658,355 research outputs found
Vitamin D: to test or not to test
No full textVitamin D deficiency has recently been linked to many chronic diseases such as MS (multiple sclerosis), cancer, rheumatoid arthritis, and diabetes. It has been a topic of debate among healthcare providers on whether or not it is beneficial to test and treat patients who have vitamin D deficiency. This paper looks at the potential mechanism of vitamin D in these disease processes and evaluates the various studies in the literature focusing on vitamin D levels and chronic diseases. This paper concludes by recommending that physicians in Allegheny County, PA, test all their adult patients for vitamin D deficiency, especially during the winter months. Vitamin D deficiency and the link to chronic disease have vast significance in the field of public health both in Allegheny County, PA, and nationwide
Data from: Entropic trap purification of long DNA
No full textThe data included in this folder are the raw data for the published paper in Lab on a Chip Journal (Lab Chip, 2018, 18, 955). This data has been deposited to DRUM to provide public access to the data and to help reproduce the work.NIH (R01-HG006851)Agrawal, Pranav; Bognár, Zsófia; Dorfman, Kevin D. (2018). Data from: Entropic trap purification of long DNA. Retrieved from the University Digital Conservancy, https://doi.org/10.13020/D6XT36
Lean thinking in long term care staffing and scheduling
No full textTo survive the ever-changing healthcare realm, long term care entities are beginning to follow the hospital industry’s lead towards lean thinking, a business methodology that strives to maximize value by decreasing waste. A long-term care network in Western PA began its lean journey a few years ago working to continuously improve processes and performance to offer residents the highest quality of care. With a growing US aging population and an increasingly insufficient nursing and direct care workforce, this network looked towards lean thinking to combat the challenge. The public health relevance is clear with a need to build a long-term care system that is reliable and sustainable to serve some of the most vulnerable individuals in the US. This essay examines the staffing and scheduling process improvement journey of two skilled nursing communities, aiming to improve staffing processes and reduce agency staff utilization. Both campuses successfully implemented the improvements of building a standardized master schedule, incorporating a team huddle into weekly operations and creating a process to obtain accurate daily care hours. With these improvements, the primary goal of reducing agency use and cost was achieved; with Campus A completely eliminating agency use and Campus B reducing agency spending by over $20,000 in five months. This essay shows how influential lean thinking can be in improving process efficiency, accuracy and cost control in long term care
Optimal taxation in R&D driven endogenous growth models
No full textE' possibile incrementare il benessere e la crescita mediante imposte in somma fissa, il cui gettito non venga usato produttivamente? E' possibile incrementare il benessere e la crescita mediante imposte sul reddito da capitale i cui proventi vengano usati per sussidiare i salari? In questo lavoro dimostriamo come la risposta ad entrame le domande possa essere positiva in modelli di crescita endogena trainata da Ricerca e Sviluppo, sia del tipo con espansione della varietà dei beni sia del tipo con aumento della qualità dei beni. Il meccanismo chiave è l'aumento dell'offerta di lavoro che le politiche descritte possono indurre. Tali politiche agiranno sui due tipi di esternalità nel modello, la prima statica la seconda dinamica. Il peso relativo di queste esternalità determinerà il segno dell'effetto totale delle politiche sul benessere sociale. Mostriamo come, per valori dei parametri coerenti con le stime disponibili, crescita e benessere possano aumentare introducendo imposte in somma fissa, il cui gettito venga sprecato, mentre il programma di tassazione del capitale e sussidi ai salari possa aumentare il benessere, anche se la crescita può ridursi.Is it possible to increase growth and welfare by raising lump-sum taxes and disposing of the tax revenues? Is it possible to increase welfare by raising capital income taxes and redistributing the revenue as a subsidy to labor income? This thesis shows these may indeed be the case in
standard R&D models with technological change, represented either by an increase in the variety of intermediate goods or by creative destruction. The key mechanism is that with elastic labor supply the tax programs can
increase the employment rate in equilibrium. This creates two spillover effects on the R&D pace. In addition the tax programs themselves will have level effect on the instantaneous utility. The relative momentums of the spillovers and the level effect determine the sign of the welfare effect. It is shown that, for parameter values consistent with available estimates,
the growth and welfare can both be improved under the wasted lump-sum tax program, and that the welfare effect can be positive even if the long-run growth rate decreases after the increase in the capital income tax
rate
Complex anisotropy beneath the Peruvian flat slab from frequency-dependent, multiple-phase shear wave splitting analysis
