A Comparison of the Utilization of Health Services in the Presence or Absence of Prescriptive Drug Insurance in a Managed Care Environment

This study tested if the availability of third party payment for prescriptive drugs as part of employer sponsored health insurance was associated with a change in the utilization of four types of health services in an independent practice association (IPA). The study employed the individual determinants component of the Andersen-Newman theoretical framework for health services utilization. Groups of employees in companies that offered health insurance identical in all ways except for the presence or absence of the prescriptive rider were included in the study which resulted in a population of 122 companies (89 with prescriptive rider insurance and 33 without prescriptive rider insurance) involving 931 members. Two years of claims data were analyzed to identify differences in utilization of primary care providers, urgent care centers, emergency departments and hospitals. Using measures of central tendency to evaluate expenditures, utilization of the relatively lower-cost health services such as visits to the primary care provider and urgent care centers was greater in the group of companies offering the rider benefit than the group of companies that did not include prescriptive drugs as part of the health care benefit. The two groups experienced similar utilization of emergency departments. The average expenditure per company for hospital utilization was 67.8% lower in the group with prescriptive insurance as compared to the group without prescriptive insurance. Taken together, average expenditures per company for the four health services totaled $1573 more for the group without prescriptive insurance as compared to the group with prescriptive insurance. The results of this study suggest that the patient with financial barriers to prescriptive medication may not be utilizing office visits to the primary care provider or urgent care center and raises a question regarding the more costly hospital services that may result

Effective teaching techniques with autistic children

The topic of discussion in this paper will be children who display autistic behavior and how they can be effectively dealt with in the classroom situation. The writer feels strongly about researching this topic because of his present involvement with autistic children in a classroom setting. The discoveries and questions raised by this paper will aid greatly in stimulating future thoughts and varied approaches aimed, at reaching and teaching this particular class of children

Washington Trust Law\u27s Extreme Makeover: Blending with the Uniform Trust Code and Taking Reform Further with Innovations in Notice, Situs, and Representation

Washington trust laws were comprehensively revised in 2011 and 2013, resulting in the integration of concepts from the Uniform Trust Code and the addition of some novel provisions. This article discusses in depth the evolution of Washington law regarding the duties to inform and report, the situs of a trust, and representation of interested parties. In addition, this article discusses other UTC provisions that were integrated into Washington statutes and gives an explanation of any departures from UTC language and prior Washington law

Washington Trust Laws\u27 Extreme Makeover: Blending with the Uniform Trust Code and Taking Reform Further with Innovations in Notice, Situs, and Representation

Washington trust laws were comprehensively revised in 2011 and 2013, resulting in the integration of concepts from the Uniform Trust Code and the addition of some novel provisions. This article discusses in depth the evolution of Washington law regarding the duties to inform and report, the situs of a trust, and representation of interested parties. In addition, this article discusses other UTC provisions that were integrated into Washington statutes and gives an explanation of any departures from UTC language and prior Washington law

Status prawny hulajnóg elektrycznych i ich użytkowników – projektowane rozwiązania i wzorce zagraniczne

