Healthcare Utilization And Expenditure Patterns Among Older Adults With Functional And Medical Decline

Purpose. As the aged population of this country grows, the U.S. healthcare system will face increased pressure to provide long-term care services and supports to increasing numbers of elderly Medicare beneficiaries. Studies have indicated that unmet long-term care need can lead to increased, unnecessary utilization of the healthcare system, thus further taxing the Medicare system. Little is known about how type of long-term care, as well as how long-term care policies—specifically payment policies—affect health care utilization. The objective of this original dissertation research was to examine the effects of place of residence (community versus residential long-term care facility) and long-term care payer type (private pay versus Medicaid) on Medicare-funded healthcare utilization in terms of both risk of potentially preventable hospitalization (PPH) and Medicare expenditures. Methods. This study utilized data from the 5% sample of 2013 Medicare claims and enrollment data from the Centers for Medicare and Medicaid Services (CMS) merged with data from the Areas Health Resource File (AHRF). A retrospective cohort analysis examined the healthcare utilization and expenditure patterns of Medicare beneficiaries for whom, based on clinical and demographic factors, the provision of formal, comprehensive long-term care would be appropriate, among four cohorts: Medicare-only beneficiaries residing in the community; Medicare-only beneficiaries residing in long-term care facilities; Medicare/Medicaid dual eligible beneficiaries residing in the community; and Medicare/Medicaid dual eligible beneficiaries residing in long-term care facilities. Results. This study found a significantly higher risk of both PPH and having Medicare expenditures in the top 90th percentile among both Medicare-only long-term care facility residents and dual eligible community residents as compared to dual eligible long-term care facility residents, yet Medicare-only long-term care facility residents had significantly lower per capita Medicare expenditures than did their dual eligible counterparts residing in long-term care facilities. The results of this study also indicate that state Medicaid bed hold policies had no statistically significant effect on either risk of PPH or on Medicare expenditures. Conclusion. The finding that Medicare-only residents of long-term care facilities are less expensive to the Medicare system, on average, than their dual eligible long-term care facility resident peers, yet are more likely to be hospitalized for a preventable condition and are more likely to be among the most expensive Medicare beneficiaries, could indicate differential patterns of intensity of medical response to similar clinical conditions between the two groups. That state Medicaid bed hold policies were not associated with any of the measures of healthcare utilization in our study seems to suggest that this Medicaid policy does not provide the perverse incentive toward higher utilization that some studies suggest

Starting a conservation collection of Sorbus pseudomeinichii

There are three endemic Sorbus species on the Isle of Arran in Scotland: Sorbus arranensis, S. pseudofennica and S. pseudomeinichii. The latter is the most recently discovered and is represented in the wild by a single individual. Seed propagation and vegetative propagation by chip budding were initiated for all three species at the Royal Botanic Garden Edinburgh (RBGE). This has been successful and there are now conservation collections of these species growing at RBGE

Human Factors Vehicle Displacement Analysis: Engineering In Motion

While positioned on the launch pad at the Kennedy Space Center, tall stacked launch vehicles are exposed to the natural environment. Varying directional winds and vortex shedding causes the vehicle to sway in an oscillating motion. The Human Factors team recognizes that vehicle sway may hinder ground crew operation, impact the ground system designs, and ultimately affect launch availability . The objective of this study is to physically simulate predicted oscillation envelopes identified by analysis. and conduct a Human Factors Analysis to assess the ability to carry out essential Upper Stage (US) ground operator tasks based on predicted vehicle motion

Understanding students’ experiences in a PE, health and well-being context:a self-determination theory perspective

