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This article presents the first-year results of a project that aimed to explore the feasibility of using a braille display and a smartphone in society to improve face-to-face communication for a person living with deafblindness, using a simulated communication situation. An applied experimental development design was implemented, followed by a pre-test in the community. Two clinicians and an engineer conducted communication tests with three communication partners with normal vision in a shopping mall. A blind clinician acting as deafblind bought an iPhone case and asked for the location of two stores. Communication partners did not report any difficulties, understood the exchanges, and were proud to have helped a person living with deafblindness. No communication breakdowns or keyboard input incidents occurred. Speech turns were not optimal but can be improved. Clinicians proposed a sequence of three training modules: (1) prior knowledge (basic operations for iPhone, software, and braille display), (2) methods for preparing a face-to-face discussion, and (3) processes during a face-to-face discussion. Results demonstrate the feasibility of using a tactile technological solution coupled with a smartphone to interact with unknown interlocutors. Technology trials form the groundwork for a 9-month case study, involving two individuals with deafblindness.

The market for long-term care (LTC) insurance is much smaller than economic theory predicts. One reason is that premium markups are prohibitively high. We aim at quantifying markups for LTC insurance due to mortality and morbidity risk. To this end, we model a shareholder value maximising insurance company that is subject to solvency regulation. Because liabilities from LTC insurance (which depend on future morbidity and mortality) are more volatile than liabilities from annuities (which only depend on future mortality), capital provisions to ensure compliance with regulatory solvency requirements are higher if an insurance company offers LTC insurance instead of annuities. At the same time, a higher volatility in the LTC insurance segment also implies a higher expected payoff to the insurance company’s shareholders. To quantify which effect prevails and which product policy is optimal, we conduct an empirically calibrated simulation study with stochastic mortality and LTC needs. Our results show that offering LTC insurance increases the upside potential to shareholders, but that effect is more than offset by a higher need for external capital. Consequently, if shareholders are to accept an LTC insurance segment, holders of an LTC insurance policy need to pay considerable markups. The more LTC insurance contracts the insurer has sold, the higher the markups.

OBJECTIVES The objective was to evaluate the effects of direct-access physiotherapy on patients presenting with a musculoskeletal disorder (MSKD) to the emergency department (ED) on clinical outcomes and use of health care resources. METHODS We conducted a randomized controlled trial in an academic ED in Quebec City, Canada. We included patients aged 18 to 80 years with minor MSKD. The intervention group had direct access to a physiotherapist (PT) in the ED immediately after triage and prior to physician assessment, and the control group received usual care by the emergency physician without PT intervention. The key variables included clinical outcomes (pain, interference of pain on function) and resources use (ED return visit, medications, diagnostic tests, additional consultations). They were analyzed using descriptive statistics and compared between groups using two-way analyses of variance, log-linear analysis, and chi-square tests. RESULTS Seventy-eight patients suffering from MSKDs were included (40.2 ± 17.6 years old; 44% women). For the primary clinical outcome, participants in the PT group (n = 40) had statistically lower levels of pain and pain interference at 1 and 3 months. In terms of resource use, participants in the PT group returned significantly less often to the ED. At baseline and 1 month, less prescription medication was used, including opioids, but there were no differences at 3 months. Although over-the-counter medication was recommended more at baseline in the PT group, there were no differences in use at 1 month, and the PT group had used them less at 3 months. There were no differences between groups at follow-up for imaging tests, other professionals consulted, and hospitalization rates. CONCLUSION Patients presenting with a MSKD to the ED with direct access to a PT had better clinical outcomes and used less services and resources than those in the usual care group after ED discharge and up to 3 months after discharge.

In this work we introduce a general equilibrium model with landlords, indebted owner-occupiers and renters to study housing markets' dynamics. We estimate it by using standard Bayesian methods and match the US data of the last decades. This framework is particularly suited to explain current trends on housing markets. We highlight the crucial relationship between interest rates, house prices and rents, and argue that it helps understanding the main driving forces. Our analysis suggests that current developments on housing markets can play a role for a recovery from the Covid pandemic as they have an expansionary effect on aggregate output. Moreover, we account for the heterogeneous impact of crisis-induced policies depending on agents' status on the housing market. We show how, despite an increase in housing prices, the welfare of landlords has been negatively hit. This is associated to the joint decrease in returns on housing and financial assets that reduces their financial incomes.

ObjectivesThe purpose of this study was to assess utility scores of patients presenting to the emergency department (ED) with a musculoskeletal disorder and to explore the influence of diverse factors on health-related quality of life.DesignSecondary analysis of data obtained before randomization during a pragmatic randomized controlled trialSettingAcademic ED in Quebec City (Canada)ParticipantsParticipants aged 18-80 years old presenting with a minor MSKD.Main Outcome MeasuresHealth-related quality of life (five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and utility scores (0 – dead, 100 – perfect health), measured with the EQ-5D-5L, were compared between subgroups and with reference values using descriptive statistics (mean, median), rankFD ANOVAs, and χ2 tests.ResultsSixty-nine participants completed the EQ-5D-5L. Mean and median utility scores were respectively 0.536 (95% CI: 0.479-0.594) and 0.531 (IQR: 0.356-0.760). Participants with higher levels of pain (7/10: 0.433) or pain interference on function (7/10: 0.294) presented significantly lower utility scores. No significant differences were found for other socio-demographic characteristics. The mean overall VAS score was 58.1 (95% CI: 52.2-64.0).ConclusionsIn patients with MSKDs presenting to the ED, higher levels of pain and pain interference on function may influence perceived health-related QoL. These findings need to be confirmed on a larger scale.Trial RegistrationThis trial was registered at the US National Institutes of Health (ClinicalTrials.gov) #NCT04009369 on July 5, 2019

ContextIn several countries, physiotherapists (PT) have been integrated within emergency departments (EDs) to help manage patients with musculoskeletal disorders (MSKDs). Still, research on the effects of such initiatives is scarce.ObjectivesTo evaluate the effects of direct access PT on MSKD patients consulting the ED in terms of clinical outcomes and use of health care resources.Design, Setting, ParticipantsRandomized controlled trial, academic ED in Quebec City (Canada), participants 18-80 years presenting with a minor MSKD.InterventionDirect access PT at the EDControlEmergency Physicians lead management (EP).Main Outcome MeasureClinical outcomes (pain, interference of pain on function) and use of resources (ED return visit, interventions, diagnostic tests, consultations) were compared between groups at ED discharge and after 1 and 3 months using two-way ANOVAs, log-linear analysis and χ2 tests.ResultsSeventy-eight patients suffering from MSKDs were included (40.2 ± 17.6 years old; 44% women). Participants in the PT group (n=40) had statistically lower levels of pain and pain interference at 1- and 3-months. They were recommended fewer imaging tests (38% vs. 78%; pConclusionPatients presenting with a MSKD to the ED with direct access to a PT had better clinical outcomes and used less services and resources than those in the usual care group after ED discharge and up to 3 months after discharge. The results of this study support the implementation of such models of care for the management of this population.Trial RegistrationThis trial is registered at the US National Institutes of Health (ClinicalTrials.gov) #NCT04009369Ethical approvalThis trial was approved by the Research Ethics Committee of the CHU de Québec - Université Laval #MP-20-2019-4307