Medicaid home and community based services (HCBS) has been the focus of widespread efforts by the... more Medicaid home and community based services (HCBS) has been the focus of widespread efforts by the federal and state government to expand access for several reasons. First, there is a growing demand by individuals to remain in their homes for as long as possible rather than to live in institutions. Second, the Supreme Court ruled in the Olmstead case in 1999 that individuals have the right to live at home or in the community if they are able to and choose to do so, rather than to be placed in institutional settings by the government. Third, a number of subsequent lawsuits against states have encouraged states to expand access to HCBS. Finally, in the past decade, the federal government has provided a number of initiatives and resources to assist states in complying with the Olmstead decision and in rebalancing their services from institutional to HCBS. In spite of these efforts, there are inequities in access to services and many individuals have unmet needs for HCBS.
Background. Brain-derived neurotrophic factor (BDNF), a neurotrophin that regulates neuronal func... more Background. Brain-derived neurotrophic factor (BDNF), a neurotrophin that regulates neuronal function and development, is implicated in several neurodegenerative conditions. Preliminary data suggest that a reduction of BDNF concentrations may lead to postchemotherapy cognitive impairment. We hypothesized that a single nucleotide polymorphism (rs6265) of the BDNF gene may predispose patients to cognitive impairment. This study aimed to evaluate the effect of BDNF gene polymorphism on chemotherapy-associated cognitive impairment.
In response to consumer demand, the Supreme Court decision in the Olmstead case and the New Freed... more In response to consumer demand, the Supreme Court decision in the Olmstead case and the New Freedom Initiative, states have unevenly expanded combinations of three Medicaid home and community based services (HCBS) : home health, state plan personal care services (PCS), and 1915(c) waivers. By 2008, the federal-state Medicaid program paid for 44 percent of the nation's estimated $205 billion total long-term care (LTC) expenditures while institutional care (e.g., nursing homes) consumed 56 percent of those expenditures. As states struggle with budget deficits in FY 2010 and beyond, the Patient Protection and Affordability Care Act of 2010 and its provisions for continued HCBS growth reflects growing concerns about the need to preserve and expand Medicaid HCBS and the need for information on program and policy trends. This paper draws from a unique national dataset to present the latest trends in participants, expenditures and policies for the three Medicaid HCBS programs. While da...
Abstract Attention is given to the flow-visualization problem posed by the'dark-core're... more Abstract Attention is given to the flow-visualization problem posed by the'dark-core'region of the vortices formed on the upper side of a delta wing; the low particle density in the core region minimizes the density of tracing particles whose presence is essential in LDV ...
Visualization and wake surveys of vortical flow over a delta wing. FM PAYNE, TT NG, RC NELSON, LB... more Visualization and wake surveys of vortical flow over a delta wing. FM PAYNE, TT NG, RC NELSON, LB SCHIFF AIAA Journal 26, 137-143, 2/1988. 2 AERODYNAMICS(AH).
A systematic review was performed to describe the findings from 19 genetic association studies th... more A systematic review was performed to describe the findings from 19 genetic association studies that have examined the genetic variants underlying four common treatment-induced chronic and late toxicities in breast cancer patients, and to evaluate the quality of reporting. Three out of 5 studies found an association between HER2 lle655Val polymorphisms and trastuzumab-induced cardiotoxicity. Two studies found a positive association between cognitive impairment and the Val allele of the COMT gene and the ε4 allele of the apolipoprotein E gene. Genetic associations were established between fatigue and the G/G genotype of IL6-174 and TNF-308, and the Met allele of the COMT gene in 4 studies. Among studies (N=8) that evaluated the genetic associations underlying peripheral neuropathy, CYP2C8∗3 variant is commonly reported as the associated gene. Most studies failed to conform to the major criteria listed in the STREGA guidelines, with a lack of transparent reporting of methods and results.
People are now living longer, but disability may affect the quality of those additional years of ... more People are now living longer, but disability may affect the quality of those additional years of life. We undertook a trial to assess whether case finding reduces disability among older primary care patients. We conducted a cluster-randomized trial of the Brief Risk Identification Geriatric Health Tool (BRIGHT) among 60 primary care practices in New Zealand, assigning them to an intervention or control group. Intervention practices sent a BRIGHT screening tool to older adults every birthday; those with a score of 3 or higher were referred to regional geriatric services for assessment and, if needed, service provision. Control practices provided usual care. Main outcomes, assessed in blinded fashion, were residential care placement and hospitalization, and secondary outcomes were disability, assessed with Nottingham Extended Activities of Daily Living Scale (NEADL), and quality of life, assessed with the World Health Organization Quality of Life scale, abbreviated version (WHOQOL-BRE...
