Mapping Supply and Demand in Kentucky\u27s Health Care System

A report submitted by Timothy S. Hare to the Research and Creative Productions Committee in 2004 on the geographical distribution of supply and demand in Kentucky\u27s health care system

Healthcare Utilization, Deprivation, and Heart-Related Disease In Kentucky

A report submitted by Timothy S. Hare to the Research and Creative Productions Committee in 2005 on the relationship between patterns of healthcare facility utilization for heart-related disease in Kentucky

Can smartphone wireless ECGs be used to accurately assess ECG intervals in pediatrics? A comparison of mobile health monitoring to standard 12-lead ECG

BACKGROUND:Arrhythmias in children are often paroxysmal, complicating the ability to capture the abnormal rhythm on routine ECG during an outpatient visit. The Alivecor Kardia Mobile (KM) device is a wireless mobile health (mHealth) device that generates a single lead ECG tracing with a FDA-approved algorithm for detection of atrial fibrillation in adults. OBJECTIVE:The goal of this study is to assess the accuracy of interval measurements on KM tracings by directly comparing to standard 12-lead ECGs in pediatric patients. METHODS:This single center, prospective study enrolled pediatric outpatients, age 20ms with 4/9 (44%) having a conduction disorder and 2/9 (22%) having marked sinus arrhythmia. Bland-Altman method of agreement demonstrated strong agreement for QRSd and QTc. The AF algorithm reported 4/30 (13%) false positive "possible AF" diagnoses (rhythm over-read on KM demonstrated n = 3 marked sinus arrhythmia, n = 1 sinus rhythm with aberrated PACs) resulting in a specificity of 87%. CONCLUSION:The Alivecor Kardia device produces accurate single lead ECG tracings in both healthy children and children with cardiac disease or rhythm abnormalities across the pediatric spectrum. This mHealth application provides an accurate, non-invasive, real-time approach for ambulatory ECG monitoring in children and adolescents

The impact of masculinity upon men with psychosis who reside in secure forensic settings

Purpose Masculinity is a core cognitive structure that plays a central role in organising attitudinal and behavioural processes. Yet there is limited research focussing upon the meaning of masculinity for men who have a past history of violent behaviour, who experience psychotic phenomena and reside in secure forensic settings. The paper aims to discuss these issues. Design/methodology/approach Q-methodology was used to elucidate the factors regarding how men who experience psychotic phenomena perceive their masculinity. Ten participants from a secure forensic setting performed a 49-statement Q-sort task. Findings Principal component factor analysis with varimax rotation was performed on the ten completed Q-sorts which revealed a three-factor solution, accounting for 57 per cent of the variance in the data. The factors were interpreted and discussed under the following headings: “assured and asserting maverick”, “calm, confident, composed conformist” and “nurturing provider in the face of adversity”. This revealed that men with psychosis have different, predominantly pro-social explanatory frameworks for their representation of masculinity. Research limitations/implications This study revealed that men with psychosis have different, predominantly pro-social explanatory frameworks for their representation of masculinity. However, the study was limited by its lack of longitudinal assessment and the inclusion of a greater number of participants may have enhanced the representativeness and generalisability of the findings. Practical implications Therapeutic discussions in respect of masculinity itself could provide men with the opportunity to develop newer, more adaptive conceptualisations of themselves, help them develop greater self-awareness and understanding of the sources of their presenting concerns, which in turn could enhance a provisional formulation of their difficulties. It would also be potentially valuable to understand how these patterns of masculinity map onto coping, recovery style and service engagement. Furthermore, services could also benefit from becoming more aware of hospitalisation being a shameful perhaps stigmatizing time for men with psychosis. Social implications It may be useful for people working in healthcare settings to be aware of how the service users they support perceive their masculinity, so the existential and deeper needs of male patients are provided with enough consideration. This is an important point, as some individuals are often reluctant or neglect to enquire about individual’s psychotic experiences and gender identification. Originality/value Although forensic psychiatric care is primarily populated by men who have committed violent acts, there is a limited research focussing upon the meaning of masculinity in this context. This is in spite of evidence which shows that maladaptive perceptions of masculinity can be reinforced during time spent residing in secure settings. The cultural constructs of masculinity and their respective impact upon the diagnosis, management and outcome of psychosis has also received little attention. Therefore, this research represents new and significant contributions to the field

Investigation, Development, and Evaluation of Performance Proving for Fault-tolerant Computers

A number of methodologies for verifying systems and computer based tools that assist users in verifying their systems were developed. These tools were applied to verify in part the SIFT ultrareliable aircraft computer. Topics covered included: STP theorem prover; design verification of SIFT; high level language code verification; assembly language level verification; numerical algorithm verification; verification of flight control programs; and verification of hardware logic

Charge injection instability in perfect insulators

We show that in a macroscopic perfect insulator, charge injection at a field-enhancing defect is associated with an instability of the insulating state or with bistability of the insulating and the charged state. The effect of a nonlinear carrier mobility is emphasized. The formation of the charged state is governed by two different processes with clearly separated time scales. First, due to a fast growth of a charge-injection mode, a localized charge cloud forms near the injecting defect (or contact). Charge injection stops when the field enhancement is screened below criticality. Secondly, the charge slowly redistributes in the bulk. The linear instability mechanism and the final charged steady state are discussed for a simple model and for cylindrical and spherical geometries. The theory explains an experimentally observed increase of the critical electric field with decreasing size of the injecting contact. Numerical results are presented for dc and ac biased insulators.Comment: Revtex, 7pages, 4 ps figure

Frontostriatal Maturation Predicts Cognitive Control Failure to Appetitive Cues in Adolescents

Adolescent risk-taking is a public health issue that increases the odds of poor lifetime outcomes. One factor thought to influence adolescents' propensity for risk-taking is an enhanced sensitivity to appetitive cues, relative to an immature capacity to exert sufficient cognitive control. We tested this hypothesis by characterizing interactions among ventral striatal, dorsal striatal, and prefrontal cortical regions with varying appetitive load using fMRI scanning. Child, teen, and adult participants performed a go/no-go task with appetitive (happy faces) and neutral cues (calm faces). Impulse control to neutral cues showed linear improvement with age, whereas teens showed a nonlinear reduction in impulse control to appetitive cues. This performance decrement in teens was paralleled by enhanced activity in the ventral striatum. Prefrontal cortical recruitment correlated with overall accuracy and showed a linear response with age for no-go versus go trials. Connectivity analyses identified a ventral frontostriatal circuit including the inferior frontal gyrus and dorsal striatum during no-go versus go trials. Examining recruitment developmentally showed that teens had greater between-subject ventral-dorsal striatal coactivation relative to children and adults for happy no-go versus go trials. These findings implicate exaggerated ventral striatal representation of appetitive cues in adolescents relative to an intermediary cognitive control response. Connectivity and coactivity data suggest these systems communicate at the level of the dorsal striatum differentially across development. Biased responding in this system is one possible mechanism underlying heightened risk-taking during adolescence

Plane-Symmetric Inhomogeneous Bulk Viscous Cosmological Models with Variable Λ\Lambda

A plane-symmetric non-static cosmological model representing a bulk viscous fluid distribution has been obtained which is inhomogeneous and anisotropic and a particular case of which is gravitationally radiative. Without assuming any {\it adhoc} law, we obtain a cosmological constant as a decreasing function of time. The physical and geometric features of the models are also discussed.Comment: 11 page