Idaho SHIBA Program Effectiveness Evaluation 2023

Each state and four territories operate State Health Insurance Assistance Programs (SHIPs) to provide free Medicare counseling to eligible beneficiaries, as well as a variety of other services that vary by state. SHIPs rely largely on certified Medicare counselors that either volunteer directly with SHIPs or are affiliated with a wide array of community partner organizations. In most states, volunteers and program activities are managed by small teams of dedicated staff. Idaho’s SHIP is the Senior Health Insurance Benefits Advisors (SHIBA) Program. The Idaho Department of Insurance (DOI) partnered with Idaho Policy Institute (IPI) to conduct a study on the effectiveness of the SHIBA program. This report analyzes four aspects of Idaho’s SHIBA program: program operations, certified Medicare counselor and volunteer management, marketing and outreach, and community partnerships. Data was collected through a variety of methods including surveys with Medicare counselors and past SHIBA beneficiaries and interviews with SHIP staff in other states, Idaho SHIBA staff, and community partner organizations. SHIPs across the country were severely impacted by the COVID-19 pandemic with the loss of significant numbers of volunteers and community partners. At a time when SHIP staff are struggling to recover from the impacts of the COVID-19 pandemic, the main takeaway from this research is that SHIPs are supported by a network of staff and volunteers who are committed to providing services that are needed by Medicare eligible Americans. This workforce of staff and volunteers is working to rebuild SHIPs into programs equipped to meet the needs of a growing Medicare eligible population. The goal of this research is to provide Idaho’s SHIBA program and SHIPs across the country with quantitative and qualitative information to help determine how to most effectively offer services, implement certified Medicare counselor and volunteer management, conduct marketing and outreach, and build strong relationships with community partners. Incorporating the best practices listed at the end of each section of this report may lead to enhancing the overall effectiveness of the SHIBA program, more volunteers and community partners, and an increase in annual beneficiary contact forms (BCFs). Key Takeaways: SHIPs are supported by dedicated staff and volunteers who are integral to the success of the program. Providing a greater variety of volunteer opportunities could help Idaho’s SHIBA program increase the accessibility of volunteering for more folks. Word of mouth outreach and referrals from other organizations are the primary way both beneficiaries and volunteers find out about SHIBA. Both are necessary to increase brand recognition and rebuild previous community partnerships. The COVID-19 pandemic resulted in significant declines in certified Medicare counselors, volunteers, and community partners for Idaho’s SHIBA program and most states interviewed for this report. Increasing the annual number of BCFs relies on recruiting more certified Medicare counselors and building more formal community partnerships. It would be beneficial to continue providing both in-person and phone counseling options that are currently available, while developing a plan to expand virtual counseling options to meet the demand of new retirees and increase resources in languages other than English

Bending and Breaking of Stripes in a Charge-Ordered Manganite

In complex electronic materials, coupling between electrons and the atomic lattice gives rise to remarkable phenomena, including colossal magnetoresistance and metal-insulator transitions. Charge-ordered phases are a prototypical manifestation of charge-lattice coupling, in which the atomic lattice undergoes periodic lattice displacements (PLDs). Here we directly map the picometer scale PLDs at individual atomic columns in the room temperature charge-ordered manganite Bi$_{0.35}$Sr$_{0.18}$Ca$_{0.47}$MnO$_3$ using aberration corrected scanning transmission electron microscopy (STEM). We measure transverse, displacive lattice modulations of the cations, distinct from existing manganite charge-order models. We reveal locally unidirectional striped PLD domains as small as $\sim$5 nm, despite apparent bidirectionality over larger length scales. Further, we observe a direct link between disorder in one lattice modulation, in the form of dislocations and shear deformations, and nascent order in the perpendicular modulation. By examining the defects and symmetries of PLDs near the charge-ordering phase transition, we directly visualize the local competition underpinning spatial heterogeneity in a complex oxide.Comment: Main text: 20 pages, 4 figures. Supplemental Information: 27 pages, 14 figure