W niniejszym artykule podjęto się próby analizy i oceny rozwiązań proponowanych w projektowanych ramach prawnych dla hulajnóg elektrycznych pod kątem uzyskania odpowiedzi na pytania dotyczące: statusu użytkowania hulajnogi, sposobu określenia praw i obowiązków użytkowania hulajnogi, statusu hulajnogi elektrycznej, czy proponowane rozwiązania są zgodne z trendami występującymi w ustawodawstwie innych państw, jaki model regulacji powinien przyjąć polski ustawodawca, czy projektowana ustawa jest kompletna. W niniejszej pracy autorzy wyróżniają cztery aspekty, które spowodowały potrzebę uregulowania: społeczny, technologiczny, ekologiczny, ubezpieczeniowy. Po omówieniu tych aspektów, w dalszej kolejności, autorzy poświęcają uwagę przebiegowi procesu legislacyjnego oraz proponowanym rozwiązaniom prawnym, co stanowi kluczowy punkt opracowania. Omówiony zostaje status urządzeń transportu osobistego, ich użytkowników, kwestie wymogów technicznych oraz obowiązków usługodawców z zakresu zapewnienia bezpieczeństwa wypożyczanych lub sprzedawanych przez nich urządzeń. Dalsza część opracowania, poświęcona jest omówieniu i analizie regulacji zagranicznych, dotyczących środków transportu osobistego, ze wskazaniem na występowanie w tym zakresie dwóch tendencji – konserwatywnej oraz liberalnej. Na zakończenie, autorzy starają odpowiedzieć się na pytanie badawcze postawione na wstępie, mając na uwadze, że inicjatywa ustawodawcza w tym zakresie była niezbędna i stanowi właściwą odpowiedź na zapotrzebowanie gospodarcze oraz społeczne. Rosnąca liczba hulajnóg elektrycznych, a także przedsiębiorstw, które zajmują się ich wynajmem sprawia, że koniecznym było wprowadzenie przepisów jednoznacznie określających status hulajnóg i ich użytkowników

The Continuum of Premenstrual Symptom Exacerbation in Women With and Without Psychiatric Comorbidities: A Nurses' Health Study

Background: It is widely known that menstrual cycle fluctuations can significantly affect a woman's mood, behavior and quality of life over the course of her reproductive years, largely due to reproductive hormonal variations during the course of the menstrual cycle. In fact, women are twice as likely as men to experience a mood disorder. Approximately 85% percent of women experience some form of premenstrual symptom exacerbation (PME) and the majority experience symptoms, which are severe enough to interfere with their daily activities. Little is known, however, about the differences in symptom severity, stress, quality of life, healthy lifestyle and wellness self-perception among women who experience PME with and without psychiatric comorbidities. In addition, little is known about how psychiatric comorbidities affect severity of PME, stress, quality of life, healthy lifestyle and wellness self-perception. Methods: This study was conducted using a comparative descriptive design to compare premenstrual symptoms, stress, quality of life, healthy lifestyle and wellness self-perception among women experiencing PME and psychiatric comorbidities to women who experience PME without psychiatric comorbidities. Women with PME were recruited from various nursing organizations using secure online surveys. After collection of socio-demographic information, premenstrual symptom severity was measured with the Premenstrual Symptoms Screening Tool (PSST), stress with the Perceived Stress Scale (PSS), quality of life with the Quality of Life Scale (QOLS) and healthy lifestyle and wellness self-perception were assessed using the Healthy Lifestyle Questionnaire (HLQ) & Wellness Self-Perception Scale (WSPS). Data Analysis: The data was cleaned, coded and assessed for outliers and shape of distribution prior to data analysis. Analysis included descriptive statistics to describe key characteristics of the sample, and inferential statistics to test the hypotheses. Results: After controlling for diet, exercise, sleep and caffeine intake, psychiatric comorbidities predicted greater PME symptom severity (β=0.22; T=2.45; P=0.02), higher perceived stress (β=0.25; T=2.61; P=0.01), and lower levels of wellness self-perception (β= -0.30; T= -3.14; P=0.00). Psychiatric comorbidities did not predict quality of life (β= -0.13; T= -1.28; P=0.20) or healthy lifestyle (β= -0.13; T= -1.43; P=0.16). Significance: These findings may inform novel pharmacologic and non-pharmacologic interventions and treatment guidelines to achieve optimal symptom management, reduce stress and improve wellness self-perception among women with PME and psychiatric comorbidities.Dr.N.P., Nursing Practice -- Drexel University, 201

Widespread presence of direction-reversing neurons in the mouse visual system

Direction selectivity, the preference of motion in one direction over the opposite, is a fundamental property of visual neurons across species. We find that a substantial proportion of direction selective neurons in the mouse visual system reverse their preferred direction of motion in response to drifting gratings at different spatiotemporal parameters. A spatiotemporally asymmetric filter model recapitulates our experimental observations