State Medicaid programs have expanded home and community-based services (HCBS). This article comp... more State Medicaid programs have expanded home and community-based services (HCBS). This article compares trends and variations in state policies for Medicaid HCBS programs in 2005 and 2010. State limitations on financial eligibility criteria and service benefits have remained stable. Although the use of consumer direction, independent providers, and family care providers has increased, some states do not have these options. The increased adoption of state cost control policies have led to large increases in persons on waiver wait lists. Access could be improved by standardizing and liberalizing state HCBS policies, but state fiscal concerns are barriers to rebalancing between HCBS and institutional services.
Limited data are available on how symptom burden affects health-related quality of life (HRQoL) i... more Limited data are available on how symptom burden affects health-related quality of life (HRQoL) in patients with sarcoma. This study aims to describe the symptom burden, HRQoL, and medication use in adult sarcoma patients. A single-center, cross-sectional study was conducted, and 79 patients were evaluated using three tools: the Rotterdam Symptom Checklist (RSCL), the Beck Anxiety Inventory (BAI), and the Functional Assessment of Cancer Therapy scale-General (FACT-G). Patients' demographic and clinical information, medication history, and use of concomitant medications were recorded. The proportion of patients with clinically significant RSCL score for a particular symptom was compared with the percentage of patients receiving medication for that symptom. The mean age was 57.3 ± 15.2 years, with majority of the patients diagnosed with stromal tumor (46.8 %), leiomyosarcoma (15.2 %), and liposarcoma (10.1 %). The most prevalent physical symptoms experienced were tiredness (2.38 ± 1.00), lack of energy (2.04 ± 1.02), and difficulty sleeping (2.00 ± 1.15). The most common psychological symptoms experienced were irritability (1.92 ± 1.01), worrying (1.86 ± 0.90), and anxiety (1.68 ± 0.74). Few (6.3 %) patients received hypnotics while 33.0 % of patients reported difficulty sleeping. A proportion of patients (27.9 %) reported experiencing lack of appetite with only 1.3 % received appetite stimulants. Adult sarcoma patients experience significant physiological and psychological symptom burden, which has a strong negative impact on HRQoL, with a number of physiological symptoms undertreated with pharmacotherapy.
As long-term care policy makers struggle with competing challenges including state budget deficit... more As long-term care policy makers struggle with competing challenges including state budget deficits and pressures to expand homeand community-based services (HCBS), there is a pressing need for information on the comparative cost of Medicaid HCBS and institutional care. This paper uses the most recent available data (2002) to present three per participant expenditure comparisons between Medicaid HCBS waivers (which require that participants have an institutional level of care need) and institutional care: (1) program expenditure (waivers vs. the comparable level of institutional provision); (2) total Medicaid expenditure (program plus other Medicaid expenditure); and (3) estimated total public expenditure (Medicaid expenditures plus state and federal supplemental- income payments). This analysis estimates that when compared with Medicaid institutional care in 2002, HCBS waivers produced a national average public expenditure saving of $43,947 per participant. doi:10.1300/J045v22n02_03.
With policy makers facing the competing challenges of budget crises and pressures to expand Medic... more With policy makers facing the competing challenges of budget crises and pressures to expand Medicaid home and community- based service programs to populations including those with traumatic brain and spinal cord injuries (TBI/SCI), this paper addresses the need for information about the development of waiver programs for this target population. This study draws from the most recent and comprehensive available dataset to present national participation and expenditure trends for all TBI/SCI waivers for the period 1995-2002, it reports findings from a national survey of policies (e.g., eligibility criteria and cost controls) used on these waiver programs in 2002, and compares the Medicaid cost of serving this target group through institutional care and waiver programs.
A new approach is proposed for reconstructing 3D lines and cameras from 2D corresponding lines ac... more A new approach is proposed for reconstructing 3D lines and cameras from 2D corresponding lines across multiple uncalibrated views. There is no requirement that the 2D corresponding lines on different images represent the same segment of a 3D line, which may not appear on all images. A 3D line is reconstructed by minimizing a geometric cost function that measures the distance of the reprojected end points of the 3D segment from the measured 2D lines on different images. An algorithmic procedure is provided with guaranteed convergence to a solution where the geometric cost function achieves a (local) minimum.
