Characteristics of persons 60 years of age and older in Linn County, Iowa

Early in 1957, 695 persons 60 years of age or older were interviewed in Linn County, Iowa. This group was randomly selected from the population of such persons residing in the county. In attempting to draw generalizations for the population of senior persons of Linn County from the survey, the following comments appear appropriate. The majority of this age group were well adjusted, considering themselves a part of the community and expressing little desire to change their present mode of life. A majority preferred to live in their own homes in their present community rather than in homes or accommodations restricted to aged persons. Not surprisingly, if persons were asked to describe the type of accommodations they would consider the most desirable for the age group, they described arrangements similar to their present living arrangements.https://lib.dr.iastate.edu/specialreports/1026/thumbnail.jp

Practice transformations to optimize the delivery of HIV primary care in community healthcare settings in the United States: A program implementation study.

BackgroundThe United States HIV care workforce is shrinking, which could complicate service delivery to people living with HIV (PLWH). In this study, we examined the impact of practice transformations, defined as efficiencies in structures and delivery of care, on demonstration project sites within the Workforce Capacity Building Initiative, a Health Resources and Services Administration (HRSA) Ryan White HIV/AIDS Program Special Projects of National Significance (SPNS).Methods and findingsData were collected at 14 demonstration project sites in 7 states and the District of Columbia. Organizational assessments were completed at sites once before and 4 times after implementation. They captured 3 transformation approaches: maximizing the HIV care workforce (efforts to increase the number of existing healthcare workforce members involved in the care of PLWH), share-the-care (team-based care giving more responsibility to midlevel providers and staff), and enhancing client engagement in primary HIV care to reduce emergency and inpatient care (e.g., care coordination). We also obtained Ryan White HIV/AIDS Program Services Reports (RSRs) from sites for calendar years (CYs) 2014-2016, corresponding to before, during, and after transformation. The RSR include data on client retention in HIV care, prescription of antiretroviral therapy (ART), and viral suppression. We used generalized estimating equation (GEE) models to analyze changes among sites implementing each practice transformation approach. The demonstration projects had a mean of 18.5 prescribing providers (SD = 23.5). They reported data on more than 13,500 clients per year (mean = 969/site, SD = 1,351). Demographic characteristics remained similar over time. In 2014, a majority of clients were male (71% versus 28% female and 0.2% transgender), with a mean age of 47 (interquartile range [IQR] 37-54). Racial/ethnic characteristics (48% African American, 31% Hispanic/Latino, 14% white) and HIV risk varied (31% men who have sex with men; 31% heterosexual men and women; 7% injection drug use). A substantial minority was on Medicaid (41%). Across sites, there was significant uptake in practices consistent with maximizing the HIV care workforce (18% increase, p < 0.001), share-the-care (25% increase, p < 0.001), and facilitating patient engagement in HIV primary care (13% increase, p < 0.001). There were also significant improvements over time in retention in HIV care (adjusted odds ratio [aOR] = 1.03; 95% confidence interval [CI] 1.02-1.04; p < 0.001), ART prescription levels (aOR = 1.01; 95% CI 1.00-1.01; p < 0.001), and viral suppression (aOR = 1.03; 95% CI 1.02-1.04; p < 0.001). All outcomes improved at sites that implemented transformations to maximize the HIV care workforce or improve client engagement. At sites that implemented share-the-care practices, only retention in care and viral suppression outcomes improved. Study limitations included use of demonstration project sites funded by the Ryan White HIV/AIDS Program (RWHAP), which tend to have better HIV outcomes than other US clinics; varying practice transformation designs; lack of a true control condition; and a potential Hawthorne effect because site teams were aware of the evaluation.ConclusionsIn this study, we found that practice transformations are a potential strategy for addressing anticipated workforce challenges among those providing care to PLWH. They hold the promise of optimizing the use of personnel and ensuring the delivery of care to all in need while potentially enhancing HIV care continuum outcomes

KIC 3749404: a heartbeat star with rapid apsidal advance indicative of a tertiary component

Heartbeat stars are eccentric (e> 0.2) ellipsoidal variables whose light curves resemble a cardiogram. We present the observations and corresponding model of KIC 3749404, a highly eccentric (e = 0.66), short period (P = 20.3 d) heartbeat star with tidally induced pulsations. A binary star model was created using phoebe, which we modified to include tidally induced pulsations and Doppler boosting. The morphology of the photometric periastron variation (heartbeat) depends strongly on the eccentricity, inclination and argument of periastron. We show that the inclusion of tidally induced pulsations in the model significantly changes the parameter values, specifically the inclination and those parameters dependent on it. Furthermore, we determine the rate of apsidal advance by modelling the periastron variation at the beginning and end of the 4-yr Kepler data set and dividing by the elapsed time. We compare the model with the theoretical expectations for classical and general relativistic apsidal motion and find the observed rate to be two orders of magnitude greater than the theoretical rate. We find that the observed rate cannot be explained by tidally induced pulsations alone and consequently hypothesise the presence of a third body in the system