Health care delivery organizations are increasingly being encouraged to implement strategies to engage patients in their health and health care yet have varying capabilities to support patient-centered care. Improving the quality of health care delivery requires a better understanding of the multi-level organizational capabilities that enable patient engagement. This dissertation develops a conceptual framework to delineate the health care system, physician practice, and team factors associated with patient engagement in chronic care.

The first study links clinical data to surveys of patients with diabetes in fourteen community health center sites to examine if the availability of team member expertise is associated with patient experiences of chronic care, and whether the relationship is consistent for small versus large sites. The second study uses a nationally representative survey of physician practices and health systems to clarify how health systems may influence the adoption of patient engagement and chronic care management capabilities in constituent physician practices. The third study utilizes Mokken scale analysis and a survey of adult primary care practices to reveal potential pacing and foundation setting in the adoption of patient engagement strategies.

Purpose of review

Recent findings

Summary

Introduction: Managing agitation in the clinical setting is a challenge that many practitioners faceregularly. Our evolving understanding of the etiological factors involved in aggressive acts has betterinformed our interventions through pharmacologic and behavioral strategies. This paper reviews theliterature on the neurobiological underpinnings of aggressive behaviors, linking psychopathology withproposed mechanisms of action of psychiatric medications shown to be effective in mitigating agitation.

Methods: We performed a review of the extant literature using PubMed as a primary database.Investigation focused on neurobiology of agitation and its relation to the current evidence base forparticular interventions.

Results: There are well-established pathways that can lead to increased autonomic response andthe potential for violence. Psychopathology and substance-induced perceptual distortions may leadto magnification and overestimation of environmental threat, heightening the potential for aggression.Additional challenges have arisen with the advent of several novel drugs of abuse, many of whichlead to atypical clinical presentations and which can elude standard drug screens. Our interventionsstill lean on the evidence base found in Project BETA (Best Practices in Evaluation and Treatmentof Agitation). Although not a new drug and not included in the Project BETA guidelines, ketamineand its use are also discussed, given its unique pharmacology and potential benefits when otherprotocoled interventions have failed.

Conclusion: Aggression can occur due to manifold reasons in the clinical setting. Having aninformed understanding of the possible determinants of agitation can help with more tailoredresponses to individual patients, limiting the unnecessary use of medications or of interventions thatcould be deemed forceful.

Both LLT polynomials and k-Schur functions were derived from the study of Macdonald polynomials, and have proved to be fruitful areas of study. A well-known conjecture due to Haglund and Haiman states that k-bandwidth LLT polynomials expand positively into $k$-Schur functions. This is trivial in the case k=1 and has been recently proved for k=2. In this work, we present a proof for the case $k=3$. In doing so, we introduce a new method for establishing linear relations among LLT polynomials.