Metal–organic fireworks: MOFs as integrated structural scaffolds for pyrotechnic materials

A new approach to formulating pyrotechnic materials is presented whereby constituent ingredients are bound together in a solid-state lattice. This reduces the batch inconsistencies arising from the traditional approach of combining powders by ensuring the key ingredients are ‘mixed’ in appropriate quantities and are in intimate contact. Further benefits of these types of material are increased safety levels as well as simpler logistics, storage and manufacture. A systematic series of new frameworks comprising fuel and oxidiser agents (group 1 and 2 metal nodes & terephthalic acid derivatives as linkers) has been synthesised and structurally characterised. These new materials have been assessed for pyrotechnic effect by calorimetry and burn tests. Results indicate that these materials exhibit the desired pyrotechnic material properties and the effect can be correlated to the dimensionality of the structure. A new approach to formulating pyrotechnic materials is proposed whereby constituent ingredients are bound together in a solid-state lattice. A series of Metal–organic framework frameworks comprising fuel and oxidiser agents exhibits the desired properties of a pyrotechnic material and this effect is correlated to the dimensionality of the structure

Adherence to Combination Prophylaxis for Prevention of Mother-to-Child-Transmission of HIV in Tanzania

BACKGROUND: Since 2008, Tanzanian guidelines for prevention of mother-to-child-transmission of HIV (PMTCT) recommend combination regimen for mother and infant starting in gestational week 28. Combination prophylaxis is assumed to be more effective and less prone to resistance formation compared to single-drug interventions, but the required continuous collection and intake of drugs might pose a challenge on adherence especially in peripheral resource-limited settings. This study aimed at analyzing adherence to combination prophylaxis under field conditions in a rural health facility in Kyela, Tanzania. METHODS AND FINDINGS: A cohort of 122 pregnant women willing to start combination prophylaxis in Kyela District Hospital was enrolled in an observational study. Risk factors for decline of prophylaxis were determined, and adherence levels before, during and after delivery were calculated. In multivariate analysis, identified risk factors for declining pre-delivery prophylaxis included maternal age below 24 years, no income-generating activity, and enrolment before 24.5 gestational weeks, with odds ratios of 5.8 (P = 0.002), 4.4 (P = 0.015) and 7.8 (P = 0.001), respectively. Women who stated to have disclosed their HIV status were significantly more adherent in the pre-delivery period than women who did not (P = 0.004). In the intra- and postpartum period, rather low drug adherence rates during hospitalization indicated unsatisfactory staff performance. Only ten mother-child pairs were at least 80% adherent during all intervention phases; one single mother-child pair met a 95% adherence threshold. CONCLUSIONS: Achieving adherence to combination prophylaxis has shown to be challenging in this rural study setting. Our findings underline the need for additional supervision for PMTCT staff as well as for clients, especially by encouraging them to seek social support through status disclosure. Prophylaxis uptake might be improved by preponing drug intake to an earlier gestational age. Limited structural conditions of a healthcare setting should be taken into serious account when implementing PMTCT combination prophylaxis

The Status Of Two New England “Endemic” Carices: Carex Elachycarpa And C. Josselynii (Cyperaceae)

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149729/1/tax00494.pd

Ventura county investigation. Basic data ...

Mode of access: Internet

SNF‐VBP Penalizes Skilled Nursing Facilities with Negative Profit Margins

RESEARCH OBJECTIVE: Skilled Nursing Facility‐Value‐based Purchasing Program (SNF‐VBP) from the Centers of Medicare and Medicaid Services (CMS) incentivizes facilities to improve quality through lower hospital readmissions. However, SNF‐VBP may penalize nursing homes that are unable to invest resources to reduce readmissions. Although existing research has examined facility characteristics and SNF‐VBP performance, the relationship between financial performance and SNF‐VBP performance is unknown. In this study, we examine the SNF‐VBP performance by the financial performance of SNFs. STUDY DESIGN: We use data from three sources: 2019 SNF‐VBP performance data from CMS, and latest available CMS cost reports for SNFs (2017), and SNF characteristic data from LTCfocus.org (2017). We use descriptive methods to examine total profit margins and SNF‐VBP performance. We examine the characteristics of facilities with positive and negative profit margins, and within these, we further examine characteristics of facilities that are rewarded or penalized under SNF‐VBP. In the adjusted analysis, we evaluate the relationship between having a negative profit margin and experiencing penalty under the SNF‐VBP controlling for several SNF characteristics including resident acuity index, occupancy percentage, payer mix, size, profit status, chain membership, and market competition. POPULATION STUDIED: All freestanding SNFs with valid SNF‐VBP and cost report data (n = 12 420). PRINCIPAL FINDINGS: Of the 12 420 SNFs, about 46.4% have a negative profit margin. Furthermore, there is a 14‐percentage point difference in average profit margins for SNFs with positive profit margins vs. SNFs with negative profit margins (6.1% vs −8.15%). About 74.5% of SNFs with negative profit margins and 71.7% of the SNFs with positive profit margins are penalized under SNF‐VBP (P < .05). Among the 9063 SNFs that are penalized, about 47.4% of the SNFs have negative profit margins with an average profit margin of −8.23%. These penalized SNFs with negative profit margins (n = 4295) have an average loss of $24 400 from SNF‐VBP (range: −$4 to −$170 000). In the adjusted analysis, the odds of being penalized under the SNF VBP program for SNFs with negative profit margins are 13$24 400—an amount that roughly approximates average annual salary of a certified nursing assistant, one of the key nursing home direct care staffs. These losses may further exacerbate quality problems in facilities that are already struggling. Alternative approaches to assist financially struggling SNFs may help them improve quality and perform better under SNF‐VBP

The Fate of Greenland: Lessons From Abrupt Climate Change

Viewed from above, Greenland offers an endless vista of whiteness interrupted only by scattered ponds of azure-colored melt water. Ninety percent of Greenland is covered by ice; its ice sheet, the largest outside Antarctica, stretches almost 1,000 miles from north to south and 600 miles from east to west. But this stark view of ice and snow is changing -- and changing rapidly. Greenland\u27s ice sheet is melting; the dazzling, photogenic display of icebergs breaking off Greenland\u27s rapidly melting glaciers has become a tourist attraction. The Fate of Greenlanddocuments Greenland\u27s warming with dramatic color photographs and investigates episodes in Greenland\u27s climate history for clues about what happens when climate change is abrupt rather than gradual. Greenland\u27s climate past and present could presage our climate future. Abrupt climate change would be cataclysmic: the melting of Greenland\u27s ice shelf would cause sea levels to rise twenty-four feet worldwide; lower Manhattan would be underwater and Florida\u27s coastline would recede to Orlando. The planet appears to be in a period of acute climate instability, exacerbated by carbon dioxide we pour into the atmosphere. As this book makes clear, it is in all of our interests to pay attention to Greenland.https://digitalcommons.library.umaine.edu/fac_monographs/1058/thumbnail.jp