Journal of Social Work in Disability & Rehabilitation, 2014
Over the past two decades, major efforts have been undertaken to expand access to Medicaid home a... more Over the past two decades, major efforts have been undertaken to expand access to Medicaid home and community-based services (HCBS) for the elderly and disabled. Despite this, many states still have long waiting lists for HCBS. Using data collected, this study examined the trends in Olmstead and related cases against states between 1999 and 2011. The findings show there were 131 cases filed during the period, and 90 cases were resolved through court rulings and settlements. These court cases have played an important role in encouraging states to expand access to HCBS programs and to transfer individuals out of institutions.
An incremental elastic‐plastic constitutive model is proposed to relate force and displacement at... more An incremental elastic‐plastic constitutive model is proposed to relate force and displacement at the contact between two identical elastic rough spheres. The model is formulated in a three‐dimensional force space defined by the normal and two tangential ...
While human papillomavirus (HPV) infection is associated with genital warts, anal cancer, and ora... more While human papillomavirus (HPV) infection is associated with genital warts, anal cancer, and oral cancer, limited research has examined what men think causes these diseases. We sought to examine knowledge and beliefs about HPV-related disease among gay and bisexual men, who are at high risk for HPV infection and HPV-related cancers, and compare them to heterosexual men. We conducted an online survey in January 2009 with a national sample of men aged 18-59 who self-identified as either gay or bisexual (n = 312) or heterosexual (n = 296). The response rate was 70%. Fewer than half of men knew that HPV can cause genital warts (41%), anal cancer (24%), and oral cancers (23%). However, gay and bisexual men typically knew more than heterosexual men about these topics. Overall, most men believed that sexual behavior causes genital warts (70%) and anal cancer (54%), and tobacco use causes oral cancer (89%). Perceived causal factors differed substantially among the three diseases, while differences by sexual orientation were fewer and smaller in magnitude.
This article presents the latest available expenditure and participation trends (1999-2002) for t... more This article presents the latest available expenditure and participation trends (1999-2002) for three Medicaid home and community-based (HCBS) programs that serve the elderly (home health, waivers, and personal care services [PCS]) and reports a national survey of ...
Medicaid home and community based services (HCBS) has been the focus of widespread efforts by the... more Medicaid home and community based services (HCBS) has been the focus of widespread efforts by the federal and state government to expand access for several reasons. First, there is a growing demand by individuals to remain in their homes for as long as possible rather than to live in institutions. Second, the Supreme Court ruled in the Olmstead case in 1999 that individuals have the right to live at home or in the community if they are able to and choose to do so, rather than to be placed in institutional settings by the government. Third, a number of subsequent lawsuits against states have encouraged states to expand access to HCBS. Finally, in the past decade, the federal government has provided a number of initiatives and resources to assist states in complying with the Olmstead decision and in rebalancing their services from institutional to HCBS. In spite of these efforts, there are inequities in access to services and many individuals have unmet needs for HCBS.
Background. Brain-derived neurotrophic factor (BDNF), a neurotrophin that regulates neuronal func... more Background. Brain-derived neurotrophic factor (BDNF), a neurotrophin that regulates neuronal function and development, is implicated in several neurodegenerative conditions. Preliminary data suggest that a reduction of BDNF concentrations may lead to postchemotherapy cognitive impairment. We hypothesized that a single nucleotide polymorphism (rs6265) of the BDNF gene may predispose patients to cognitive impairment. This study aimed to evaluate the effect of BDNF gene polymorphism on chemotherapy-associated cognitive impairment.
In response to consumer demand, the Supreme Court decision in the Olmstead case and the New Freed... more In response to consumer demand, the Supreme Court decision in the Olmstead case and the New Freedom Initiative, states have unevenly expanded combinations of three Medicaid home and community based services (HCBS) : home health, state plan personal care services (PCS), and 1915(c) waivers. By 2008, the federal-state Medicaid program paid for 44 percent of the nation's estimated $205 billion total long-term care (LTC) expenditures while institutional care (e.g., nursing homes) consumed 56 percent of those expenditures. As states struggle with budget deficits in FY 2010 and beyond, the Patient Protection and Affordability Care Act of 2010 and its provisions for continued HCBS growth reflects growing concerns about the need to preserve and expand Medicaid HCBS and the need for information on program and policy trends. This paper draws from a unique national dataset to present the latest trends in participants, expenditures and policies for the three Medicaid HCBS programs. While da...
