Medicine and Health Sciences Commons^™

Mediodorsal Thalamic Neurons Mirror The Activity Of Medial Prefrontal Neurons Responding To Movement And Reinforcement During A Dynamic Dnmtp Task, Rikki L.A. Miller Phd, Miranda J. Francoeur, Brett M. Gibson, Robert G. Mair

Faculty Publications

The mediodorsal nucleus (MD) interacts with medial prefrontal cortex (mPFC) to support learning and adaptive decision-making. MD receives driver (layer 5) and modulatory (layer 6) projections from PFC and is the main source of driver thalamic projections to middle cortical layers of PFC. Little is known about the activity of MD neurons and their influence on PFC during decision-making. We recorded MD neurons in rats performing a dynamic delayed nonmatching to position (dDNMTP) task and compared results to a previous study of mPFC with the same task (Onos et al., 2016). Criterion event-related responses were observed for 22% …

Community Paramedicine Pilot Programs: Lessons From Maine, Karen B. Pearson Mlis, Ma, George Shaler Mph

Emergency Medical Services (EMS)

Community paramedicine programs are beginning to flourish across the nation, and the need to provide demonstration or pilot programs is essential to providing a consistent and high-level standard for this model of care. While the overarching goals are to align with the Triple Aim, piloting a community paramedicine program also allows each community to develop and implement a program tailored to the healthcare needs of their specific community. A successful program builds the evidence base that can then be used to create legislative change necessary to financially sustain this model of care across the healthcare delivery system. This article provides …

Charting A Pathway Forward: Redesigning And Realigning Supports And Services For Maine's Older Adults, Eileen Griffin Jd, Elizabeth C. Gattine Jd

Disability & Aging

The current growth of the population age 65 and older is one of the most significant demographic trends in the history of this country and is especially significant for Maine, where the number of people age 65 and older is growing even faster than the rest of the nation. By 2025, over a quarter of Maine’s population is expected to be age 65 and older. Because the cost of long term paid support is out of reach for many Mainers, public financing—particularly Medicaid financing—is an essential tool for addressing the long term support needs of older adults. But Medicaid is …

Knowledge Of Health Insurance Concepts And The Affordable Care Act Among Rural Residents, Erika C. Ziller Phd

Health System Reform

Health insurance literacy is central to identifying eligibility for coverage and subsidies, choosing a plan, and using optimal healthcare services under the Affordable Care Act (ACA) or other insurance reform initiatives. To fully benefit from policy efforts to improve health insurance access, rural residents must have the ability to select the plan that best meets their healthcare needs. However, a higher proportion of rural residents possess characteristics that may put them at risk of lower health insurance literacy, including lower incomes and educational attainment, less experience with private insurance, and historically higher uninsured rates. Using Health Reform Monitoring Survey data …

The Implications Of Using A Broad Versus Narrow Set Of Criteria In Research, Leonard A. Jason, Kristen D. Gleason Phd, Pamela Fox

Faculty Publications

The Fukuda et al. criteria is the most widely used clinical case definition for diagnosing patients with chronic fatigue syndrome (CFS). Despite the frequency with which the Fukuda criteria are applied, the list of symptoms outlined in this case definition were not well enough specified to be easily applied to research settings. In 2005, Reeves et al. laid out a set of standards for operationalizing the Fukuda definition, specifying scales and cutoff scores for measuring the symptom criteria. This operationalization, often known as the empirical criteria, has been shown to identify an unexpectedly large number of patients, seemingly widening the …

Social Isolation And Loneliness In Older People: A Closer Look At Definitions, Mary Lou Ciolfi, Frances Jimenez Ba

Disability & Aging

Social isolation and loneliness are related and the terms are often used interchangeably, but they are distinct concepts with different definitions, health impacts, and interventions. Our population is aging and older people are at increased risk for both social isolation and loneliness and the associated negative health consequences. Understanding the important differences between social isolation and loneliness will help us recognize them earlier in vulnerable populations, engage in more meaningful conversations with older adults about their own risks, and will inform the development and delivery of more individualized, meaningful, and cost-effective interventions.

