ANALYSIS OF KENTUCKY MEDICAID MANAGED CARE VERSUS FEE-FOR-SERVICE SYSTEMS: MEDICATION ADHERENCE IN PATIENTS WITH PREVALENT CHRONIC DISEASES

Objectives: Managed care organizations reduce healthcare costs and may improve patient health outcomes by encouraging better control of prevalent chronic diseases. The purpose of this study was to determine whether changing from a fee-for-service program to a capitated managed care program improved medication adherence for Medicaid patients in Kentucky with hypertension, hypercholesterolemia, or type 2 diabetes. Methods: We conducted a quasi-experimental study of patients enrolled in Kentucky Medicaid to evaluate the impact of transitioning to capitated managed care in November 2011. Medication adherence was measured using the proportion of days covered (PDC) method. Multivariable analyses measured the adjusted differences in adherence as a result of the implementation of capitated managed care. Results: Adjusted analyses indicate an average decrease in PDC by about 17-22 days of therapy coverage in the post-policy time period. However, no significant difference in adherence rate changes between the treatment and control populations were observed. Conclusions: Results indicate clinically inconclusive evidence regarding the immediate effect of the implementation of Medicaid managed care in Kentucky on medication adherence rates in patients with prevalent chronic diseases. There is a need to address the decline in average adherence rates, and the efficacy of Medicaid managed care based on medication adherence

User documentation for the MSK and OMS intelligent tutoring systems

This user's guide describes how to use the Intelligent Tutoring Systems for the Manual Select Keyboard (MSK) and the Orbital Maneuvering System (OMS) and how to use the C code that runs the mockup version of the MSK

An intelligent tutoring system for the investigation of high performance skill acquisition

The issue of training high performance skills is of increasing concern. These skills include tasks such as driving a car, playing the piano, and flying an aircraft. Traditionally, the training of high performance skills has been accomplished through the use of expensive, high-fidelity, 3-D simulators, and/or on-the-job training using the actual equipment. Such an approach to training is quite expensive. The design, implementation, and deployment of an intelligent tutoring system developed for the purpose of studying the effectiveness of skill acquisition using lower-cost, lower-physical-fidelity, 2-D simulation. Preliminary experimental results are quite encouraging, indicating that intelligent tutoring systems are a cost-effective means of training high performance skills

Microelectrophoresis of selected mineral particles

Particle mobilities of ilmenite, labradorite plagioclase, enstatite pyroxene, and olivine were measured with a Rank microelectrophoresis system to evaluate indicated mineral separability. Sodium bicarbonate buffer suspension media with and without additives (0.0001 M DTAB and 5 percent v/v ethylene glycol) were used to determine differential adsorption by mineral particles and modification of relative mobilities. Good separability between some minerals was indicated; additives did not enhance separability

A knowledge engineering taxonomy for intelligent tutoring system development

This paper describes a study addressing the issue of developing an appropriate mapping of knowledge acquisition methods to problem types for intelligent tutoring system development. Recent research has recognized that knowledge acquisition methodologies are not general across problem domains; the effectiveness of a method for obtaining knowledge depends on the characteristics of the domain and problem solving task. Southwest Research Institute developed a taxonomy of problem types by evaluating the characteristics that discriminate between problems and grouping problems that share critical characteristics. Along with the problem taxonomy, heuristics that guide the knowledge acquisition process based on the characteristics of the class are provided

Research into the development of a knowledge acquisition taxonomy

The focus of the research was on the development of a problem solving taxonomy that can support and direct the knowledge engineering process during the development of an intelligent tutoring system. The results of the research are necessarily general. Being only a small initial attempt at a fundamental problem in artificial intelligence and cognitive psychology, the process has had to be bootstrapped and the results can only provide pointers to further, more formal research designs

Response of silicon solar cell to pulsed laser illumination

The response of silicon solar cell(s) to pulsed laser illumination is discussed. The motivation was due to the interest of Earth to space/Moon power beaming applications. When this work began, it was not known if solar cells would respond to laser light with pulse lengths in the nanosecond range and a repetition frequency in the kHz range. This is because the laser pulse would be shorter than the minority carrier lifetime of silicon. A 20-nanosecond (ns) full width half max (FWHM) pulse from an aluminum-gallium/arsenide (Al-Ga-As) diode laser was used to illuminate silicon solar cells at a wavelength of 885 nanometers (nm). Using a high-speed digital oscilloscope, the response of the solar cells to individual pulses across various resistive loads was observed and recorded

Vacuum Strength of Two Candidate Glasses for a Space Observatory

The strengths of two candidate glass types for use in a space observatory were measured. Samples of ultra-low expansion glass (ULE) and borosilicate (Pyrex) were tested in air and in vacuum at room temperature (20 C) and in vacuum after being heated to 200 C. Both glasses tested in vacuum showed an increase in strength over those tested in air. However, there was no statistical difference between the strength of samples tested in vacuum at room temperature and those tested in vacuum after heating to 200 C

Early predictors of separation anxiety disorder : early stranger anxiety, parental pathology and prenatal factors

&lt;i&gt;Objective:&lt;/i&gt; The present study seeks to extend research on the etiology of separation anxiety disorder (SAD) in a German-speaking sample by examining differences between children with SAD and healthy comparisons, using a retrospective-reporting paradigm. &lt;i&gt;Method:&lt;/i&gt; The sample included 106 children with SAD and 44 healthy children between the ages of 4 and 14 years. Parents completed questionnaires and structured clinical interviews to assess parental pathology, pregnancy variables and strong early stranger anxiety. &lt;i&gt;Results:&lt;/i&gt; Children with SAD were more likely than healthy children to have had a phase of stronger stranger anxiety in infancy. Further, early stranger anxiety remained a significant predictor of SAD after controlling for maternal depression. Meaningful effects were not found for the influence of parental age at birth or other pregnancy factors. &lt;i&gt;Conclusion:&lt;/i&gt; This study provides beginning evidence of the potential predictive value of strong stranger anxiety in distinguishing children with SAD from those with no disorder, above and beyond the influence of parental pathology.</jats:p