Mapping and Risk Assessment of Juniper Encroachment Into a Prairie Landscape

Juniper encroachment is a considerable threat to the prairie ecosystems of the Great Plains because it has the potential to alter native grasslands by changing soil characteristics, limiting herbaceous biomass, and hindering native community regeneration. Accurate maps of juniper cover and predictions of areas at risk for future expansion are needed to support proactive management measures. Therefore, our objectives are to: (1) Develop a practical workflow for large-scale juniper mapping using Landsat 8 Operational Land Imager (OLI) imagery and partial unmixing techniques, (2) Compare the classification accuracies from the resulting map based on different juniper density thresholds and different types of imagery, (3) Develop a predictive spatial model for the distribution of low-density juniper based on distance to seed source and environmental covariates and determine the prediction accuracy, and (4) Use the resulting maps to evaluate the extent of current juniper establishment and the risk of future encroachment. The study area encompasses counties bordering the Missouri River in southeastern South Dakota and northeastern Nebraska and covering approximately 23,000 km2. We applied a matched filtering technique to classify juniper with snowcovered and snow-free winter imagery (December-March) and snow-free spring imagery (April-June). We found that using the snow-covered winter images suppressed background spectral signatures and resulted in a higher overall classification accuracy of 93.7% for juniper densities above 15 percent, compared to snow-free winter imagery and spring imagery. When characterizing juniper densities below 10 percent our 30-meter pixel level classification map was unreliable, with an 11% probability of correctly classifying juniper. Therefore, we used Random Forests, a machine-learning algorithm, to develop a model of low-density (≤ 15%) juniper based on classified juniper cover and other ecological factors. We used the receiver operating characteristics (ROC) curve to evaluate model predictions; accuracy was high with an area under the curve (AUC) of 0.884. Our susceptibility map indicated that an additional 7.7% of the study area currently contained low densities of juniper and had high to very high risk of future encroachment. This study will provide agencies and land managers with information and techniques needed to address juniper encroachment in the Northern Great Plains

Speed training: Library Instruction in 30 Minutes or Less

A question plaguing many librarians today is how we get information out about our resources and services when everyone is so busy. One answer may be to offer express classes. Since the spring of 2013, the Lichtenberger Engineering Library at the University of Iowa has offered a series of 15-30 minute drop-in classes as part of a series called Library Xpress Classes. This series targeted one topic each week and repeated the same class twice each Thursday to reach a broader range of people. Fifty classes have been offered over the two semesters. These sessions were open to faculty, staff, graduate, and undergraduate students. Topics covered include basics on popular databases (Compendex, SciFinder, PubMed, etc.), citation management software (Endnote and Refworks), alerts and notifications, and popular types of resources (patents and standards). The classes are not set up to cover everything completely but just to give an overview and brief introduction to products and services that otherwise might not be seen. The sessions are taught by librarians with different areas of expertise from the range of libraries on campus. Some classes were more successful than others; the citation management software sessions were the most popular. In the spring 2013 semester, the classes averaged a 4.5 in overall usefulness rating on a scale of 1-5 with 5 being most useful. More students attended the 2:30 pm afternoon sessions and most of the attendees were graduate students. The classes often have repeat students. In one class on Refworks, a graduate student noted he had never heard of Compendex until it was mentioned in this class. He, then, went on to sign up for 4 more of the sessions offered that semester as soon as he realized how helpful they were. The Xpress Class series has proven to be an overall success. As time goes on the Library will continue to make adjustments to the programs so that it will continue to improve its outreach to students, faculty, and staff