After Closure: Options For Pursuing A High Performance Rural Health System, Andrew F. Coburn Phd

Rural Hospitals (Flex Program)

Presented at the 2017 National Rural Health Association Annual Meeting. Coburn, a member of the Rural Policy Research Institute Panel, discussed the following key questions: What kind of rural health system is possible in places that cannot support a full-service hospital? How does a rural community navigate the transition from hospital-centric care toward new models that deliver high performance? What implementation support will be needed? Coburn noted that there is no single model for re-configuring the rural health system after hospital closure; local assets, affiliations and partnerships, financial and delivery flexibility and capacities must be critically assessed to determine the …

New Outpatient Experience Survey Design: A Quality Improvement Case Study, Nathan Paluso

Muskie School Capstones and Dissertations

The purpose of this capstone project is to evaluate the implementation process for a new survey methodology introduced by Maine Medical Partners (MMP), by following the Plan-Do-Study-Act (PDSA) quality improvement cycle framework. This new survey has been implemented to collect data on patients’ experiences in the MMP outpatient facilities, and is offered to the patients via iPad at check-out after their appointment. Through observation at MMP practices and MMP staff interviews, strengths and weaknesses of the implementation process have been identified. Evidence-based solutions pertaining to the identified weaknesses have been selected through a literature review and are incorporated in recommendations …

A Guide For Assessing Older Adults’ Needs On Maine Islands, Beatrice Byrne

Muskie School Capstones and Dissertations

This template may help Maine island communities identify older adults’ needs and island resources, in order to allow older adults to age in the island communities.

Three interviews with island health leaders, one community conversation with older islanders, and one pilot test provided information about what to include in the template.

The template includes a demographic survey, guides for conducting semi-structured interviews and group conversations with older adults and caregivers, a guide and worksheet for analyzing the data, a guide for assessing community resources, a guide for dissemination, and a list of additional resources.

The Role Of Public Versus Private Health Insurance In Ensuring Health Care Access & Affordability For Low-Income Rural Children, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Amanda Burgess Mppm

Access / Insurance

Medicaid and the Children’s Health Insurance Program (CHIP) have played a critical role in ensuring access to health insurance coverage among children and have been particularly important sources of coverage for rural children. More than 35.5 million children were enrolled in Medicaid or CHIP in September 2016—accounting for just over half of total Medicaid and CHIP enrollment. Given the large proportion of rural children covered by public insurance, it is critically important to understand the role of that coverage in ensuring access to affordable healthcare for rural children. Using data from the 2011-2012 National Survey of Children’s Health, this study …

Experience Of Adults With Special Needs In Sexual Education Programs, Kate C. Hallissey

Thinking Matters Symposium Archive

Adults with special needs are discouraged from exploring their sexuality, expressing it, accessing sexual health care, and learning about their sexual rights. As a result, this population experiences higher rates of sexually transmitted diseases and sexual abuse than the general population (Saxe & Flanagan, 2014). Adults with special needs deserve to receive sexual education programming that provides them with the information they need to make informed choices about sexuality and relationships. Understanding their experiences in sexual education programs can better inform future programming for this population.

Therapist Experience Treating Female Sexual Assault Survivors, Melinda Irving

Thinking Matters Symposium Archive

Sexual assault often results in survivors experiencing Post traumatic stress disorder or depression. The phenomena of treating survivors in therapy after a sexual assault, has been researched thoroughly from the view of clients. Qualitative research done from therapists experiences is not as abundant in the literature. Therapists experiences treating female survivors of sexual abuse was explored, using a phenomenological research method. Examining therapist's perspective on providing therapy with survivors, can support other therapists working with women who have survived a sexual assault

Lcsw-Perceived Therapeutic Alliance And Job Satisfaction A Correlational Pilot Study, Daniel J. Kelly

Thinking Matters Symposium Archive

One-hundred-and-fifty Licensed Clinical Social Workers (LCSWs) were sent surveys measuring demographics, therapeutic alliance, and job satisfaction. Past literature suggests that clinician-perceived therapeutic alliance is related to job satisfaction. Results of this study failed to confirm this. Implications and limitations are discussed

Veterans Experience Using Acupuncture As An Alternative Treatment, Stacy Leet

Thinking Matters Symposium Archive

There is growing dissatisfaction within the veteran community with their conventional health care options. This dissatisfaction has led to an increase in seeking complementary and alternative treatments, like acupuncture. There is increased need to understand the experience of veterans who use acupuncture as an alternative treatment for their physical or mental health care needs. This phenomenological study interviewed veterans (n=6) to gain a deeper understanding of their experiences using acupuncture as alternative treatment. The outcomes of this study will add to the knowledge base and provide social workers and health providers a wider range of care options that will continue …

Racialization Of Heroin Use And The Emergence Of A Public Health Issue, Ellen Pogson

Thinking Matters Symposium Archive

How is race used as a tool in newspaper publications to shape public opinion of the heroin epidemic in Portland, Maine, between the years 2014-­‐2016?

