Medicaid 1915(c) home and community-based services waivers across the states.

This article provides State-level data on the Medicaid 1915(c) home and community-based services (HCBS) waivers program. Medicaid 1915(c) waiver participants were 32 percent of the Medicaid participants in institutional care in 1997. These data document wide interstate variation in organizational oversight and program policies for the waivers. Many structural barriers to HCBS waiver growth existed. Case management services, in some form, were normative for most HCBS waiver participants, but formal mechanisms to assess client satisfaction and service quality were less common. Substantial new growth in this program may require fundamental changes in HCBS waiver policies

Studies of the nucler equation of state using numerical calculations of nuclear drop collisions

A numerical calculation for the full thermal dynamics of colliding nuclei was developed. Preliminary results are reported for the thermal fluid dynamics in such processes as Coulomb scattering, fusion, fusion-fission, bulk oscillations, compression with heating, and collisions of heated nuclei

Explaining Actual Causation via Reasoning About Actions and Change

In causality, an actual cause is often defined as an event responsible for bringing about a given outcome in a scenario. In practice, however, identifying this event alone is not always sufficient to provide a satisfactory explanation of how the outcome came to be. In this paper, we motivate this claim using well-known examples and present a novel framework for reasoning more deeply about actual causation. The framework reasons over a scenario and domain knowledge to identify additional events that helped to "set the stage" for the outcome. By leveraging techniques from Reasoning about Actions and Change, the approach supports reasoning over domains in which the evolution of the state of the world over time plays a critical role and enables one to identify and explain the circumstances that led to an outcome of interest. We utilize action language AL for defining the constructs of the framework. This language lends itself quite naturally to an automated translation to Answer Set Programming, using which, reasoning tasks of considerable complexity can be specified and executed. We speculate that a similar approach can also lead to the development of algorithms for our framework

Impact of Electron-Phonon Coupling on Near-Field Optical Spectra

The finite momentum transfer ($\boldsymbol{q}$) longitudinal optical response $\sigma^L(\boldsymbol{q},\omega)$ of graphene has a peak at an energy $\omega=\hbar v_F q$. This corresponds directly to a quasiparticle peak in the spectral density at momentum relative to the Fermi momentum $k_F -q$. Inclusion of coupling to a phonon mode at $\omega_E$ results, for $\omega<|\omega_E|$, in a constant electron-phonon renormalization of the bare bands by a mass enhancement factor $(1+\lambda)$ and this is followed by a phonon kink at $\omega_E$ where additional broadening begins. Here we study the corresponding changes in the optical quasiparticle peaks which we find to continue to directly track the renormalized quasiparticle energies until $q$ is large enough that the optical transitions begin to sample the phonon kink region of the dispersion curves where linearity in momentum is lost in the renormalized Dirac Fermion dispersion curves and the correspondence to a single quasiparticle energy is lost. Nevertheless there remains in $\sigma^L(\boldsymbol{q},\omega)$ features analogous to the phonon kinks of the dispersion curves which are observable through variation of $q$ and $\omega$.Comment: 6 pages, 5 figure

Student Experience in Brett Hall: A Case Study of Renovations to Facilitate Inclusion

Accessibility cannot be achieved through a one-size fits all approach. In order to create universally inclusive environments, thoughtful design must be incorporated to provide individuals with spaces that foster thriving and positively contribute to well-being. This study investigates how accessibility renovations using inclusive design impact the experience of students in the university residential life setting. This is achieved through a case study of the student experience living in Brett Hall dormitory at the University of Massachusetts Amherst, which was recently renovated to accommodate students with a range of complex needs. To provide a comprehensive case, this study includes the analysis of floor plans, photos, walkthrough notes, and interviews with two staff members and two students who currently live in the residence hall. Individual semi-structured interviews were conducted with two UMass students that currently live in Brett Hall to investigate how the renovations influence their experiences and the meaning they attribute to their living space. These findings contribute to university planners’ understanding of how to renovate existing residential facilities to be more universally accessible for all students. Creating spaces that are accessible to everyone is a critical step in understanding how the college experience can be maximized for all students, especially those living with disabilities

Evaluation of thallium-201 scanning for detection of latent coronary artery disease

The use of thallium imaging as a noninvasive method to accurately screen shuttle passengers for latent coronary artery disease was investigated. All radionuclide procedures were performed using an Anger type camera with a high resolution collimator. A minimum of 200,000 counts were collected for each image using a 20% window centered on the 69-83 keV X-rays. For the images obtained following injection with the patient at rest, the testing was begun 10 minutes after injection. Injections of TT during exercise were made at a point near the termination of the treadmill procedure as determined by either the appearance of ST segment changes on the electrocardiogram consistant with subendocardial ischemia, the appearance of angina-like chest pain in the patient or fatigue in the patient which required cessation of the test. The severity of heart disease was based on the medical history, physical exam, exercise electrocardiograms, chest X-rays and the coronary arteriogram

