Characterization and Representation of Patient Use of Virtual Health Technology in Primary Care

Purpose. Advances in virtual care technology have made healthcare more convenient and accessible. The goal of this study was to elucidate current patient portal behaviors by examining the pattern of time and service type use of patients, via data provided by access logs within electronic health records, to increase communication and care coordination through online healthcare portals. Methods. We conducted a retrospective study of patients in an academic healthcare center over a 5-year period using access log records in electronic health records (EHR). Dimensionality reduction analysis was applied to group portal functionalities into more interpretable and meaningful feature domains, followed by negative binomial regression analysis to evaluate how patient and practice characteristics affected the use of each feature domain. Results. Patient portal usage was categorized into four feature domains: messaging, health information management, billing/insurance, and resource/education. Individuals having more chronic conditions, lab tests or prescriptions generally had greater patient portal usage. However, patients who were male, elderly, in minority groups, or living in rural areas persistently had lower portal usage. Individuals on public insurance were also less likely than those on commercial insurance to use patient portals, though Medicare patients showed greater portal usage on health information management features and uninsured patients had greater usage on viewing resource/education features. Having Internet access only affected the use of messaging features, but not other feature. Conclusions. Efforts in enrolling patients in online portals does not guarantee patients using the portals to manage their health. While promoting the use of virtual health tools as part of patient-center care delivery model, primary care clinicians need to be aware of technological, socioeconomic, and cultural challenges faced by their patients

Correspondences - Online Journal For The Academic Study of Western Esotericism, Volume 2.2

Welcome to Correspondences, an international, peer-reviewed online journal devoted to the academic study of Western esotericism. By providing a wider forum of debate regarding issues and currents in Western esotericism than has previously been possible, Correspondences is committed to publishing work of a high academic standard as determined by a peer-review process, but does not require academic credentials as prerequisite for publication. Students and non-affiliated academics are encouraged to join established scholars in submitting insightful, well-researched articles that offer new ideas, positions, or information to the field

Down memory lane : a mixed method investigation of the reminiscence bump in the dynamics of autobiographical memory

Research into the reminiscence bump aims to improve our understanding of how the memories formed during our adolescence and early adulthood subsequently influence our autobiographical recollections later in life. The purpose of this study was to investigate the temporal dynamics of autobiographical memory in a sample involving two different age groups of adult South African participants. The main objective of the research was to explore the participants’ memories for salient events and to determine whether these memories exhibit the typical reminiscence bump that has been found in autobiographical memory research. This sample consisted of two sets of cohorts, totalling 48 research participants. The first group comprised participants ranging between the ages of 40 and 59 years, and the second group involved participants ranging between the ages of 60 to 79 years. A convergent parallel mixed method approach was adopted in this study. Both quantitative and qualitative data, on the distribution, valence and life domain importance of the reminiscence bump, were collected through the lifeline interview method. The results confirmed that reminiscence bumps are reflected in the memories of both age groups between the ages of 10 and 30 years. Most life events recalled were of positive affect thus confirming the positivity bias in older adults. The family and home life domains were indicated as the most important life domains in the autobiographical memories of both groups. The main conclusion drawn from the study was that there was not a significant difference in the dynamics of the autobiographical memories between the two groups, as reflected in the temporal characteristics of their reminiscence bumps. Future research could further explore the patterns of memories, and researchers could in particular investigate the semantic and affective aspects of these autobiographical memories in more depth.PsychologyM.A. (Psychology

