Impact of High Deductible Health Plans on Diabetes Care Quality and Outcomes: Systematic Review

ObjectiveTo provide a review of the impact of high deductible health plans (HDHPs) on the utilizations of services required for optimal management of diabetes and subsequent health outcomes.MethodsSystematic literature review of studies published between January 1, 2000, and May 7, 2021, was conducted that examined the impact of HDHP on diabetes monitoring (eg, recommended laboratory and surveillance testing), routine care (eg, ambulatory appointments), medication management (eg, medication initiation, adherence), and acute health care utilization (eg, emergency department visits, hospitalizations, incident complications).ResultsOf the 303 reviewed articles, 8 were relevant. These studies demonstrated that HDHPs lower spending at the expense of reduced high-value diabetes monitoring, routine care, and medication adherence, potentially contributing to the observed increases in acute health care utilization. Additionally, patient out-of-pocket costs for recommended screenings doubled, and total health care expenditures increased by 49.4% for HDHP enrollees compared with enrollees in traditional health plans. Reductions in disease monitoring and routine care and increases in acute health care utilization were greatest in lower-income patients. None of the studies examined the impact of HDHPs on access to diabetes self-management education, technology use, or glycemic control.ConclusionAlthough HDHPs reduce some health care utilization and costs, they appear to do so at the expense of limiting high-value care and medication adherence. Policymakers, providers, and payers should be more cognizant of the potential for negative consequences of HDHPs on patients’ health.     

Body size and area‐incidence relationships: is there a general pattern?

Aim This paper tests firstly for the existence of a general relationship between body size of terrestrial animals and their incidence across habitat patches of increasing size, and secondly for differences in this relationship between insects and vertebrates. Location The analysis was based on the occupancy pattern of 50 species from 15 different landscapes in a variety of ecosystems ranging from Central European grassland to Asian tropical forest. Methods The area‐occupancy relationship was described by incidence functions that were calculated using logistic regression. A correlation analysis between body size of the species and the patch area referring to the two given points of the incidence function was performed. In order to test for an effect of taxon (insects vs. vertebrates), an analysis of covariance was conducted. Results In all species, the incidence was found to increase with increasing patch area. The macroecological analysis showed a significant relationship between the incidence in habitat patches and the body size of terrestrial animals. The area requirement was found to increase linearly with increasing body size on a log‐log scale. This relationship did not differ significantly between insects and vertebrates. Conclusions The approach highlighted in this paper is to associate incidence functions with body size. The results suggest that body size is a general but rather rough predictor for the area requirements of animals. The relationship seems valid for a wide range of body sizes of terrestrial animals. However, further studies including isolation of habitats as well as additional species traits into the macroecological analysis of incidence functions are needed.     

Rates of small-scale species mobility in alvar limestone grassland

Abstract. Small-scale species frequency and cumulative species frequency were studied in four plots in limestone grassland of the Veronica spicata-Avenula pratensis association on Stora Alvaret on the Baltic island of Öland, Sweden. Species mobility was expressed as increase in cumulative species frequency in 20 subplots of 100 cm². Observed cumulative frequencies from 1985–1989 in all four plots, and from 1985–1995 in one plot were compared with values following from two null models, a ‘minimal mobility’ model and a random mobility model. In ca. 50 % of the cases the observed cumulative frequency was not significantly different from the random expectation. However, in many such cases the mean annual frequency was either very high or very low. Three ways of calculating the mobility rate are presented though only one is used: (observed cumulative frequency -lowest annual frequency) / expected cumulative frequency. Values × 100 range from 0 to 100. There were slight differences between the four plots which were interpreted in terms of differences in grazing intensity and soil depth. It is stressed that the idea of the Carousel model has never been meant to suggest that all species would show random mobility, which we now quantify, but that species differ in their mobility rate and that the mean rate is much higher than generally realized.     

Distribution of Fusarium wilt of Bambara nut (Vigna subterranea (L.) Verdc.) in farmers’ fields’ of Busia County in Western Kenya and its management using farmyard manure

A study was carried out to determine Fusarium wilt distribution in Bambara nut farmers’ fields and its management using farm yard manure (FYM). Four villages in Busia County were purposively sampled for the study. The data generated were subjected to analysis of variance and treatment means separated by least significant difference test. Fusarium wilt incidence in the fields ranged from 14.63 to 43.56%. In the greenhouse, FYM reduced the disease incidence by 10.2% and severity by 9.5% on the black landrace and 1.9 and 12.8%, respectively, on the red landrace. In the field, FYM reduced disease incidence by 9.1% and severity by 6.9% on the black landrace and 10.4 and 10.4%, respectively, on the red landrace. Farm yard manure had the lowest area under disease progress curve irrespective of the landrace. The study confirmed the presence of the pathogen in the fields and the ability to manage the disease using FYM.     

