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Studies linking election outcomes to economics frequently assume that the economy’s salience is constant. This study shows that the economy’s salience systematically fluctuates. The number of voters focused on economic issues shifted dramatically throughout the 2008 campaign as the recession worsened and this change occurred well before the financial markets collapsed in September 2008. However, even during the recession substantial numbers of individuals said their vote was based on non-economic issues and for these individuals there was no relationship between their assessment of the economy and their electoral choice. Consistent with extant theories of issue attention, citizens who were the hardest hit by the recession and those who had the most anxiety about suffering a financial dislocation in the future were most likely to consider economic performance electorally important while secure voters were less likely to be economic voters. [Copyright &y& Elsevier]

While scholars have hypothesised that a strong welfare state should reduce voters' incentives to base their votes on economic outcomes, evidence for this proposition remains mixed. This article tests whether differences in welfare protections across American states affect the relationship between economic performance and support for the president's party in 430 state legislative elections from 1970 to 1989. Analysing the results of over 42,000 contests in which an incumbent was running for re-election, it finds that while unemployment insurance programmes do not affect the importance of economic performance, the electoral fortunes of presidential co-partisans are less strongly tied to the national economy in states with generous anti-poverty programmes. Thus by reducing vulnerability to poverty, economic safety-nets lower the salience of the economy and provide electoral cover for politicians during economic slowdowns. [ABSTRACT FROM AUTHOR]

Examines the question of whether crown release might hasten the development of large trees in second-growth northern hardwoods in northern Wisconsin. Measurement of growth response to a wide range of past thinning treatments in seven stands; Method; Findings; Suggestion that 30 cm DBH sugar maples (Acer saccharum Marsh.) given full crown release would reach 50 cm DBH (the mean size of canopy trees in old-growth stands) in 46-49 years, compared with 92 years with no treatment; Potentional of crown release for enhancing foliar height diversity and increasing the number of canopy gaps, standing snags, and fallen logs.

Background: The United States is currently experiencing a heroin epidemic. Recent reports have demonstrated a three-fold increase in heroin use among Americans since 2007 with a shift in demographics to more women and white Americans. Furthermore, there has been a correlation between the recent opioid epidemic and an increase in heroin abuse. Much has been written about epidemiology and prevention of heroin abuse, but little has been dedicated to the surgical implications, complications, and resource utilization. Discussion: This article focuses on the surgical problems encountered from heroin abuse and how to manage them in a constant effort to improve morbidity and mortality for these heroin abusers. [ABSTRACT FROM AUTHOR]

Background: Gender may influence outcomes following traumatic brain injury (TBI) although the mechanism is unknown. Animal TBI studies suggest that gender differences in endogenous hormone production may be the source. Limited retrospective clinical studies on gender present varied conclusions. Pediatric patients represent a unique population as pubescent children experience up-regulation of endogenous hormones that varies dramatically by gender. Younger children do not have these hormonal differences. The aim of this study was to compare pubescent and prepubescent females with males after isolated TBI to identify independent predictors of mortality., Methods: We performed a retrospective review of the National Trauma Data Bank Research Data Sets from 2007 and 2008 looking at all blunt trauma patients 18 years or younger who required hospital admission after isolated, moderate-to-severe TBI, defined as head Abbreviated Injury Scale (AIS) score 3 or greater. We excluded all individuals with AIS score of 3 or greater for any other region to limit the confounding effect of comorbidities. Based on the median age of menarche, we defined two age groups as follows: prepubescent (0-12 years) and pubescent (>12 years). Analysis was performed to compare trauma profiles and outcomes between groups. Our primary outcome measure was in-hospital mortality., Results: A total of 20,280 patients met inclusion criteria; 10,135 were prepubescent, and 10,145 were pubescent. Overall mortality was 6.9%, and lower mortality was noted among prepubescent patients compared with pubescent (5.2% vs. 8.6%, p < 0.0001). Although female gender did not predict reduced mortality in the prepubescent cohort (adjusted odds ratio, 1.05; 95% confidence interval, 0.85-1.30; p = 0.63), female gender was associated with reduced mortality in the pubescent (adjusted odds ratio, 0.78; 95% confidence interval, 0.65-0.93; p = 0.007)., Conclusion: In contrast to prepubescent female gender, pubescent female gender predicts reduced mortality following isolated, moderate-to-severe TBI. Endogenous hormonal differences may be a contributing factor and require further investigation., Level of Evidence: Prognostic study, level III.

