The Barrier that Deters the Geriatric Population from Receiving Quality Healthcare

Purpose : This literature analysis aims to understand the tangible and intangible barriers that impact the growing geriatric population in preventing from receiving quality healthcare Methods: This literature review allowed for the investigation of the various types of barriers when the American geriatric population tries to access high-quality healthcare. Different types of settings were considered; however, there was a focus on Philadelphia. The analysis allowed for the creation of possible associations and solutions for this issue. Additional articles about the most significant barriers were searched based on an original article by Horton and Johnson (2010). Results: Cost seems to be one of the important, tangible aspects in regards to the lack of access and quality of care (Fitzpatrick et al. 2004). The highest percentage of all health spending consisted of the elderly population. As of 2016, there were 7,000 practicing geriatricians in the United States (Hafner 2016). There is a positive relationship between health literacy, of the geriatric population, and perception of social standing (Fernandez et al. 2016). Approximately 20% of elderly patients belonged to the dislike subgroup--making going to the doctor the most cited reason for delaying care (Sun and Smith 2017). Conclusion: Medical professionals, public health officials, and policymakers must address the negative aging stereotypes and delay of health care delay amongst the geriatric population. Once the negative stigma of aging is gone, then additional programs and resources can be developed to assist the elderly population. Recently there has been a shift towards patient/person-centered care--focusing on “personal choice and autonomy for people receiving health services” (Kogan, A. C., Wilber, K., & Mosqueda, L. 2016)

Pilot Study of Psychopathology Among Roman Catholic Secular Clergy

This pilot study gathered information regarding overall levels of psychopathology in a nationally selected, random sample of U.S. Roman Catholic secular (i.e., diocesan) priests using the Symptom Checklist-90-Revised (SCL-90-R; Derogatis, 2004). The study yielded a response rate of 45%. One-half of the participants reported marked psychological problems, with interpersonal sensitivity, anxiety, and depression most strongly correlated with the instrument’s overall index of psychopathology. Four dimensional scales were elevated (i.e., obsessive-compulsive, interpersonal sensitivity, depression, psychoticism), as were two indices (i.e., GSI, PST). Implications and directions for future research are discussed

Subunit Interactions of Recombinant HIV-1 Reverse Transcriptase With Mutations at L289

Reverse transcriptase (RT) is a dimeric enzyme required for replication of the human immunodeficiency virus (HIV). If the subunits of the RT dimer are dissociated, the enzyme is no longer active; therefore, identification of subunit binding sites could lead to potential targets for antiviral therapy. In order to identify where subunit binding of RT occurs, mutations were made at leucine (L) 289, a residue believed to be involved in dimerization through hydrophobic interactions with other leucines. L289 is the central leucine of a leucine repeat sequence which resembles a leucine zipper protein-DNA binding motif. Two mutations, leucine to arginine (L289R) and leucine to proline (L289P), were created using PCR mutagenesis. The mutations in the RT gene were verified by DNA sequencing, and cloned into a yeast expression vector using recombinant DNA techniques. The RT mutants were purified from yeast and compared to wild type RT in terms of specific activity, subunit dissociation, and subunit association using RT polymerase activity assays, fluorescence studies, and analytical gel filtration. Only the L289P mutant showed significantly less specific activity than wild type RT, and neither mutation affected RNase H activity. Both mutants dissociated into monomers slightly more easily than wild type RT, and both mutants were slower to associate to form dimers than wild type RT. L289P dimers dissociated slightly more easily than L289R dimers and were slower to reassociate. These mutations had only moderate effects on subunit interactions. If leucine 289 was part of a leucine zipper and directly involved in subunit binding, then both mutations would have had much greater effects on subunit interactions. Also, since RT subunit interactions are known to be hydrophobic in nature, the mutation to arginine, which is very hydrophilic, was expected to have a greater effect on dimerization than the proline mutation. However, the opposite was observed and the L289P mutation had a greater effect than the L289R mutation. These results are consistent with recent 3-dimensional computer modeling studies which indicate that leucine 289 is too far from the dimer interface to be involved in subunit binding. Leucine 289 is probably very important for maintaining secondary structure and proper folding of the enzyme, but it is not directly involved in subunit interactions

Patterns and potential solutions to coastal geohazards at Golovin, Alaska

Thesis (M.S.) University of Alaska Fairbanks, 2014The objective of this research is to measure the localized potential for shoreline change and flooding on the Golovin spit, Alaska. Long-term trends of shoreline change have been measured using multi-temporal aerial photography and satellite imagery from 1972-2013, while seasonal and annual changes in shoreline geometry have been measured by re-surveying the beach in July 2012, July 2013, and October 2013. The local bathymetry was updated with data derived from the WorldView-2 satellite to increase the spatial resolution of nearshore topography. These inputs were then integrated to establish an XBeach 1-dimensional numerical model connecting offshore storm water elevations to nearshore dynamics. The spit was found to experience episodic erosion of beach sediments, followed by sediment accretion. This resulted in a dynamic position of the shoreline, with no long-term trend in either the offshore or landward directions. Modeled storms resulted in inundation of low elevations of the spit at a 5- year return interval, with inundation of infrastructure on a 25-year return interval. The modeled results suggest overwash of the entire spit at the 50-100-year return interval. All models were based on the best available forcing data from hindcast modeling. Reinforcing and increasing the elevation of a temporary berm and/or a permanent levee structure, using a 25-year return interval as a design parameter, would help to reduce localized flooding on the spit, and may be considered in the future

