Encouraging Integrated Care for Dual Eligibles

Outlines examples and elements of integrated care models for those eligible for both Medicare and Medicaid, including multidisciplinary care teams, comprehensive provider networks, and data sharing, that would eliminate inefficiencies and reduce costs

Assessment of the effects and limitations of the 1998 to 2008 Abbreviated Injury Scale map using a large population-based dataset

BACKGROUND: Trauma systems should consistently monitor a given trauma population over a period of time. The Abbreviated Injury Scale (AIS) and derived scores such as the Injury Severity Score (ISS) are commonly used to quantify injury severities in trauma registries. To reflect contemporary trauma management and treatment, the most recent version of the AIS (AIS08) contains many codes which differ in severity from their equivalents in the earlier 1998 version (AIS98). Consequently, the adoption of AIS08 may impede comparisons between data coded using different AIS versions. It may also affect the number of patients classified as major trauma. METHODS: The entire AIS98-coded injury dataset of a large population based trauma registry was retrieved and mapped to AIS08 using the currently available AIS98-AIS08 dictionary map. The percentage of codes which had increased or decreased in severity, or could not be mapped, was examined in conjunction with the effect of these changes to the calculated ISS. The potential for free text information accompanying AIS coding to improve the quality of AIS mapping was explored. RESULTS: A total of 128280 AIS98-coded injuries were evaluated in 32134 patients, 15471 patients of whom were classified as major trauma. Although only 4.5% of dictionary codes decreased in severity from AIS98 to AIS08, this represented almost 13% of injuries in the registry. In 4.9% of patients, no injuries could be mapped. ISS was potentially unreliable in one-third of patients, as they had at least one AIS98 code which could not be mapped. Using AIS08, the number of patients classified as major trauma decreased by between 17.3% and 30.3%. Evaluation of free text descriptions for some injuries demonstrated the potential to improve mapping between AIS versions. CONCLUSIONS: Converting AIS98-coded data to AIS08 results in a significant decrease in the number of patients classified as major trauma. Many AIS98 codes are missing from the existing AIS map, and across a trauma population the AIS08 dataset estimates which it produces are of insufficient quality to be used in practice. However, it may be possible to improve AIS98 to AIS08 mapping to the point where it is useful to established registries

Intra-Rater reliability of the Functional Movement Screen (FMS) amongst NHS Physiotherapists

Objectives: The primary aim of this study was to evaluate the intra-rater reliability of the FMS amongst a group of novice National Health Service (NHS) Physiotherapists. The secondary objective was to establish if Intra-rater reliability differed between non-specialist rotational Physiotherapists and Physiotherapists working within the musculoskeletal (MSk) setting. Design: Reliability Study. Method: Forty participants with no recent MSk injury were video recorded completing the 7 component FMS tests. Six NHS Physiotherapists with no previous experience using the FMS attended a 2 hour training programme delivered by a certified FMS practitioner. Raters then viewed and scored videos of the 40 participants completing the FMS. Results: The intra-rater reliability of FMS composite scores was Excellent (mean ICC of 0.91 (95% CI 0.81-0.96)). The non-specialist rotational Physiotherapist group demonstrated Good-Excellent intra-rater reliability (ICC 0.9; 95% CI 0.79-0.95). Specialist MSk Physiotherapists demonstrated Excellent intra-rater reliability (ICC 0.92; 95% CI 0.84-0.96). Intra-rater reliability of the 7 component tests of the FMS ranged from Poor-Excellent (KW 95% CI 0.11-0.98). Conclusion: Among novice NHS Physiotherapists, the FMS composite score demonstrated Excellent intra-rater reliability. MSk specialists were found to demonstrate a marginally superior level of intra-rater agreement compared to non-specialist rotational Physiotherapists; however this is likely to be negligible in a clinical context. Clinical specialism also appears to have little impact on the intra-rater reliability of FMS components with both groups of raters achieving a Poor-Excellent level of agreement. Keywords: Intra-rater, reliability, functional movement screen, FM

Restoring Native Plant and Pollinator Communities on New York City Green Roofs

Urban development has dramatically decreased habitat for native plants and other wildlife. One of the native insect groups affected by this change are the bees and wasps (Order: Hymenoptera), which provide valuable ecosystem services like pollination of crops and ornamental plants. These insects are experiencing rapid population declines in urbanizing areas. A major obstacle to restoring pollinator populations in cities is the scarcity of space available that can be managed as habitat. A potential solution to this is to create patches of native vegetation on green roofs. Green roofs consist of live plants, growing media, and a drainage layer on top of a waterproof membrane. Most green roofs are planted with a mixture of non-native succulent plants (mostly from the genus Sedum), which are favored for their high survivorship and low maintenance requirements. On roofs with somewhat deeper media, a greater diversity of plants, including native plants typical of local grasslands, can persist. Here, we report on the differences in abundance and diversity of Hymenoptera attracted to native green roofs, Sedum green roofs, non-vegetated roofs, and ground-level green spaces. Preliminary data indicate extensive insect use of green roofs, with higher abundances on roofs planted with native species. The next phase of this research will involve comparing how the landscape context provided by different neighborhoods affects the development of the green roof biological communities

