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    Assessing Care Integration for Dual-Eligible Beneficiaries: A Review of Quality Measures Chosen by States in the Financial Alignment Initiative

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    Caring for the 9 million low-income elderly or disabled adults who are eligible for full benefits under both Medicare and Medicaid can be extremely costly. As part of the federal Financial Alignment Initiative, states have the opportunity to test care models for dual-eligibles that integrate acute care, behavioral health and mental health services, and long-term services and supports, with the goals of enhancing access to services, improving care quality, containing costs, and reducing administrative barriers. One of the challenges in designing these demonstrations is choosing and applying measures that accurately track changes in quality over time—essential for the rapid identification of effective innovations. This brief reviews the quality measures chosen by eight demonstration states as of December 2013. The authors find that while some quality domains are well represented, others are not. Quality-of-life measures are notably lacking, as are informative, standardized measures of long-term services and supports

    Effects of a hyperimmunized egg product on voluntary physical activity levels, serum inflammatory markers, and owner perception of joint pain of dogs with osteoarthritis

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    Osteoarthritis (OA) affects about 20% of adult dogs in North America, resulting in reduced range of motion, difficulty climbing and jumping, reduced physical activity, and lower quality of life. A double-blind, placebo-controlled study was conducted to evaluate the effects of short-term supplementation of hyperimmunized egg (HIE) on voluntary activity levels, serum chemistry and inflammatory markers, and owner perception of joint pain in dogs diagnosed with OA. Eighty-two client-owned dogs with clinical signs and veterinary diagnosis of OA were enrolled and sixty-nine dogs (mean age = 8.0 ± 3.4 yr; mean BW = 32.3 ± 11.3 kg) completed a 49-d study composed of a 7-d baseline period followed by a 42-d treatment period. The Institutional Animal Care and Use Committee at the University of Illinois approved all procedures, and owner consent was received prior to experimentation. Enrolled dogs were randomly assigned to one of three treatment groups: treatment 1 (placebo; 0 g HIE/chew; n = 22), treatment 2 (2 g HIE/chew; n = 24), and treatment 3 (3 g HIE/chew; n = 23). Assigned treatments were given in the form of soft-chew treats, with dogs receiving one treat for every 9.07 kg BW daily. A physical examination, radiographs, and blood sample collection were performed at the time of enrollment (d -7) and dogs were sent home with the assigned treatment and a HeyRex (Wellington, New Zealand) activity monitor to wear continuously for 49 d. In addition, owners were required to complete canine brief pain inventory (CBPI) and Liverpool osteoarthritis in dogs (LOAD) survey questionnaires at baseline (d -7), and on d 14, 28, and 42 of the study. On the last day of the study (d 42), another blood sample was collected. Blood samples were used for serum chemistry and inflammatory marker measurements. Statistical analysis was conducted using SAS® (version 9.3; SAS Institute, Inc., Cary, NC) using the Mixed Models procedure with a repeated measures design. Data were reported as means ± SEM with statistical significance set at P<0.05 with P<0.10 considered a trend. Results of CBPI survey data showed some significant time effects, with average pain; pain as of right now; interference with the ability to rise from a lying position; interference with the ability to walk; interference with the ability to climb; pain severity score; and pain interference score decreasing (P<0.05) over time. CBPI scores for pain at its least and interference with general activity tended to decrease (P<0.10) over time. Blood C-reactive protein concentrations tended to be greater (P<0.10) in dogs fed the low-dose HIE compared to those fed the placebo or high-dose HIE. Voluntary physical activity was different due to treatment and time. Weekly, weekday, and weekend activity data were greater (P<0.05) in dogs fed the low-dose HIE than for dogs fed placebo or high-dose HIE. Baseline activity data were highest in this group, however, so these differences did not appear to be due to HIE treatment. Weekly, weekday, and weekend activity decreased (P<0.05) over time. In conclusion, results of the current study did not show significant changes in physical activity levels, blood markers, or owner perception of joint pain after consuming a HIE product. Although HIE products of a different source, of higher quality, or of higher dosage may be of interest for future research, the results of the current study do not support the use of HIE for alleviating clinical signs associated with canine OA

    The cell of origin dictates the temporal course of neurofibromatosis-1 (Nf1) low-grade glioma formation.