The incidence, distribution and expression of Australian grapevine yellows, restricted growth and late season leaf curl diseases in selected Australian vineyards

Surveys were conducted in four Chardonnay vineyards for 3 to 6 years and one Shiraz vineyard for 3 years to determine the yearly percentage of grapevines affected by Australian grapevine yellows disease (AGYd), restricted growth disease (RGd) and late season leaf curl disease (LSLCd). In each of the Chardonnay vineyards in each year, all three diseases were characterised by remission of disease in some grapevines, recurrence of disease in other grapevines and new observations of disease in previously unaffected grapevines. The pattern of temporal incidence of each disease was different between vineyards for the survey period. Although Koch's postulates have not been fulfilled, phytoplasmas are considered to be the most likely cause of AGYd. While some grapevines exhibited a combination of AGYd and RGd or AGYd and LSLCd, both RGd and LSLCd can occur independently of AGYd. Statistical analyses using log-linear models also indicated that RGd and LSLCd were not always associated with AGYd. Thus, it is possible that phytoplasmas are not the cause of RGd or LSLCd and their association is coincidental. Expression of AGYd in Shiraz grapevines occurred later in the season compared to Chardonnay. Very little recurrence of AGYd was observed in the Shiraz grapevines indicating that the variety Shiraz responds differently to phytoplasma infections, assuming that AGYd in Shiraz is a phytoplasma caused disease. RGd and LSLCd were not observed on any grapevines in the Shiraz vineyard.     

美洲蜚蠊机械感受器输出信号的计算机分析

对蜚蠊单个机械感受器诱发反应峰电位的历程及幅度,使用系列分析、栅分析、时序分布、累加密度函数、栅—频分析、特征参数的伪三维隐线显示、峰电位幅度概率密度函数、峰电位间隔概率密度函数等分析方法,获得较多的神经信号间隔编码信息,以揭示刺激和反应之间的复杂关系。峰电位间隔和栅—频分析图由函数经曲线拟合后,分别求得描述其动态过程的时间常数τ_1,τ_2和τ_3,应用上述多种分析显示方法,使研究者更为直观地观察和定量描述刺激—反应间的动态关系。     

Some epidemiological models with nonlinear incidence

Epidemiological models with nonlinear incidence rates can have very different dynamic behaviors than those with the usual bilinear incidence rate. The first model considered here includes vital dynamics and a disease process where susceptibles become exposed, then infectious, then removed with temporary immunity and then susceptible again. When the equilibria and stability are investigated, it is found that multiple equilibria exist for some parameter values and periodic solutions can arise by Hopf bifurcation from the larger endemic equilibrium. Many results analogous to those in the first model are obtained for the second model which has a delay in the removed class but no exposed class.Research supported in part by Centers for Disease Control Contract 200-87-0515. Support services provided at University House Research Center at the University of IowaResearch supported in part by NSERC A-8965 and the University of Victoria President's Committee on Faculty Research and Travel     

Patterns of cancer in geographic and endogamous subdivisions of the Hutterite Brethren of Canada

The Hutterite Brethren comprise a religious isolate and live on communal agricultural farms (colonies) in North America. In 1976 there were approximately 15,000 Canadian Brethren living in 179 colonies of the three endogamous subdivisions, the Dariusleut, Lehrerleut, and Schmiedeleut. Dariusleut and Lehrerleut colonies are located in both Alberta and Saskatchewan, and the Schmiedeleut are in Manitoba. Brethren were identified on population-based cancer registries of the three Prairie Provinces and among death registrations in the vital statistics of Alberta and Saskatchewan. The method of ascertainment was by a search for the 15 contemporary surnames and verification by address. 89 male and 91 female Brethren were identified who had cancer during the period, 1956--1975. The numbers of observed cancers were less than expected from provincial incidence rates for males and females in each province. The largest deficits were for female Brethren in Manitoba and Saskatchewan. There is a marked deficiency of cancer of the uterine cervix among female Brethren. In males there is a significant deficit of lung cancer. The Hutterite way of life contributes to a low risk for cancers of smoking-associated sites. However, there is evidence that male Brethren in Alberta may be at relatively increased risk for stomach cancer and leukemias. The site distribution patterns of cancers among the three endogamous leut are similar.     

The orientation behaviour of the lesser spearnosed bat, Phyllostomus discolor (Chiroptera) in a model roost

The orientation behaviour of bats (Phyllostomus discolor, Phyllostomidae), flying inside an octagonal roost-like chamber (ø: 100cm; h: 150cm) was examined.It has been shown that the bats begin turning manoeuvres during flight by turning their head towards the direction they intend to proceed to. During early phases of the flights, cumulative navigation errors were evident, indicating that endogenous spatial information plays a major role in the orientation of the bats. During later phases of the flight this error is diminished again. So it can be concluded that the bats start to use exogenous spatial information for orientation while approaching the target.In order to investigate the relative importance of vision, echolocation and endogenous spatial information for approaching the roost, the landing lattices inside the test arena were changed for non-grid dummies. We found that: 1. combined visual and endogenous information are more important than echoacoustical cues, 2. the bats learned quickly to switch their orientation behaviour in order to get a better performance in avoiding the dummies, 3. the learning performance was influenced by the visual similarity of dummies and the real landing lattice.     

反复电针对慢性痛的累加治疗作用及其机制研究

本研究从基础和临床两方面观察了反复电针对慢性痛的累加治疗作用,并结合疼痛患者及慢性痛动物模型中几种神经肽的放射免疫测定及相应受体拮抗剂的药理学研究结果,探讨了产生累加效应的可能机制。结果表明,在临床脊髓损伤性痉挛患者,１００Ｈｚ穴位体表电刺激有效地缓解痉挛并有累加效应;在临床慢性痛患者,２／１５Ｈｚ变频ＴＥＮＳ刺激有效地治疗疼痛并具有累加效应。在关节炎模型大鼠,电针刺激能产生明显的镇痛并具有累加效