Types of Co-existing Chronic Physical Conditions and Newly-diagnosed Depression, its Treatment and Economic Outcomes among Medicaid Beneficiaries with Type 2 Diabetes

Diabetes is a widely prevalent metabolic condition. Adults with type 2 diabetes mellitus (T2DM) also have many coexisting chronic physical conditions. Coexisting chronic physical conditions among individuals with T2DM may be concordant (conditions that overlap with T2DM in their pathogenesis and management plans such as cardiovascular diseases) or discordant (conditions with unrelated pathogenesis or management plans such as musculoskeletal disorders) or dominant (conditions whose severity eclipses all other illness management plans such as metastatic cancer). There is documented evidence on the negative consequences of depression in adults with T2DM. However, there is only limited knowledge on how the types of coexisting chronic physical conditions (defined as concordant, discordant or dominant conditions) influence the risk for developing depression, subsequent depression treatment patterns and economic consequences of depression treatment, among adults with T2DM. Therefore the aims of this dissertation were to examine (1) the association of risk of newly-diagnosed depression with types of coexisting chronic physical conditions among adults with T2DM (2) the association between types of coexisting chronic physical conditions and depression treatment among adults with T2DM and newly-diagnosed depression was analyzed and (3) whether the relationship between depression treatment and total and T2DM-related healthcare care expenditures vary by types of coexisting chronic physical conditions among non-elderly adult Medicaid beneficiaries with T2DM and newly-diagnosed depression. A retrospective longitudinal cohort study design was used. Patient-level data were obtained from multi-year, multi-state Medicaid claims. Non-elderly (ages 18-64), fee-for-service Medicaid beneficiaries with T2DM who were depression free were followed for a period of 12 months to identify newly-diagnosed depression. The final study population consisted of 59,857 Medicaid beneficiaries of whom N=5,974 had newly diagnosed depression. After controlling for other risk factors, those with dominant conditions were at 17% higher risk (p=0.0006) and those with both concordant and discordant conditions were found to be at 30% higher risk (p\u3c.0001) to develop newly-diagnosed depression as compared to those with concordant conditions only. Individuals with dominant conditions (p\u3c0.05) were less likely to receive depression treatment with only antidepressants compared to those with discordant conditions only. Individuals with dominant conditions were more likely to receive depression treatment with only psychotherapy (p\u3c.01) as compared to those with discordant conditions only. No statistically significant associations were observed between types of coexisting chronic physical conditions and receipt of adequate depression treatment. As compared to no depression treatment, treating depression reduced total healthcare expenditures. As compared to no depression treatment, treatment with only antidepressants was associated with 17% reduction in total healthcare expenditures, treatment with only psychotherapy was associated with 22% reduction in total healthcare expenditures and treatment with both antidepressants and psychotherapy was associated with 28% reductions in total healthcare expenditures. As compared to no depression treatment, treatment with both antidepressants and psychotherapy was associated with reductions in total healthcare expenditures among all types of coexisting chronic physical condition groups. In summary, these results indicate that among adults with T2DM, newly-diagnosed depression rates, its treatment and economic benefits vary by types of coexisting chronic physical conditions

Exploring blockchain technologies with an innovative multi-layered ontology design tool and eMudra – a novel peer to peer currency exchange application

Recent years have witnessed significant interest in shared economy applications and consequently a proliferation of such applications have emerged where people are monetizing their things. This thesis focuses on solving the problem of leftover foreign currency exchange as a shared economy application. Existing shared economy applications such as Ola, Uber or Airbnb are not deployed as decentralized applications (Dapps) leveraging blockchain and the Internet of Things (IoT), which are relatively recent technologies leading to more efficient applications that do not require the intervention of trusted third parties. Blockchain technology can be merged with IoT infrastructure to provide an immutable ledger of all the transactions related to shared economy applications; an immutable ledger is critical to the elimination of trusted third parties, making the system trustless. When blockchain and IoT are combined they can give rise to a plethora of useful shared economy applications — automatic payment mechanisms, digital rights management are some instances and in the case of this thesis a unique solution for the leftover foreign currency exchange problem. This thesis demonstrates the implementation of a novel permissioned consortium blockchain-based leftover foreign currency exchange platform that has been designed using a multi-layered blockchain ontology created with an innovative ontology design tool. The leftover foreign currency exchange problem arises because every year millions of travellers undertake international tours and need to perform currency exchange. However, there is a deficit of suitable currency exchange applications that would help travellers exchange money profitably and conveniently, especially small amounts of cash. This thesis proposes a novel peer to peer currency exchange application – e-Mudra, exploiting blockchain technology that would allow users to choose or quote their preferred exchange rates and exchange currencies including cash money with peer travellers without any middleman deciding the rates. The research work described focuses on an in-depth study of blockchain technology and a new multi-layered blockchain ontology is created with an innovative ontology design tool that facilitates generation of simple and complex ontologies enabling the design of blockchain (and other) applications using these ontologies. The novel ontology design tool created in this research work following a new Ontology Development Life Cycle and an ontology design methodology was used to design a blockchain ontology and a wallet ontology as examples of use, where the currency exchange application design (e-Mudra) is an instance of the blockchain ontology

