How Engaged Are Consumers in Their Health and Health Care, and Why Does It Matter?

Summarizes findings on U.S. patients' ability to manage their health and health care by income level, education, Medicaid status, and health status. Examines access to care by level of engagement among the chronically ill. Discusses policy implications

NGC 4438: Ram pressure sweeping of a tidally disrupted galaxy

NGC 4438 is the highly HI deficient peculiar spiral in the center of the Virgo cluster. Observations are given of the neutral hydrogen emission obtained with the Very Large Array (VLA) in the D-array configuration. These observations map out the total HI as determined from single dish measurements, and show the hydrogen to be confined to a region about one third the size of the optical disk and displaced to the side of the galaxy opposite M87. The hydrogen content of the galaxy is over an order of magnitude less than that expected for a galaxy of its type. The data suggest that the HI deficiency is a result of ram pressure stripping of the gas in the outer regions of the galaxy by the hot intracluster medium after being tidally perturbed

Spectral emittance of soot

Spectral emittance of thin soot layers on transparent substrate

When Patient Activation Levels Change, Health Outcomes and Costs Change, Too

Patient engagement has become a major focus of health reform. However, there is limited evidence showing that increases in patient engagement are associated with improved health outcomes or lower costs. This report examined the extent to which a single assessment of engagement, the Patient Activation Measure, was associated with health outcomes and costs over time, and whether changes in assessed activation were related to expected changes in outcomes and costs. The report uses data on adult primary care patients from a single large health care system where the Patient Activation Measure is routinely used. Results indicating higher activation in 2010 were associated with nine out of thirteen better health outcomes -- including better clinical indicators, more healthy behaviors, and greater use of women's preventive screening tests -- as well as with lower costs two years later. Changes in activation level were associated with changes in over half of the health outcomes examined, as well as costs, in the expected directions. These findings suggest that efforts to increase patient activation may help achieve key goals of health reform and that further research is warranted to examine whether the observed associations are causal

Gas in merging galaxies

We present observations of the neutral hydrogen, ionized hydrogen, and starlight of galaxies chosen from the 'Toomre Sequence' of merging galaxies. This sequence is meant to represent the progressive stages of the merger of two disk galaxies into a single elliptical-like remnant. The galaxies in this study span the full range of this sequence. The stars and atomic gas are very differently distributed, with the stars more widely distributed at early stages, and the gas much more widely distributed at later stages. Large quantities of neutral gas are sent to large radii (greater than or approximately equal to 100 h(exp -1) kpc), and still persist even after the central remnant has relaxed to an r(sup 1/4) light profile. There are a few times 10(exp 9) solar masses h(exp -2) of both molecular and atomic gas in each of these systems. Throughout the different stages, about half of the total gas mass lies within the galaxies' optical bodies. The fraction of this mass that is in neutral hydrogen drops rapidly in the later stage mergers, suggesting that atomic gas is processed into molecular gas, stars, and hot gas during the merger and resulting starburst. Star formation occurs at all stages of the interaction, both within the tails and in the central bodies. In the early stages, the H(alpha) shows many arcs and plumes. In the late stages, there are large H 2 regions in the tails which are associated with large quantities of neutral hydrogen. There is always a very good correlation between optical, H(alpha), and H1 peaks, with N(sub H1) greater than or approximately equal 3 x 10(exp 20) cm(exp -2) at the location of the H2 regions in the tails

Second-Generation Consumerism: Increasing Consumer Activation to Improve Health Outcomes and Lower Costs for Patients with Chronic Disease

With health care costs increasing, some policymakers have sought to make patients better health care consumers through increased cost-sharing linked with greater information on the cost of care. These may be successful cost containment strategies in the short term. But patients are just as likely to forgo necessary as unnecessary care, which ultimately leads to greater demand for more intensive and expensive care in the long term. Patients can, however, play an important role in preventing the onset of chronic conditions or preventing deterioration in health once they have been diagnosed with a chronic condition. In this chapter we discuss tools available to identify and empower—or activate —patients to be better managers of their health. We also suggest heath care delivery reform options to encourage the expansion of programs that empower patients to improve their health and control personal health care costs, thereby improving health outcomes and containing costs for all