Therapist Self-Disclosure with Adolescents: A Consensual Qualitative Research Study

Surprisingly little empirical attention has focused on therapist self-disclosure as an intervention with youth. Given the dearth of research in this area and the rising interest in evidenced-based practice, this study hoped to provide a deeper understanding of the effective use of therapist self-disclosure with adolescents. Twelve master\u27s- and doctoral-level child therapists were interviewed regarding their use of therapist self-disclosure with adolescent clients. Participants largely felt that it was important to use therapist self-disclosure carefully and for the benefit of the client. Most participants had some level of training on therapist self-disclosure and felt that the intervention can be beneficial. Overall, certain types of self-disclosure were viewed as more effective than others when participants were driven by specific intentions. Specifically, therapists shared past experiences and helpful strategies when they sought to model/teach or normalize an adolescent\u27s experiences, while self-involving disclosures were used to get unstuck in therapy or provide direct feedback. When participants discussed a specific instance of therapist self-disclosure with an adolescent, all identified positive effects of their therapist self-disclosures, but their paths to achieve these effects varied. Results indicated that the initial therapeutic relationship influenced the intention behind therapist self-disclosures, as well as the actual content of the disclosures. Limitations and implications for training, practice, and research are addressed

Supervisors\u27 Reports of the Effects of Supervisor Self-Disclosure on Supervisees

Using consensual qualitative research, researchers interviewed 16 supervisors regarding their use of self-disclosure in supervision. Supervisors reported that their prior training in supervisor self-disclosure (SRSD) came via didactic sources and encouraged judicious use of SRSD. Supervisors used SRSD to enhance supervisee development and normalize their experiences; supervisors did not use SRSD when it derailed supervision or was developmentally inappropriate for supervisees. In describing specific examples of the intervention, SRSD occurred in good supervision relationships, was stimulated by supervisees struggling, was intended to teach or normalize, and focused on supervisors\u27 reactions to their own or their supervisees\u27 clients. SRSD yielded largely positive effects on supervisors, supervisees, the supervision relationship, and supervisors\u27 supervision of others

Clients\u27 Experiences Giving Gifts to Therapists

Nine therapy clients were interviewed regarding their experiences of giving gifts to therapists. Data were analyzed using consensual qualitative research. In describing a specific event when they gave a gift that was accepted, participants described having a good relationship with the therapist and usually identified their therapy concerns as relationship or family struggles or both. Most bought a relatively inexpensive gift they thought their therapist would like and gave it during a nontermination session to express appreciation or mark an important life event. Most participants acknowledged mixed emotions when giving the gift and noted that any discussion of the gift was brief and did not explore its deeper meaning. Nevertheless, most participants perceived that gift events positively affected them and their therapists

The Barriers that Deter the Geriatric Population From Receiving Healthcare

In the United States, the geriatric population is considered to include individuals that are 65 years or older. In 2016, there was an estimated 49.2 million elderly Americans (Roberts, Ogunwole, Blakeslee, & Rabe 2018). Since the advances of modern medicine are prospering, this number is expected to increase drastically. Furthermore, the geriatric population is projected to double, from 2010 to 2030, to 20% or 72 million Americans (Horton and Johnson 2010). Looking further into the future, the American geriatric population is expected to be 83.7 million in 2050 (Ortman, Velkoff, & Hogan 2014). In a 2016 Center for Disease Control and Prevention (CDC) report, the American geriatric population self-reported the highest percentage of “fair” or “poor” overall health (Center for Disease Control and Prevention 2018b). In response, the United States Department of Health and Human Services set up additional programs and resources to improve this rating; however, with the many health complications that older Americans face, there has been a surprising inconsistent quality of care for this population. The disparity becomes significant since many geriatric patients deal with chronic health complications. Previous studies show that there are both tangible and intangible factors as to why the geriatric population face issues with access to healthcare or the quality of care. This retrospective analysis looked at the different types of barriers for the geriatric population in the United States. This study investigated the barriers in rural settings, urban settings, and more specifically Philadelphia, where the medical field is expanding to better care for this population. Physicians’ behavior and attitude towards patients, “difficulty in getting to the doctor, the absence of services, lack of career progression opportunities for physicians, and the increased financial burden” are the many barriers, which geriatric patients face when trying to access quality healthcare (Douthit, Dwolatzky, & Biswas 2015). One might think tangible barriers, such as the cost of medical care, would be the major barrier facing this population. However, studies concluded that the perceived behavior and attitude of the physician is the most significant barrier that deters the geriatric population from wanting to receive medical care. Possible solutions to this issue include reform of healthcare policy and focusing on patient-centered care