A Protocol for Examining and Mapping Elder Abuse Pathways in Iowa

This study and report is intended to guide and empower rural communities to map out, evaluate, and bolster the network of organizations, advocates, and governments to help combat elder abuse and neglect in all forms. It is the result of an in-depth examination of the discrete points in the east-central Iowa corridor, which generated several insights and recommendations. Many of the impediments stem from a lack of funding, and not from a lack of motivation, commitment, or effort from the three pillars of the Iowa system, Heritage Area Agency on Aging providers, Adult Protective Service workers, and law enforcement. Key informants urge cities and counties to earmark tax dollars, victim assistance funds, and civil monetary penalty funds to pay for local pilot projects, including enhanced multidisciplinary teams. Renewed focus could be placed on: dispelling myths and misconceptions surrounding elder abuse; increasing public awareness of the local organizations and people involved in identifying, reporting, responding to, and resolving incidents of abuse; acknowledging that no one person or organization can do it all alone, and encouraging systems agents to begin changing their culture and protocols; involving additional social workers and therapists in the system to address the complex family dynamics and relationships that are often at the heart of elder abuse; providing increased and easier access to persons qualified to assess an elder’s mental health and capacity for making decisions; funding for state and county attorneys to increase prosecution, increase state and local level specialized elder abuse units, and provide state-wide training of special prosecutors to handle elder abuse cases; and providing funding for individuals or organizations who are willing and available to make decisions for an elder, such as a financial or healthcare agent, guardian, conservator, Social Security Representative Payee, or other fiduciary

Waiving Medicaid Regulations During a Public Health Crisis: Identifying Heterogeneous Effects of Suspending Pre-Admission Screening Requirements on COVID-19 Deaths

Background: During the COVID-19 Public Health Emergency, states were authorized to waive Pre-Admission Screening Resident Review (PASRR), a federal regulation requiring all individuals be evaluated before admission into a federally qualified nursing facility. We suspect states waived PASRR to reallocate resources from admission towards infection control and outbreak mitigation. However, by waiving PASRR and fast-tracking admissions, vulnerable elders may have been exposed to COVID-19 and unexpectedly placed at substantial risk for increased morbidity. Methodology: We reviewed all COVID-19 Medicaid emergency waiver requests to identify states waiving PASRR. We then analyzed daily, state-level COVID-19 deaths with a panel regression model, controlling for state and time fixed effects, and daily case rates. Finally, we expanded the model to identify heterogeneous effects shaped by market and administrative oversight factors. Results: Suspending PASRR led to significant declines in state COVID-19 deaths (–2.3 deaths per 100,000 population, p < 0.001). However, the effect waiving PASRR varied by excess nursing bed capacity (7.3 deaths per 100,000 population, p = 0.024) and historical PASRR deficiencies (0.9 deaths per 100,000, p = 0.009). Implications: Within the first month of the COVID-19 emergency invocation, nearly all states suspended PASRR, which our estimates suggest averted 7,600 deaths nationwide. However, we found that greater pre-emergency bed availability and less administrative oversight may have reduced the effectiveness of a PASRR waiver. While future research should aim to understand the mechanisms for such heterogeneity, immediate concerns relate to the variation, both between and within states, for adhering to a critical regulation protecting older adults

Identification of Emergency Department Visits in Medicare Administrative Claims: Approaches and Implications

