The Impact of a Regulatory Intervention on Resident-Centered Nursing Home Care: Rhode Island's Individualized Care Pilot

Evaluates a pilot project to promote resident-centered care through activities integrated with recertification inspections, including visits from a nonregulatory entity, and its impact on understanding, consideration, and implementation of practices

Stability of ice/rock mixtures with application to a partially differentiated Titan

Titan’s moment of inertia, calculated assuming hydrostatic equilibrium from gravity field data obtained during the Cassini–Huygens mission, implies an internal mass distribution that may be incompatible with complete differentiation. This suggests that Titan may have a mixed ice/rock core, possibly consistent with slow accretion in a gas-starved disk, which may initially spare Titan from widespread ice melting and subsequent differentiation. A partially differentiated Titan, however, must still efficiently remove radiogenic heat over geologic time. We argue that compositional heterogeneity in the major saturnian satellites indicates that Titan formed from planetesimals with disparate densities. The resulting compositional anomalies would quickly redistribute to form a vertical density gradient that would oppose thermal convection. We use elements of the theory of double-diffusive convection to create a parameterized model for the thermal evolution of ice/rock mixtures with a stabilizing compositional gradient. To account for large uncertainties in material properties and accretionary processes, we perform simulations for a wide range of initial conditions. Ultimately, for realistic density gradients, double-diffusive convection in the ice/rock interior can delay, but not prevent, ice melting and differentiation, even if a substantial fraction of potassium is leached from the rock component. Consequently, Titan is not partially differentiated

A New Medicare End-of-Life Benefit for Nursing Home Residents

A new Medicare benefit is needed to support end-of-life care for those spending their final days in a nursing home, say the authors of this article. Arguing that the current hospice benefit is a poor fit with the nursing home setting, the authors recommend a new benefit that would enable nursing home residents to receive individualized palliative and psychosocial services in addition to rehabilitative services

The Influence of Medicare Home Health Payment Incentives: Does Payer Source Matter?

During the late 1990s, an interim payment system (IPS) was instituted to constrain Medicare home health care expenditures. Previous research has largely focused on the implications of the IPS for Medicare patients, but our study broadens the analysis to consider patients with other payer sources. Using the National Home and Hospice Care Survey, we found similar effects of the IPS across payer types. Specifically, the IPS was associated with a decrease in access to care for the sickest patients, less agency assistance with activities of daily living, and shorter length-of-use. However, these changes did not translate into worse discharge outcomes.Medicare, health, incentives

Counting chirps : acoustic monitoring of cryptic frogs

Funding for the frog survey was received from the National Geographic Society/Waitt Grants Program (No. W184-11). The EPSRC and NERC helped to fund this research through a PhD grant (No. EP/1000917/1) to D.L.B. R.A. and G.J.M. acknowledge initiative funding from the National Research Foundation of South Africa.1 .  Global amphibian declines have resulted in a vital need for monitoring programmes that follow population trends. Monitoring using advertisement calls is ideal as choruses are undisturbed during data collection. However, methods currently employed by managers frequently rely on trained observers, and/or do not provide density data on which to base trends. 2 .  This study explores the utility of monitoring using acoustic spatially explicit capture-recapture (aSECR) with time of arrival (ToA) and signal strength (SS) as a quantitative monitoring technique to measure call density of a threatened but visually cryptic anuran, the Cape peninsula moss frog Arthroleptella lightfooti. 3 .  The relationships between temporal and environmental variables (date, rainfall, temperature) and A. lightfooti call density at three study sites on the Cape peninsula, South Africa were examined. Acoustic data, collected from an array of six microphones over four months during the winter breeding season, provided a time series of call density estimates. 4 .  Model selection indicated that call density was primarily associated with seasonality fitted as a quadratic function. Call density peaked mid-breeding season. At the main study site, the lowest recorded mean call density (0·160 calls m-2 min-1) occurred in May and reached its peak mid-July (1·259 calls m-2 min-1). The sites differed in call density, but also the effective sampling area. 5 .  Synthesis and applications.The monitoring technique, acoustic spatially explicit capture–recapture (aSCR), quantitatively estimates call density without disturbing the calling animals or their environment, while time of arrival (ToA) and signal strength (SS) significantly add to the accuracy of call localisation, which in turn increases precision of call density estimates without the need for specialist field staff. This technique appears ideally suited to aid the monitoring of visually cryptic, acoustically active species.Publisher PDFPeer reviewe

