely to qualify for different credit offers – either better or worse – than they would expect to get based on the score they purchased.
- Score discrepancies may generate consumer harm: When discrepancies exist between the scores consumers purchase and the scores used for decision-making by lenders in the marketplace, consumers may take action that does not benefit them. For example, consumers who have reviewed their own score may expect a certain price from a lender may waste time and effort applying for loans they are not qualified for, or may accept offers that are worse than they could get.
- Consumers unlikely to know about score discrepancies: There is no way for consumers to know how the score they receive will compare to the score a creditor uses in making a lending decision. As such, consumers cannot exclusively rely on the credit score they receive to understand how lenders will view their creditworthiness.
The Bureau recommends that consumers consider the following in evaluating the credit score they receive:
- Shop around for credit. Consumers benefit by shopping for credit. Regardless of the scores different lenders use, they may offer different loan terms because they operate different risk models or face different competitive pressures. Consumers should not rule out of seeking lower priced credit because of assumptions they make about their credit score. While some consumers are reluctant to shop for credit out of fear that they will harm their credit score, that negative impact may be overblown. Inquiries generally do not result in a large reduction in a consumer credit score.
- Check the credit report for accuracy and dispute errors. Credit scores are calculated based on information in a consumer’s credit file. Inaccurate information may be the difference between a consumer being approved or denied a loan. Before shopping for major credit items, the Bureau recommends that consumers review their credit files for inaccuracies. Each of the nationwide credit bureaus is required by law to provide credit reports for free to consumers who request them once every 12 months.