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Impact of Medicaid expansion on substance abuse treatment
Get PDFIntroduction: The Medicaid expansion has insured millions of Americans since the passage of the Affordable Care Act in 2010. Among this newly insured population, many of the enrollees have been diagnosed with a substance abuse disorder. Patients who have a substance use disorder diagnosis typically have multiple conditions that are treated simultaneously. When these patients have to seek healthcare services they are often uninsured. Unfortunately, since the patients are uninsured, the most frequent healthcare access points have been through admissions to more expensive areas of healthcare delivery such as the emergency department and subsequent inpatient services. The goals of the Medicaid expansion not only included expanding coverage to the uninsured, but it also attempted to increase access to various forms of treatments while also decreasing the overall delivery of uncompensated care. Uncompensated care has been a persistent budgetary strain to healthcare providers across the nation.
Purpose of study: This research attempted to examine how the Medicaid expansion specifically impacted the SUD population’s access to treatments, whether uncompensated care utilization among this population was impacted, and whether the expanded coverage impacted the overall healthcare spending across the country.
Methodology: This research summarizes the relative peer review articles and their descriptions of the impact Medicaid expansion has had on the SUD population. An interview with a subject matter expert was also used in this research.
Results/Discussion: The examination of expanded treatment access to services like medication-assisted-treatment has shown notable promise. There was also progress observed in uncompensated care utilization rates for facilities delivering treatment to SUD patients, including community health centers and emergency departments. However, overall spending trends for the entire healthcare sector showed mixed results. Much of this research was dependent upon state adoption of the Medicaid expansion. At the time of this research, 41 states have accepted the terms of the Medicaid expansion, while 9 states have opted not to participate. The impact that non-expansion states have had on overall research numbers is a potential subject of further research
The New Old Logic of AI: A Review of Mark Coeckelbergh’s The Political Philosophy of AI and Calvin Lawrence’s Hidden in White Sight
Get PDFThe New Old Logic of AI: A Review of Mark Coeckelbergh’s The Political Philosophy of AI and Calvin Lawrence’s Hidden in White Sight by Steven Wandler, St. Catherine Universit
Transdiaphragmatic Intercostal Hernia Repair in a Patient with Previous Thoracic Surgery
Get PDFA transdiaphragmatic intercostal hernia (TDIH) describes the herniation of abdominal contents through diaphragm and chest wall defects. It has been documented following traumatic injuries as well as after episodes of increased thoracoabdominal pressure. However, those resulting from iatrogenic cause remain uncommon and are less often recorded. We report an iatrogenic TDIH in a patient presenting 39 days after a complicated thoracic procedure, highlighting the surgical technique used for successful hernia reduction, diaphragmatic closure, and rib re-approximation. The case reinforces the possibility of a TDIH occurring as a post-surgical complication. Surgeons should anticipate the potential development of TDIH, particularly after thoracic procedures in patients with significant pre-existing conditions, such as chronic obstructive pulmonary disease (COPD) and cirrhosis. Such clinical awareness should be coupled with apt corrective surgical strategies thereby providing greater opportunity for successful patient recovery
Robotic Hysterectomy: Surgical Approach and Outcomes Among a Large Institutional Cohort
Get PDFIntroduction
The purpose of this report is to describe a technique for performing a robotic total laparoscopic hysterectomy (rTLH) with clinical outcomes on safety and efficiency. The rationale for our approach is based on a critical evaluation of the literature.
Methods
Data from all rTLH procedures performed on our gynecologic oncology service between January 2017 and December 2019 were retrospectively reviewed. Using this database, perioperative data including surgical times, intra- and postoperative complications, and length of hospital stays were evaluated. The steps used to perform the procedure were outlined and illustrated.
