The Impact of Incarceration on Health and Health Care Utilization: a System Perspective.

BACKGROUND: Previously incarcerated individuals report high rates of chronic disease and reduced health care access. We characterized the impact of recent incarceration in jail or prison on chronic disease burden and health care utilization. METHODS AND FINDINGS: Incarceration data over 10 years were matched to health system data and patients were classified by recent incarceration status. Each cohort was stratified by gender and neighborhood socioeconomic status for utilization analysis. Main outcomes were chronic disease incidence and health care utilization. Incarceration had a significant but small effect on chronic disease incidence. Incarceration had a moderate to large effect on emergency department and behavioral health utilization, with additional differences seen by gender and socioeconomic status. CONCLUSION: Incarceration's impact on quantity and type of health care utilization varies with socioeconomic status and gender. Future work should evaluate the impact of length or number of cycles of incarceration on health or health care utilization.

Grasping the Alternative: Reaching and Eyegaze Reveal Children's Processing of Negation.

There is evidence that children begin to understand negation early in the preschool years, but children's processing of negation is not well understood. We examined children's processing of denial negation using a variant of the visual world paradigm called the Shopping Task. In this task, participants help a puppet to find the items on a shopping list, selecting from two potential items on each trial in response to the puppet's affirmative ("the next item is an apple") or negation ("the next item is not an orange") sentence. In this binary decision context, participants' eye gaze and reaching behavior were tracked as they selected the item the puppet wants. Participants were 78 children aged 4-5 years and a comparison group of 30 adults. Results showed that children took longer to process negation than affirmative sentences, and that this difference arose early in processing. Further, children's eye gaze behavior suggested that on negation trials they regularly looked first to the negated object and were considering the negated meaning early in processing. Adults did not take longer to process negation than affirmative sentences, but their eye gaze behavior also indicated early consideration of negated meanings for negation sentences. We also examined relationships between children's language and executive function skills and their processing of negation and found no significant relationships. We conclude that both adults and children activate to-be-negated information in the processing of negation. Children, however, are less efficient at processing negation in this context.

Clinical decision support for high-cost imaging: A randomized clinical trial.

There is widespread concern over the health risks and healthcare costs from potentially inappropriate high-cost imaging. As a result, the Centers for Medicare and Medicaid Services (CMS) will soon require high-cost imaging orders to be accompanied by Clinical Decision Support (CDS): software that provides appropriateness information at the time orders are placed via a best practice alert for targeted (i.e. likely inappropriate) imaging orders, although the impacts of CDS in this context are unclear. In this randomized trial of 3,511 healthcare providers at Aurora Health Care, we study the impacts of CDS on the ordering behavior of providers. We find that CDS reduced targeted imaging orders by a statistically significant 6%, however there was no statistically significant change in the total number of high-cost scans or of low-cost scans. The results suggest that the impending CMS mandate requiring healthcare systems to adopt CDS may modestly increase the appropriateness of high-cost imaging.