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    Low-grade gliomas are one of the most common brain tumors in children, where they frequently form within the optic pathway (optic pathway gliomas; OPGs). Since many OPGs occur in the context of the Neurofibromatosis Type 1 (NF1) cancer predisposition syndrome, we have previously employed Nf1 genetically-engineered mouse (GEM) strains to study the pathogenesis of these low-grade glial neoplasms. In the light of the finding that human and mouse low-grade gliomas are composed of Olig2+ cells and that Olig2+ oligodendrocyte precursor cells (OPCs) give rise to murine high-grade gliomas, we sought to determine whether Olig2+ OPCs could be tumor-initiating cells for Nf1 optic glioma. Similar to the GFAP-Cre transgenic strain previously employed to generate Nf1 optic gliomas, Olig2+ cells also give rise to astrocytes in the murine optic nerve in vivo. However, in contrast to the GFAP-Cre strain where somatic Nf1 inactivation in embryonic neural progenitor/stem cells (Nf1flox/mut; GFAP-Cre mice) results in optic gliomas by 3 months of age in vivo, mice with Nf1 gene inactivation in Olig2+ OPCs (Nf1flox/mut; Olig2-Cre mice) do not form optic gliomas until 6 months of age. These distinct patterns of glioma latency do not reflect differences in the timing or brain location of somatic Nf1 loss. Instead, they most likely reflect the cell of origin, as somatic Nf1 loss in CD133+ neural progenitor/stem cells during late embryogenesis results in optic gliomas at 3 months of age. Collectively, these data demonstrate that the cell of origin dictates the time to tumorigenesis in murine optic glioma

    Leveraging Academic-Service Partnerships: Implications for Implementing the RWJ/IOM's Recommendations to Improve Quality, Access, and Value in Academic Medical Centers

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    Transformation of the current healthcare system is critical to achieve improved quality, safety, value, and access. Patients with multiple, chronic health conditions require integrated care coordination yet the current health care system is fragmented and complex. Nursing must play a key role in constructing a system that is value based and patient focused. The Robert Wood Johnson/Institute of Medicine (RWJ/IOM) report on the future of nursing outlines strategic opportunities for nursing to take a lead role in this transformation. Partnerships across academic institutions and health care systems have the potential to address issues through mutual goal setting, sharing of risks, responsibilities, and accountability, and realignment of resources. The purpose of this paper is to present Stony Brook University Medical Center's (SBUMC) academic-service partnership which implemented several of the RWJ/IOM recommendations. The partnership resulted in several initiatives that improved quality, safety, access, and value. It also characterized mutual goal setting, shared missions and values, and a united vision for health care

    Using a model of group psychotherapy to support social research on sensitive topics

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    This article describes the exploratory use of professional therapeutic support by social researchers working on a sensitive topic. Talking to recently bereaved parents about the financial implications of their child's death was expected to be demanding work, and the research design included access to an independent psychotherapeutic service. Using this kind of professional support is rare within the general social research community, and it is useful to reflect on the process. There are likely to be implications for collection and interpretation of data, research output and the role and experience of the therapist. Here, the primary focus is the potential impact on researcher well-being

    Electroencephalogram approximate entropy influenced by both age and sleep

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    The use of information-based measures to assess changes in conscious state is an increasingly popular topic. Though recent results have seemed to justify the merits of such methods, little has been done to investigate the applicability of such measures to children. For our work, we used the approximate entropy (ApEn), a measure previously shown to correlate with changes in conscious state when applied to the electroencephalogram (EEG), and sought to confirm whether previously reported trends in adult ApEn values across wake and sleep were present in children. Besides validating the prior findings that ApEn decreases from wake to sleep (including wake, rapid eye movement (REM) sleep, and non-REM sleep) in adults, we found that previously reported ApEn decreases across vigilance states in adults were also present in children (ApEn trends for both age groups: wake > REM sleep > non-REM sleep). When comparing ApEn values between age groups, adults had significantly larger ApEn values than children during wakefulness. After the application of an 8 Hz high-pass filter to the EEG signal, ApEn values were recalculated. The number of electrodes with significant vigilance state effects dropped from all 109 electrodes with the original 1 Hz filter to 1 electrode with the 8 Hz filter. The number of electrodes with significant age effects dropped from 10 to 4. Our results support the notion that ApEn can reliably distinguish between vigilance states, with low-frequency sleep-related oscillations implicated as the driver of changes between vigilance states. We suggest that the observed differences between adult and child ApEn values during wake may reflect differences in connectivity between age groups, a factor which may be important in the use of EEG to measure consciousness

    Case Study: Effects of Psychosocial Factors on a Geriatric Patient with Guillain Barré Syndrome

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    The purpose of this case report is to determine how a change in intrinsic motivation and environmental factors help physical and functional improvements in a 77-year-old male patient with Guillain Barré Syndrome (GBS) in the geriatric population. Interventions to promote this change included patient education about lifestyle choices along with endurance and balance exercises. Patient psychological state, community access, and general education about interventions/dosing had an effect on the patient\u27s participation in his prescribed HEP. His comorbidities hindered his overall progress over the course of his treatment and should be addressed to improve patient outcomes. Activities that were more salient and stimulating to the patient, such as a swimming class or participating in a social event were reported to be more likely to be completed. These types of activities may address the patient’s GBS and associated comorbidities.https://soar.usa.edu/casmsummer2019/1000/thumbnail.jp
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