Driving Value in Medicaid Primary Care: The Role of Shared Support Networks for Physician Practices

Examines the challenges of transforming small primary care practices under healthcare reform and options for Medicaid to drive changes through practice supports to help implement and sustain new models of care or catalyze investments in new systems

Post-impact behavior of composite solid rocket motor cases

In recent years, composite materials have seen increasing use in advanced structural applications because of the significant weight savings they offer when compared to more traditional engineering materials. The higher cost of composites must be offset by the increased performance that results from reduced structural weight if these new materials are to be used effectively. At present, there is considerable interest in fabricating solid rocket motor cases out of composite materials, and capitalizing on the reduced structural weight to increase rocket performance. However, one of the difficulties that arises when composite materials are used is that composites can develop significant amounts of internal damage during low velocity impacts. Such low velocity impacts may be encountered in routine handling of a structural component like a rocket motor case. The ability to assess the reduction in structural integrity of composite motor cases that experience accidental impacts is essential if composite rocket motor cases are to be certified for manned flight. The study described herein was an initial investigation of damage development and reduction of tensile strength in an idealized composite subjected to low velocity impacts

Lois Whaley Highsmith

After originally studying chemical engineering at Penn State, Lois Highsmith decided to instead pursue nursing. At Jefferson she found a passion for community health nursing, specifically related to obstetrics, gynecology, and maternal child health. Ms. Highsmith graduated in 1986 and over the years worked mostly in maternal care but also in psychology. Among other positions, she worked for ten years at Pennsylvania Hospital where she founded STEPS, Strategies to Encourage Parental Self-Sufficiency, a teen pregnancy clinic, and worked as a home visitor for Mercy Home Health educating new moms about postpartum care. Since 2002 she has worked for Nurse Family Partnership, a home visiting program for first-time pregnant women that teaches women about child development, pregnancy, women’s health, and community resources.https://jdc.jefferson.edu/nursing_oral_histories/1014/thumbnail.jp

The Implications of Inequality for Fiscal Federalism (or Why the Federal Government Should Pay for Local Public Schools)

In designing public policy, a question of first principle is the degree to which government services—and the mechanisms of collecting revenue to finance those services—should be centralized within and across political systems. To inform their assessments of where redistribution should properly occur, public finance researchers have, to date, worked backwards from different assumptions about the mobility of residents within the political community. Scholars have disagreed about the viability of local governments’ efforts to redistribute wealth—with traditionalists arguing that these efforts are made impossible by residential mobility, and recent reformists countering that limitations on mobility indeed allow for limited redistribution at the local level. But these arguments have largely sidestepped questions about what level of centralization is theoretically optimal for redistributive programs. And by focusing on the empirical question of residential mobility, they have ignored a variable that—I seek to demonstrate—is at least as important. In this Essay, I argue that those two deficiencies in the literature are connected. I introduce a simple model to show that economic redistribution becomes more difficult—indeed, approaches impossibility—as economic inequality increases, regardless of one’s assumptions about levels of mobility (by the rich or poor). That is because economic inequality has an inherent spatial dimension: so long as citizens exhibit anything short of perfect mobility (and perfect responsiveness to redistributive policy), its rise will result in an increasing geographic concentration of fiscal resources available to governments. For this reason, higher levels of economic inequality strengthen the case for centralizing the financing of any public good or program with redistributive goals—including the great bulk of what contemporary governments aim to do. I introduce the concept of a “fiscal unit” to refer to the geographic scope of public financing—which might be, depending on the program, a school district boundary, a county, a state, or the entire country. In order to achieve an equitable allocation of public goods, policymakers should respond to rising income inequality by shifting the site of revenue collection to occur at widely drawn “fiscal units”. This can take two forms. It can be done by expanding the scope of fiscal boundaries—for example, by funding locally-administered programs at the state or federal level. Alternatively, policymakers could respond to inequality by increasing fiscal transfers from higher levels of government (wider fiscal units) to lower, geographically smaller governments. Rather than an afterthought, the existing level of economic inequality within a political community may be the single most important question for this aspect of policy design. Where wealth is unequally distributed, the primary responsibility of assessing the revenues used to finance public goods should be assumed by levels of government representing the greatest number of people. This paper thus suggests that policymakers should respond to rising income inequality by shifting not only the burden but also the site of redistributive taxation