An Evaluation of the 2 + 2 for Teachers: Alternative Performance Appraisal Program in the Norfolk Public Schools PRIME Project

The current study was a utilization-focused implementation evaluation of the 2 + 2 for Teachers: Alternative Performance Appraisal Program (2 + 2). The 2 + 2 program is an experimental appraisal program designed to support substantial instructional reform in the Norfolk, Virginia based PRIME (Public school Restructuring through Innovative Mainstream Education) systemic reform project. Through frequent classroom observations by administrators, peers, and students, who offer two compliments and two suggestions for improvement at each observation, the 2 + 2 program provides a framework for teacher collaboration and professional growth. Ultimately, improved instruction is an expected outcome, but was not evaluated in this study. The formative evaluation of the initial 1996-97 implementation of 2 + 2 focused on adaptive program improvement, implementation processes, and how the 2 + 2 program made a difference to teachers. Both quantitative and qualitative methods were employed. Research on school restructuring efforts of the last decade indicates that a collaborative culture among teachers can have a positive impact on teacher efficacy (certainty) and on systemic reform efforts. General agreement also exists in the education field that traditional teacher performance appraisal systems are largely ineffective in bringing about improved instruction, and are a source of anxiety for teachers. The evaluation found overwhelmingly positive participant response to the 2 + 2 program. Most teachers reported they experimented with new strategies, experienced improved interaction with colleagues, were greatly encouraged by positive feedback, and preferred 2 + 2 as an appraisal system. Barriers to program implementation included uneven administrative support and time constraints. A need for a systemic perspective was indicated to sustain both the growth of 2 + 2 and the entire PRIME project

Examining the Sustainability of Restored Sub-Tidal Oyster Reefs in Coastal Louisiana

Climate related alterations and anthropogenic disturbance threaten the ecological integrity and sustainability of coastal estuaries. Many activities seek to restore and sustain these at-risk areas with the goal of restoring systems to historic patterns of succession and community development; however long-term monitoring of restoration projects remains limited. Additionally, restoration efforts aim to achieve certain success thresholds, however, these thresholds are often vague, absent, or inconsistent, and receive little long-term analyses following restoration. A key coastal engineer, the eastern oyster (Crassostrea virginica), provides multiple ecosystem services, but recent population decline has prompted investment in restoration. Restoration activities include cultch planting, reef enhancement, incorporation into living shorelines, and hatchery construction for oyster seed. This work examines restoration trajectories and project sustainability for two oyster restoration projects in coastal Louisiana. Here I quantify on-reef oyster density and demography, adjacent shoreline movement, and water filtration services for a living shoreline project in Sister Lake Louisiana 11 years post-construction (2009 – 2020), as well as examine the outcomes of oyster restoration projects implemented across Louisiana as part of the early restoration funding from the Deepwater Horizon Oil Spill. Restored reefs persisted through time but decreased in integrity and robustness 2-3 years post-restoration. Declines were likely influenced by sub-optimal water quality (i.e., salinity) and heavy localized harvest. Despite these declines, reefs still provided crucial ecosystem services (i.e., water filtration) to estuarine habitats. While success thresholds vary between restoration projects, I suggest restoration success thresholds may incorporate three different performance criteria (achievement of target densities; provision of ecosystem services; achievement of harvest quotas). For these criteria to be met and detected, incorporation of long-term monitoring and adaptative management are crucial. This work provides critical information for managers on the outcomes of oyster restoration projects and explains specific variables which influence project sustainability

Hyaluronidase: A Potential New Treatment for Acute Respiratory Distress Syndrome

Acute respiratory distress syndrome, also known as diffuse alveolar damage, is an acute injury to the lungs. Patients experience severe shortness of breath and require mechanical ventilation. It is not a specific disease, but an acute lung dysfunction associated with a variety of disorders: pneumonia, shock, sepsis, and trauma. A similar lesion occurs in newborn infants, called hyaline disease of the newborn. It occurs in premature babies and has the same pathophysiological mechanism as acute respiratory distress syndrome. Hyaline membranes are a pathologic feature of acute respiratory distress syndrome, consisting of basophilic structures that coat alveolar surfaces. They prevent oxygen exchange and are the basis of the lethality of this disorder. The syndrome is associated with very high levels of hyaluronan in broncho-alveolar lavage specimens. We postulate that the hyaline membranes of acute respiratory distress syndrome are hyaluronan-rich structures associated with serum hyaluronan-binding proteins such as fibrinogen and fibrin. Potent infectious influenza viruses are recurrent pandemics and potential terrorist threats. Lethality of influenza infection correlates with the presence of hyaline membranes. Installation of hyaluronidase as an aerosol would provide a new treatment for acute respiratory respiratory distress syndrome, for which there has been no new treatment in 45 years. The pig is the only species other than humans that develop hyaline membranes. Employing this treatment in the porcine model would provide a direct test of the hypothesis