The scarcity of fossil fuels in medium and long term has led to several researchers to propose different alternatives to replace them, where the biodiesel had been proposed as the main replacement of ...conventional diesel oil. The main technical problem of this fuel is that doesn´t have an adequate behavior in cold environments whereby several alternatives has been proposed for improve biodiesel cold flow properties. Biodiesel made from oilseeds with high contents of saturated fatty acids like palm oil shown higher oxidation stability and high heating value but they have cold flow properties worse than other biodiesels due to solidification of the fatty acids at high temperatures. Due to this behavior, among alternatives for improve cold flow properties in the biodiesel can be finding mixture´s oils with a high content of unsaturated fatty acids, oil fractionation, Alkyl esters structure modification and additive use. The option selected must be studied in detail, due to variability of the biodiesel composition and all options can involve complications. It was observed throughout the review that some of them can improve cold flow properties up to 20°C, but their effect on this kind of biodiesel has to be evaluated in detail.
To estimate the number and geographic distribution of children and adolescents in the United States who reside in counties with neither child and adolescent psychiatrists nor sufficient Internet ...broadband to support telepsychiatry services.
This analysis combined data from the Health Resources and Services Administration's Area Health Resource Files on child psychiatrist workforce with Federal Communications Commission information on broadband coverage to generate a composite of in-person and digital access to child psychiatric services throughout the United States. Using multivariable fixed-effects Poisson regression analysis, we estimated the number of children and adolescents (aged 5-19 years) without access to psychiatric services and examined disparities across counties in the United States.
We estimate that 6,035,402 children and adolescents in the United States (approximately 10%) have inadequate in-person and digital availability of child psychiatric services within their counties. Although this was true for only 3% of children and adolescents in urban counties, this applied to more than half (51%) in rural counties (adjusted odds ratio AOR = 2.71; 95% CI = 1.94, 3.78; p < .001). Likewise, only 3% of children and adolescents in high-income counties had insufficient digital and physical access, compared to more than 4 in 10 children and adolescents (41%) in low-income counties (AOR = 0.43; 95% CI = 0.30-0.61; p < .001). Counties with a higher density of Black and Hispanic residents had greater likelihood of service availability (p < 0.001), potentially a function of living in metropolitan communities.
Although telehealth holds promise for promoting access to child and adolescent psychiatric services, large disparities in overall access to services persists in rural and low-income communities.
The COVID-19 pandemic has forced telehealth to be the primary means through which patients interact with their providers. There is a concern that the pandemic will exacerbate the existing disparities ...in overall healthcare utilization and telehealth utilization. Few national studies have examined the changes in telehealth use during the COVID-19 pandemic.
Data on 6.8 and 6.4 million employer-based health plan beneficiaries in 2020 and 2019, respectively, were collected in 2020. Unadjusted rates were compared both before and after the week of the declaration of the COVID-19 pandemic as a national emergency. Trends in weekly utilization were also examined using a difference-in-differences regression framework to quantify the changes in telemedicine and office-based care utilization while controlling for the patient's demographic and county-level sociodemographic measures. All analyses were conducted in 2020.
More than a 20-fold increase in the incidence of telemedicine utilization after March 13, 2020 was observed. Conversely, the incidence of office-based encounters declined by almost 50% and was not fully offset by the increase in telemedicine. The increase in telemedicine was greatest among patients in counties with low poverty levels (β=31.70, 95% CI=15.17, 48.23), among patients in metropolitan areas (β=40.60, 95% CI=30.86, 50.34), and among adults than among children aged 0–12 years (β=57.91, 95% CI=50.32, 65.49).
The COVID-19 pandemic has affected telehealth utilization disproportionately on the basis of patient age and both the county-level poverty rate and urbanicity.
Historically, there has been a shortage of child psychiatrists in the United States, undermining access to care. This study updated trends in the growth and distribution of child psychiatrists over ...the past decade.
Data from the Area Health Resource Files were used to compare the number of child psychiatrists per 100 000 children ages 0 to 19 between 2007 and 2016 by state and county. We also examined sociodemographic characteristics associated with the density of child psychiatrists at the county level over this period using negative binomial multivariable models.
From 2007 to 2016, the number of child psychiatrists in the United States increased from 6590 to 7991, a 21.3% gain. The number of child psychiatrists per 100 000 children also grew from 8.01 to 9.75, connoting a 21.7% increase. County- and state-level growth varied widely, with 6 states observing a decline in the ratio of child psychiatrists (ID, IN, KS, ND, SC, and SD) and 6 states increasing by >50% (AK, AR, NH, NV, OK, and RI). Seventy percent of counties had no child psychiatrists in both 2007 and 2016. Child psychiatrists were significantly more likely to practice in high-income counties (
< .001), counties with higher levels of postsecondary education (
< .001), and metropolitan counties compared with those adjacent to metropolitan regions (
< .05).
