Why Do Some CAHs Close Their Skilled Nursing Facility Services While Others Retain Them? (Briefing Paper #32)

Variations in reimbursement policies and swing bed use suggest that the incentives influencing the decisions of CAHs regarding their Skilled Nursing Facility (SNF) units may differ from those of urban hospitals. Based on a review of the literature and conversations with members of the Flex Monitoring Team’s Expert Work Group, we expected the financial decision regarding SNF unit operation to be more complex for CAHs than for PPS hospitals largely because the decision involves the profitability of a PPS-reimbursed SNF within a cost-based facility. In the case of the CAH, the indirect and facility costs associated with operating a PPS-reimbursed SNF unit must be subtracted from the cost base of the cost-reimbursed acute care services thereby reducing reimbursement for those services. We also expected that the availability of swing beds (which can be used effectively to manage acute care length of stay issues without compromising acute care reimbursement) would be a significant factor in decisions to close SNF units. We identified other factors that might influence a CAH’s decision to retain a SNF unit including: the need for an alternative to swing beds to manage length of stay issues for CAHs with consistently high acute care census levels; community need and preference (which might be particularly important for municipal and county-owned hospitals); and limitations on SNF unit closure imposed by state Certificate of Need regulations. Among the potential factors influencing a CAH’s decision to close or retains its SNF units, only the latter factor (i.e., the influence of Certificate of Need regulations) was not supported by our study. We interviewed 20 CAHs operating in eleven states, including 11 hospitals that had closed their SNF units and 9 that continued to operate their services. This report discusses our findings in detail; there is also a policy brief which highlights the same findings

Numerical study of multilayer adsorption on fractal surfaces

We report a numerical study of van der Waals adsoprtion and capillary condensation effects on self-similar fractal surfaces. An assembly of uncoupled spherical pores with a power-law distributin of radii is used to model fractal surfaces with adjustable dimensions. We find that the commonly used fractal Frankel-Halsey-Hill equation systematically fails to give the correct dimension due to crossover effects, consistent with the findings of recent experiments. The effects of pore coupling and curvature dependent surface tension were also studied.Comment: 11 pages, 3 figure

Hemodynamic, Functional, and Clinical Responses to Pulmonary Artery Denervation in Patients With Pulmonary Arterial Hypertension of Different Causes: Phase II Results From the Pulmonary Artery Denervation-1 Study

Background—The mechanisms underlying pulmonary arterial hypertension (PAH) are multifactorial. The efficacy of pulmonary artery denervation (PADN) for idiopathic PAH treatment has been evaluated. This study aimed to analyze the hemodynamic, functional, and clinical responses to PADN in patients with PAH of different causes. Methods and Results—Between April 2012 and April 2014, 66 consecutive patients with a resting mean pulmonary arterial pressure ≥25 mmHg treated with PADN were prospectively followed up. Target drugs were discontinued after the PADN procedure. Hemodynamic response and 6-minute walk distance were repeatedly measured within the 1 year post PADN follow-up. The clinical end point was the occurrence of PAH-related events at the 1-year follow-up. There were no PADNrelated complications. Hemodynamic success (defined as the reduction in mean pulmonary arterial pressure by a minimal 10% post PADN) was achieved in 94% of all patients, with a mean absolute reduction in systolic pulmonary arterial pressure and mean pulmonary arterial pressure within 24 hours of −10 mmHg and −7 mmHg, respectively. The average increment in 6-minute walk distance after PADN was 94 m. Worse PAH-related events occurred in 10 patients (15%), mostly driven by the worsening of PAH (12%). There were 8 (12%) all-cause deaths, with 6 (9%) PAH-related deaths. Conclusions—PADN was safe and feasible for the treatment of PAH. The PADN procedure was associated with significant improvements in hemodynamic function, exercise capacity, and cardiac function and with less frequent PAH-related events and death at 1 year after PADN treatment. Further randomized studies are required to confirm the efficacy of PADN for PAH

Decadal changes of the Western Arabian sea ecosystem

Historical data from oceanographic expeditions and remotely sensed data on outgoing longwave radiation, temperature, wind speed and ocean color in the western Arabian Sea (1950–2010) were used to investigate decadal trends in the physical and biochemical properties of the upper 300 m. 72 % of the 29,043 vertical profiles retrieved originated from USA and UK expeditions. Increasing outgoing longwave radiation, surface air temperatures and sea surface temperature were identified on decadal timescales. These were well correlated with decreasing wind speeds associated with a reduced Siberian High atmospheric anomaly. Shoaling of the oxycline and nitracline was observed as well as acidification of the upper 300 m. These physical and chemical changes were accompanied by declining chlorophyll-a concentrations, vertical macrofaunal habitat compression, declining sardine landings and an increase of fish kill incidents along the Omani coast

Soil methane sink capacity response to a long-term wildfire chronosequence in Northern Sweden

Boreal forests occupy nearly one fifth of the terrestrial land surface and are recognised as globally important regulators of carbon (C) cycling and greenhouse gas emissions. Carbon sequestration processes in these forests include assimilation of CO2 into biomass and subsequently into soil organic matter, and soil microbial oxidation of methane (CH4). In this study we explored how ecosystem retrogression, which drives vegetation change, regulates the important process of soil CH4 oxidation in boreal forests. We measured soil CH4 oxidation processes on a group of 30 forested islands in northern Sweden differing greatly in fire history, and collectively representing a retrogressive chronosequence, spanning 5000 years. Across these islands the build-up of soil organic matter was observed to increase with time since fire disturbance, with a significant correlation between greater humus depth and increased net soil CH4 oxidation rates. We suggest that this increase in net CH4 oxidation rates, in the absence of disturbance, results as deeper humus stores accumulate and provide niches for methanotrophs to thrive. By using this gradient we have discovered important regulatory controls on the stability of soil CH4 oxidation processes that could not have not been explored through shorter-term experiments. Our findings indicate that in the absence of human interventions such as fire suppression, and with increased wildfire frequency, the globally important boreal CH4 sink could be diminished