Scale Setting in QCD and the Momentum Flow in Feynman Diagrams

We present a formalism to evaluate QCD diagrams with a single virtual gluon using a running coupling constant at the vertices. This method, which corresponds to an all-order resummation of certain terms in a perturbative series, provides a description of the momentum flow through the gluon propagator. It can be viewed as a generalization of the scale-setting prescription of Brodsky, Lepage and Mackenzie to all orders in perturbation theory. In particular, the approach can be used to investigate why in some cases the ``typical'' momenta in a loop diagram are different from the ``natural'' scale of the process. It offers an intuitive understanding of the appearance of infrared renormalons in perturbation theory and their connection to the rate of convergence of a perturbative series. Moreover, it allows one to separate short- and long-distance contributions by introducing a hard factorization scale. Several applications to one- and two-scale problems are discussed in detail.Comment: eqs.(51) and (83) corrected, minor typographic changes mad

Improved fidelity of triggered entangled photons from single quantum dots

We demonstrate the on-demand emission of polarisation-entangled photon pairs from the biexciton cascade of a single InAs quantum dot embedded in a GaAs/AlAs planar microcavity. Improvements in the sample design blue shifts the wetting layer to reduce the contribution of background light in the measurements. Results presented show that >70% of the detected photon pairs are entangled. The high fidelity of the (|HxxHx>+|VxxVx>)/2^0.5 state that we determine is sufficient to satisfy numerous tests for entanglement. The improved quality of entanglement represents a significant step towards the realisation of a practical quantum dot source compatible with applications in quantum information.Comment: 9 pages. Paper is available free of charge at http://www.iop.org/EJ/abstract/1367-2630/8/2/029/, see also 'A semiconductor source of triggered entangled photon pairs', R. M. Stevenson et al., Nature 439, 179 (2006

The mass gap and vacuum energy of the Gross-Neveu model via the 2PPI expansion

We introduce the 2PPI (2-point-particle-irreducible) expansion, which sums bubble graphs to all orders. We prove the renormalizibility of this summation. We use it on the Gross-Neveu model to calculate the mass gap and vacuum energy. After an optimization of the expansion, the final results are qualitatively good.Comment: 14 pages,19 eps figures, revtex

Bilocal expansion of the Borel amplitude and the hadronic tau decay width

The singular part of Borel transform of a QCD amplitude near the infrared renormalon can be expanded in terms of higher order Wilson coefficients of the operators associated with the renormalon. In this paper we observe that this expansion gives nontrivial constraints on the Borel amplitude that can be used to improve the accuracy of the ordinary perturbative expansion of the Borel amplitude. In particular, we consider the Borel transform of the Adler function and its expansion around the first infrared renormalon due to the gluon condensate. Using the next-to-leading order Wilson coefficient of the gluon condensate operator, we obtain an exact constraint on the Borel amplitude at the first IR renormalon. We then extrapolate, using judiciously chosen conformal transformations and Pade approximants, the ordinary perturbative expansion of the Borel amplitude in such a way that this constraint is satisfied. This procedure allows us to predict the $O(\alpha_s^4)$ coefficient of the Adler function, which gives a result consistent with the estimate by Kataev and Starshenko using a completely different method. We then apply this improved Borel amplitude to the tau decay width, and obtain the strong coupling constant $\alpha_s(M_Z) =0.1193 \pm 0.0007_{exp.} \pm 0.0010_{EW+CKM} \pm 0.0009_{meth.} \pm 0.0003_{evol.}$. We then compare this result with those of other resummation methods.Comment: 30 pages, 4 eps-figures, revtex; version as appears in PRD; no major changes; more careful rounding of some number

Identification of molecular markers of delayed graft function based on the regulation of biological ageing

Introduction: Delayed graft function is a prevalent clinical problem in renal transplantation for which there is no objective system to predict occurrence in advance. It can result in a significant increase in the necessity for hospitalisation post-transplant and is a significant risk factor for other post-transplant complications. Methodology: The importance of microRNAs (miRNAs), a specific subclass of small RNA, have been clearly demonstrated to influence many pathways in health and disease. To investigate the influence of miRNAs on renal allograft performance post-transplant, the expression of a panel of miRNAs in pre-transplant renal biopsies was measured using qPCR. Expression was then related to clinical parameters and outcomes in two independent renal transplant cohorts. Results: Here we demonstrate, in two independent cohorts of pre-implantation human renal allograft biopsies, that a novel pre-transplant renal performance scoring system (GRPSS), can determine the occurrence of DGF with a high sensitivity (>90%) and specificity (>60%) for donor allografts pre-transplant, using just three senescence associated microRNAs combined with donor age and type of organ donation. Conclusion: These results demonstrate a relationship between pre-transplant microRNA expression levels, cellular biological ageing pathways and clinical outcomes for renal transplantation. They provide for a simple, rapid quantitative molecular pre-transplant assay to determine post-transplant allograft function and scope for future intervention. Furthermore, these results demonstrate the involvement of senescence pathways in ischaemic injury during the organ transplantation process and an indication of accelerated bio-ageing as a consequence of both warm and cold ischaemia