Framed by Self-Determination Theory, this investigation explored student experience as they engaged in their physical education (PE), health and well-being (HWB) curriculum in Scotland for the first time. We aimed to uncover the features of various learning environments that appeared to impact upon student motivation in PE over the period one academic year. We carried out focus group interviews with students from one state secondary school (secondary 1 and 2; ages 12–14) and its feeder primary schools (primary 7; age 11 years) immediately after a selection of PE lessons throughout the year. Furthermore, to provide some additional context for our analysis, the students in each year completed a questionnaire (pre–post) to identify and understand their motivation for PE over time. The results from the interviews indicated that students had a number of positive and negative PE experiences. However, the results from the questionnaire demonstrate that the students’ experiences during the first year of this ‘new’ curriculum had little impact on their motivation for PE. The findings highlight the importance of mixed methods research to provide context-specific account of student experience. This detail may be critical for the development of informed and effective pedagogy that supports student learning, health and well-being

Sensory experiences of individuals with Autism Spectrum Disorder and autistic traits: a mixed methods approach

There has been a recent increase in research into sensory sensitivity in Autism Spectrum Disorders (ASDs), which has prompted the inclusion of sensory issues as an explicit criterion in the impending revision of diagnostic guidelines (DSM-5: American Psychiatric Association, 2010). However, one of the most interesting aspects of research in this field is that a clear disparity exists between the results of self- or parent-report studies and behavioural studies. The former class of studies shows that those with ASD report clear, consistent differences in their sensory experiences (Baranek et al., 2006; Crane et al., 2009; Leekam et al., 2007), whereas the findings in the behavioural field are complex to interpret, with all but a few areas of sensory processing (e.g. visual search: Joliffe & Baron-Cohen, 1997; Shah & Frith, 1983, 1993) demonstrating consistent consensus (e.g. Dudova et al., 2011; Tavassoli et al., 2012a). The thesis presented here aims to explore the nature of sensory sensitivities in those with ASD and the broader autism phenotype (BAP) further using a combination of qualitative and quantitative research designs. In addition, an approach was developed (the Sensory Audit: Chapter 8) which can be used to objectively assess an environment for sensory stressors. Chapters 2 and 3 report the development of a sensory questionnaire (GSQ: Robertson & Simmons, 2012), which was administered to those with varying AQ scores, as measured by the Autism Spectrum Quotient (AQ: Baron-Cohen et al., 2001). There were both quantitative (Chapter 2) and qualitative (Chapter 3) features of the questionnaire. In the quantitative component, seven modalities were assessed (vision, audition, gustation, olfaction, touch, vestibular processing and proprioception), taking into account both hyper- and hypo-sensitivity to stimuli. We found that there was a strong, positive relationship between sensory sensitivity and AQ score, with medium scorers (who would be unlikely to be diagnosed with ASD) reporting significantly more difficulties with sensory stimuli than low scorers. For Chapter 3, we found that those with high levels of autistic traits (i.e. may be likely to have a diagnosis of ASD) tended to report using different coping techniques from medium and low scorers (e.g. avoiding situations and using sensory soothing rather than non-sensory soothing). The results from these studies suggest that sensory issues may be prevalent throughout the population and that the differences observed in Chapter 2 are mirrored in the themes extracted for each group in Chapter 3. The second set of studies (Chapters 4-6) report data from three focus groups (caregivers of those with autism, adults with ASD and an elderly control group), as well as from interactive group interviews with children who have autism. Although similar themes (e.g. control, consequences of problematic stimuli and positive effects of sensory stimuli) arose in all four studies, there were different types of information gathered from the groups. For those with ASD (Chapter 4 and Chapter 5), the discussion mainly centred around how sensory stimuli made them feel, and the implications of this for them. For the caregivers (Chapter 4) and the elderly group (who mainly discussed their relatives’ experiences) (Chapter 6), the themes reflected their own experiences, concentrating on the implications of adverse reactions to sensory stimuli (for both themselves and their loved ones). The data from these studies provide insight into living with someone who has sensory issues, for both those with a diagnosis of ASD and their caregivers, as well as the relatives of elderly individuals suffering from vision and hearing loss. Chapter 7 reports a study into the relationship between olfactory processing and the broader autism phenotype (as measured by the AQ). Participants completed the AQ as well as the Sniffin’ Sticks Extended Test. A subset of the sample (n=62) also completed the Glasgow Sensory Questionnaire (GSQ) that was developed as part of Chapter 2. As expected, there were no significant differences in the Threshold, Discrimination or Identification performance of those with high and low AQ scores. However, there was significantly greater intra-participant variability in the Threshold scores for the top 15% of scorers on the AQ. Furthermore, a similar relationship to that reported in Chapter 2 between sensory score and autistic traits was observed. These results indicate that there may be other differences in various aspects of performance in those with ASD that are not being targeted by current behavioural paradigms (which may explain the disparity between reported sensory differences and those observed using direct measurement). Finally, the last study reported is that of the development of a pilot Sensory Audit. This was an effort to apply the information gained from our previous research in a practical, useful way for individuals with ASD. Details of the development of the Sensory Audit, as well as the results of the pilot study are reported in Chapter 8. By making this freely available, we hope to help companies ensure that their working environments do not contain any undue stressors that could increase stress for those with sensory issues in their workforce. The results are discussed in light of three overarching themes of the thesis as a whole. Firstly, the potential mechanisms underlying sensory responsiveness in ASD, with the suggestion that emotional states may be an important avenue to consider in future research. Secondly, the impact of atypical sensory processing on caregivers, with particular attention paid to the compensation of these issues by caregivers, and the social implications of challenging behaviour instigated by unpleasant sensory stimuli. Thirdly, the data are discussed in light of the relationship between sensory processing and the broader autism phenotype (as measured using the AQ). The greater levels of intra-participant variability in the olfactory task (Chapter 7) are highlighted, as is the elevated sensory responsiveness of those with moderate levels of autistic traits reported in Chapters 2 and 3. The final section of the discussion deals with the limitations of the thesis, potential practical applications of the research and future directions