Despite the increased ratio of child psychiatrists per 100 000 children in the United States over the past decade, there remains a dearth of child psychiatrists, particularly in parts of the United States with lower levels of income and education.
COVID-19 vaccination campaigns continue in the United States, with the expectation that vaccines will slow transmission of the virus, save lives, and enable a return to normal life in due course. ...However, the extent to which faster vaccine administration has affected COVID-19-related deaths is unknown. We assessed the association between US state-level vaccination rates and COVID-19 deaths during the first five months of vaccine availability. We estimated that by May 9, 2021, the US vaccination campaign was associated with a reduction of 139,393 COVID-19 deaths. The association varied in different states. In New York, for example, vaccinations led to an estimated 11.7 fewer COVID-19 deaths per 10,000, whereas Hawaii observed the smallest reduction, with an estimated 1.1 fewer deaths per 10,000. Overall, our analysis suggests that the early COVID-19 vaccination campaign was associated with reductions in COVID-19 deaths. As of May 9, 2021, reductions in COVID-19 deaths associated with vaccines had translated to value of statistical life benefit ranging between $625 billion and $1.4 trillion.
Background: Little is known regarding the extent to which substance use disorder (SUD) treatment facilities adopt comprehensive services to meet patients' medical and social needs.Objective: To ...examine trends in the availability of comprehensive services within outpatient SUD treatment facilities from 2018 to 2022.Methods: We used data from the Mental Health and Addiction Treatment Tracking Repository, a national database of SUD treatment facilities (n = 13,793). We examined the availability of four domains of comprehensive services and four types of SUD treatment services from 2018 to 2022. We conducted bivariate and multivariate logistic regression predicting the availability of a comprehensive service model (defined as having at least one service from each service domain), controlling for organizational and community characteristics.Results: Comprehensive services were increasingly offered from 2018 to 2022. In unadjusted and adjusted models, facilities which were externally accredited (OR: 1.50; 95%CI: 1.30-1.74), accepted Medicaid (OR: 1.51; 95%CI: 1.30-1.74), performed community outreach (OR: 2.05; 95%CI: 1.80-2.33), provided naloxone and overdose education (OR: 3.50; 95%CI: 3.06-3.99), had a robust SUD treatment infrastructure (OR: 2.33; 95%CI; 2.08-2.62), and were located in a county with a lower percentage of White residents (OR: 0.99; 95%CI: 0.99-0.99), a higher percentage of residents in poverty (OR: 1.02; 95%CI: 1.00-1.03), and the Northeast compared with the South (OR: 1.21; 95%CI: 1.01-1.45), had significantly higher odds of adopting a comprehensive service model.Conclusion: Findings highlight the importance of factors reflecting experience with organizational change efforts and enhanced external support. Policymakers working to enhance the uptake of comprehensive services should focus on obtaining the financial and technical support necessary to develop these models.Background: Little is known regarding the extent to which substance use disorder (SUD) treatment facilities adopt comprehensive services to meet patients' medical and social needs.Objective: To examine trends in the availability of comprehensive services within outpatient SUD treatment facilities from 2018 to 2022.Methods: We used data from the Mental Health and Addiction Treatment Tracking Repository, a national database of SUD treatment facilities (n = 13,793). We examined the availability of four domains of comprehensive services and four types of SUD treatment services from 2018 to 2022. We conducted bivariate and multivariate logistic regression predicting the availability of a comprehensive service model (defined as having at least one service from each service domain), controlling for organizational and community characteristics.Results: Comprehensive services were increasingly offered from 2018 to 2022. In unadjusted and adjusted models, facilities which were externally accredited (OR: 1.50; 95%CI: 1.30-1.74), accepted Medicaid (OR: 1.51; 95%CI: 1.30-1.74), performed community outreach (OR: 2.05; 95%CI: 1.80-2.33), provided naloxone and overdose education (OR: 3.50; 95%CI: 3.06-3.99), had a robust SUD treatment infrastructure (OR: 2.33; 95%CI; 2.08-2.62), and were located in a county with a lower percentage of White residents (OR: 0.99; 95%CI: 0.99-0.99), a higher percentage of residents in poverty (OR: 1.02; 95%CI: 1.00-1.03), and the Northeast compared with the South (OR: 1.21; 95%CI: 1.01-1.45), had significantly higher odds of adopting a comprehensive service model.Conclusion: Findings highlight the importance of factors reflecting experience with organizational change efforts and enhanced external support. Policymakers working to enhance the uptake of comprehensive services should focus on obtaining the financial and technical support necessary to develop these models.
The coronavirus disease 2019 (COVID-19) pandemic has placed unprecedented strain on patients and health care professionals and institutions, but the association of the pandemic with use of ...preventive, elective, and nonelective care, as well as potential disparities in use of health care, remain unknown.