Abstract Attention is given to the flow-visualization problem posed by the'dark-core're... more Abstract Attention is given to the flow-visualization problem posed by the'dark-core'region of the vortices formed on the upper side of a delta wing; the low particle density in the core region minimizes the density of tracing particles whose presence is essential in LDV ...
Visualization and wake surveys of vortical flow over a delta wing. FM PAYNE, TT NG, RC NELSON, LB... more Visualization and wake surveys of vortical flow over a delta wing. FM PAYNE, TT NG, RC NELSON, LB SCHIFF AIAA Journal 26, 137-143, 2/1988. 2 AERODYNAMICS(AH).
A systematic review was performed to describe the findings from 19 genetic association studies th... more A systematic review was performed to describe the findings from 19 genetic association studies that have examined the genetic variants underlying four common treatment-induced chronic and late toxicities in breast cancer patients, and to evaluate the quality of reporting. Three out of 5 studies found an association between HER2 lle655Val polymorphisms and trastuzumab-induced cardiotoxicity. Two studies found a positive association between cognitive impairment and the Val allele of the COMT gene and the ε4 allele of the apolipoprotein E gene. Genetic associations were established between fatigue and the G/G genotype of IL6-174 and TNF-308, and the Met allele of the COMT gene in 4 studies. Among studies (N=8) that evaluated the genetic associations underlying peripheral neuropathy, CYP2C8∗3 variant is commonly reported as the associated gene. Most studies failed to conform to the major criteria listed in the STREGA guidelines, with a lack of transparent reporting of methods and results.
People are now living longer, but disability may affect the quality of those additional years of ... more People are now living longer, but disability may affect the quality of those additional years of life. We undertook a trial to assess whether case finding reduces disability among older primary care patients. We conducted a cluster-randomized trial of the Brief Risk Identification Geriatric Health Tool (BRIGHT) among 60 primary care practices in New Zealand, assigning them to an intervention or control group. Intervention practices sent a BRIGHT screening tool to older adults every birthday; those with a score of 3 or higher were referred to regional geriatric services for assessment and, if needed, service provision. Control practices provided usual care. Main outcomes, assessed in blinded fashion, were residential care placement and hospitalization, and secondary outcomes were disability, assessed with Nottingham Extended Activities of Daily Living Scale (NEADL), and quality of life, assessed with the World Health Organization Quality of Life scale, abbreviated version (WHOQOL-BRE...
State Medicaid programs have expanded home and community-based services (HCBS). This article comp... more State Medicaid programs have expanded home and community-based services (HCBS). This article compares trends and variations in state policies for Medicaid HCBS programs in 2005 and 2010. State limitations on financial eligibility criteria and service benefits have remained stable. Although the use of consumer direction, independent providers, and family care providers has increased, some states do not have these options. The increased adoption of state cost control policies have led to large increases in persons on waiver wait lists. Access could be improved by standardizing and liberalizing state HCBS policies, but state fiscal concerns are barriers to rebalancing between HCBS and institutional services.
Limited data are available on how symptom burden affects health-related quality of life (HRQoL) i... more Limited data are available on how symptom burden affects health-related quality of life (HRQoL) in patients with sarcoma. This study aims to describe the symptom burden, HRQoL, and medication use in adult sarcoma patients. A single-center, cross-sectional study was conducted, and 79 patients were evaluated using three tools: the Rotterdam Symptom Checklist (RSCL), the Beck Anxiety Inventory (BAI), and the Functional Assessment of Cancer Therapy scale-General (FACT-G). Patients' demographic and clinical information, medication history, and use of concomitant medications were recorded. The proportion of patients with clinically significant RSCL score for a particular symptom was compared with the percentage of patients receiving medication for that symptom. The mean age was 57.3 ± 15.2 years, with majority of the patients diagnosed with stromal tumor (46.8 %), leiomyosarcoma (15.2 %), and liposarcoma (10.1 %). The most prevalent physical symptoms experienced were tiredness (2.38 ± 1.00), lack of energy (2.04 ± 1.02), and difficulty sleeping (2.00 ± 1.15). The most common psychological symptoms experienced were irritability (1.92 ± 1.01), worrying (1.86 ± 0.90), and anxiety (1.68 ± 0.74). Few (6.3 %) patients received hypnotics while 33.0 % of patients reported difficulty sleeping. A proportion of patients (27.9 %) reported experiencing lack of appetite with only 1.3 % received appetite stimulants. Adult sarcoma patients experience significant physiological and psychological symptom burden, which has a strong negative impact on HRQoL, with a number of physiological symptoms undertreated with pharmacotherapy.