Regulation of cell behaviour and identity in a branching epithelium

Branching morphogenesis is critical for the development of many organs including the lung, pancreas, kidney, breast and prostate. In the developing kidney, the branching epithelium is called the ureteric bud; it is divided into tip regions, at its ends, and the stalk regions everywhere else. The tip regions are capable of inducing nephron formation, unlike the stalk regions. Tip regions are also the regions where most branching occurs. The cells of the tip regions of the ureteric bud have the ability to proliferate and differentiate into cells of the stalk region. Although differentiation and morphogenesis of the ureteric bud have been studied for many years, the mechanisms that control their overall pattern remain unknown. In this thesis, I have tested a specific set of hypotheses in which both differentiation and morphogenesis are controlled by a self-organization based on inhibitory interactions between tip and stalk cells.Using micro dissection and organ culture I show that;• The ureteric bud is composed of at least two distinct populations of cells, those that bind Dolichos biflorus agglutinin (DBA) and those that do not. These correspond to the stalk and tip regions respectively. DBA is a marker of regions of the ureteric bud in which branching morphogenesis is inactivated. When branching morphogenesis is inactivated a change in cell behaviour of the tip cells of the ureteric bud takes place. Tip regions change to a stalk-like behaviour as they loose the expression of tip-specific markers with a parallel increase in stalk markers.• Stalk cells are capable of giving rise to tip cells. Using DBA as a marker of stalk cells, I investigate the mechanisms controlling branching of the ureteric bud. Firstly, I tested the hypothesis that branches rarely arise from the stalks of the ureteric bud because they have lost the ability to branch; it seems that the stalk cells retain their ability to become tips when provided with an appropriate environment. Differentiation of ureteric bud cells is therefore surprisingly plastic.• I also tested the hypothesis that tips of the ureteric bud space out by sensing and responding to other tips in the vicinity. There are two components to this hypothesis;(i) that tips are separated within the epithelium by a lateral inhibition mechanism that prevents new tips forming close to existing ones, and(ii) that tips of extending epithelia are repelled by the presence of nearby tips, so that they spread out to fill space optimally.I have gained evidence against the first hypothesis and show that tips can form from stalk regions. I have investigated the second hypothesis by manipulating cultures so that the tips of separate ureteric bud are placed on a collision course. These clustered ureteric buds prematurely ceased branching and appeared to be compressed in the direction of the collision with the neighbouring clustered kidney. This supports the idea that the tips of the ureteric bud interact with each other to avoid colliding. I did not find convincing evidence to suggest that the tips at the periphery of the colliding ureteric buds were influencing the position of their nearest neighbour. In addition to this, I attempted to compare the closest distance between tips when kidneys are placed on a collision course or are cultured in isolation.The data presented in this thesis provide evidence both to partially support, and also to limit, the specific self-organization hypothesis tested

Association between Electronic Prescribing among Ambulatory Care Providers and Adverse Drug Event Hospitalizations in Older Adults

Purpose. This dissertation research sought to determine whether the proportion of physicians using electronic prescribing (e-prescribing) was associated with the hospitalization rate for adverse drug events (ADEs) among patients aged 65 and older in 2011. Additionally, we sought to determine whether increases in the proportion of e-prescribing physicians in a county were associated with decreases in the hospitalization rate for ADE among older adults. Methods. Two study designs were used, a cross-sectional study using 2011 data and a pre-post- study using 2008 and 2011 data. Data from the 2008 and 2011 State Inpatient Databases, the Office of the National Coordinator Health IT Dashboard, and the Area Health Resource File were gathered for six states: Arizona, Florida, Maryland, Michigan, New Jersey, and Washington. ADE hospitalization rates were calculated for adults 65 years and older. The independent variable, the rate of e-prescribing, was an ecological measure for both analyses. Multivariable linear regression examined county rates of ADE hospitalization in 2011, multivariable logistic regression examined the odds that a discharge would have been ADE associated versus other causes in 2011, and negative binomial regression was used to model the ADE hospitalization rate among older adults in 2011 based on the ADE hospitalization rate in 2008, the change in e-prescribing rates, and county characteristics. Results. Results indicated that county e-prescribing rates were not significantly associated with county ADE hospitalization rates among older adults (p=0.4705). Further, after adjusting for patient, provider, health infrastructure, and community factors, the county e-prescribing rate was not a significant factor in determining the odds of an ADE hospitalization. Change in e-prescribing rates was not significantly associated with the change in ADE hospitalization rates; no other county characteristics were found to be significant factors. Conclusion. Though the adoption of e-prescribing has continued to increase throughout the U.S., our findings indicate that population-level benefits, such as decreased ADE hospitalization among older adults, have yet to be seen. It may be too early to detect population-level changes due to low levels of implementation of health information technologies, such as e-prescribing. Researchers and policy makers must continue to monitor the population impact that the implementation of HITs is having on the health of the nation