The Changing Nature of Poverty

Since the beginning of the War on Poverty, the poverty rate has fluctuated widely, and at the same time the poverty population has undergone many changes, some mirroring the changing stereotypes of the poor and others less pronounced than the changing stereotypes would lead us to believe. A feminization of poverty has occurred, with many more of the poor now in households headed by women. Interestingly, aging of the poverty population has not occurred despite growth in the elderly segment of the overall population. Concerning turnover in the poverty population, we find that despite poverty theories emphasizing persistence, recurrent poverty is relatively rare and poverty is not generally passed from one generation to the next. Poverty prevention has come from both economic growth and government transfers; however, inequality in economic growth has contributed to poverty. With the proportion of elderly and female- headed households likely to continue at a high level into the future, poverty rates are also likely to remain high unless government transfers are increased.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66979/2/10.1177_000271628547900103.pd

Tunable Chiral Second-Order Nonlinear Optical Chromophores Based on Helquat Dications

Fourteen new dipolar cations have been synthesized, containing methoxy or tertiary amino electron donor groups attached to helquat (Hq) acceptors. These Hq derivatives have been characterized as their TfO^– salts by using various techniques including NMR and electronic absorption spectroscopies. UV–vis spectra show intense, relatively low energy absorptions with λ_(max) ≈ 400–600 nm, attributable to intramolecular charge-transfer (ICT) excitations. Single-crystal X-ray structures have been solved for two of the chromophores, one as its PF_6^– salt, revealing centrosymmetric packing arrangements (space groups Pbca and P1̅). Molecular quadratic nonlinear optical (NLO) responses have been determined directly by using hyper-Rayleigh scattering (HRS) with a 800 nm laser, and indirectly via Stark (electroabsorption) spectroscopy for the low energy absorption bands. The obtained static first hyperpolarizabilities β_0 range from moderate to large: (9–140) × 10^(–30) esu from HRS in MeCN and (44–580) × 10^(–30) esu from the Stark data in PrCN. The magnitude of β_0 increases upon either extending the π-conjugation length or replacing a methoxy with a tertiary amino electron donor substituent. Density functional theory (DFT) and time-dependent DFT calculations on selected tertiary amino chromophores confirm that the low energy absorptions have ICT character. Relatively good agreement between the simulated and experimental UV–vis absorption spectra is achieved by using the CAM-B3LYP functional with the 6-311G(d) basis set. The β_(tot) values predicted by using DFT at the same level of theory are large ((472–1443) × 10^(–30) esu in MeCN). Both the theoretical and experimental results show that para-conjugation between Hq and electron donor fragments is optimal, and enlarging the Hq unit is inconsequential with respect to the molecular quadratic NLO response

Clinical pharmacist services within intensive care unit recovery clinics: An opinion of the critical care practice and research network of the American College of Clinical Pharmacy

Intensive care unit recovery clinics (ICU- RCs) have been proposed as a potential mechanism to address the multifaceted unmet needs of intensive care unit (ICU) survivors and caregivers. The needs of this population include, but are not limited to, medication optimization, addressing physical function and psychological needs, coordination of care, and other interventions that may help in improving patient recovery and reducing the rate of preventable readmissions. The objective of this opinion paper is to identify and describe clinical pharmacy services for the management of ICU survivors and their caregivers in an ICU- RC. The goals are to guide the establishment and development of clinical pharmacist involvement in ICU- RCs and to highlight ICU recovery research and educational opportunities. Recommendations provided in this paper are based on the following: a review of published data on clinical pharmacist involvement in the ICU- RCs; a consensus of clinical pharmacists who provide direct patient care to ICU survivors and caregivers; and a review of published guidelines and literature focusing on the management of ICU survivors and caregivers. These recommendations define areas of clinical pharmacist involvement in ICU- RCs. Consequently, clinical pharmacists can promote education on Post Intensive Care Syndrome and Post Intensive Care Syndrome- Family; improve medication adherence; facilitate appropriate referrals to primary care providers and specialists; ensure comprehensive medication management and medication reconciliation; provide assessment of inappropriate and appropriate medications after hospitalization; address adverse drug events, medication errors, and drug interactions; promote preventive measures; and facilitate medication acquisition with the goal of improving patient outcomes and reducing health care system costs.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163579/2/jac51311.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163579/1/jac51311_am.pd

