Payment Systems, Market Factors and Long-Term Care Hospitals.

Long-Term Care Hospitals (LTCHs) have recently emerged as an important alternative to traditional settings for post-acute care (PAC), including skilled nursing facilities (SNFs) and inpatient rehabilitation hospitals (IRFs). LTCHs are accredited acute care hospitals and primarily serve long-staying patients with complex medical conditions. LTCHs have historically played a fairly minor role in the health care system, but in recent years have grown quickly in number, in Medicare outlays and in importance. LTCHs are generally the most expensive PAC setting and payment rates for clinically similar patients have been as high as 12 times the rates received by other PAC providers. But, whether LTCH treatment practices differ substantially from other, less well paid providers, is not well understood. To promote equitable reimbursement, regulation and coverage under the Medicare program, policymakers must understand how LTCH patients, treatment practices, and outcomes of care compare to other PAC providers. This dissertation takes a close look at LTCHs and their role in PAC markets. First, LTCHs' role in PAC markets is quantitatively assessed by identifying similarity in structural characteristics, patient caseloads, and inputs to patient care among LTCHs, SNFs, and IRFs; this analysis also identifies local market characteristics associated with LTCHs' regional variation. This analysis reveals that LTCHs are more similar to other PAC providers than previously thought. Substitution of treatment appears to occur primarily among LTCHs, and hospital-based SNFs and IRFs. Second, the policy effect of prospective payment on LTCH practices is estimated. Because hospitals must qualify as LTCHs for Medicare payment, LTCHs face competing incentives to control costs and maintain their eligibility to LTCH payment rates. This analysis finds that the response to prospective payment varies across LTCHs. Finally, how well LTCHs, SNFs, and IRFs substitute for each other in providing care to prolonged mechanically ventilated patients is tested. Comparison of patient health and cost outcomes suggests that LTCHs produce better patient outcomes among some, but not all patients.Ph.D.Health Services Organization & PolicyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/61579/1/ecshelto_1.pd

(Un-) healthy ageing: Geographic inequalities in disability-free life expectancy in England and Wales

Health expectancies are an indicator of healthy ageing that reflect quantity and quality of life. Using limiting long term illness and mortality prevalence, we calculate disability-free life expectancy for small areas in England and Wales between 1991 and 2011 for males and females aged 50–74, the life stage when people may be changing their occupation from main career to retirement or alternative work activities. We find that inequalities in disability-free life expectancy are deeply entrenched, including former coalfield and ex-industrial areas and that areas of persistent (dis-) advantage, worsening or improving deprivation have health change in line with deprivation change. A mixed health picture for rural and coastal areas requires further investigation as do the demographic processes which underpin these area level health differences

Can Canadian paramedic students accurately estimate pediatric weight?

Paramedics are taught several methods for estimating pediatric weight, including various age-based formulae. Previous studies have demonstrated that paramedics find estimation of pediatric weights challenging, and their estimation abilities are often inaccurate

Expressions 2016

https://openspace.dmacc.edu/expressions/1032/thumbnail.jp

Goal-neglect links Stroop interference with working memory capacity

Relationships between Stroop interference and working memory capacity may reflect individual differences in resolving conflict, susceptibility to goal neglect, or both of these factors. We compared relationships between working memory capacity and three Stroop tasks: a classic, printed color-word Stroop task, a cross-modal Stroop, and a new version of cross-modal Stroop with a concurrent auditory monitoring component. Each of these tasks showed evidence of interference between the semantic meaning of the color word and the to-be-named color, suggesting these tasks each require resolution of interference. However, only Stroop interference in the print-based task with high proportions of congruent trials correlated significantly with working memory capacity. This evidence suggests that the relationships observed between Stroop interference and working memory capacity are primarily driven by individual differences in the propensity to actively maintain a goal. (C) 2012 Elsevier B.V. All rights reserved

The rhetorical price of freedom: the impact of outsourced critical thinking on deliberative democracy

