Paying Family Medical Caregivers for Children's Home Healthcare in Colorado: A Working Medicaid Model.

OBJECTIVE: To compare the characteristics and healthcare use of children with medical complexity who receive paid certified nursing assistant (CNA) care by a family member (family CNA) and by a traditional nonfamily member (nonfamily CNA). STUDY DESIGN: This was retrospective cohort study of children who received CNA care through Colorado's Medicaid paid family caregiving program between 2017 and 2019 by a home healthcare agency. We compared patient characteristics between the family CNA and nonfamily CNA groups. A multivariable Poisson regression model was used to compare hospitalization rates (days in the hospital per year), adjusting for patient age patient sex, nursing care, and complex chronic condition. RESULTS: Of 861 patients, 79% (n = 680) received family CNA care and 21% (n = 181) received nonfamily CNA care. Patient demographics and hospitalization did not differ between the groups, although patients who had family CNAs were less likely to receive additional nursing-level care (42% vs 60%, P < .01). Family and nonfamily CNA caregivers had similar characteristics, except that family CNA caregivers had substantially better 3-year retention (82% vs 9%, P < .01) despite lower average hourly pay ($14.60 vs $17.60 per hour, P < .01). Hospitalizations were rare (<10% of patients). In the adjusted model, patients who received family CNA care experienced 1 more hospitalized day per year, compared with patients who received nonfamily CNA care (P < .001). CONCLUSIONS: Paid family caregivers provided CAN-level care to children with medical complexity with a greater employee retention compared with nonfamily CNA caregivers, with marginally different hospitalization rates using a family-centered approach. This model may help address workforce shortages while also providing income to family caregivers.

Inpatient Pediatric Palliative Care Consult Requests and Recommendations.

INTRODUCTION: Little is known about the requests for and recommendations from inpatient pediatric palliative care (PPC) consults and whether they differ by patient location (ward vs. intensive care unit) or patient type (new vs. established with PPC). METHODS: Single-center, retrospective cohort study comparing PPC consult requests and recommendations for children who received a PPC consult between January 1, 2018 and June 30, 2019. Comparisons were made by patient location and patient type using bivariate statistics. RESULTS: Three hundred twenty-seven PPC encounters were evaluated. Symptoms were more likely to be addressed in consults for ward patients than for intensive care unit patients. Compared with established patients, consults for new patients occurred significantly later in the hospital course and were more likely to be for psychosocial support or goals of care. DISCUSSION: We found variability in PPC consult requests and recommendations that may inform future work and targeted education for primary providers.

Spatial and Temporal Characteristics of Historical Oil and Gas Wells in Pennsylvania: Implications for New Shale Gas Resources.

Recent large-scale development of oil and gas from low-permeability unconventional formations (e.g., shales, tight sands, and coal seams) has raised concern about potential environmental impacts. If left improperly sealed, legacy oil and gas wells colocated with that new development represent a potential pathway for unwanted migration of fluids (brine, drilling and stimulation fluids, oil, and gas). Uncertainty in the number, location, and abandonment state of legacy wells hinders environmental assessment of exploration and production activity. The objective of this study is to apply publicly available information on Pennsylvania oil and gas wells to better understand their potential to serve as pathways for unwanted fluid migration. This study presents a synthesis of historical reports and digital well records to provide insights into spatial and temporal trends in oil and gas development. Areas with a higher density of wells abandoned prior to the mid-20th century, when more modern well-sealing requirements took effect in Pennsylvania, and areas where conventional oil and gas production penetrated to or through intervals that may be affected by new Marcellus shale development are identified. This information may help to address questions of environmental risk related to new extraction activities.

Spatial stochastic modeling of sedimentary formations to assess CO2 storage potential.

Carbon capture and sequestration (CCS) is a technology that provides a near-term solution to reduce anthropogenic CO2 emissions to the atmosphere and reduce our impact on the climate system. Assessments of carbon sequestration resources that have been made for North America using existing methodologies likely underestimate uncertainty and variability in the reservoir parameters. This paper describes a geostatistical model developed to estimate the CO2 storage resource in sedimentary formations. The proposed stochastic model accounts for the spatial distribution of reservoir properties and is implemented in a case study of the Oriskany Formation of the Appalachian sedimentary basin. Results indicate that the CO2 storage resource for the Pennsylvania part of the Oriskany Formation has substantial spatial variation due to heterogeneity of formation properties and basin geology leading to significant uncertainty in the storage assessment. The Oriskany Formation sequestration resource estimate in Pennsylvania calculated with the effective efficiency factor, E=5%, ranges from 0.15 to 1.01 gigatonnes (Gt) with a mean value of 0.52 Gt of CO2 (E=5%). The methodology is generalizable to other sedimentary formations in which site-specific trend analyses and statistical models are developed to estimate the CO2 sequestration storage capacity and its uncertainty. More precise CO2 storage resource estimates will provide better recommendations for government and industry leaders and inform their decisions on which greenhouse gas mitigation measures are best fit for their regions.

Thought suppression, impaired regulation of urges, and Addiction-Stroop predict affect-modulated cue-reactivity among alcohol dependent adults.

Abstinent alcohol dependent individuals commonly employ thought suppression to cope with stress and intrusive cognitions about alcohol. This strategy may inadvertently bias attention towards alcohol-related stimuli while depleting neurocognitive resources needed to regulate urges, manifested as decreased heart rate variability (HRV) responsivity to alcohol cues. The present study tested the hypothesis that trait and state thought suppression, impaired regulation of urges, and alcohol attentional bias as measured by the Addiction-Stroop would have significant effects on the HRV responsivity of 58 adults in residential treatment for alcohol dependence (mean age=39.6 ± 9.4, 81% female) who participated in an affect-modulated cue-reactivity protocol. Regression analyses controlling for age, level of pre-treatment alcohol consumption, and baseline HRV indicated that higher levels of trait thought suppression, impaired regulation of alcohol urges, and attentional fixation on alcohol cues were associated with lower HRV responsivity during stress-primed alcohol cue-exposure. Moreover, there was a significant state × trait suppression interaction on HRV cue-responsivity, such that alcohol dependent persons reporting high levels of state and trait suppression exhibited less HRV during cue-exposure than persons reporting low levels of state and trait suppression. Results suggest that chronic thought suppression taxes regulatory resources reflected in reduced HRV responsivity, an effect that is particularly evident when high trait suppressors engage in intensive suppression of drinking-related thoughts under conditions of stress. Treatment approaches that offer effective alternatives to the maladaptive strategy of suppressing alcohol urges may be crucial for relapse prevention.