No full textFlat or shallow subduction is a relatively widespread global occurrence, but the dynamics remain poorly understood. In particular, the interaction between flat slabs and the surrounding mantle flow has yet to be studied in detail. Here we present measurements of seismic anisotropy to investigate mantle flow beneath the Peruvian flat-slab segment, the largest present-day region of flat subduction. We conduct a detailed shear wave splitting analysis at a long-running seismic station (NNA) located near Lima, Peru. We present measurements of apparent splitting parameters (fast direction ? and delay time ?t) for SKS, ScS, and local S phases from 80 events. We observe well-defined frequency dependence and backazimuthal variability, indicating the likely presence of complex anisotropy. Forward modeling the observations with two or three layers of anisotropy reveals a likely layer with a trench-normal fast direction underlying a layer with a more trench-oblique (to trench-subparallel) fast direction. In order to further constrain the anisotropic geometry, we analyzed the source-side splitting from events originating within the slab measured at distant stations. Beneath the flat-slab segment, we found trench-normal fast splitting directions in the subslab mantle, while within the dipping portion of the slab further to the east, likely trench-subparallel anisotropy within the slab itself. This subslab pattern contradicts observations from elsewhere in South America for “normal” (i.e., more steeply dipping) slab conditions. It is similar, however, to inferences from other shallowly dipping subduction zones around the world. While there is an apparent link between slab dip and the surrounding mantle flow, at least beneath Peru, the precise nature of the relationship remains to be clarified
Resident-centered initiative and long-term-care services
No full textObjective: As the aging population in the United States is expected to double to over 85 million citizens by 2050, the demand for long-term-care services will dramatically increase, as 70% of elders will require some kind of support service in their lives. here is an increasing trend of long-term-care entities, such as the Jewish Association on Aging located in Pittsburgh, PA, adopting more “person-centered” care. These culture changes are a shift away from traditional institutional care and involve incorporating the wishes and values of the resident into his plan of care. Purpose: The purpose of this essay is to evaluate the Jewish Association on Aging’s person-centered dining room initiative to determine its impact on both the organization and the lives of its residents. Public Health Relevance: With the increase in elders demanding long-term-care support, it is necessary to provide services to empower them continue this next chapter of their lives in a healthy, meaningful and positive manner These resident-centered initiatives represent a shift in the way care is delivered throughout all levels of care and hve real cost implications that can limit the high public health expenditures the nation faces Methods: Meal and dining cost data were compared between a traditional dining room, where food is brought up on trays from the kitchen, and the new person-centered dining room in the skilled nursing facility in which choices are made and meals are cooked in real-time in a home-like dining environment. These quantitative data were augmented with observational data and anecdotal evidence to compare perceptions and attitudes of residents and staff about the differences in dining experiences in the two different dining rooms. Conclusion: Tray service was found to produce significantly more pounds of waste and higher waste costs compared to the new resident-centered dining initiatives. Residents in the new dining unit spent more time eating and spent more time socializing with other residents and the staff. In the short-term, the new dining initiative improves the quality of dining experiences. It is reasonable to assume that in the long-run, this initiative will have a positive impact on physical health of residents
MeSH term explosion and author rank improve expert recommendations
No full textInformation overload is an often-cited phenomenon that reduces the productivity, efficiency and efficacy of scientists. One challenge for scientists is to find appropriate collaborators in their research. The literature describes various solutions to the problem of expertise location, but most current approaches do not appear to be very suitable for expert recommendations in biomedical research. In this study, we present the development and initial evaluation of a vector space model-based algorithm to calculate researcher similarity using four inputs: 1) MeSH terms of publications; 2) MeSH terms and author rank; 3) exploded MeSH terms; and 4) exploded MeSH terms and author rank. We developed and evaluated the algorithm using a data set of 17,525 authors and their 22,542 papers. On average, our algorithms correctly predicted 2.5 of the top 5/10 coauthors of individual scientists. Exploded MeSH and author rank outperformed all other algorithms in accuracy, followed closely by MeSH and author rank. Our results show that the accuracy of MeSH term-based matching can be enhanced with other metadata such as author rank
Applying Lean Principles to Long-Term Care Settings
