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Background:Chronic disease in older adults is estimated to account for 84% of annual health care spending in the United States, with many preventable costs expected to rise as the population continues to age. Introduction:Telehealth Intervention Programs for Seniors (TIPS) is a community-embedded program targeting low-income older adults, providing weekly assessment of vital signs and subjective wellness, and wrap-around aging services. Materials and Methods:TIPS recruited 765 volunteers over 55 years, who were Medicaid and/or Medicare eligible. Data were collected from 2014 to 2016 [median enrollment 343 days (105–435)] using 12 TIPS sites. This observational study evaluated the efficacy of TIPS by measuring within-subject changes in self-reported hospital visits and <30-day readmissions, before and during TIPS participation. Data of 617 participants (median age 74.3; interquartile range 16) were analyzed. Results:Self-reported hospital visits were reduced by 28.9% (p = 0.0013). Medicare participants benefited the most, with a 50% (p < 0.0001) reduction in hospital visits, and a 75.5% (p = 0.017) reduction in <30-day readmissions. Multivariate analysis revealed that participants (1) Medicaid-registered (odds ratio [OR] = 2.72, 95% confidence interval [CI] 0.392–1.611), (2) reporting feeling unwell (OR = 1.33, 95% CI 0.118–0.459), and (3) living alone (OR = 2.34, 95% CI 0.115–1.592) were significantly more likely than other participants to experience a hospital visit. Discussion:TIPS demonstrates that community-embedded health services can reduce rates of hospital visits in older adults. Conclusion:The success of TIPS highlights the potential of successfully deployed remote patient-monitoring initiatives in reducing the utilization of costly health services. [ABSTRACT FROM AUTHOR]

The article focuses on the impact of adoption on new arbitration procedure by the Court of Chancery of the State of Delaware on court cases related to arbitration agreements. It informs that the procedure arises competition for adjudications and two issues multi-forum litigations and increase in the popularity of commercial arbitration. It examines Chancery-sponsored arbitration procedure in context of corporate law.

Surveillance of Staphylococcus aureus infections in 3 northern remote communities of Saskatchewan was undertaken. Rates of methicillin-resistant infections were extremely high (146-482/10,000 population), and most (98.2%) were caused by USA400 strains. Although USA400 prevalence has diminished in the United States, this strain is continuing to predominate throughout many northern communities in Canada. [ABSTRACT FROM AUTHOR]

Objective. To propose and test a method that produces an unbiased estimate of the average effect of smoking cessation on weight gain. Previous estimates may be biased due to unobservable differences in attributes of quitters and continuing smokers. An accurate estimate of weight gain due to cessation is important for policymakers, health managers, clinicians, consumers, and developers of smoking cessation aids. Study Setting. Our analysis consisted of an instrumental variables (IVs) approach in which treatment assignment in randomized smoking cessation trials served as a random source of variation in probability of quitting. Data Collection. We searched the medical literature for previously conducted smoking cessation trials that contained data suitable for our reanalysis. Principal Findings. We identified one trial for our reanalysis, the Lung Health Study, a randomized smoking cessation trial with 5,887 smokers aged 35–60 from 1986 to 1994 in several sites across the United States. In our IV reanalysis, we estimated a 9.7 kg weight gain over 5 years due to cessation, as compared with the conventional estimate of 5.3 kg. Conclusions. The true effect of smoking cessation on weight gain may be larger than previously estimated. This result indicates the importance of fully understanding the possible weight effects of cessation and underscores the need to accompany cessation programs with weight management interventions. The result, however, does not overturn the conclusion that the net health benefits of quitting are positive and very large. The application of the IV technique we propose is likely to be useful in a variety of contexts in which one is interested in the effect of one health condition on another. [ABSTRACT FROM AUTHOR]

This study examined the mental health needs, knowledge, and utilization of counseling services among graduate students at a large university in the western United States. Almost half of graduate student respondents reported having had an emotional or stress-related problem over the past year, and over half reported knowing a colleague who had had an emotional or stress-related problem over the past year. Self-reported mental health needs were significantly and negatively related to confidence about one's financial status, higher functional relationship with one's advisor, regular contact with friends, and being married. Utilization of counseling services was positively associated with an index of depression symptoms, the number of semesters in school, and identifying as female. Those students who had experienced a significant mental health event in the past year and had higher functional relationships with their advisors were significantly more likely to utilize counseling services. Findings suggest a need for increased attention to graduate student mental health needs, especially the role of financial confidence in student well-being and the relationship of graduate students with their advisors. [ABSTRACT FROM AUTHOR]

Explores the applicability of the adoption of business management and marketing principles by academic libraries in the United States. Comparison between commercialism and higher education; Extent of commercialism in academic libraries; Possible alternatives to commercialism; Implication of alternatives for academic libraries.

Examines the state of electronic journals indexing in the social sciences and its prospects as a mainstream tool for research in the United States. Advantages over paper serials; Drawbacks; Demand for articles and the lack of visibility; Elements that should be included in electronic citation; Summary of indexing and abstracting activity in exclusively electronic journals.

The author reflects on the need for research and evaluation of state health reforms. He cites the enactment of Massachusetts of near universal health insurance coverage in 2006. The author suggests that increase activity around state-level health care reform provides a set of challenges for different sectors of the health services research community.

