Provider Perspectives on the Influence of Family on Nursing Home Resident Transfers to the Emergency Department: Crises at the End of Life.

Background. Nursing home (NH) residents often experience burdensome and unnecessary care transitions, especially towards the end of life. This paper explores provider perspectives on the role that families play in the decision to transfer NH residents to the emergency department (ED). Methods. Multiple stakeholder focus groups (n = 35 participants) were conducted with NH nurses, NH physicians, nurse practitioners, physician assistants, NH administrators, ED nurses, ED physicians, and a hospitalist. Stakeholders described experiences and challenges with NH resident transfers to the ED. Focus group interviews were recorded and transcribed verbatim. Transcripts and field notes were analyzed using a Grounded Theory approach. Findings. Providers perceive that families often play a significant role in ED transfer decisions as they frequently react to a resident change of condition as a crisis. This sense of crisis is driven by 4 main influences: insecurities with NH care; families being unprepared for end of life; absent/inadequate advance care planning; and lack of communication and agreement within families regarding goals of care. Conclusions. Suboptimal communication and lack of access to appropriate and timely palliative care support and expertise in the NH setting may contribute to frequent ED transfers

Probing the initial conditions of high-mass star formation -- IV. Gas dynamics and NH2_2D chemistry in high-mass precluster and protocluster clumps

The initial stage of star formation is a complex area study because of its high density and low temperature. Under such conditions, many molecules become depleted from the gas phase by freezing out onto dust grains. However, the deuterated species could remain gaseous and are thus ideal tracers. We investigate the gas dynamics and NH$_2$D chemistry in eight massive pre/protocluster clumps. We present NH$_2$D 1$_{11}$-1$_{01}$ (at 85.926 GHz), NH$_3$ (1, 1) and (2, 2) observations in the eight clumps using the PdBI and the VLA, respectively. We find that the distribution between deuterium fractionation and kinetic temperature shows a number density peak at around $T_{\rm kin}=16.1$ K, and the NH$_2$D cores are mainly located at a temperature range of 13.0 to 22.0 K. We detect seven instances of extremely high deuterium fractionation of $1.0 \leqslant D_{\rm frac} \leqslant 1.41$. We find that the NH$_2$D emission does not appear to coincide exactly with either dust continuum or NH$_3$ peak positions, but often surrounds the star-formation active regions. This suggests that the NH$_{2}$D has been destroyed by the central young stellar object (YSO) due to its heating. The detected NH$_2$D lines are very narrow with a median width of $\rm 0.98\pm0.02 km/s$. The extracted NH$_2$D cores are gravitationally bound ($\alpha_{\rm vir} < 1$), are likely prestellar or starless, and can potentially form intermediate-mass or high-mass stars. Using NH$_3$ (1, 1) as a dynamical tracer, we find very complicated dynamical movement, which can be explained by a combined process with outflow, rotation, convergent flow, collision, large velocity gradient, and rotating toroids. High deuterium fractionation strongly depends on the temperature condition. NH$_2$D is a poor evolutionary indicator of high-mass star formation in evolved stages, but a useful tracer in the starless and prestellar cores.Comment: 27 pages, 25 figures, 6 tables, accepted for publication in A&

How the hydrogen bond in NH4_4F is revealed with Compton scattering

In order to probe electron wave functions involved in the bonding of NH$_4$F, we have performed Compton scattering experiments in an oriented single crystal and in a powder. Ab initio calculations of the Compton profiles for NH$_4$F and NH$_4$Cl are used to enlighten the nature of the bonds in the NH$_4$F crystal. As a consequence, we are able to show significant charge transfer in the ammonium ion which is not observable using other methods. Our study provides a compelling proof for hydrogen bond formation in NH$_4$F.Comment: 4 pages, 5 figures, accepted for publication as a Regular Article in Physical Review

Covering the Care: Cost Sharing Reductions in NH

This brief uses national data to describe the NH population who received Cost Sharing Reductions for coverage on the NH Marketplace

Developing 2015 High-Resolution Impervious Cover Estimates for the 52 Towns in the Piscataqua Region Estuaries Partnership: Final Report

Estimates of 2015 impervious cover (IC) for the 52 towns of the Piscataqua Region Estuaries Partnership (PREP) were generated from 2015 1-foot imagery (for the 42 towns in NH) and 2015 1-meter NAIP imagery (for the 10 towns in Maine). The 2015 IC mapping updated previous high resolution mapping developed from 2010 (New Hampshire) and 2011 (Maine) orthophotography for the study area. Impervious features covered 32,462 acres (5.8% of the land area) in the New Hampshire towns and 13,295 acres (5.3% of the land area) in the Maine towns, with a total of 46,634 (5.6% of the land area) acres mapped in the entire study area. The towns with the highest percent impervious cover in 2015 were in New Hampshire, and included Portsmouth (26.7%), New Castle (20.0%), and Seabrook (20.0%). The largest increases in IC between 2010 and 2015 occurred in Rochester, NH (122 acres), Wells, ME (64 acres), and Seabrook, NH (64 acres). Minimal amounts of IC increases occurred in most towns, with the least amounts in Madbury, NH (4 acres), New Castle, NH (2 acres), and Brookfield, NH (2 acres)

Good Jobs, Strong Economy 9/3/2000

New Hampshire residents believe the state’s economy is currently strong and is likely to get stronger over the next several years. NH Civic Exchange: NH 2000 Surve

Improving convergence in smoothed particle hydrodynamics simulations without pairing instability

The numerical convergence of smoothed particle hydrodynamics (SPH) can be severely restricted by random force errors induced by particle disorder, especially in shear flows, which are ubiquitous in astrophysics. The increase in the number NH of neighbours when switching to more extended smoothing kernels at fixed resolution (using an appropriate definition for the SPH resolution scale) is insufficient to combat these errors. Consequently, trading resolution for better convergence is necessary, but for traditional smoothing kernels this option is limited by the pairing (or clumping) instability. Therefore, we investigate the suitability of the Wendland functions as smoothing kernels and compare them with the traditional B-splines. Linear stability analysis in three dimensions and test simulations demonstrate that the Wendland kernels avoid the pairing instability for all NH, despite having vanishing derivative at the origin (disproving traditional ideas about the origin of this instability; instead, we uncover a relation with the kernel Fourier transform and give an explanation in terms of the SPH density estimator). The Wendland kernels are computationally more convenient than the higher-order B-splines, allowing large NH and hence better numerical convergence (note that computational costs rise sub-linear with NH). Our analysis also shows that at low NH the quartic spline kernel with NH ~= 60 obtains much better convergence then the standard cubic spline.Comment: substantially revised version, accepted for publication in MNRAS, 15 pages, 13 figure