In contemporary media ecologies, news consumers delegate the generation of political opinion to trusted outside entities. Consumers trust these purported experts, media personalities, or news outlets because their affect, values, ethos, or party positioning appeal to them in a way that confirms their own thoughts and opinions. This deferral of opinion to a source perceived to have greater authority and experience has potential consequences for democracy. For-profit news outlets—broadcast, print, and digital—court audiences and encourage exclusivity and loyalty in their attention. In so doing, they deliver to viewers a tranche of beliefs articulated together and carefully maintained through partisan discourse and blockage of outside ideas. This process cultivates an exclusive rhetorical ecology that functions as a closed system and impoverishes the discursive environment in which democracy—by way of compromise—flourishes. This study forwards the idea of outsourcing as a way to account for the complex rhetorical and ethical issues surrounding such an ecology. To describe the theory of rhetorical outsourcing, I draw on scholarship in rhetorical ecologies, rhetorical circulation studies, deliberative rhetoric, political theory and communication, rhetorical and organizational ethics, systems theory, and media studies. This study includes analysis of recent data from the Pew Research Center on the habits of both news consumers and producers as well as analysis of certain news media, applying current rhetorical theory and scholarship to disentangle participation in media ecologies. I argue that the creation and maintenance of closed systems created by media ecologies raises ethical dilemmas for news producers and preys on consumers who trust them with the cultivation and protection of political identities. These closed systems lead to further political polarization and impoverish discursive potential, having a negative impact on deliberative democracy as power shifts away from citizens and into the hands of the media who control the messaging

Local area unemployment, individual health and workforce exit: ONS Longitudinal Study

This work was jointly funded by the Economic and Social Research Center (ESRC) and the United Kingdom’s Medical Research Council, under the Lifelong Health and Wellbeing Cross-Council Programme initiative [ES/L002892/1]. CeLSIUS is supported by the ESRC Census of Population Programme (Award Ref: ES/ K000365/1)

Mouse models of preterm birth: Suggested assessment and reporting guidelines

Preterm birth affects approximately 1 out of every 10 births in the United States, leading to high rates of mortality and long-term negative health consequences. To investigate the mechanisms leading to preterm birth so as to develop prevention strategies, researchers have developed numerous mouse models of preterm birth. However, the lack of standard definitions for preterm birth in mice limits our field\u27s ability to compare models and make inferences about preterm birth in humans. In this review, we discuss numerous mouse preterm birth models, propose guidelines for experiments and reporting, and suggest markers that can be used to assess whether pups are premature or mature. We argue that adoption of these recommendations will enhance the utility of mice as models for preterm birth

Quantum Mechanics of the Doubled Torus

We investigate the quantum mechanics of the doubled torus system, introduced by Hull [1] to describe T-folds in a more geometric way. Classically, this system consists of a world-sheet Lagrangian together with some constraints, which reduce the number of degrees of freedom to the correct physical number. We consider this system from the point of view of constrained Hamiltonian dynamics. In this case the constraints are second class, and we can quantize on the constrained surface using Dirac brackets. We perform the quantization for a simple T-fold background and compare to results for the conventional non-doubled torus system. Finally, we formulate a consistent supersymmetric version of the doubled torus system, including supersymmetric constraints.Comment: 31 pages, 1 figure; v2: references added, minor corrections to final sectio

Historical Trajectories of Disaster Risk in Dominica

The calamitous consequences of 2017 Hurricane Maria for the Caribbean island of Dominica highlighted the acute and increasing susceptibility of the region to disasters. Despite increasing international attention to disaster risk reduction, recovery from hazard events can be especially lengthy and difficult for small island developing states. In this article, we build on existing understandings of disaster risk as a physical and social condition, showing that historical processes are fundamental to understanding how conditions of risk emerge and persist over time. We take an integrated approach to analyzing the drivers of risk accumulation, using the example of Dominica, where processes set in motion during the colonial period have shaped the location of people and assets, the degree to which they might be harmed, the societal repercussions of that harm and the prospects for recovery. We focus on the underlying economic vulnerabilities and physical exposure to hazards created by agricultural, economic, and social practices, and successive disaster responses that have constrained recovery. Uncovering these historical drivers and persistent issues, elucidates lessons for pursuing a more resilient development trajectory, including through the promotion of economic restructuring and diversification, and land reform