The Burden of Out-of-Pocket Health Spending Among Older Versus Younger Adults: Analysis from the Consumer Expenditure Survey, 1998-2003

Analyzes the extent to which health care spending as a share of income has differed among younger adults versus people ages 65 and older, both at a single point in time (2003) and over the six-year period from 1998 to 2003

MRI white matter lesion segmentation using an ensemble of neural networks and overcomplete patch-based voting

[EN] Accurate quantification of white matter hyperintensities (WMH) from Magnetic Resonance Imaging (MRI) is a valuable tool for the analysis of normal brain ageing or neurodegeneration. Reliable automatic extraction of WMH lesions is challenging due to their heterogeneous spatial occurrence, their small size and their diffuse nature. In this paper, we present an automatic method to segment these lesions based on an ensemble of overcomplete patch-based neural networks. The proposed method successfully provides accurate and regular segmentations due to its overcomplete nature while minimizing the segmentation error by using a boosted ensemble of neural networks. The proposed method compared favourably to state of the art techniques using two different neurodegenerative datasets. (C) 2018 Elsevier Ltd. All rights reserved.This research has been done thanks to the Australian distinguished visiting professor grant from the CSIRO (Commonwealth Scientific and Industrial Research Organisation) and the Spanish "Programa de apoyo a la investigacion y desarrollo (PAID-00-15)" of the Universidad Politecnica de Valencia. This research was partially supported by the Spanish grant TIN2013-43457-R from the Ministerio de Economia y competitividad. This study has been carried out also with support from the French State, managed by the French National Research Ageny in the frame of the Investments for the future Program IdEx Bordeaux (ANR-10-IDEX-03-02, HL-MRI Project), Cluster of excellence CPU and TRAIL (HR-DTI ANR-10-LABX-57) and the CNRS multidisciplinary project Defi imag'In. Some of the data used in this work was collected by the AIBL study group. Funding for the AIBL study is provided by the CSIRO Flagship Collaboration Fund and the Science and Industry Endowment Fund (SIEF) in partnership with Edith Cowan University (ECU), Mental Health Research Institute (MHRI), Alzheimer's Australia (AA), National Ageing Research Institute (NARI), Austin Health, Macquarie University, CogState Ltd, Hollywood Private Hospital, and Sir Charles Gairdner Hospital.Manjón Herrera, JV.; Coupe, P.; Raniga, P.; Xia, Y.; Desmond, P.; Fripp, J.; Salvado, O. (2018). MRI white matter lesion segmentation using an ensemble of neural networks and overcomplete patch-based voting. Computerized Medical Imaging and Graphics. 69:43-51. https://doi.org/10.1016/j.compmedimag.2018.05.001S43516

Acute hospital dementia care: results from a national audit

Background: Admission to an acute hospital can be distressing and disorientating for a person with dementia, and is associated with decline in cognitive and functional ability. The objective of this audit was to assess the quality of dementia care in acute hospitals in the Republic of Ireland. Methods: Across all 35 acute public hospitals, data was collected on care from admission through discharge using a retrospective chart review (n = 660), hospital organisation interview with senior management (n = 35), and ward level organisation interview with ward managers (n = 76). Inclusion criteria included a diagnosis of dementia, and a length of stay greater than 5 days. Results: Most patients received physical assessments, including mobility (89 %), continence (84 %) and pressure sore risk (87 %); however assessment of pain (75 %), and particularly functioning (36 %) was poor. Assessment for cognition (43 %) and delirium (30 %) was inadequate. Most wards have access at least 5 days per week to Liaison Psychiatry (93 %), Geriatric Medicine (84 %), Occupational Therapy (79 %), Speech & Language (81 %), Physiotherapy (99 %), and Palliative Care (89 %) Access to Psychology (9 %), Social Work (53 %), and Continence services (34 %) is limited. Dementia awareness training is provided on induction in only 2 hospitals, and almost half of hospitals did not offer dementia training to doctors (45 %) or nurses (48 %) in the previous 12 months. Staff cover could not be provided on 62 % of wards for attending dementia training. Most wards (84 %) had no dementia champion to guide best practice in care. Discharge planning was not initiated within 24 h of admission in 72 % of cases, less than 40 % had a single plan for discharge recorded, and 33 % of carers received no needs assessment prior to discharge. Length of stay was significantly greater for new discharges to residential care (p < .001). Conclusion: Dementia care relating to assessment, access to certain specialist services, staffing levels, training and support, and discharge planning is sub-optimal, which may increase the risk of adverse patient outcomes and the cost of acute care. Areas of good practice are also highlighted

Teamwork execution and team resilience: A multi-study examination of reciprocal and longitudinal relationships