ObjectivesAdministrative claims data sets are often used for emergency care research and policy investigations of healthcare resource utilization, acute care practices, and evaluation of quality improvement interventions. Despite the high profile of emergency department (ED) visits in analyses using administrative claims, little work has evaluated the degree to which existing definitions based on claims data accurately captures conventionally defined hospital‐based ED services. We sought to construct an operational definition for ED visitation using a comprehensive Medicare data set and to compare this definition to existing operational definitions used by researchers and policymakers.MethodsWe examined four operational definitions of an ED visit commonly used by researchers and policymakers using a 20% sample of the 2012 Medicare Chronic Condition Warehouse (CCW) data set. The CCW data set included all Part A (hospital) and Part B (hospital outpatient, physician) claims for a nationally representative sample of continuously enrolled Medicare fee‐for‐services beneficiaries. Three definitions were based on published research or existing quality metrics including: 1) provider claims–based definition, 2) facility claims–based definition, and 3) CMS Research Data Assistance Center (ResDAC) definition. In addition, we developed a fourth operational definition (Yale definition) that sought to incorporate additional coding rules for identifying ED visits. We report levels of agreement and disagreement among the four definitions.ResultsOf 10,717,786 beneficiaries included in the sample data set, 22% had evidence of ED use during the study year under any of the ED visit definitions. The definition using provider claims identified a total of 4,199,148 ED visits, the facility definition 4,795,057 visits, the ResDAC definition 5,278,980 ED visits, and the Yale definition 5,192,235 ED visits. The Yale definition identified a statistically different (p < 0.05) collection of ED visits than all other definitions including 17% more ED visits than the provider definition and 2% fewer visits than the ResDAC definition. Differences in ED visitation counts between each definition occurred for several reasons including the inclusion of critical care or observation services in the ED, discrepancies between facility and provider billing regulations, and operational decisions of each definition.ConclusionCurrent operational definitions of ED visitation using administrative claims produce different estimates of ED visitation based on the underlying assumptions applied to billing data and data set availability. Future analyses using administrative claims data should seek to validate specific definitions and inform the development of a consistent, consensus ED visitation definitions to standardize research reporting and the interpretation of policy interventions.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136706/1/acem13140_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136706/2/acem13140-sup-0001-DataSupplementS1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136706/3/acem13140.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136706/4/acem13140-sup-0002-DataSupplementS2.pd

Characterizing Bighorn Sheep Foraging Sites Using the Modified Robel Pole in the Southern Black Hills, South Dakota

Evaluating foraging behavior of bighorn sheep (Ovis canadensis) and filling information gaps for their habitat requirements is important for population level management in the southern Black Hills of South Dakota. Our objectives were to: (1) evaluate the overall summer foraging area post lambing use during July and August for standing herbage with the modified Robel pole (1.27 cm bands) with visual obstruction readings (VOR) related to clipped herbage at ground level; (2) calibrate the Robel pole visual obstruction (bands) with clipped vegetation; and (3) develop guidelines for monitoring the landscape of the bighorn sheep foraging areas. The study area is located in a ponderosa pine (Pinus ponderosa ) savanna with few shrubs and dominated with native grasses. Each transect had 10 visual obstruction (bands) stations spaced 10 meters apart with 4 visual obstruction readings at each station. At 4 stations, total vegetation was clipped at ground level within a 0.25-m2  circular hoop. Clipped standing herbage ranged from 418 kg/ha to 3731 kg/ha with a mean of 1519 kg/ha. VOR measurements ranged from 0.2 cm to 14.9 cm with a 3.9 cm mean. Calibration of the modified Roble pole (visual obstruction of bands) with transect means using linear regression reliability predicted average clipped standing herbage (dry weights) within the bighorn sheep foraging area. The relationship was significant (R2  = 0.65; F1, 27  = 50.75, P  &lt; 0.01). Cluster analysis (ISODATA) applied to the pole readings (VOR) and herbage resulted in 3 categories: short, intermediate and tall. We recommend 14 Robel pole transects (100 m in length) for VOR measurements within key foraging areas for future monitoring of herbaceous biomass for bighorn sheep. Foraging sites were in areas with little overstory tree canopy, close to rocky escape terrain, and where abundant grasses and forbs had little woody debris. The modified Robel pole provides a simple, reliable and cost effective alternative to clipping vegetation and obtaining dry weights

State Variability in the Prevalence and Healthcare Utilization of Assisted Living Residents with Dementia

