Our Parents, Ourselves: Health Care for an Aging Population; A Report of the Dartmouth Atlas Project

The new Dartmouth Atlas, funded by The John A. Hartford Foundation, is a report card that analyzes Medicare data to show us where the United States is making progress in patient-centered, evidence-based care for Medicare beneficiaries and where improvement is still needed. It also offers insight into regional variations in care.Filling in the gaps in our knowledge about the state of care across the country will help health care providers, health systems, and patients and families work together to improve care for all older adults.This Dartmouth Atlas report looks at a number of measures from Medicare data, including:The number of days older adults spend in contact with the health care system;Use of high-risk medications;Cancer screening rates (and how they compare with recommendations);30-day hospital readmission rates;Annual Wellness Visit (AWV) rates;Late hospice referral; andThe number of days spent in intensive care.The report also offers a historical look at key practices, comparing data from 2003-05 and 2012

Synactic structure and its effects on performance in a second language

SIGLEAvailable from British Library Document Supply Centre- DSC:D37051/81 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Operationalising and measuring language dominance

The paper offers a new way to measure language ability in bilinguals, based on measures of lexical richness. The validity of proposed approach is tested in a variety of ways

Diamond (111) surface reconstruction and epitaxial graphene interface

The evolution of the diamond (111) surface as it undergoes reconstruction and subsequent graphene formation is investigated with angle-resolved photoemission spectroscopy, low energy electron diffraction, and complementary density functional theory calculations. The process is examined starting at the C(111)-(2x1) surface reconstruction that occurs following detachment of the surface adatoms at 920 {\deg}C, and continues through to the liberation of the reconstructed surface atoms into a free-standing monolayer of epitaxial graphene at temperatures above 1000 {\deg}C. Our results show that the C(111)-(2x1) surface is metallic as it has electronic states that intersect the Fermi-level. This is in strong agreement with a symmetrically {\pi}-bonded chain model and should contribute to resolving the controversies that exist in the literature surrounding the electronic nature of this surface. The graphene formed at higher temperatures exists above a newly formed C(111)-(2\times1) surface and appears to have little substrate interaction as the Dirac-point is observed at the Fermi-level. Finally, we demonstrate that it is possible to hydrogen terminate the underlying diamond surface by means of plasma processing without removing the graphene layer, forming a graphene-semiconductor interface. This could have particular relevance for doping the graphene formed on the diamond (111)surface via tuneable substrate interactions as a result of changing the terminating species at the diamond-graphene interface by plasma processing.Comment: 10 pages, 4 figure

Assessing L2 vocabulary depth with word associates format tests: issues, findings, and suggestions

Word Associates Format (WAF) tests are often used to measure second language learners’ vocabulary depth with a focus on their network knowledge. Yet, there were often many variations in the specific forms of the tests and the ways they were used, which tended to have an impact on learners’ response behaviors and, more importantly, the psychometric properties of the tests. This paper reviews the general practices, key issues, and research findings that pertain to WAF tests in four major areas, including the design features of WAF tests, conditions for test administration, scoring methods, and test-taker characteristics. In each area, a set of variables is identified and described with relevant research findings also presented and discussed. Around eight topics, the General Discussion section provides some suggestions and directions for the development of WAF tests and the use of them as research tools in the future. This paper is hoped to help researchers become better aware that the results generated by a WAF test may vary depending on what specific design the test has, how it is administered and scored, and who the learners are, and consequently, make better decisions in their research that involves a WAF test

Doubly charged silicon vacancy center, Si-N complexes, and photochromism in N and Si codoped diamond

Diamond samples containing silicon and nitrogen are shown to be heavily photochromic, with the dominant visible changes due to simultaneous change in total SiV0/− concentration. The photochromism treatment is not capable of creating or destroying SiV defects, and thus we infer the presence of the optically inactive SiV2− . We measure spectroscopic signatures we attribute to substitutional silicon in diamond, and identify a silicon-vacancy complex decorated with a nearest-neighbor nitrogen SiVN, supported by theoretical calculations

Individualized decision aid for diverse women with lupus nephritis (IDEA-WON): A randomized controlled trial.