Impacts of variations in Caspian Sea surface area on catchment-scale and large-scale climate

The Caspian Sea (CS) is the largest inland lake in the world. Large variations in sea level and surface area occurred in the past and are projected for the future. The potential impacts on regional and large-scale hydroclimate are not well understood. Here, we examine the impact of CS area on climate within its catchment and across the northern hemisphere, for the first time with a fully coupled climate model. The Community Earth System Model (CESM1.2.2) is used to simulate the climate of four scenarios: (1) larger than present CS area, (2) current area, (3) smaller than present area, and (4) no-CS scenario. The results reveal large changes in the regional atmospheric water budget. Evaporation (E) over the sea increases with increasing area, while precipitation (P) increases over the south-west CS with increasing area. P-E over the CS catchment decreases as CS surface area increases, indicating a dominant negative lake-evaporation feedback. A larger CS reduces summer surface air temperatures and increases winter temperatures. The impacts extend eastwards, where summer precipitation is enhanced over central Asia and the north-western Pacific experiences warming with reduced winter sea ice. Our results also indicate weakening of the 500-hPa troughs over the northern Pacific with larger CS area. We find a thermal response triggers a southward shift of the upper troposphere jet stream during summer. Our findings establish that changing CS area results in climate impacts of such scope that CS area variations should be incorporated into climate model simulations, including palaeo and future scenarios. Plain Language Summary The Caspian Sea is the largest land-locked water body in the world. It is filled by rivers draining a vast region from northern Russia to Iran. The size of the Caspian Sea has varied considerably over recent centuries and millennia due to various factors, including changes in climate. Conversely, as the area of the sea changes it also has impacts on the climate, but there are significant questions about how and where those impacts would be felt. In this study we used a state-of-the-art climate model in which we specified different sizes of Caspian Sea in order to examine how the climate changes as its area increases. We observed that the local seasonal cycle of temperatures gets smaller, and evaporation increases, while there are more spatially complex changes in local rainfall. Furthermore, the impacts on atmospheric circulation occur as far as the north Pacific, with resulting increases in temperature and decreases in sea-ice coverage in winter as the Caspian area increases. The climate impacts are so significant and geographically extensive that climate models used to simulate climate change (both in future and past scenarios) should incorporate changes to the Caspian Sea area if they are to robustly model regional climate

Feasibility of trial procedures for a randomised controlled trial of a community based group exercise intervention for falls prevention for visually impaired older people: the VIOLET study

Background Visually impaired older people (VIOP) have a higher risk of falling than their sighted peers, and are likely to avoid physical activity. The aim was to adapt the existing Falls Management Exercise (FaME) programme for VIOP, delivered in the community, and to investigate the feasibility of conducting a definitive randomised controlled trial (RCT) of this adapted intervention. Methods Two-centre randomised mixed methods pilot trial and economic evaluation of the adapted group-based FaME programme for VIOP versus usual care. A one hour exercise programme ran weekly over 12 weeks at the study sites (Newcastle and Glasgow), delivered by third sector (voluntary and community) organisations. Participants were advised to exercise at home for an additional two hours over the week. Those randomised to the usual activities group received no intervention. Outcome measures were completed at baseline, 12 and 24 weeks. The potential primary outcome was the Short Form Falls Efficacy Scale – International (SFES-I). Participants’ adherence was assessed by reviewing attendance records and self-reported compliance to the home exercises. Adherence with the course content (fidelity) by instructors was assessed by a researcher. Adverse events were collected in a weekly phone call. Results Eighteen participants, drawn from community-living VIOP were screened; 68 met the inclusion criteria; 64 participants were randomised with 33 allocated to the intervention and 31 to the usual activities arm. 94% of participants provided data at the 12 week visit and 92% at 24 weeks. Adherence was high. The intervention was found to be safe with 76% attending nine or more classes. Median time for home exercise was 50 min per week. There was little or no evidence that fear of falling, balance and falls risk, physical activity, emotional, attitudinal or quality of life outcomes differed between trial arms at follow-up. Conclusions The intervention, FaME, was implemented successfully for VIOP and all progression criteria for a main trial were met. The lack of difference between groups on fear of falling was unsurprising given it was a pilot study but there may have been other contributory factors including suboptimal exercise dose and apparent low risk of falls in participants. These issues need addressing for a future trial