Type of Multimorbidity and Complementary and Alternative Medicine Use among Adults

Objective. To examine the association between type of multimorbidity and CAM use among adults with multimorbidity. Methods. The current study used a cross-sectional design with retrospective data from 2012 National Health Interview Survey. Multimorbidity was classified into two groups: (1) adults with coexisting physical and mental illnesses and (2) adults with two or more chronic physical illnesses only. CAM use was measured using a set of 18 variables. Logistic regression and multinomial logistic regressions were used to assess the association between the type of multimorbidity and ever used CAM, CAM use in the past 12 months, and type of CAM. Results. Overall, 31.2% of adults with coexisting physical and mental illnesses and 20.1% of adults with only physical illnesses used CAM in the past 12 months. Adults with coexisting physical and mental illnesses were more likely to ever use CAM (AOR = 1.68, 95% CI = 1.49, 1.90), use CAM in the past 12 months (AOR = 1.32, 95% CI = 1.15, 1.52), and use mind-body therapies in the past 12 months (AOR = 1.36, 95% CI = 1.16, 1.59) compared to adults with only physical illnesses. Conclusion. Multimorbidity of chronic physical and mental illnesses was associated with higher CAM use

Depression Treatment Decreases Healthcare Expenditures Among Working Age Patients With Comorbid Conditions and Type 2 Diabetes Mellitus Along With Newly-Diagnosed Depression

Background: There are many studies in the literature on the association between depression treatment and health expenditures. However, there is a knowledge gap in examining this relationship taking into account coexisting chronic conditions among patients with diabetes. We aim to analyze the association between depression treatment and healthcare expenditures among adults with Type 2 Diabetes Mellitus (T2DM) and newly-diagnosed depression, with consideration of coexisting chronic physical conditions. Methods: We used multi-state Medicaid data (2000–2008) and adopted a retrospective longitudinal cohort design. Medical conditions were identified using diagnosis codes (ICD-9-CM and CPT systems). Healthcare expenditures were aggregated for each month for 12 months. Types of coexisting chronic physical conditions were hierarchically grouped into: dominant, concordant, discordant, and both concordant and discordant. Depression treatment categories were as follows: antidepressants or psychotherapy, both antidepressants and psychotherapy, and no treatment. We used linear mixed-effects models on log-transformed expenditures (total and T2DM-related) to examine the relationship between depression treatment and health expenditures. The analyses were conducted on the overall study population and also on subgroups that had coexisting chronic physical conditions. Results: Total healthcare expenditures were reduced by treatment with antidepressants (16 % reduction), psychotherapy (22 %), and both therapy types in combination (28 %) compared to no depression treatment. Treatment with both antidepressants and psychotherapy was associated with reductions in total healthcare expenditures among all groups that had a coexisting chronic physical condition. Conclusions: Among adults with T2DM and chronic conditions, treatment with both antidepressants and psychotherapy may result in economic benefits

Internet of Things, blockchain and shared economy applications

This paper explores how the Internet of Things and blockchain technology can benefit shared economy applications. The focus of this research is understanding how blockchain can be exploited to create decentralised, shared economy applications that allow people to monetise, securely, their things to create more wealth. Shared economy applications such as Airbnb and Uber are well-known applications, but there are many other opportunities to share in the digital economy. With the recent interest in the Internet of Things and blockchain, the opportunity exists to create a myriad of sharing applications, e.g. peer-to-peer automatic payment mechanisms, foreign exchange platforms, digital rights management and cultural heritage to name but a few. While many types of shared economy scenarios are proliferating, few of them, so far, leverage the Internet of Things and blockchain as technologies to build distributed applications. This paper discusses how we might make use of the Internet of Things and blockchains to create secure shared economy distributed applications. Presented are examples of such distributed applications in the context of an Internet of Things architecture using blockchain technology