To examine changes in health care use during the first 2 months of the COVID-19 pandemic in March and April of 2020 relative to March and April of 2019 and 2018, and to examine whether changes in use differ by patient's zip code-level race/ethnicity or income.
This cross-sectional study analyzed health insurance claims for patients from all 50 US states who receive health insurance through their employers. Changes in use of preventive services, nonelective care, elective procedures, prescription drugs, in-person office visits, and telemedicine visits were examined during the first 2 months of the COVID-19 pandemic in 2020 relative to existing trends in 2019 and 2018. Disparities in the association of the pandemic with health care use based on patient's zip code-level race and income were also examined.
Data from 5.6, 6.4, and 6.8 million US individuals with employer-sponsored insurance in 2018, 2019, and 2020, respectively, were analyzed. Patient demographics were similar in all 3 years (mean SD age, 34.3 18.6 years in 2018, 34.3 18.5 years in 2019, and 34.5 18.5 years in 2020); 50.0% women in 2018, 49.5% women in 2019, and 49.5% women in 2020). In March and April 2020, regression-adjusted use rate per 10 000 persons changed by -28.2 (95% CI, -30.5 to -25.9) and -64.5 (95% CI, -66.8 to -62.2) for colonoscopies; -149.1 (95% CI, -162.0 to -16.2) and -342.1 (95% CI, -355.0 to -329.2) for mammograms; -60.0 (95% CI, -63.3 to -54.7) and -118.1 (95% CI, -112.4 to -113.9) for hemoglobin A1c tests; -300.5 (95% CI, -346.5 to -254.5) and -369.0 (95% CI, -414.7 to -323.4) for child vaccines; -4.6 (95% CI, -5.3 to -3.9) and -10.9 (95% CI, -11.6 to -10.2) for musculoskeletal surgery; -1.1 (95% CI, -1.4 to -0.7) and -3.4 (95% CI, -3.8 to -3.0) for cataract surgery; -13.4 (95% CI, -14.6 to -12.2) and -31.4 (95% CI, -32.6 to -30.2) for magnetic resonance imaging; and -581.1 (95% CI, -612.9 to -549.3) and -1465 (95% CI, -1496 to -1433) for in-person office visits. Use of telemedicine services increased by 227.9 (95% CI, 221.7 to 234.1) per 10 000 persons and 641.6 (95% CI, 635.5 to 647.8) per 10 000 persons. Patients living in zip codes with lower-income or majority racial/ethnic minority populations experienced smaller reductions in in-person visits (≥80% racial/ethnic minority zip code: 200.0 per 10 000 95% CI, 128.9-270.1; 79%-21% racial/ethnic minority zip code: 54.2 per 10 000 95% CI, 33.6-74.9) but also had lower rates of adoption of telemedicine (≥80% racial/ethnic minority zip code: -71.6 per 10 000 95% CI, -87.6 to -55.5; 79%-21% racial/ethnic minority zip code: -15.1 per 10 000 95% CI, -19.8 to -10.4).
In this cross-sectional study of a large US population with employer-sponsored insurance, the first 2 months of the COVID-19 pandemic were associated with dramatic reductions in the use of preventive and elective care. Use of telemedicine increased rapidly but not enough to account for reductions in in-person primary care visits. Race and income disparities at the zip code level exist in use of telemedicine.
A diversity of health professional disciplines provide services for children with autism spectrum disorder (ASD) in the United States. We conducted a systematic review examining the availability, ...distribution, and competencies of the US workforce for autism-related child health care services, and assess studies' strength of evidence.
We searched PubMed, PsychINFO, Embase, and Google Scholar from 2008 to 2018 for relevant US-based studies. Two investigators independently screened and evaluated studies against a set of prespecified inclusion criteria and evaluated strength of evidence (SOE) using a framework designed to integrate a mixed-methods research.
Of 754 records identified, 33 studies (24 quantitative, 6 qualitative, and 3 mixed-methods) were included. Strength of evidence associated was low-to-moderate, with only 8 studies (24%) satisfying criteria for strong SOE. Geographies and provider cadres varied considerably. The most common specialties studied were pediatricians (n = 13), occupational therapists (n = 12), speech therapists (n = 11), physical therapists (n = 10), and child psychiatrists (n = 8). Topical areas included the following: provider availability by service area and care delivery model; qualitative assessments of provider availability and competency; role of insurance mandates in increasing access to providers: and disparities in access. Across provider categories, we found that workforce availability for autism-related services was limited in terms of overall numbers, time available, and knowledgeability. The greatest unmet need was observed among minorities and in rural settings. Most studies were short term, were limited in scope, and used convenience samples.
There is limited evidence to characterize the availability and distribution of the US workforce for autism-related child health care services. Existing evidence to date indicates significantly restricted availability.
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