The Pay-Off on Nursing Home Report Cards

For the past decade, policymakers have used public reporting of quality measures as a strategy to improve quality in nursing homes. In theory, public reporting might improve overall quality in two ways: first, if consumers choose nursing homes with better performance, and second, if public reporting encourages nursing homes to improve their performance. Has public reporting had its intended effects? Does improving quality give nursing homes a competitive advantage in the marketplace, thereby improving their bottom line? This Issue Brief summarizes a series of studies that assess the impact of public reporting on nursing home quality and on the financial performance of these facilities

Changes in Consumer Demand Following Public Reporting of Summary Quality Ratings: An Evaluation in Nursing Homes

A nursing home report card that converted 12 measures of quality into a simple 5-star system significantly affected consumer demand for low- and high-scoring facilities. One-star facilities typically lost 8 percent of their market share and 5-star facilities gained more than 6 percent of their market share. These results support the use of summary measures in report cards

Tax Consequences of Distributing Equity Compensation Rights in Divorce

This article discusses the federal tax issues arising from the equitable distribution of compensatory stock options and restricted stock in divorce. While the tax consequences of distributing vested options and shares are clear, the treatment of unvested rights is muddled. This article explains the state of the law and provides practical advice to divorce lawyers who confront these issues

Highly ordered tailored three-dimensional hierarchical nano/microporous gold–carbon architectures

The preparation and characterization of three-dimensional hierarchical architectures, consisting of monolithic nanoporous gold or silver films formed on highly ordered 3D microporous carbon supports, are described. The formation of these nano/microporous structures involves the electrodeposition or sputtering of metal alloys onto the lithographically patterned multi-layered microporous carbon, followed by preferential chemical dealloying of the less noble component. The resulting hierarchical structure displays a highly developed 3D interconnected network of micropores with a nanoporous metal coating. Tailoring the nanoporosity of the metal films and the diameter of the large micropores has been accomplished by systematically changing the alloy compositions via control of the deposition potential, plating solution and coarsening time. SEM imaging illustrates the formation of unique biomimetic nanocoral- or nanocauliflower-like self-supporting structures, depending on the specific preparation conditions. The new 3D hierarchical nano/microporous architectures allow for enhanced mass transport and catalytic activity compared to common nanoporous films prepared on planar substrates. The functionality of this new carbon–gold hierarchical structure is illustrated for the greatly enhanced performance of enzymatic biofuel cells where a substantially higher power output is observed compared to the bare microporous carbon substrate

Methods for confidence interval estimation of a ratio parameter with application to location quotients

BACKGROUND: The location quotient (LQ) ratio, a measure designed to quantify and benchmark the degree of relative concentration of an activity in the analysis of area localization, has received considerable attention in the geographic and economics literature. This index can also naturally be applied in the context of population health to quantify and compare health outcomes across spatial domains. However, one commonly observed limitation of LQ is its widespread use as only a point estimate without an accompanying confidence interval. METHODS: In this paper we present statistical methods that can be used to construct confidence intervals for location quotients. The delta and Fieller's methods are generic approaches for a ratio parameter and the generalized linear modelling framework is a useful re-parameterization particularly helpful for generating profile-likelihood based confidence intervals for the location quotient. A simulation experiment is carried out to assess the performance of each of the analytic approaches and a health utilization data set is used for illustration. RESULTS: Both the simulation results as well as the findings from the empirical data show that the different analytical methods produce very similar confidence limits for location quotients. When incidence of outcome is not rare and sample sizes are large, the confidence limits are almost indistinguishable. The confidence limits from the generalized linear model approach might be preferable in small sample situations. CONCLUSION: LQ is a useful measure which allows quantification and comparison of health and other outcomes across defined geographical regions. It is a very simple index to compute and has a straightforward interpretation. Reporting this estimate with appropriate confidence limits using methods presented in this paper will make the measure particularly attractive for policy and decision makers