Exploring blockchain technologies with an innovative multi-layered ontology design tool and eMudra – a novel peer to peer currency exchange application

Recent years have witnessed significant interest in shared economy applications and consequently a proliferation of such applications have emerged where people are monetizing their things. This thesis focuses on solving the problem of leftover foreign currency exchange as a shared economy application. Existing shared economy applications such as Ola, Uber or Airbnb are not deployed as decentralized applications (Dapps) leveraging blockchain and the Internet of Things (IoT), which are relatively recent technologies leading to more efficient applications that do not require the intervention of trusted third parties. Blockchain technology can be merged with IoT infrastructure to provide an immutable ledger of all the transactions related to shared economy applications; an immutable ledger is critical to the elimination of trusted third parties, making the system trustless. When blockchain and IoT are combined they can give rise to a plethora of useful shared economy applications — automatic payment mechanisms, digital rights management are some instances and in the case of this thesis a unique solution for the leftover foreign currency exchange problem. This thesis demonstrates the implementation of a novel permissioned consortium blockchain-based leftover foreign currency exchange platform that has been designed using a multi-layered blockchain ontology created with an innovative ontology design tool. The leftover foreign currency exchange problem arises because every year millions of travellers undertake international tours and need to perform currency exchange. However, there is a deficit of suitable currency exchange applications that would help travellers exchange money profitably and conveniently, especially small amounts of cash. This thesis proposes a novel peer to peer currency exchange application – e-Mudra, exploiting blockchain technology that would allow users to choose or quote their preferred exchange rates and exchange currencies including cash money with peer travellers without any middleman deciding the rates. The research work described focuses on an in-depth study of blockchain technology and a new multi-layered blockchain ontology is created with an innovative ontology design tool that facilitates generation of simple and complex ontologies enabling the design of blockchain (and other) applications using these ontologies. The novel ontology design tool created in this research work following a new Ontology Development Life Cycle and an ontology design methodology was used to design a blockchain ontology and a wallet ontology as examples of use, where the currency exchange application design (e-Mudra) is an instance of the blockchain ontology

A multi-layered ontological approach to blockchain technology

In 2009, blockchain led the foundation of an era of cryptocurrencies with Bitcoin playing the role of avant-garde in the series. This phenomenal technology behind Bitcoin has been visualized by many as having far reaching impacts not only in finance and economy, but also in other sectors. This decade has witnessed the emergence of different types of blockchain, associated platforms and a plethora of applications without any standardization of the associated concepts. To facilitate a common interpretation of this technology among its users, we present a multi-layered blockchain ontology that can be leveraged for constructing a structured knowledge management and representation system in this domain. We propose a new Ontology Development Life Cycle and a methodology for the design of such complex ontologies of emerging technologies like blockchain. We devised a prototype tool leveraging the proposed methodology that will enable implementing a multi-layered modularized ontology for any domain and design applications for that domain

eMudra - A leftover foreign currency exchange system utilizing the blockchain technology

The global travel industry leaves almost every traveller with some amount of leftover foreign currency at the end of the trip. Most travellers are unable to use these leftover foreign currencies efficiently and profitably because exchange bureau rates do not favour the traveller nor accept low denomination coins. In this paper, we explore existing currency exchange systems for leftover foreign currency and consider prevalent challenges. We propose an innovative system, eMudra, for exchanging cash based leftover foreign currency by integrating smart kiosk-based systems with peer-to-peer currency exchange utilizing the concept of blockchain technology alleviating the challenges. A key component of our system advocates the role of wearable technology for secure identification with a kiosk-based transactions user interface. We have implemented, tested and evaluated eMudra components - the User Wallet and the Transaction Management Network as a permissioned consortium blockchain while simulating the kiosk interface and associated physical bill and coin exchange. Leftover foreign currency lying unused in the wallets and drawers of travellers is significant and can easily add up to billions if considered globally. Our blockchain based system, eMudra, can play an important role in bringing these currencies back into the global economy by making money deposit, management and exchange process easy and lucrative