Frequency of Participation in an Employee Fitness Program and Health Care Expenditures

Regular physical activity is strongly linked to prevention of costly chronic health conditions. However, there has been limited examination of the impact that level of participation in physical activity promotion programs has on health care costs. This study examined a fitness reimbursement program (FRP) offered to small employers. FRP participants received $20 reimbursement every month they visited their fitness center ≥12 days. Visits were recorded electronically. Participants were assigned to 4 mutually exclusive cohorts by mean monthly fitness center visits: low (<4 visits); low-moderate (≥4 and <8 visits), high-moderate (≥8 and <12 visits), and high (≥12 visits, which qualified for reimbursement). Cohorts were matched by inverse propensity score weighting on demographic, health status, health care supply, and socioeconomic characteristics. Between-cohort differences in propensity score-weighted health care costs, starting from FRP program sign-up, were examined with a generalized linear model. Analyses were conducted with and without high-cost outliers during the pre- and post-FRP period. A total of 8723 participants (mean follow-up: 11.1 months) were identified during October 2010-June 2013. With high-cost outliers removed (n?=?226), a pattern of lower per-member-per-month health care costs was observed with increasing participation: compared with the low cohort, monthly savings were:$6.14 (2.6%) for low-moderate (P?=?0.60), $16.40 (6.9$20.01 (8.4%) for high (P?=?0.08). With high-cost outliers included, significant monthly cost savings were observed for the moderate-high ($43.52, P?Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140192/1/pop.2015.0102.pd

CGM properties in VELA and NIHAO simulations; the OVI ionization mechanism: dependence on redshift, halo mass and radius

We study the components of cool and warm/hot gas in the circumgalactic medium (CGM) of simulated galaxies and address the relative production of OVI by photoionization versus collisional ionization, as a function of halo mass, redshift, and distance from the galaxy halo center. This is done utilizing two different suites of zoom-in hydro-cosmological simulations, VELA (6 halos; $z>1$) and NIHAO (18 halos; to $z=0$), which provide a broad theoretical basis because they use different codes and physical recipes for star formation and feedback. In all halos studied in this work, we find that collisional ionization by thermal electrons dominates at high redshift, while photoionization of cool or warm gas by the metagalactic radiation takes over near $z\sim2$. In halos of $\sim 10^{12}M_{\odot}$ and above, collisions become important again at $z<0.5$, while photoionization remains significant down to $z=0$ for less massive halos. In halos with $M_{\textrm v}>3\times10^{11}~M_{\odot}$, at $z\sim 0$ most of the photoionized OVI is in a warm, not cool, gas phase ($T\lesssim 3\times 10^5$~K). We also find that collisions are dominant in the central regions of halos, while photoionization is more significant at the outskirts, around $R_{\textrm v}$, even in massive halos. This too may be explained by the presence of warm gas or, in lower mass halos, by cool gas inflows

Perceptual thresholds for foot slipping in animated characters

The computer game industry continues to progress toward realistic-looking character motion. However, even in state-of-the-art games, the use of motion capture data in character animation may result in errors such as “foot slipping,” where the feet do not match up with the floor properly during translation. Various algorithms have been proposed to minimize foot slipping, including one which changes limb lengths. While foot slipping decreases the realism of character motion, there must be some threshold below which this error is imperceptible; devoting further processor time in these cases is wasteful. We apply the classical method of perception threshold determination using a set of motion clips with parameterized slipping error. From this experiment, we develop guidelines for acceptable error. Furthermore, we show that introducing simple camera motion may increase the perceptual threshold, and thus could be used to “mask” foot slipping errors