Direct Evidence for Termination of Obscured Star Formation by Radiatively Driven Outflows in Reddened QSOs

We present optical to far-infrared photometry of 31 reddened QSOs that show evidence for radiatively driven outflows originating from AGN in their rest-frame UV spectra. We use these data to study the relationships between the AGN-driven outflows, and the AGN and starburst infrared luminosities. We find that FeLoBAL QSOs are invariably IR-luminous, with IR luminosities exceeding 10^{12} Solar luminosities in all cases. The AGN supplies 76% of the total IR emission, on average, but with a range from 20% to 100%. We find no evidence that the absolute luminosity of obscured star formation is affected by the AGN-driven outflows. Conversely, we find an anticorrelation between the strength of AGN-driven outflows, as measured from the range of outflow velocities over which absorption exceeds a minimal threshold, and the contribution from star formation to the total IR luminosity, with a much higher chance of seeing a starburst contribution in excess of 25% in systems with weak outflows than in systems with strong outflows. Moreover, we find no convincing evidence that this effect is driven by the IR luminosity of the AGN. We conclude that radiatively driven outflows from AGN can have a dramatic, negative impact on luminous star formation in their host galaxies. We find that such outflows act to curtail star formation such that star formation contributes less than ~25% of the total IR luminosity. We also propose that the degree to which termination of star formation takes place is not deducible from the IR luminosity of the AGN.Comment: Accepted for publication in Ap

Kinetics of occupancy of defect states in poly(3-hexylthiophene): fullerene solar cells

Energetics and kinetics of defects in the effective band gap of organic bulk heterojunctions are determined by means of capacitance methods. The technique consists of calculating the junction capacitance derivative with respect to the angular frequency of the small voltage perturbation applied to thin film poly(3-hexylthiophene) (P3HT) and [6,6]-phenyl C61-butyric acid methyl ester solar cells, varying the temperature. The analysis reveals the presence of defect bands (shallow acceptors) centered at E0 = 35 meV above the highest-occupied molecular orbital level of P3HT. The total density of defects results of order 1016 cm− 3. Characteristic frequency is obtained to be situated within the range of 1–10 Hz. Defect bands acting as negatively charged levels are responsible for the p-doping of the active layer and the band-bending near the cathode contact, as derived from Mott–Schottky capacitance–voltage analysis

Probing the interactions of phenol with oxygenated functional groups on curved fullerene-like sheets in activated carbon

The mechanism(s) of interactions of phenol with oxygenated functional groups (OH, COO and COOH) in nanopores of activated carbon (AC) is a contentious issue among researchers. This mechanism is of particular interest because a better understanding of the role of such groups in nanopores would essentially translate to advances in AC production and use, especially in regard to the treatment of organic-based wastewaters. We therefore attempt to shed more light on the subject by employing density functional theory (DFT) calculations in which fullerene-like models integrating convex or concave structure, which simulate the eclectic porous structures on AC surface, are adopted. TEM analysis, EDS mapping and Boehm titration are also conducted on actual phenol-adsorbed AC. Our results suggest the widely-reported phenomenon of decreased phenol uptake on AC due to increased concentration of oxygenated functional groups is possibly attributed to the increased presence of the latter on the convex side of the curved carbon sheets. Such a system effectively inhibits phenol from getting direct contact with the carbon sheet, thus constraining any available π–π interaction, while the effect of groups acting on the concave part of the curved sheet does not impart the same detriment

Monocrystalline Si/β\beta-Ga2_2O3_3 p-n heterojunction diodes fabricated via grafting

The $\beta$-Ga$_2$O$_3$ has exceptional electronic properties with vast potential in power and RF electronics. Despite the excellent demonstrations of high-performance unipolar devices, the lack of p-type doping in $\beta$-Ga$_2$O$_3$ has hindered the development of Ga$_2$O$_3$-based bipolar devices. The approach of p-n diodes formed by polycrystalline p-type oxides with n-type $\beta$-Ga$_2$O$_3$ can face severe challenges in further advancing the $\beta$-Ga$_2$O$_3$ bipolar devices due to their unfavorable band alignment and the poor p-type oxide crystal quality. In this work, we applied the semiconductor grafting approach to fabricate monocrystalline Si/$\beta$-Ga$_2$O$_3$ p-n diodes for the first time. With enhanced concentration of oxygen atoms at the interface of Si/$\beta$-Ga$_2$O$_3$, double side surface passivation was achieved for both Si and $\beta$-Ga$_2$O$_3$ with an interface Dit value of 1-3 x 1012 /cm2 eV. A Si/$\beta$-Ga$_2$O$_3$ p-n diode array with high fabrication yield was demonstrated along with a diode rectification of 1.3 x 107 at +/- 2 V, a diode ideality factor of 1.13 and avalanche reverse breakdown characteristics. The diodes C-V shows frequency dispersion-free characteristics from 10 kHz to 2 MHz. Our work has set the foundation toward future development of $\beta$-Ga$_2$O$_3$-based transistors.Comment: 32 pages, 10 figures. The preliminary data were presented as a poster in the 5th US Gallium Oxide Workshop, Washington, DC. August 07-10, 202