As long-term care policy makers struggle with competing challenges including state budget deficit... more As long-term care policy makers struggle with competing challenges including state budget deficits and pressures to expand homeand community-based services (HCBS), there is a pressing need for information on the comparative cost of Medicaid HCBS and institutional care. This paper uses the most recent available data (2002) to present three per participant expenditure comparisons between Medicaid HCBS waivers (which require that participants have an institutional level of care need) and institutional care: (1) program expenditure (waivers vs. the comparable level of institutional provision); (2) total Medicaid expenditure (program plus other Medicaid expenditure); and (3) estimated total public expenditure (Medicaid expenditures plus state and federal supplemental- income payments). This analysis estimates that when compared with Medicaid institutional care in 2002, HCBS waivers produced a national average public expenditure saving of $43,947 per participant. doi:10.1300/J045v22n02_03.
With policy makers facing the competing challenges of budget crises and pressures to expand Medic... more With policy makers facing the competing challenges of budget crises and pressures to expand Medicaid home and community- based service programs to populations including those with traumatic brain and spinal cord injuries (TBI/SCI), this paper addresses the need for information about the development of waiver programs for this target population. This study draws from the most recent and comprehensive available dataset to present national participation and expenditure trends for all TBI/SCI waivers for the period 1995-2002, it reports findings from a national survey of policies (e.g., eligibility criteria and cost controls) used on these waiver programs in 2002, and compares the Medicaid cost of serving this target group through institutional care and waiver programs.
A new approach is proposed for reconstructing 3D lines and cameras from 2D corresponding lines ac... more A new approach is proposed for reconstructing 3D lines and cameras from 2D corresponding lines across multiple uncalibrated views. There is no requirement that the 2D corresponding lines on different images represent the same segment of a 3D line, which may not appear on all images. A 3D line is reconstructed by minimizing a geometric cost function that measures the distance of the reprojected end points of the 3D segment from the measured 2D lines on different images. An algorithmic procedure is provided with guaranteed convergence to a solution where the geometric cost function achieves a (local) minimum.
Journal of Social Work in Disability & Rehabilitation, 2014
Over the past two decades, major efforts have been undertaken to expand access to Medicaid home a... more Over the past two decades, major efforts have been undertaken to expand access to Medicaid home and community-based services (HCBS) for the elderly and disabled. Despite this, many states still have long waiting lists for HCBS. Using data collected, this study examined the trends in Olmstead and related cases against states between 1999 and 2011. The findings show there were 131 cases filed during the period, and 90 cases were resolved through court rulings and settlements. These court cases have played an important role in encouraging states to expand access to HCBS programs and to transfer individuals out of institutions.
An incremental elastic‐plastic constitutive model is proposed to relate force and displacement at... more An incremental elastic‐plastic constitutive model is proposed to relate force and displacement at the contact between two identical elastic rough spheres. The model is formulated in a three‐dimensional force space defined by the normal and two tangential ...
While human papillomavirus (HPV) infection is associated with genital warts, anal cancer, and ora... more While human papillomavirus (HPV) infection is associated with genital warts, anal cancer, and oral cancer, limited research has examined what men think causes these diseases. We sought to examine knowledge and beliefs about HPV-related disease among gay and bisexual men, who are at high risk for HPV infection and HPV-related cancers, and compare them to heterosexual men. We conducted an online survey in January 2009 with a national sample of men aged 18-59 who self-identified as either gay or bisexual (n = 312) or heterosexual (n = 296). The response rate was 70%. Fewer than half of men knew that HPV can cause genital warts (41%), anal cancer (24%), and oral cancers (23%). However, gay and bisexual men typically knew more than heterosexual men about these topics. Overall, most men believed that sexual behavior causes genital warts (70%) and anal cancer (54%), and tobacco use causes oral cancer (89%). Perceived causal factors differed substantially among the three diseases, while differences by sexual orientation were fewer and smaller in magnitude.
This article presents the latest available expenditure and participation trends (1999-2002) for t... more This article presents the latest available expenditure and participation trends (1999-2002) for three Medicaid home and community-based (HCBS) programs that serve the elderly (home health, waivers, and personal care services [PCS]) and reports a national survey of ...
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Papers by Terence Ng