Effect of November 2016 Medicare and Medicaid Programs Policy of Requirements of Participation (RoP) for Nursing Homes on Quality Measures

Policymaking has a long and complex history in long-term care, which is one of the most highly regulated industries in the United States. The Final Rule for Reform of Requirements of Participation (RoP) for Long-Term Care Facilities was published with Phase I of III effective November 26, 2016. A retrospective program evaluation using data from the Centers for Medicare & Medicaid Services (CMS) Nursing Home Compare was conducted of 14,210 SNFs/ NFs. This study used a quantitative approach to determine the impact of the RoP on four quality measures: percentage of long-stay residents who received an antipsychotic, long-stay residents with moderate to severe pain, long-stay residents who were physically restrained, and short-stay residents with pressure ulcers that are new or worsened. Data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 24. Significant changes were observed in the percentage of each of the four quality measures pre- and post-implementation of the RoP. Logistic models indicate the influence of ownership and location on quality measure percentages RoP. This study adds to existing literature regarding the impact of regulatory stringency on nursing homes and provides important recommendations for policymakers and future research

Cultural Competence in Mental Health Care

A PowerPoint presentation, titled Cultural Competence in Mental Health Care, given by Lynn Geurin, Taunya Carpenter, and Megan Cox at the Justice Festival held on the campus of Morehead State University on October 19, 2022

Apple Imprinting

Anthocyanin is the pigment that develops in the skin of apples and produces the red color associated with some apple cultivars. Apples are dependent on light to develop anthocyanins. This is the reason why some apples develop leaf-like shapes in their pigment on the skin; the leaf excludes the light in its shape and the red color pigment doesn’t develop. Apple imprinting is a lightmanipulation technique used to produce an intentional design on the skin of apples. This technique is used in Japan where fruit can be a prized gift, and apples imprinted with special logos can bring a very high price. One orchard in western Canada imprints the logos of two competing hockey teams on apples to increase the value and obtain a considerable return on their investment. Iowa orchardists could create a valuable addition to their marketing strategies if they use apple imprinting techniques. The purpose of this study was to imprint apples with the goal of learning the process in Iowa with local apple cultivars

Continuity and Change in Values in Midlife: Testing the Age Stability Hypothesis

21 pagesBackground/Study Context: The “age stability” hypothesis suggests that adults have significant continuities in values over time, whereas the “situational influence” hypothesis suggests that change continues, especially in response to new events and experiences. Deeply ingrained, terminal values may be more stable than other, more instrumental, values. Less research examines changing values than examines changing personality traits and attitudes. Methods: Hypotheses were tested with data from A Study of Leisure During Adulthood (ASOLDA), a 9-year panel study of middle-aged adults (average age of 45 at the beginning of data collection). Mixed-model regressions and descriptive statistics were used to examine changes and stability over time in global values, measured by the List of Values (LOV), and instrumental values related to leisure. Results: Significant correlations were found in both terminal and instrumental values over time (autocorrelations ranging from .13 to .23). There was no linear or curvilinear pattern of change over time. Respondents reported a wide range of positive and negative life events and variations over time in reflections on their life structure, but these variations were unrelated to changes in values. Conclusion: Results support the age stability hypothesis, rather than the situational influence hypothesis, with similar results for both terminal and instrumental values. It is suggested that the consistent values of respondents may have helped them weather the wide range of often-difficult circumstances many reported experiencing. Future research should examine this hypothesis

Kinetic intermediates in amyloid assembly

In contrast to an expected Ostwald-like ripening of amyloid assemblies, the nucleating core of the Dutch mutant of the Aβ peptide of Alzheimer’s disease assembles through a series of conformational transitions. Structural characterization of the intermediate assemblies by isotope-edited IR and solid-state NMR reveals unexpected strand orientation intermediates and suggests new nucleation mechanisms in a progressive assembly pathway

Intracellular Zn2+ transients modulate global gene expression in dissociated rat hippocampal neurons