Idaho Permanent Supportive Housing: Comparative Analysis

Permanent supportive housing (PSH) uses a Housing First approach to house people experiencing homelessness and living with a disabling condition. Idaho Housing and Finance Association (IHFA) partnered with Idaho Policy Institute (IPI) to conduct a statewide evaluation comparing scattered-site and single-site PSH programs at Low-Income Housing Tax Credit (LIHTC) properties in Idaho. Of the 151 PSH units in Idaho, 96 are in service consisting of 30 scattered-site and 66 single-site units. Additionally, 55 scattered-site units are anticipated to open in the next two years. No single-site PSH programs using LIHTC are planned. Future single-site PSH programs will require strong public-private partnerships modeled after successful programming in Ada County. This report includes a description of current LIHTC PSH programming in Idaho, recommendations of data required for future evaluations, and key considerations for resource and activity prioritization

Commensurate Stripes and Phase Coherence in Manganites Revealed with Cryogenic Scanning Transmission Electron Microscopy

Incommensurate charge order in hole-doped oxides is intertwined with exotic phenomena such as colossal magnetoresistance, high-temperature superconductivity, and electronic nematicity. Here, we map at atomic resolution the nature of incommensurate order in a manganite using scanning transmission electron microscopy at room temperature and cryogenic temperature ($\sim$ 93K). In diffraction, the ordering wavevector changes upon cooling, a behavior typically associated with incommensurate order. However, using real space measurements, we discover that the underlying ordered state is lattice-commensurate at both temperatures. The cations undergo picometer-scale ($\sim$6-11 pm) transverse displacements, which suggests that charge-lattice coupling is strong and hence favors lattice-locked modulations. We further unearth phase inhomogeneity in the periodic lattice displacements at room temperature, and emergent phase coherence at 93K. Such local phase variations not only govern the long range correlations of the charge-ordered state, but also results in apparent shifts in the ordering wavevector. These atomically-resolved observations underscore the importance of lattice coupling and provide a microscopic explanation for putative "incommensurate" order in hole-doped oxides

Evaluation of a Subject specific dual-transmit approach for improving B1 field homogeneity in cardiovascular magnetic resonance at 3T

BACKGROUND: Radiofrequency (RF) shading artifacts degrade image quality while performing cardiovascular magnetic resonance (CMR) at higher field strengths. In this article, we sought to evaluate the effect of local RF (B(1) field) shimming by using a dual-source–transmit RF system for cardiac cine imaging and to systematically evaluate the effect of subject body type on the B(1) field with and without local RF shimming. METHODS: We obtained cardiac images from 37 subjects (including 11 patients) by using dual-transmit 3T CMR. B(1) maps with and without subject-specific local RF shimming (exploiting the independent control of transmit amplitude and phase of the 2 RF transmitters) were obtained. Metrics quantifying B(1) field homogeneity were calculated and compared with subject body habitus. RESULTS: Local RF shimming across the region encompassed by the heart increased the mean flip angle (μ) in that area (88.5 ± 15.2% vs. 81.2 ± 13.3%; P = 0.0014), reduced the B(1) field variation by 42.2 ± 13%, and significantly improved the percentage of voxels closer to μ (39% and 82% more voxels were closer to ± 10% and ± 5% of μ, respectively) when compared with no RF shimming. B(1) homogeneity was independent of subject body type (body surface area [BSA], body mass index [BMI] or anterior-posterior/right-left patient width ratio [AP/RL]). Subject specific RF (B(1)) shimming with a dual-transmit system improved local RF homogeneity across all body types. CONCLUSION: With or without RF shimming, cardiac B1 field homogeneity does not depend on body type, as characterized by BMI, BSA, and AP/RL. For all body types studied, cardiac B(1) field homogeneity was significantly improved by performing local RF shimming with 2 independent RF-transmit channels. This finding indicates the need for subject-specific RF shimming

Integrated design of motor drives using random heuristic optimization for aerospace applications

High power density for aerospace motor drives is a key factor in the successful realization of the More Electric Aircraft (MEA) concept. An integrated system design approach offers optimization opportunities, which could lead to further improvements in power density. However this requires multi-disciplinary modelling and the handling of a complex optimization problem that is discrete and non¬linear in nature. This paper proposes a multi-level approach towards applying random heuristic optimization to the integrated motor design problem. Integrated optimizations are performed independently and sequentially at different levels assigned according to the 4-level modelling paradigm for electric systems. This paper also details a motor drive sizing procedure, which poses as the optimization problem to solve here. Finally, results comparing the proposed multi-level approach with a more traditional single-level approach is presented for a 2.5 kW actuator motor drive design. The multi-level approach is found to be more computationally efficient than its counterpart