Convergent Surface Water Distributions in U.S. Cities

Earth's surface is rapidly urbanizing, resulting in dramatic changes in the abundance, distribution and character of surface water features in urban landscapes. However, the scope and consequences of surface water redistribution at broad spatial scales are not well understood. We hypothesized that urbanization would lead to convergent surface water abundance and distribution: in other words, cities will gain or lose water such that they become more similar to each other than are their surrounding natural landscapes. Using a database of more than 1 million water bodies and 1 million km of streams, we compared the surface water of 100 US cities with their surrounding undeveloped land. We evaluated differences in areal (A WB) and numeric densities (N WB) of water bodies (lakes, wetlands, and so on), the morphological characteristics of water bodies (size), and the density (D C) of surface flow channels (that is, streams and rivers). The variance of urban A WB, N WB, and D C across the 100 MSAs decreased, by 89, 25, and 71%, respectively, compared to undeveloped land. These data show that many cities are surface water poor relative to undeveloped land; however, in drier landscapes urbanization increases the occurrence of surface water. This convergence pattern strengthened with development intensity, such that high intensity urban development had an areal water body density 98% less than undeveloped lands. Urbanization appears to drive the convergence of hydrological features across the US, such that surface water distributions of cities are more similar to each other than to their surrounding landscapes. © 2014 The Author(s)

Export production and carbonate dissolution in the central equatorial Pacific Ocean over the past 1 Myr

In order to quantify changes in export production and carbonate dissolution over the past 1 Myr in the central equatorial Pacific Ocean we analyzed Ba, P, Al, Ti, and Ca in 1106 samples from five piston cores gathered from 5°S to 4°N at 140°W. We focused on Ba/Ti, Al/Ti, and P/Ti ratios as export proxies and employed areally integrated time slice as well as time series strategies. Carbonate maxima from 0-560 kyr are characterized by 15-30% greater export than carbonate minima. The increases in export fall on glacial δ¹⁸O transitions rather than glacial maxima. From 560-800 kyr, overlapping with the mid-Pleistocene transition, there is a very large increase in total export yet no glacial-interglacial variability. The highest latitudes (5°S and 4°N) record minimal absolute export change from glacials to interglacials and yet record the most extreme minima in percent CaCO₃, indicating that carbonate records there are dominated by dissolution, whereas near the equator they are more influenced by changes in export.Copyright 2000 by the American Geophysical Union

Hyperglycemia, Type 2 Diabetes, and Depressive Symptoms: The British Whitehall II study

International audienceOBJECTIVE: To examine the recent suggestion that impaired fasting glucose may protect against depression, whereas a diagnosis of diabetes might then result in depression. RESEARCH DESIGN AND METHODS: Cross-sectional analysis of 4,228 adults (mean age 60.7 years, 73.0% men) who underwent oral glucose tolerance testing and completed the Center for Epidemiologic Studies Depression scale (CES-D). RESULTS: After adjustment for demographic factors, health behaviors, and clinical measurements (BMI, waist circumference, lipid profile, and blood pressure), there was a U-shaped association between fasting glucose and depression (P(curve) = 0.001), with elevated CES-D at low and very high glucose levels. This finding was replicable with 2-h postload glucose (P = 0.11) and A1C (P = 0.007). CONCLUSIONS: The U-shaped association between blood glucose and CES-D, with the lowest depression risk seen among those in the normoglycemic range of A1C, did not support the hypothesized protective effect of hyperglycemia

Adverse clinical sequelae after skin branding: a case series

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Hollow Microneedle-based Sensor for Multiplexed Transdermal Electrochemical Sensing

The development of a minimally invasive multiplexed monitoring system for rapid analysis of biologically-relevant molecules could offer individuals suffering from chronic medical conditions facile assessment of their immediate physiological state. Furthermore, it could serve as a research tool for analysis of complex, multifactorial medical conditions. In order for such a multianalyte sensor to be realized, it must be minimally invasive, sampling of interstitial fluid must occur without pain or harm to the user, and analysis must be rapid as well as selective