Making Training Memorable: Assessing the Impact of Animated Video on Learner Satisfaction, Engagement and Knowledge Retention

Media rich video provides attributes such as animation, narration, and music that can be incorporated into learning modules which have high potential to promote learning. This project evaluated the impact of transitioning a learning module from static PowerPoint slides to animated (media rich) video on employee satisfaction, engagement, and knowledge retention. Learner satisfaction and engagement was measured using a validated survey instrument designed to evaluate the effectiveness, appeal, and efficiency of the animated video about Hospice and Palliative Care. Knowledge retention was measured by comparing post-test scores between the initial and subsequent second post-test. A retrospective design was used to evaluate learner performance between PowerPoint slides and Animated Video. Previous post-test score means of learners who received the traditional learning content delivered through PowerPoint slides were compared to those learners who received the same learning content through Animated Video. Overall, subjects responded positively toward the animated video and subjects strongly supported using animated video to deliver the training content as opposed to PowerPoint slides. Post-test scores between the initial and second post-test scores showed no difference between the two scores indicating that the subjects retained the information. Employee performance on the post-test improved significantly compared to the performance of employees in the retrospective population who received the content from PowerPoint slides. Implementing animated video to deliver Hospice and Palliative Care training to hospital employees resulted in improved employee learning and favorable employee 3 perceptions about the use of animated video to deliver hospital training to employees

Foster youth group homes: A needs assessment

The focus of this study is to identify the key elements of effective care in foster youth group homes from perspectives of the direct care staff. Specific outcomes are now measured in group home care, they are listed as follows: children must be protected from abuse and neglect; they must have stable living arrangements; they must have services to meet educational, physical, and mental health needs, and they must have a plan for youth to transition into adulthood

Crack path determination for non-proportional mixed-mode fatigue

The objective of this work is to study crack path deflection under proportional and non-proportional mixed-mode fatigue and predict crack branching direction based on linear elastic fracture mechanics (LEFM) driving forces. Under proportional in-phase mixed Mode I / Mode II loading conditions, crack growth direction has previously been observed in some materials to shift from tensile-dominated Mode I to shear-dominated Mode II or mixed-mode crack growth at higher proportions of initial Mode II loading, but non-proportional loads are not well-characterized. An LEFM approach is desired in order to implement the model in crack growth software such as the boundary element-based fracture analysis package FRANC3D. A novel specimen configuration has been designed and analyzed for generation of wide ranges of mixed-mode loading conditions in a single test. This specimen and a more conventional thin-walled tubular specimen have been used to test polycrystalline nickel-base superalloy Inconel 718 under proportional in-phase and 3 kinds of non-proportional fatigue loading. Stress intensity factors for the various configurations have been analyzed with FRANC3D. Modal transition from Mode I (tensile) to Mode II (shear) crack branching has been observed in several load cases. Qualitative microscopy of fracture surfaces was used to characterize the difference between crack branch modes. An LEFM approach based on an effective stress intensity factor range, which incorporates the maximum value and range of each appropriate stress intensity (Mode I or Mode II), has been used to successfully predict the crack deflection angles, and in some cases to quantify modal transition, within each load case considered. Variability between load cases and specimen configurations points to the limitations of LEFM in providing a general predictor of crack path behavior across all types of non-proportional mixed mode loading.Ph.D.Committee Chair: Johnson, William Steven; Committee Member: Neu, Richard W.; Committee Member: Qu, Jianmin; Committee Member: Sanders, Thomas H.; Committee Member: Thadhani, Naresh N

COVID-19 and Xenophobia: Reckoning with East Asian Identities in the United States

This paper examines how the recent wave of COVID-19-related xenophobia towards East Asian Americans has affected participants\u27 perceptions of their identities as Asian Americans, as well as how race-related experiences prior to COVID have influenced the way that people are able to cope with explicit anti-Asian sentiment