BackgroundTreatment decision-making regarding immunosuppressive therapy is challenging for individuals with lupus. We assessed the effectiveness of a decision aid for immunosuppressive therapy in lupus nephritis.Methods and findingsIn a United States multicenter, open-label, randomized controlled trial (RCT), adult women with lupus nephritis, mostly from racial/ethnic minority backgrounds with low socioeconomic status (SES), seen in in- or outpatient settings, were randomized to an individualized, culturally tailored, computerized decision aid versus American College of Rheumatology (ACR) lupus pamphlet (1:1 ratio), using computer-generated randomization. We hypothesized that the co-primary outcomes of decisional conflict and informed choice regarding immunosuppressive medications would improve more in the decision aid group. Of 301 randomized women, 298 were analyzed; 47% were African-American, 26% Hispanic, and 15% white. Mean age (standard deviation [SD]) was 37 (12) years, 57% had annual income of <$40,000, and 36% had a high school education or less. Compared with the provision of the ACR lupus pamphlet (n = 147), participants randomized to the decision aid (n = 151) had (1) a clinically meaningful and statistically significant reduction in decisional conflict, 21.8 (standard error [SE], 2.5) versus 12.7 (SE, 2.0; p = 0.005) and (2) no difference in informed choice in the main analysis, 41% versus 31% (p = 0.08), but clinically meaningful and statistically significant difference in sensitivity analysis (net values for immunosuppressives positive [in favor] versus negative [against]), 50% versus 35% (p = 0.006). Unresolved decisional conflict was lower in the decision aid versus pamphlet groups, 22% versus 44% (p < 0.001). Significantly more patients in the decision aid versus pamphlet group rated information to be excellent for understanding lupus nephritis (49% versus 33%), risk factors (43% versus 27%), medication options (50% versus 33%; p ≤ 0.003 for all); and the ease of use of materials was higher in the decision aid versus pamphlet groups (51% versus 38%; p = 0.006). Key study limitations were the exclusion of men, short follow-up, and the lack of clinical outcomes, including medication adherence.ConclusionsAn individualized decision aid was more effective than usual care in reducing decisional conflict for choice of immunosuppressive medications in women with lupus nephritis.Trial registrationClinicaltrials.gov, NCT02319525

Global access to surgical care: a modelling study

Background More than 2 billion people are unable to receive surgical care based on operating theatre density alone. The vision of the Lancet Commission on Global Surgery is universal access to safe, aff ordable surgical and anaesthesia care when needed. We aimed to estimate the number of individuals worldwide without access to surgical services as defi ned by the Commission’s vision. Methods We modelled access to surgical services in 196 countries with respect to four dimensions: timeliness, surgical capacity, safety, and aff ordability. We built a chance tree for each country to model the probability of surgical access with respect to each dimension, and from this we constructed a statistical model to estimate the proportion of the population in each country that does not have access to surgical services. We accounted for uncertainty with oneway sensitivity analyses, multiple imputation for missing data, and probabilistic sensitivity analysis. Findings At least 4·8 billion people (95% posterior credible interval 4·6–5·0 [67%, 64–70]) of the world’s population do not have access to surgery. The proportion of the population without access varied widely when stratifi ed by epidemiological region: greater than 95% of the population in south Asia and central, eastern, and western sub- Saharan Africa do not have access to care, whereas less than 5% of the population in Australasia, high-income North America, and western Europe lack access. Interpretation Most of the world’s population does not have access to surgical care, and access is inequitably distributed. The near absence of access in many low-income and middle-income countries represents a crisis, and as the global health community continues to support the advancement of universal health coverage, increasing access to surgical services will play a central role in ensuring health care for all

Erasmus Language students in a British University – a case study

Students’ assessment of their academic experience is actively sought by Higher Education institutions, as evidenced in the National Student Survey introduced in 2005. Erasmus students, despite their growing numbers, tend to be excluded from these satisfaction surveys, even though they, too, are primary customers of a University. This study aims to present results from bespoke questionnaires and semi-structured interviews with a sample of Erasmus students studying languages in a British University. These methods allow us insight into the experience of these students and their assessment as a primary customer, with a focus on language learning and teaching, university facilities and student support. It investigates to what extent these factors influence their levels of satisfaction and what costs of adaptation if any, they encounter. Although excellent levels of satisfaction were found, some costs affect their experience. They relate to difficulties in adapting to a learning methodology based on a low number of hours and independent learning and to a guidance and support system seen as too stifling. The results portray this cohort’s British University as a well-equipped and well-meaning but ultimately overbearing institution, which may indicate that minimising costs can eliminate some sources of dissatisfaction