Background: Chronic disease in older adults is estimated to account for 84% of annual health care spending in the United States, with many preventable costs expected to rise as the population continues to age. Introduction: Telehealth Intervention Programs for Seniors (TIPS) is a community-embedded program targeting low-income older adults, providing weekly assessment of vital signs and subjective wellness, and wrap-around aging services. Materials and Methods: TIPS recruited 765 volunteers over 55 years, who were Medicaid and/or Medicare eligible. Data were collected from 2014 to 2016 [median enrollment 343 days (105-435)] using 12 TIPS sites. This observational study evaluated the efficacy of TIPS by measuring within-subject changes in self-reported hospital visits and <30-day readmissions, before and during TIPS participation. Data of 617 participants (median age 74.3; interquartile range 16) were analyzed. Results: Self-reported hospital visits were reduced by 28.9% ( p  = 0.0013). Medicare participants benefited the most, with a 50% ( p < 0.0001) reduction in hospital visits, and a 75.5% ( p  = 0.017) reduction in <30-day readmissions. Multivariate analysis revealed that participants (1) Medicaid-registered (odds ratio [OR] = 2.72, 95% confidence interval [CI] 0.392-1.611), (2) reporting feeling unwell (OR = 1.33, 95% CI 0.118-0.459), and (3) living alone (OR = 2.34, 95% CI 0.115-1.592) were significantly more likely than other participants to experience a hospital visit. Discussion: TIPS demonstrates that community-embedded health services can reduce rates of hospital visits in older adults. Conclusion: The success of TIPS highlights the potential of successfully deployed remote patient-monitoring initiatives in reducing the utilization of costly health services.

Background: The purpose of this study is to explore how a patient's height and weight can be used to predict the effective dose to a reference phantom with similar height and weight from a chest abdomen pelvis computed tomography scan when machine-based parameters are unknown. Since machine-based scanning parameters can be misplaced or lost, a predictive model will enable the medical professional to quantify a patient's cumulative radiation dose., Methods: One hundred mathematical phantoms of varying heights and weights were defined within an x-ray Monte Carlo based software code in order to calculate organ absorbed doses and effective doses from a chest abdomen pelvis scan. Regression analysis was used to develop an effective dose predictive model. The regression model was experimentally verified using anthropomorphic phantoms and validated against a real patient population., Results: Estimates of the effective doses as calculated by the predictive model were within 10% of the estimates of the effective doses using experimentally measured absorbed doses within the anthropomorphic phantoms. Comparisons of the patient population effective doses show that the predictive model is within 33% of current methods of estimating effective dose using machine-based parameters., Conclusions: A patient's height and weight can be used to estimate the effective dose from a chest abdomen pelvis computed tomography scan. The presented predictive model can be used interchangeably with current effective dose estimating techniques that rely on computed tomography machine-based techniques.

Individual insurance is the only source of health coverage for people without access to employer-sponsored insurance or public insurance. Individual insurance traditionally has been sought by older, sicker individuals who perceive the need for insurance more than younger, healthier people. The attraction of a sicker population to the individual market creates adverse selection, leading insurers to employ medical underwriting--which most states allow--to either avoid those with the greatest health needs or set premiums more reflective of their expected medical use. Recently, however, several factors have prompted insurers to recognize the growth potential of the individual market: a declining proportion of people with employer-sponsored insurance, a sizeable population of younger, healthier people forgoing insurance, and the likelihood that many people receiving subsidies to buy insurance under proposed health insurance reforms would buy individual coverage. Insurers are pursuing several strategies to expand their presence in the individual insurance market, including entering less-regulated markets, developing lower-cost, less-comprehensive products targeting younger, healthy consumers, and attracting consumers through the Internet and other new distribution channels, according to a new study by the Center for Studying Health System Change (HSC). Insurers' strategies in the individual insurance market are unlikely to meet the needs of less-than-healthy people seeking affordable, comprehensive coverage. Congressional health reform proposals, which envision a larger role for the individual market under a sharply different regulatory framework, would likely supersede insurers' current individual market strategies.

From 2001 to 2008, the Robert Wood Johnson Foundation funded the Economic Research Initiative on the Uninsured (ERIU), housed at the University of Michigan. The goals of ERIU were to increase, diversify, and improve the quality and quantity of economics research on the uninsured, and to translate that research into the type of resources that are useful to policymakers, policy analysts, researchers, and members of the media. One of the primary objectives of ERIU was to fund research projects that explored economic issues about the uninsured in new, yet rigorous and interesting ways. ERIU began by commissioning six critical syntheses of the existing research. These syntheses were intended to inform researchers of what we know and what we don't know about the uninsured. In eight years, ERIU funded more than 50 new research projects on a variety of coverage topics aimed at addressing the gaps in knowledge highlighted in these syntheses. These projects, involving more than 100 researchers, resulted in over 70 conference and seminar presentations worldwide and approximately 40 articles published in peer-reviewed journals.

The gap between the two worlds of researchers and policymakers renders the use of research in the policy-making process problematic. Policymakers have three primary needs in their use of research evidence: clear translation, accessible and easy-to-use information, and relevance to the policy context. These needs are sometimes at odds with the priorities of the research community. This paper describes the Robert Wood Johnson Foundation's Synthesis Project, which aims to strengthen links between research and policy making by synthesizing evidence on pressing health policy questions.