Background: In adult trauma, mortality varies with race and insurance status. In the elderly, insurance type has little impact on mortality after trauma and the influence of race is reduced. How race and insurance affect pediatric trauma requires further attention. We hypothesized that mortality after pediatric trauma is influenced by insurance type and not race., Methods: We reviewed all cases of blunt trauma in children ≤13 y requiring admission, using the National Trauma Data Bank Research Data Sets for 2007 and 2008. Exclusions included an Abbreviated Injury Score of 6 for any body region, dead on arrival, and missing data. Our primary outcome measure was in-hospital mortality., Results: We identified 831 Asian (1.2%), 10,592 black (15.5%), 45,173 white (66.2%), and 8498 Hispanic (12.5%) children, and 3161 children (4.6%) classified as other race. Mean age was 7.4 ± 4.5 y, 11.9% were uninsured, and overall in-hospital mortality was 1.4%. Multivariable modeling indicated that race was not associated with increased mortality (Asian versus white, adjusted odds ratio [AOR] 1.05, P = 0.88; black versus white, AOR 0.92, P = 0.42; Hispanic versus white, AOR 0.87, P = 0.26; and other race versus white, AOR 1.01, P = 0.96). In contrast, insurance status (any insurance versus no insurance, AOR 0.6, P < 0.01) and insurance type (private insurance versus no insurance, AOR 0.47, P < 0.01; Medicaid versus no insurance, 0.67, P < 0.01) predicted reduced mortality., Conclusions: Insurance status and insurance type are important predictors of mortality after pediatric trauma while, in contrast, race is not., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Cirrhosis is known to be a significant risk factor for morbidity and mortality following trauma such that its presence is a requirement for trauma center transfer. The impact of trauma center level on post-injury survival in cirrhotic patients has not been well studied., Methods: The National Trauma Databank (version 7) was used to identify patients admitted with cirrhosis as a preexisting comorbidity. Patients who were dead on arrival, died in the emergency department, or had missing trauma center information were excluded. Our primary outcome measure was overall mortality stratified by admission trauma center level. Logistic regression analysis was used to derive adjusted mortality results., Results: A total of 3,395 patients met inclusion criteria (0.16% of all National Trauma Databank patients). Patients admitted to a Level I center were more likely to be younger and minorities, experience penetrating injuries, and require immediate operative intervention despite similar Injury Severity Scores (ISS). Overall mortality was lower at Level I centers compared with other centers (10.3% vs. 14.0%, p = 0.001). After logistic regression, Level I centers were associated with significantly lower mortality compared with non-Level I centers (adjusted odds ratio, 0.70; 95% confidence interval, 0.53-0.89; p = 0.004)., Conclusion: The mortality for cirrhotic patients admitted to a Level I trauma center was significantly less compared with those admitted to non-Level I centers. The etiology of this improved outcome needs to be identified and transmitted to non-Level I centers., Level of Evidence: Epidemiologic study, level III.

Background: Little focus is on health care disparities in the elderly, a population largely covered by public insurance. We characterized insurance type and race in elderly trauma patients to determine if lack of insurance or minority status predict increased mortality., Methods: The National Trauma Data Bank (version 7.0) was queried for all adult blunt trauma patients. We divided patients into two cohorts (15-64 or ≥ 65 years) based on age for universal Medicare eligibility. Our primary outcome measure was in-hospital mortality. Multiple logistic regression was used to control for confounding variables., Results: A total of 541,471 patients met inclusion criteria. Among younger patients, the most common insurance type was private (41.0%), with 26.9% uninsured. In contrast, the most common insurance type among older patients was Medicare (64.6%), with 6.0% uninsured. Within the younger cohort, private insurance (adjusted odds ratio [AOR], 0.6; p < 0.01) and other insurance (AOR, 0.8; p < 0.01) predicted reduced mortality, while Medicare predicted similar mortality (AOR, 1.1; p = 0.18) compared with no insurance. Black race (AOR, 1.4; p < 0.01) and Hispanic ethnicity (AOR, 1.4; p < 0.01) predicted higher mortality compared with white race. Within the older cohort, no insurance predicted similar mortality as Medicare (AOR, 1.0; p = 0.43), private insurance (AOR, 1.0; p = 0.51), and other insurance (AOR, 1.0; p = 0.71). Hispanic ethnicity predicted increased mortality (AOR, 1.4; p < 0.01), while Asian race was protective (AOR, 0.7; p = 0.01) compared with white race., Conclusion: Elderly trauma patients present primarily with Medicare, while younger trauma patients are mostly privately insured; elderly patients are four times more likely to be insured. Disparities caused by lack of insurance and minority race are reduced in elderly trauma patients., Level of Evidence: Epidemiologic/prognostic study, level III.