Results
826 cases of rTLH were performed during the study period. 688 of these cases were included for analysis. Malignant diagnoses were found in 218 cases. The median time from skin-to-skin for the entire cohort was 28.43 minutes for benign rTLH +/- BSO (bilateral salpingo oophorectomy) and 30.23 minutes for rTLH/BSO/cancer staging. Surgical complications included vaginal laceration, vaginal bleeding, urinary tract infection, serous fluid leakage from the incision, abdominal wall abscess, pelvic abscess, surgical site infection, serosal tear, enterotomy, rectal injury, acute kidney injury, perforated diverticulitis, and incarcerated bowel through the ventral hernia. The median length of stay was 1 day. The surgical technique is illustrated step by step.
Conclusion
This paper describes a safe and efficient technique to perform rTLH and shows that surgical times, complication rates, and length-of-stays compare favorably to the literature. A description of the technique clarifies many of the details of this procedure which can be made routine to minimize error and surgeon discrepancies. We encourage readers to use this paper as a guide to modify their techniques for robotically assisted laparoscopic hysterectomy
Photo of Chuck Yeager Next to Another Pilot
No full textUndated photo of Chuck Yeager next to an unidentified pilot.https://mds.marshall.edu/yeager/1238/thumbnail.jp
The simulation of elastic wave propagation in presence of void in the subsurface
Get PDFUnderground voids, whether man-made (e.g., mines and tunnels) or naturally occurring (e.g., karst terrain), can cause a variety of threats to surface activity. Therefore, it is important to be able to locate and characterize a potential void in the subsurface so that mitigating measures can be taken. In real-world environments, the subsurface properties and the existence of a void is not known, so the problem is challenging to solve. The numerical analysis conducted in this study takes a step toward understanding the seismic response with and without a void in various types of domains. The Finite Difference Method (FDM) and Finite Element Method (FEM) numerical techniques were used to analyze 1-D and 2-D seismic wave propagation for homogenous domains, layered domains, and with voids in the domain. The outputs of each numerical method were compared via their results and computational efficiency, which has not been completed in the current literature. Additionally, different void shapes were placed in the computational models to analyze each method’s void detection ability.
For 1-D wave propagation, both methods produced identical results at different loading frequencies and Courant numbers. Computationally, both methods have similar run times, while FDM had a simpler implementation than FEM. In a 2-D simulation, COMSOL was used for the FEM, and the staggered-grid technique was used for the FDM. Slight dispersion was observed in all the FDM solutions, where this was attributed to the step size; however, using a smaller step size significantly increased the computational time. For a homogenous model, both methods produced similar vertical particle velocity contours and surface time histories. Computationally, FDM outperformed FEM, and due to its ease of implementation, it was recommended for homogenous wave propagation. A three-layered domain was analyzed that featured a silty clay upper layer, and two lower rock layers. Contours of vertical particle velocity displayed that the majority of the wave remained in the upper third of the domain because of the harsh difference in material properties between the first and second layers. Additionally, a numerical model was created that consisted of the material properties obtained by ultrasonic testing. Reflections were seen in the generated seismograms but were not as visible as the ones seen in the three-layered case because the measured properties are alike and allow the wave to travel easily through the domain. After analyzing the wave propagation in a domain without a void, three void shapes were placed at the center of the domain (ellipse, circle, and square), and the resulting wave propagation was analyzed. There was minimal noise near the interface of rounded shapes in the FDM results, which was attributed to the staircase approximation used to define the shape. The surface time histories displayed reflections due to the void that were not seen in homogeneous cases. The elliptical void produced slightly more pronounced reflections because the length of the shape was larger than the circle and square. The reflections were also more easily seen in the rock domain than in soil. It was difficult locating voids in the three-layer case, but plots that computed the difference between the no-void and void case revealed that the voids did affect wave propagation. The elliptical void had the largest maximum difference of the seismograms, which occurred at the receiver closest to the void. There were differences between the subtracted plots from each method, where this was attributed to the different source incorporation. However, future studies will need to be completed to fully analyze why these plots differed between each method. Reflections from the void were more easily seen in the domain featuring the results from ultrasonic testing because of the similar rock properties that the samples shared. The elliptical void had the most perturbations compared to the square and circular voids. Overall, the FEM had longer computational times than the FDM, but both methods can successfully analyze wave propagation in the studied domains