The purpose of this multi-study paper was to examine relationships between variables within an input-mediator-outcome (IMO) framework of team effectiveness in sport over the course of a competitive season. In Study 1, 1,566 athletes (Mage = 22.1 years, SD = 5.2) from 104 teams completed measures of teamwork execution and team resilience at two timepoints (two months apart) during a season. Multilevel structural equation modeling (MSEM) revealed significant, reciprocal, and positive relationships between teamwork execution and characteristics of resilience, as well as significant, reciprocal, and negative relationships between teamwork execution and vulnerability under pressure, from Time 1 (T1) to Time 2 (T2) at both the individual and team level. Study 2 built on these findings by testing propositions from the IMO model of team effectiveness. Measures of perceived athlete leadership quality (input; T1), teamwork execution and team resilience (mediators; T2), and team performance (outcome; Time 3 [T3]) were completed by 1,117 athletes (Mage = 24.8, SD = 5.6) within 92 teams over eight months. MSEM showed perceived athlete leadership quality had significant positive association with teamwork execution and characteristics of resilience at player and team levels, and significant negative relationship with player-level vulnerability under pressure. Of the mediators assessed at T2, only teamwork execution had a significant and positive relationship with perceived team performance at T3, specifically at the player level. Our findings highlight the reciprocal relationship between teamwork execution and team resilience, the importance of athlete leadership in fostering these mediators, and the associations of those variables on perceptions of team performance

Saccadic Eye Movement Characteristics in Adult Niemann-Pick Type C Disease: Relationships with Disease Severity and Brain Structural Measures

Niemann-Pick Type C disease (NPC) is a rare genetic disorder of lipid metabolism. A parameter related to horizontal saccadic peak velocity was one of the primary outcome measures in the clinical trial assessing miglustat as a treatment for NPC. Neuropathology is widespread in NPC, however, and could be expected to affect other saccadic parameters. We compared horizontal saccadic velocity, latency, gain, antisaccade error percentage and self-paced saccade generation in 9 adult NPC patients to data from 10 age-matched controls. These saccadic measures were correlated with appropriate MRI-derived brain structural measures (e.g., dorsolateral prefrontal cortex, frontal eye fields, supplemental eye fields, parietal eye fields, pons, midbrain and cerebellar vermis) and with measures of disease severity and duration. The best discriminators between groups were reflexive saccade gain and the two volitional saccade measures. Gain was also the strongest correlate with disease severity and duration. Most of the saccadic measures showed strongly significant correlations with neurophysiologically appropriate brain regions. While our patient sample is small, the apparent specificity of these relationships suggests that as new diagnostic methods and treatments become available for NPC, a broader range of saccadic measures may be useful tools for the assessment of disease progression and treatment efficacy.No external funding was received for this study. JCLL self-funded computational, travel and accommodation costs to conduct his component of this research in Melbourne

Human peritoneal mesothelial cells display phagocytic and antigen-presenting functions to contribute to intraperitoneal immunity

Mesothelial cells lining the peritoneal cavity are strategically positioned to respond to and counter intraperitoneal infections, cancer cells, and other challenges. We have investigated human peritoneal mesothelial cells (HPMCs) for phagocytic activity, expression of surface MHC Class II and accessory molecules involved in antigen presentation, and the ability to present recall antigens to T cells. Phagocytosis of dextran, latex beads and Escherichia coli was observed by flow cytometry, and internalization was visualised using confocal and electron microscopy. Flow cytometry and/or cellular ELISA showed constitutive expression of ICAM-I, LFA-3, and B7-1, but not B7-2 or MHC II. Interferon-gamma induced MHC II and ICAM-1 expression in a dose- and time-dependent manner. Importantly, HPMCs induced autologous CD3+ T lymphocyte proliferation (3H-incorporation) after pulse with recall antigen. HPMCs equipped with phagocytic and antigen-presenting machinery are anticipated to have an integral role in intraperitoneal immune surveillance

Black Box 2018

The Black Box is a student based creative publication serving the Embry-Riddle Prescott campus. It is our goal to provide a showcase for the creativity and talent of the Embry-Riddle students. Creative works by members of Embry-Riddle\u27s faculty and staff are included. Cover Art: Ryan Standley; Editor: Kelvin Russell

Establishing the Scope and Methodological Approach to Out-of-hospital Outcomes and Effectiveness Research

: Outcomes research offers out-of-hospital medicine a valuable methodology for studying the effectiveness of services provided in the out-of hospital setting. A clear understanding of the history and constructs of outcomes research is necessary for its integration into emergency medical services research. This report describes the conceptual framework of outcomes research and key methodological considerations for the successful implementation of out-of-hospital outcomes research. Illustrations of the specific applications of outcomes research and implications to existing methodologies are given, as well as suggestions for improved interdisciplinary research.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75033/1/j.aem.2004.04.014.pd

Risk Adjustment and Outcome Measures for Out-of-hospital Respiratory Distress

: The purpose of the Emergency Medical Services Outcomes Project (EMSOP) is to develop a foundation and framework for out-of-hospital outcomes research. In prior work, this group delineated the priority conditions, described conceptual models, suggested core and risk adjustment measures potentially useful to emergency medical services research, and summarized out-of-hospital pain measurement. In this fifth article in the EMSOP series, the authors recommend specific risk-adjustment measures and outcome measures for use in out-of-hospital research on patients presenting with respiratory distress. The methodology included systematic literature searches and a structured review by an expert panel. The EMSOP group recommends use of pulse oximetry, peak expiratory flow rate, and the visual analog dyspnea scale as potential risk-adjustment measures and outcome measures for out-of-hospital research in patients with respiratory distress. Furthermore, using mortality as an outcome measure is also recommended. Future research is needed to alleviate the paucity of validated tools for out-of-hospital outcomes research.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73779/1/j.aem.2004.03.010.pd