For aging populations age 65 years and older, lack of social engagement, or social isolation, is a public health issue that can have serious health implications. The ability to engage socially can decrease with aging populations due to many factors, such as health status and mobility. As social engagement decreases, the potential for serious diseases, such as dementia, increases. Limited social connections and engagement can be linked to healthcare utilization through increased rates of re-hospitalization as well as potentially decreased ability to and increased need to regularly access physician services. The aim of this research is to expand on the existing body of work in the area of care access and social isolation among aging populations, to examine the relationship between physician office visits and social activity and what differences may exist between those who live in urban and non-urban settings. A cross-sectional analysis was conducted using data from the Fall 2019 Medicare Current Beneficiary Survey (MCBS). The number of physician office visits participants have annually was the variable of primary interest. Physician visits were categorized dichotomously into moderate or no use and high use. Individuals with 11 or more visits were considered to be high utilizers within this data set and those with 10 visits or less as low. The key independent variables in this analysis are social activities and geography of the respondent. Social activities are defined has having social limitations, from respondents indicating limited activities most or all of the time in the past month, or low limitations, indication of some or no limitation of activities within the past month. Metropolitan Statistical Area (MSA) was used to categorize respondents as residing in an urban or rural community. The study population included 11,670 individuals over the age of 65. Approximately 15% of respondents were categorized as high health service utilizers and 85% were low or average. Only 7% of respondents were noted as having high levels of restrictions on social activities. The majority (81%) of respondents were classified as residing in a metro area compared to 19% residing in non-metro areas. High restrictions on social activities were associated with higher numbers of physician visits Approximately 10.6% of individuals with high social restrictions were also categorized as having higher numbers of physician visits compared to 6.6% among those with low social restrictions (OR=1.667; 95%CI: 1.47-1.89). No associations between geography and physician visits were noted. This study found a relationship between restricted social engagement and higher utilization of physician services. These findings were not consistent when adjusting for additional covariates of interest. Because poor general health can play a large part in both the ability to engage socially and high utilization of physician visits in aging populations, these findings underscore the importance of enhancing community services and opportunities for social engagement as health policy tools for improving health and quality of life for aging individuals.

INTRODUCTION: Unplanned hospital visits have emerged as a quality metric encompassing many aspects of postoperative morbidity and deficiencies in the transition from inpatient to outpatient care. This study aims to identify patient, encounter, and organizational factors that may influence Emergency Department (ED) visits and readmissions following bariatric surgery. METHODS: A modified version of a framework initially proposed by Vest et al. in their systematic review of the determinants of preventable readmissions was used as a conceptual framework for this study. The Michigan Bariatric Surgery Collaborative (MBSC) database was used to identify patients undergoing all primary bariatric procedures at 40 centers with >100 patients in the database from 2006–2015. Multivariate logistic regression modeling was used to identify factors associated with unplanned hospital visits. Using an indirect standardization process, each sites’ observed to expected ratio for 30-day readmission was calculated. The association between each site’s adjusted readmission rate with their rate of ED visits, Emergency Department-Sourced readmissions (EDSR), major complications, and compliance with best practices were calculated with Pearson’s correlation coefficients. RESULTS: Younger age, greater comorbidities, increased length of stay, procedure type, and Medicaid/Medicare insurance were significantly associated with readmissions in a multivariate logistic regression model. There was significant variation among sites’ adjusted rates of readmission, EDSR, best practice compliance, and major complications. There was a moderately strong association between each sites’ adjusted readmission rate with their rate of EDSR (r=0.53), major complications (r=0.53), and ED visits (r=0.55). However, the association between bariatric centers’ compliance with best practices to reduce unplanned hospital visits and their readmission rates was fairly weak (r= -0.14). CONCLUSION: Several individual, encounter, and organization-level characteristics are associated with an increased risk of unplanned visits after bariatric surgery. Bariatric centers are more likely to have higher readmission rates if their site has higher rates of major complications and if their ED is less likely to treat and then discharge bariatric patients. Further examination of organizational characteristics of bariatric programs that affect postoperative readmissions, including ED practices, is needed to better guide future initiatives aimed at improving this quality metric.

Advances in surgical technique and medical management have led to fundamental changes in surgical care allowing for a paradigm shift from inpatient to outpatient surgery. Enhanced recovery pathways have moved surgical recovery from inpatient to outpatient settings requiring informal caregiver support. The purpose of this study was to determine the prevalence of caregiver burden in this patient population and to explore whether caregiver burden contributes to preventable use of emergency room services. The conceptual framework supporting this retrospective cross-sectional study was Andersen's behavioral model of health services utilization. Data collected from 28 urologic patient/caregiver pairs were analyzed using descriptive statistics and linear and logistic regression. Findings indicated measurable caregiver burden in 2 of the 5 Caregiver Reaction Assessment (CRA) subscales: impact on schedule and impact on health. Findings also indicated a measurable protective effect of high socioeconomic status of caregivers and the CRA subscale of impact on finances, and a possible protective effect of caregiver self-esteem as measured by the CRA subscale and emergency room utilization within the first 30 days after enhanced recovery surgery. Social change implications include improving the surgical experience of patients and caregivers and enhancing the use of health care resources.