Women’s Experience with a Mindful Eating Course on a University Campus: A Pilot Study

Background: Weight and eating are sources of distress for many women and most weight-loss diets fail to sustain their effects over time. Mindful eating focuses on the processes involved in eating (e.g., hunger, satiety, emotion) rather than on the regulation of weight, and is grounded in mindfulness meditation practices. Purpose: The purpose of this mixed-methods pilot study was to understand the experiences (attitudes, feelings, behaviors) of participants taking a course in mindful eating, and to know in what respects this approach showed promise for women in general. Methods: Seven university staff and faculty women (ages 37 - 59, BMI 21.76 – 40.42) participated in mindful eating classes taught over an 8- week period. Qualitative data were analyzed using intrinsic case study design, supported by pre- and postmeasures of mindful eating and disordered eating. Results: Three major themes were derived: Increased Awareness, New Behaviors in Eating, and Barriers to Practice, with notable experiences in limiting food intake. According to the MEQ, there was a significant increase in the Awareness domain (p = .045). Conclusion: Mindful eating can be incorporated into daily life and offer a way for women to regulate and enjoy their eating. Although there are challenges in making time for the practices, the study supports further exploration of mindful eating as both preventative and health-enhancing for women

The relationship between self-reported sensory experiences and autistic traits in the general population:a mixed methods analysis

There have been few examples of inductive research in sensory reactivity, particularly in relation to autistic traits among the general population. This study used a mixed methods approach to explore the nature of sensory experiences among people with different levels of autistic traits. Participants completed the Glasgow Sensory Questionnaire and the Autism Spectrum Quotient. Both quantitative and qualitative analyses were performed on the data. Responses to the open questions were analyzed as part of this study, and the closed questionnaire data have been reported elsewhere. Data were coded and responses quantitatively compared by group. In addition, data were qualitatively analyzed using a general inductive approach, which resulted in two themes: “problematic sensory experiences” and “calming sensory experiences.” Results show that coping mechanisms and certain aspects of the sensory experience vary according to autistic trait level, and provide insight into the nature of sensory reactivity across the general population