Exploring the Role of Executive Functioning Capacity in Patient Activation and Health Outcomes Among Medicaid Members With Multiple Comorbidities.

Patient activation, the perceived capacity to manage one's health, is positively associated with better health outcomes and lower costs. Underlying characteristics influencing patient activation are not completely understood leading to gaps in intervention strategies designed to improve patient activation. We suggest that variability in executive functioning influences patient activation and ultimately has an impact on health outcomes.

The wellness incentives and navigation project: design and methods.

Background: About 35 % of non-elderly U.S. adult Medicaid enrollees have a behavioral health condition, such as anxiety, mood disorders, substance use disorders, and/or serious mental illness.

Word-finding impairment in veterans of the 1991 Persian Gulf War.

Approximately one quarter of 1991 Persian Gulf War Veterans experience cognitive and physiological sequelae that continue to be unexplained by known medical or psychological conditions. Difficulty coming up with words and names, familiar before the war, is a hallmark of the illness. Three Gulf War Syndrome subtypes have been identified and linked to specific war-time chemical exposures.

Quality of Care for Chronic Conditions Among Disabled Medicaid Enrollees: An Evaluation of a 1915 (b) and (c) Waiver Program.

Importance: Examining the impact of Medicaid-managed care home-based and community-based service (HCBS) alternatives to institutional care is critical given the recent rapid expansion of these models nationally.

Objective: We analyzed the effects of STAR+PLUS, a Texas Medicaid-managed care HCBS waiver program for adults with disabilities on the quality of chronic disease care.

Design, Setting, And Participants: We compared quality before and after a mandatory transition of disabled Medicaid enrollees older than 21 years from fee-for-service (FFS) or primary care case management (PCCM) to STAR+PLUS in 28 counties, relative to enrollees in counties remaining in the FFS or PCCM models.

Executive functioning in attention-deficit/hyperactivity disorder: questioning the notion of planning deficits with heart rate reactivity.

This study employed a paired stimulus paradigm to compare phasic changes in heart rate among children (age categories 6-8, 9-10, and 11-12) and adults (age categories 18-19 and 20-22) with attention-deficit/hyperactivity disorder (ADHD) and age-matched controls. A sample of 95 participants (19 ADHD-diagnosed children, 34 controls, 20 ADHD-diagnosed adults, and 22 controls) solved a planning task, the Tower of London, through 4 levels of difficulty. It was hypothesized that groups with ADHD would show greater heart rate acceleration and less final deceleration than would controls, and that these heart rate responses would change with age and difficulty level as well.

Planning: fixed-foreperiod event-related potentials during the Tower of London task.

Slow wave ERPs were recorded from 28 young adults as they generated plans for various difficulty levels of a fixed-foreperiod version of the Tower of London task. The resulting waveform included three segments: (1) a left-lateralized negative early-interval wave, which was frontally maximal but not sensitive to difficulty, (2) a right-lateralized frontally maximal mid-interval wave, which was more positive for more difficult problems, and (3) a left lateralized centrally maximal negative-ramping contingent negative variation (CNV) late wave, which was more negative for more difficult problems. The current study adds to the current literature in that it finds that the frontal and central neural utilization with difficulty changes across plan generation.

Structural connectivity of Broca's area and medial frontal cortex.

Despite over 140 years of research on Broca's area, the connections of this region to medial frontal cortex remain unclear. The current study investigates this structural connectivity using diffusion-weighted MRI tractography in living humans. Our results show connections between Broca's area and Brodmann's areas (BA) 9, 8, and 6 (both supplementary motor area (SMA) in caudal BA 6, and Pre-SMA in rostral BA 6).

Deconstructing the tower: parameters and predictors of problem difficulty on the Tower of London task.

The Tower of London (TOL) task has been widely used in both clinical and research realms. In the current study, 104 healthy participants attempted all possible moderate- to high-difficulty TOL problems in order to determine: (1) optimal measures of problem solving performance, (2) problem characteristics, other than the minimum moves necessary to solve the problem, that determine participants' difficulty in solving problems successfully, quickly, and efficiently, and (3) effects of increased task experience on which problem characteristics determine problem difficulty. A factor analysis of six performance measures found that, regardless of task experience, problem difficulty could be captured well either by a single factor corresponding to general quality of solution or possibly by three subordinate factors corresponding to solution efficiency, solution speed, and initial planning speed.

Predictors of mortality following symptomatic pulmonary embolism in patients undergoing noncardiac surgery.

Purpose: To determine 30-day mortality and predictors of mortality following perioperative pulmonary embolism (PE).

Methods: We searched both the Mayo Clinic electronic medical records and Autopsy Registry, between January 1, 1998 and December 31, 2001, for patients who developed PE within 30 days after noncardiac surgery performed under general or neuraxial anesthesia. Medical records of all identified patients were reviewed using standardized data collection forms.