Objectives: Almost 1 million older and disabled adults who require long‐term care reside in assisted living (AL), approximately 40% of whom have a diagnosis of Alzheimer\u27s disease and related dementias (ADRD). States vary in their regulations specific to dementia care that may influence the presence of residents with ADRD in AL and their outcomes. The objectives of this study were to describe the state variability in the prevalence of ADRD among Medicare beneficiaries residing in larger (25+ bed) ALs and their healthcare utilization. Design: Retrospective observational national study. Participants: National cohort of 293,336 Medicare fee‐for‐service enrollees residing in larger (25+ bed) ALs in 2016 and 2017 including 88,867 (30.3%) residents with ADRD. We compared this cohort\u27s characteristics and healthcare utilization with that of individuals with ADRD who resided in nursing homes (NHs; n = 602,521) and the community (n = 2,074,420). Methods: Medicare enrollment data, claims, and the NH Minimum Data Set were used to describe differences among ADRD patients in AL, NHs, and the community. We present rates of NH admission and hospitalization, by state, adjusting for age, sex, race, dual eligibility, and chronic conditions. Results: The prevalence of ADRD among AL residents varied by state, ranging from 24% to 47%. In 2017, AL residents with ADRD had higher rates of NH admission than their community‐dwelling counterparts (adjusted national average = 24%, ranging from 14% to 35% among states). AL residents with ADRD had higher rates of hospitalization (38%) than populations in either NHs (29%) or the community (34%), and ranged from 29% to 45% of residents among states. Conclusion: These findings have implications for states as they regulate AL and for healthcare professionals whose patients reside in AL. Future work is needed to understand specific elements of states’ regulatory environments and local markets that may impact access and outcomes for this vulnerable population of residents with ADRD. J Am Geriatr Soc 68:1504‐1511, 2020

A Research Report: Business and Wealth Transfer in Nonmetropolitan Nebraska 2012 Nebraska Rural Poll Results

Table of Contents Executive Summary ......................................................................... i Introduction ............................................................................. 1 Businesses in the Community .................................................................. 2 Figure 1. Expected Number of Businesses in Local Community Five Years from Now by Community Size .................................................................................... 2 Figure 2. Most Likely Outcome when Business Owner Leaves or Retires in Community ................. 3 Business Exits and Transitions .............................................................. 4 Table 1. Concern with Business Exits ........................................................ 4 Figure 3. Concern that Business Closings will Affect Ability to Get Needed Things by Occupation..................... 5 Table 2. Views of Community Strategies for Business Exits ........................

Defining emergency department episodes by severity and intensity: A 15-year study of Medicare beneficiaries

Background. Episodes of Emergency Department (ED) service use among older adults previously have not been constructed, or evaluated as multi-dimensional phenomena. In this study, we constructed episodes of ED service use among a cohort of older adults over a 15-year observation period, measured the episodes by severity and intensity, and compared these measures in predicting subsequent hospitalization. Methods. We conducted a secondary analysis of the prospective cohort study entitled the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). Baseline (1993) data on 5,511 self-respondents 70 years old were linked to their Medicare claims for 1991-2005. Claims then were organized into episodes of ED care according to Medicare guidelines. The severity of ED episodes was measured with a modified-NYU algorithm using ICD9-CM diagnoses, and the intensity of the episodes was measured using CPT codes. Measures were evaluated against subsequent hospitalization to estimate comparative predictive validity. Results. Over 15 years, three-fourths (4,171) of the 5,511 AHEAD participants had at least 1 ED episode, with a mean of 4.5 episodes. Cross-classification indicated the modified-NYU severity measure and the CPT-based intensity measure captured different aspects of ED episodes (kappa = 0.18). While both measures were significant independent predictors of hospital admission from ED episodes, the CPT measure had substantially higher predictive validity than the modified-NYU measure (AORs 5.70 vs. 3.31; p < .001). Conclusions. We demonstrated an innovative approach for how claims data can be used to construct episodes of ED care among a sample of older adults. We also determined that the modified-NYU measure of severity and the CPT measure of intensity tap different aspects of ED episodes, and that both measures were predictive of subsequent hospitalization. © 2010 Kaskie et al; licensee BioMed Central Ltd