Dynamically-Driven Star Formation In Models Of NGC 7252

We present new dynamical models of the merger remnant NGC 7252 which include star formation simulated according to various phenomenological rules. By using interactive software to match our model with the observed morphology and gas velocity field, we obtain a consistent dynamical model for NGC 7252. In our models, this proto-elliptical galaxy formed by the merger of two similar gas-rich disk galaxies which fell together with an initial pericentric separation of ~2 disk scale lengths approximately 620 Myr ago. Results from two different star formation rules--- density-dependent and shock-induced--- show significant differences in star formation during and after the first passage. Shock-induced star formation yields a prompt and wide-spread starburst at the time of first passage, while density-dependent star formation predicts a more slowly rising and centrally concentrated starburst. A comparison of the distributions and ages of observed clusters with results of our simulations favors shock-induced mechanism of star formation in NGC 7252. We also present simulated color images of our model of NGC 7252, constructed by incorporating population synthesis with radiative transfer and dust attenuation. Overall the predicted magnitudes and colors of the models are consistent with observations, although the simulated tails are fainter and redder than observed. We suggest that a lack of star formation in the tails, reflected by the redder colors, is due to an incomplete description of star formation in our models rather than insufficient gas in the tails.Comment: 11 pages, 9 figures, to be published in MNRA

The role of primary care providers in patient activation and engagement in self-management: a cross-sectional analysis

Background The increasing burden of chronic illness highlights the importance of self-care and shifts from hierarchical and patriarchal models to partnerships. Primary care providers (PCPs) play an important role in supporting patients in self-management, enabling activation and supporting chronic care. We explored the extent to which PCPs’ beliefs about the importance of the patients’ role relate to the frequency in which they report engaging in collaborative and partnership-building behaviors with patients. Methods PCPs’ beliefs were measured using the Clinician Support for Patient Activation Measure (CS-PAM). We also assessed whether PCPs’ CS-PAM scores were positively associated with changes in their patients’ Patient Activation Measure (PAM) scores. Participants included 181 PCPs from a single accountable care organization in Minnesota who completed an online survey. We conducted bivariate analyses and multivariate regression models to examine relationships between CS-PAM and PCP self-management support behaviors and changes in level of patient activation. Results PCPs with high CS-PAM scores were much more likely to engage in supportive self-management and patient behavior change approaches, such as involving the patient in agenda-setting, problem-solving, and collaboratively setting behavioral goals, than were PCPs with low CS-PAM scores. More positive PCPs’ belief in the patients’ role in self-management was positively correlated with improvements in their patients’ level of patient activation. Conclusions More positive PCP beliefs about the patients’ role in self-management was strongly related to PCP behaviors geared towards increasing patient activation

Star Clusters in the Tidal Tails of Interacting Galaxies: Cluster Populations Across a Variety of Tail Environments

We have searched for compact stellar structures within 17 tidal tails in 13 different interacting galaxies using F606W- and F814W- band images from the Wide Field Planetary Camera 2 (WFPC2) on the Hubble Space Telescope (HST). The sample of tidal tails includes a diverse population of optical properties, merging galaxy mass ratios, HI content, and ages. Combining our tail sample with Knierman et al. (2003), we find evidence of star clusters formed in situ with Mv < -8.5 and V-I < 2.0 in 10 of 23 tidal tails; we are able to identify cluster candidates to Mv = -6.5 in the closest tails. Three tails offer clear examples of "beads on a string" star formation morphology in V-I color maps. Two tails present both tidal dwarf galaxy (TDG) candidates and cluster candidates. Statistical diagnostics indicate that clusters in tidal tails may be drawn from the same power-law luminosity functions (with logarithmic slopes ~ -2 - -2.5) found in quiescent spiral galaxies and the interiors of interacting systems. We find that the tail regions with the largest number of observable clusters are relatively young (< 250 Myr old) and bright (V < 24 mag arcsec^(-2)), probably attributed to the strong bursts of star formation in interacting systems soon after periapse. Otherwise, we find no statistical difference between cluster-rich and cluster-poor tails in terms of many observable characteristics, though this analysis suffers from complex, unresolved gas dynamics and projection effects.Comment: Accepted for publication in the Astrophysical Journal. 27 pages, 8 figure

How Dry Are Red Mergers?

The focus of current research in galaxy evolution has increasingly turned to understanding the effect that mergers have on the evolution of systems on the red sequence. For those interactions purported to occur dissipationlessly (so called "dry mergers"), it would appear that the role of gas is minimal. However, if these mergers are not completely dry, then even low levels of gas may be detectable. The purpose of our study is to test whether early type galaxies with HI in or around them, or "wet" ellipticals, would have been selected as dry mergers by the criteria in van Dokkum (2005, AJ, 130, 2647). To that end, we examine a sample of 20 early types from the HI Rogues Gallery with neutral hydrogen in their immediate environs. Of these, the 15 brightest and reddest galaxies match the optical dry merger criteria, but in each case, the presence of HI means that they are not truly dry.Comment: 8 pages plus 1 table and 5 figures; accepted for publication in A