Zinc (Zn2+) is an integral component of many proteins and has been shown to act in a regulatory capacity in different mammalian systems, including as a neurotransmitter in neurons throughout the brain. While Zn2+ plays an important role in modulating neuronal potentiation and synaptic plasticity, little is known about the signaling mechanisms of this regulation. In dissociated rat hippocampal neuron cultures, we used fluorescent Zn2+ sensors to rigorously define resting Zn2+ levels and stimulation-dependent intracellular Zn2+ dynamics, and we performed RNA-Seq to characterize Zn2+-dependent transcriptional effects upon stimulation. We found that relatively small changes in cytosolic Zn2+ during stimulation altered expression levels of 931 genes, and these Zn2+ dynamics induced transcription of many genes implicated in neurite expansion and synaptic growth. Additionally, while we were unable to verify the presence of synaptic Zn2+ in these cultures, we did detect the synaptic vesicle Zn2+ transporter ZnT3 and found it to be substantially upregulated by cytosolic Zn2+ increases. These results provide the first global sequencing-based examination of Zn2+-dependent changes in transcription and identify genes that may mediate Zn2+-dependent processes and functions. </div

The Importance of Audit Firm Characteristics and the Drivers of Auditor Change in UK Listed Companies

This paper explores the importance of audit firm characteristics and the factors motivating auditor change based on questionnaire responses from 210 listed UK companies (a response rate of 70%). Twenty-nine potentially desirable auditor characteristics are identified from the extant literature and their importance elicited. Exploratory factor analysis reduces these variables to eight uncorrelated underlying dimensions: reputation/quality; acceptability to third parties; value for money; ability to provide non-audit services; small audit firm; specialist industry knowledge; non-Big Six large audit firm; and geographical proximity. Insights into the nature of 'the Big Six factor' emerge. Two thirds of companies had recently considered changing auditors; the main reasons cited being audit fee level, dissatisfaction with audit quality and changes in top management. Of those companies that considered change, 73% did not actually do so, the main reasons cited being fee reduction by the incumbent and avoidance of disruption. Thus audit fee levels are both a key precipitator of change and a key factor in retaining the status quo

Association between rheumatoid arthritis disease activity, progression of functional limitation and long-term risk of orthopaedic surgery : Combined analysis of two prospective cohorts supports EULAR treat to target DAS thresholds

Objectives: To examine the association between disease activity in early rheumatoid arthritis (RA), functional limitation and long-term orthopaedic episodes. Methods: Health Assessment Questionnaire (HAQ) disability scores were collected from two longitudinal early RA inception cohorts in routine care; Early Rheumatoid Arthritis Study and Early Rheumatoid Arthritis Network from 1986 to 2012. The incidence of major and intermediate orthopaedic surgical episodes over 25 years was collected from national data sets. Disease activity was categorised by mean disease activity score (DAS28) annually between years 1 and 5; remission (RDAS≤2.6), low (LDAS>2.6-3.2), low-moderate (LMDAS≥3.2-4.19), high-moderate (HMDAS 4.2-5.1) and high (HDAS>5.1). Results: Data from 2045 patients were analysed. Patients in RDAS showed no HAQ progression over 5 years, whereas there was a significant relationship between rising DAS28 category and HAQ at 1 year, and the rate of HAQ progression between years 1 and 5. During 27 986 person-years follow-up, 392 intermediate and 591 major surgeries were observed. Compared with the RDAS category, there was a significantly increased cumulative incidence of intermediate surgery in HDAS (OR 2.59 CI 1.49 to 4.52) and HMDAS (OR 1.8 CI 1.05 to 3.11) categories, and for major surgery in HDAS (OR 2.48 CI 1.5 to 4.11), HMDAS (OR 2.16 CI 1.32 to 3.52) and LMDAS (OR 2.07 CI 1.28 to 3.33) categories. There was no significant difference in HAQ progression or orthopaedic episodes between RDAS and LDAS categories. Conclusions: There is an association between disease activity and both poor function and long-term orthopaedic episodes. This illustrates the far from benign consequences of persistent moderate disease activity, and supports European League Against Rheumatism treat to target recommendations to secure low disease activity or remission in all patients.Peer reviewedFinal Published versio