Research my world: crowdfunding research pilot project evaluation

Report evaluating the pilot project Research My World: a collaboration between pozible.com and Deakin University to crowdfund Australian research<br /

Low-intensity topic-specific group parenting programmes: enhancing intervention outcomes

Low-intensity parenting programmes play a key role in a public health approach to parenting support and are designed to be a cost-effective intervention for child conduct problems. Several studies that have evaluated a single topic-specific Triple P–Positive Parenting Program Discussion Group, an example of a low-intensity parenting programme, have found promising results for improving child and parent outcomes among parents with young children. This thesis aimed to examine ways to enhance the intervention outcomes of low-intensity topic-specific parenting groups for parents with young children. In study one, the effects of generalisation promotion strategies, such as teaching multiple exemplars, were examined. As a single training exemplar may not be sufficient for parents to effectively generalise parenting skills, multiple exemplars may assist parents to flexibly apply skills across a range of behaviours and settings leading to greater change in child behaviour, parenting practices, and parenting self-efficacy. This study also sought to extend the literature by examining the effects of low-intensity parenting groups with parents of primary school aged children using topics relevant to this development phase and investigating outcomes for mothers and fathers separately. A two arm randomised control trial design was used to compare the two conditions (single exemplar vs. multiple exemplar). Participants were 75 mothers and 58 fathers with a 5-8 year old child displaying at least a mild level of conduct problems. They represented 78 families: 66 two-parent families and 12 single parent families. Among two-parent families, there were 55 mother-father pairs, nine mothers who participated alone, and two fathers who participated alone. The majority of the single parent families were mothers (n = 11). Self-report measures of child behaviour, parenting practices, parenting self-efficacy, parent’s perceptions of their parenting role experience, parental mental health, inter-parental conflict, partner support, and partner relationship satisfaction were completed by parents at pre-intervention, post-intervention, and 6-month follow-up. Satisfaction with each intervention condition and the individual sessions was also examined. Low-intensity topic-specific parenting groups led to improvements on a range of child and parent outcomes for both mothers and fathers of primary school aged children. Receiving multiple exemplars resulted in more robust change in mother- and father-rated child behaviour, mothers’ parenting practices, and mothers’ behavioural parenting self-efficacy at post-intervention. For mothers in the multiple exemplar condition, superior improvements in child behaviour, parenting practices, and behavioural parenting self-efficacy were maintained at 6-month follow-up. Greater improvements in mothers’ setting parenting self-efficacy, mental health, and perceptions of partner support were also found at 6-month follow-up among the multiple exemplar condition. The second study in this thesis added to the literature on low-intensity parenting programmes by exploring whether addressing parental mental health, in addition to parenting, was beneficial for parents with young children. As poor parental mental health is linked with child conduct problems, negative parenting practices, and can negatively impact the effects of parenting programmes for families, simultaneously addressing parental mental health when delivering low-intensity parenting programmes may be advantageous. A mixed-method quasi-experimental evaluation of a combined low-intensity parenting and mental health programme was conducted. Thirteen families with a 3-8 year old child took part in the study. Self-report symptoms of anxiety, depression, and stress and ineffective parenting practices were obtained at pre-intervention, mid-intervention, post-intervention, and 3-month follow-up. Parents also completed self-report measures of child behaviour, parenting self-efficacy, parent’s perceptions of their parenting role experience, family relationships, and positive mental health at pre-intervention, post-intervention, and 3-month follow-up. Post-intervention semi-structured interviews were conducted with 12 parents and explored parents’ experiences of taking part in the programme, their perceived impact of the programme, and their implementation of strategies. The combined intervention produced promising changes in parenting practices and parental mental health. Parents perceived some positive impacts after attending the programme and generally the combined programme was acceptable to participating parents. Collectively, the findings from the two studies suggest that low-intensity topic-specific group parenting programmes have positive effects for young children and parents. Delivering multiple exemplars leads to added benefits and addressing parental mental health simultaneously has positive effects for families

Galectin‐3 in venous thrombosis: A possible new target for improved patient care

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/143719/1/rth212087_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/143719/2/rth212087.pd

Enhancing outcomes of low-intensity parenting groups through sufficient exemplar training: a randomized control trial

Low-intensity parenting groups, such as the Triple P-Positive Parenting Program Discussion Groups, appear to be a cost-effective intervention for child conduct problems. Several studies evaluating a Triple P Discussion Group on disobedience found promising results for improving child and parent outcomes. However, a sufficient exemplar training approach that incorporates generalization promotion strategies may assist parents to more flexibly apply positive parenting principles to a broader range of child target behaviors and settings, leading to greater change. We compared the effects of sufficient exemplar training to an existing narrowly focused low-intensity intervention. Participants were 78 families with a 5–8 year-old child. Sufficient exemplar training resulted in more robust changes in child behavior and superior outcomes for mothers on measures of parenting behavior, parenting self-efficacy, mental health, and perceptions of partner support at post-intervention and 6-month follow-up. These results indicate that teaching sufficient exemplars may promote generalization leading to enhanced intervention outcomes