No full textWhile rising healthcare expenditures, staffing shortages, and issues relating to quality and patient outcomes are not exclusive to long-term care, this sector faces unique challenges due to the gaps in funding and lack of proper resources in the space. With a growing aging population and an increasing need for long-term support services, it is of high public health significance that the organizations providing these services think about how they plan to adequately support this demand despite the barriers they are currently facing. These organizations may benefit from applying management theories like Lean which focuses on increasing value while decreasing costs and waste within a system. By changing the culture to support continuous improvement, long-term care organizations can begin to achieve more desired outcomes despite the issues at hand. This essay focuses on my experience with Presbyterian Seniorcare Network’s application of Lean during my Administrative Residency. The Lean projects I completed during my time focus on areas such as staffing, billing, and safety
A Case Study of Telemedicine in Long Term Care
No full textIn March 2020, the COVID pandemic spurred a national state of emergency as infections rose exponentially. The pandemic forced clinicians to take extra precautions to control the infection. To support hospitals and health systems, the government changed federal reimbursement rates to make telemedicine more financially viable. The allowance for widespread remote patient visits has opened a door for a growing service in healthcare. The long-term care population has been significantly affected by this pandemic, accounting for a large portion of the mortalities. As we move forward, the US government will have to decide on the future of telemedicine service coverage. Thus, there is a need to study how hospitals have adapted to include telemedicine into their care models. To best inform the policymakers before they make this decision, it is imperative to learn what impact telemedicine services has had during this period. Based on the case study done that analyzed findings from multiple long-term care facilities, associated with UPMC and Genesis Healthcare, there is a role for telemedicine in long-term care as well as a lot of challenges to navigate within the space. These long-term care facilities saw success in increasing behavioral health care use, reducing hospital transfers, and the ability to leverage existing telehealth models. Some of challenges they saw had to do with technological education gaps in the older population, staffing issues, and the lack of capital infrastructure. The recommendations for policy revolve around determining best practices for telemedicine and stratifying reimbursement to maximize effective use. Past policy, there are changes that health systems can consider like more robust clinical training or collaborating to determine high efficacy treatments that would better patient care. Future research should examine health system cost complementarities, as well as internet accessibility and the related health outcomes
The role of vitamin D in type 1 diabetes complications: a cross sectional analysis of the Pittsburgh EDC study
No full textBackground: It has been postulated that vitamin D deficiency may be associated with diabetic complications. A comprehensive analysis of microvascular and macrovascular complications, however, has not been conducted in patients with type 1 diabetes. Hence, we investigated the associations between vitamin D levels and the prevalence of microalbuminuria, overt nephropathy, impaired endothelial function, end stage renal failure, confirmed distal symmetric polyneuropathy, coronary artery disease and lower extremity arterial disease in individuals with type 1 diabetes.\ud
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Methods: We measured circulating 25(OH)D and 25(OH)D3 in 214 individuals with type 1 diabetes who participated in the 25 year clinical visit of the Pittsburgh Epidemiology of Diabetes Complications study of childhood onset type 1 diabetes (n=214, mean age = 51 years and median diabetes duration = 42 years). Cross-sectional associations of 25(OH)D and 25(OH)D3 with diabetic complications were assessed with multivariable logistic regression adjusted for diabetes duration, sex, BMI, season of visit, HbA1c, insulin dose per body weight, hypertension, HDL and non-HDL cholesterol, WBC count, estimated glomerular filtration rate and albumin to creatinine ratio, as appropriate.\ud
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Results: Fully adjusted models revealed that each 1 ng/ml increase in 25(OH)D was associated with 3% to 6% lower odds of microalbuminuria (OR=0.97, 95% CI=0.94, 0.99), impaired eGFR (OR=0.96, 95% CI=0.93, 0.99) and confirmed distal symmetric polyneuropathy (OR=0.94, 95% CI=0.90, 0.98). Similar results were found for 25(OH)D3. These vitamin D metabolites were not independently associated with overt nephropathy, end stage renal failure, coronary heart disease or lower extremity arterial disease.\ud
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Conclusions: In this cohort of middle-aged adults with type 1 diabetes, both higher 25(OH)D and 25(OH)D3 were related with a lower prevalence of early diabetic kidney disease and diabetic neuropathy, but not with advanced renal disease and macrovascular disease. For the interest of public health, it would be imperative to determine whether vitamin D levels can further predict the risk of developing these diabetic complications
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