The Logan City Environmental Department operates a facility that consists of 460 acres of fairly shallow lagoons (~ 5'deep) for biological wastewater treatment that meets targets for primary and secondary treatments (solids, biological oxygen demand (BOD), and pathogen removal). Significant natural algal growth occurs in these lagoons, which improves BOD removal through oxygenation and also facilitates N removal through volatilization as ammonia under high pH conditions created by algal growth. Phosphorus, however, is non-volatile and stays in the water and likely cycles in and out of algal cells as they grow and die in the lagoons. In the near future, the regulatory limits on phosphorus released from the Logan wastewater treatment facility are likely to become significantly lower to counter potential downstream eutrophication. One way to potentially lower phosphorus levels in the wastewater effluent is through management of algal growth in the lagoons. As mentioned above, algae growth naturally occurs in the treatment lagoons and if the algal biomass is harvested when growth yields are highest, the phosphorus contained in the cells could be removed to obtain phosphorus-free water. The algal biomass could then be used for production of biofuels. This research focuses on laboratory and pilot assessments to show the ability of algae indigenous to the Logan lagoons to uptake phosphorus and produce biomass that can be used for biofuel production.

Wildfires have caused concern as they have increased in severity and intensity over the last few decades. Land managers have sought management actions to mitigate the risk of wildfire by reducing fuel loads, thus decreasing wildfire intensity. Camp Williams is a National Guard camp near Bluffdale, Utah, where small arms and artillery training occurs. Managers at Camp Williams have created fuel breaks by implementing targeted sheep and goat grazing to remove fine fuel and thin brush. Management objectives set utilization of fine fuels (herbaceous) at 80% by weight. Questions arose regarding the ecological impact of the prescribed grazing rates in these fuel breaks. This study evaluated three fuel breaks and quantified the impacts of targeted sheep and goat grazing at 80% utilization. During the summer of 2015, herbaceous cover, shrub cover, shrub density, and bunch grass density was collected along eight paired (inside fuel break and outside fuel breaks) transects. Results indicate that the current management grazing plan could lead to an increase of invasive annual grasses, which may be counterproductive in fuel breaks. Often fine fuel treatments rely on high levels of grazing utilization (> 80%). However, high levels of utilization can lead to ecological degradation by reducing or eliminating native bunchgrasses. The objectives of the second study conducted were to determine how different levels of grazing utilization (30%, 50%, and 80%) relate to fuel characteristics and subsequent fire behavior. Results suggest that moderating grazing utilization levels (50%) may allow for more sustainable fuel reduction treatments while still reducing wildfire risks.

Muskrats (Ondatra zibethicus) are associated with marshlands throughout North America. Their impact on marsh vegetation is well documented. In recent years, research pertaining to marsh ecosystems has emphasized the role of interspersion of marsh vegetation to higher faunal diversity and productivity. Muskrats can provide a natural control of aquatic emergents if managed properly. Experimentation at Fish Springs National Wildlife Refuge, Utah, has attempted to ascertain whether vegetation-utilization index could be used for determining muskrat population levels and to evaluate the impact of muskrats on their primary food resource, Olney's bulrush (Scirpus americanus). Three known populations of muskrats were maintained within wire-mesh enclosures 0.4-0.9 ha in size. Variable length transects were used to estimate the number of grazed stems of Olney's bulrush present in an enclosure for a 5-day period. Estimated number of grazed stems was divided by muskrat-days to give an estimate of the number of grazed stems muskrat-1 day-1. A consistant relation between the known muskrat population and the number of stems grazed muskrat-1 day-1 (23 .0) was found, indicating that a valid index could be formulated using vegetation utilization data. Assessment of plant species utilization was analyzed from dietary composition obtained from stomach contents. Olney's bulrush was the most utilized food resource. Phragmites (Phragmites australis) was the most utilized resource in the absence of bulrush. The potential effects of muskrat grazing was determined using exclosures in homogeneous stands of the above vegetation. A 4x4 randomized block design with varying levels of simulated grazing was employed for monthly replications duringthe growing season for 2 years. Effect of repeated grazing was found to be highly significant for clipping rates within and between months for both years. Vegetative yield was measured as mean dry weight (g) per stem per plot. Significant differences in yield were noted among the grazing rates. Repeated grazing of emergent vegetation by muskrats can have a marked effect on the plants' ability to grow.

Practices of land use in Utah show need for community action aimed at more adequate utilization of land and water resources. Use of land for crop production in Utah is limited by topography, soil type, elevation, climate, and moisture. Because of limitations imposed, only a small portion of the land area may be used for cultivated farming. As a rule, large land holdings in Utah are not regularly tilled but are used as range for raising livestock.

Indiana University-Purdue University Indianapolis (IUPUI) / Poor oral health is associated with pain, decreased chewing function, negative social perceptions, and reduced quality of life. Low-income adults disproportionally have worse oral health and use dental services at lower rates than higher-income adults. This disparity is associated with individual demographic and socioeconomic factors, cost and coverage barriers, as well as the supply and location of dental providers. Although the full causal pathway remains elusive, evidence suggests an association with poor oral health and an exacerbation of chronic diseases symptoms. Thus, adequate provision of dental care has important population health implications. Despite this importance, dental care use among low-income adults is particularly underexplored. Furthermore, existing research lacks robust methodological designs to mitigate bias from unobserved confounders. Dental coverage for low-income adults through Medicaid is emerging as a way to provide services to this population. However, given state budget constraints, comprehensive public dental benefits are uncommon or at risk of being cut. Therefore, it is important to quantify the individual and economic value of dental care use among adult Medicaid enrollees. This dissertation examines factors and outcomes associated with dental care use among Medicaid-enrolled adults in Indiana. This dissertation includes three studies 1) a pooled cross-sectional analysis that measures the association of individual and community level factors with dental care use, 2) a repeated measures study with individual fixed effects to examine whether receipt of preventive dental care is associated with fewer subsequent non-preventive dental visits and lower total annual dental expenditures, and 3) an empirical study that utilizes an instrumental variable estimation method to examine the effect of preventive dental visits on medical and pharmacy expenditures. Overall, this dissertation attempts to understand the correlates of dental care use, the effectiveness of preventive dental care, and the association between preventive dental care and medical expenditures.

No description available.

No description available.