How does the portrayal of the heroin user inform public policy and health care interventions?

Rural Opioid Prevention And Treatment Strategies: The Experience In Four States [Working Paper], John A. Gale Ms, Anush Hansen Ms,Ma, Martha Elbaum Williamson Mpa

Mental Health / Substance Use Disorders

Although opioid use rates are comparable in rural and urban counties, rural opioid users tend to be younger, unmarried, have lower incomes, and are more likely to lack health insurance, all vulnerabilities that may negatively impact their ability to seek treatment and recover. Additionally, the rural health care system is characterized by numerous resource, workforce, access, and geographic challenges that complicate the delivery of specialized care for OUDs in rural communities. The nature and scope of the opioid crisis vary across rural communities and require multifaceted, community-based strategies to address the problem. Based on interviews with key stakeholders in Indiana, …

Perceptions Of Successful Aging Among Maine Elders With Physical Limitations: Insights From Qualitative Interviews, Madeline Minor, Rebecca Knight

Thinking Matters Symposium Archive

Research Question: How do elders living with a disability perceive the aging process?

Rural Opioid Prevention And Treatment Strategies: The Experience In Four States [Policy Brief], John A. Gale Ms, Anush Yousefian Hansen Ms,Ma, Martha Elbaum Williamson Mpa

Mental Health / Substance Use Disorders

Little is known about what states with large rural populations are doing to combat opioid use disorders (OUD) in rural communities. This qualitative study identified rural challenges to the provision of OUD prevention, treatment, and recovery services and explored promising strategies to tackle the opioid crisis in rural communities.

The Effects Of Behavioral Momentum On Increasing Expressive Writing Behaviors In Children Resistant To Writing Tasks, Hannah D. Batley Psyd

All Student Scholarship

Within this study, the author aimed to expand the research on high-probability/lowprobability (high-p/low-p) interventions to examine the effects of behavioral momentum on the academic behavior of expressive writing. Two second-grade students were selected based on a history of avoidance of with writing tasks, where motivation was determined to be the primary variable impacting expressive writing engagement. An alternating treatments design was used to compare the effects of a traditional expressive writing prompt to the utilization of a high-p/low-p response sequence where instructions to engage in high-probability writing tasks preceded the prompt to complete lowprobability writing tasks. Two dependent variables were …

Assessment Of The Use Of Overdose Education And Naloxone Distribution By Maine Buprenorphine/Naloxone Prescribers, Stephen Kirsch

Muskie School Capstones and Dissertations

Background: Overdose deaths, specifically related to opioids, have been identified as a public health problem both nationally and in the state of Maine. Overdose Education and Naloxone Distribution (OEND) is an innovative model of patient education that has been shown to be effective in increasing knowledge of overdose risk and has the potential to help reduce opiate related overdose deaths.

Methods: A 28-item web-based survey examining clinician attitudes, OEND practices and characteristics was distributed to 196 Maine based physicians with a Drug Enforcement Agency waiver to prescribe burprenorphine/naloxone. Facilitators and barriers to the provision of OEND were also assessed. Surveys …

Urine Cotinine In Children And Parental Behavior Modification: A Pilot Study, Teresa Lachance

Muskie School Capstones and Dissertations

“Urine Cotinine in Children and Parental Behavior Modification” was designed by Dr. Deirdre Burns, a pediatrician at the Barbara Bush Children’s Hospital (BBCH). It was implemented as a pilot study to determine whether urine cotinine testing in children who are admitted to the hospital for respiratory illness and tracking parental smoking behaviors over time was feasible. Parents were given a brief survey to assess their current smoking behaviors and to understand their readiness to quit smoking. They received smoking cessation materials provided by the Breathe Easy Coalition of Maine. These materials outline information about second-hand and third-hand smoke, and encourage …