Constructing Finite Frames of a Given Spectrum and Set of Lengths

When constructing finite frames for a given application, the most important consideration is the spectrum of the frame operator. Indeed, the minimum and maximum eigenvalues of the frame operator are the optimal frame bounds, and the frame is tight precisely when this spectrum is constant. Often, the second-most important design consideration is the lengths of frame vectors: Gabor, wavelet, equiangular and Grassmannian frames are all special cases of equal norm frames, and unit norm tight frame-based encoding is known to be optimally robust against additive noise and erasures. We consider the problem of constructing frames whose frame operator has a given spectrum and whose vectors have prescribed lengths. For a given spectrum and set of lengths, the existence of such frames is characterized by the Schur-Horn Theorem---they exist if and only if the spectrum majorizes the squared lengths---the classical proof of which is nonconstructive. Certain construction methods, such as harmonic frames and spectral tetris, are known in the special case of unit norm tight frames, but even these provide but a few examples from the manifold of all such frames, the dimension of which is known and nontrivial. In this paper, we provide a new method for explicitly constructing any and all frames whose frame operator has a prescribed spectrum and whose vectors have prescribed lengths. The method itself has two parts. In the first part, one chooses eigensteps---a sequence of interlacing spectra---that transform the trivial spectrum into the desired one. The second part is to explicitly compute the frame vectors in terms of these eigensteps; though nontrivial, this process is nevertheless straightforward enough to be implemented by hand, involving only arithmetic, square roots and matrix multiplication

An Emergency Room Decision-Support Program That Increased Physician Office Visits, Decreased Emergency Room Visits, and Saved Money

The objective of this study was to evaluate an Emergency Room having a Decision-Support (ERDS) program designed to appropriately reduce ER use among frequent users, defined as 3 or more visits within a 12-month period. To achieve this, adults with an AARP Medicare Supplement Insurance plan insured by UnitedHealthcare Insurance Company (for New York residents, UnitedHealthcare Insurance Company of New York) were eligible to participate in the program. These included 7070 individuals who elected to enroll in the ERDS program and an equal number of matched nonparticipants who were eligible but either declined or were unreachable. Program-related benefits were estimated by comparing the difference in downstream health care utilization and expenditures between engaged and not engaged individuals after using propensity score matching to adjust for case mix differences between these groups. As a result, compared with the not engaged, engaged individuals experienced better care coordination, evidenced by a greater reduction in ER visits (P=0.033) and hospital admissions (P=0.002) and an increase in office visits (P<0.001). The program was cost-effective, with a return on investment (ROI) of 1.24, which was calculated by dividing the total program savings ($3.41 million) by the total program costs ($2.75 million). The ROI implies that for every dollar invested in this program, $1.24 was saved, most of which was for the federal Medicare program. In conclusion, the decrease in ER visits and hospital admissions and the increase in office visits may indicate the program helped individuals to seek the appropriate levels of care. (Population Health Management 2014;17:257?264)Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140184/1/pop.2013.0117.pd

Antipsychotic dose escalation as a trigger for Neuroleptic Malignant Syndrome (NMS): literature review and case series report

Background: “Neuroleptic malignant syndrome” (NMS) is a potentially fatal idiosyncratic reaction to any medication which affects the central dopaminergic system. Between 0.5% and 1% of patients exposed to antipsychotics develop the condition. Mortality rates may be as high as 55% and many risk factors have been reported. Although rapid escalation of antipsychotic dose is thought to be an important risk factor, to date it has not been the focus of a published case series or scientifically defined. &lt;p/&gt;Aims: To identify cases of NMS and review risk factors for its development with a particular focus on rapid dose escalation in the 30 days prior to onset. &lt;p/&gt;Methodology: A review of the literature on rapid dose escalation was undertaken and a pragmatic definition of “rapid dose escalation” was made. NMS cases were defined using DSM-IV criteria and systematically identified within a secondary care mental health service. A ratio of titration rate was calculated for each NMS patient and “rapid escalators” and “non rapid escalators” were compared. &lt;p/&gt;Results: 13 cases of NMS were identified. A progressive mean dose increase 15 days prior to the confirmed episode of NMS was observed (241.7mg/day during days 1-15 to 346.9mg/day during days 16-30) and the mean ratio of dose escalation for NMS patients was 1.4. Rapid dose escalation was seen in 5/13 cases and non rapid escalators had markedly higher daily cumulative antipsychotic dose compared to rapid escalators. &lt;p/&gt;Conclusions: Rapid dose escalation occurred in less than half of this case series (n=5, 38.5%), although there is currently no consensus on the precise definition of rapid dose escalation. Cumulative antipsychotic dose – alongside other known risk factors - may also be important in the development of NMS