Previous research has examined evidence-based hospital to SNF transitional care (TC) interventions and reported reductions in readmissions and overall cost savings (e.g. INTERACT, Ouslander, et al., ...2011). However, while small scale clinical trials of TC interventions have provided some support for their efficacy (Toles, et al., 2016), little is known about general trends in SNF TC practices and how they relate to 30-day hospital readmissions. The current study fills this gap by measuring the TC practices of Ohio SNFs using data collected through two waves of a state wide survey of SNFs (over 95% response rates) and 30-day hospital readmissions, utilizing data from the nursing home Minimum Data Set (MDS 3.0). Utilizing a technique developed in the econometric literature known as instrumental variables, it is possible to statistically control for potential non-measured confounding variables that result in endogeneity. After controlling for facility, county, and individual factors, those individuals who move to a SNF with the INTERACT program in place (OR = 1.118, p < .01) or a mature TC program (OR = 1.196, p < .05) have more 30-day rehospitalizations compared to those individuals who move to a SNF with no TC program. When a differential distance IV (DDIV) is included the effects are reversed and no longer significant (OR = .405, p > .01 and OR = .785, p > .01 respectively). These results suggest that when using IV analyses, evidence-based and mature TC programs are associated with lower readmissions, though the effects are not statistically significant.
Recent studies have documented that normal adults exhibit considerable variability in cognitive performance from one occasion to another. We investigated this phenomenon in a study in which 143 ...adults ranging from 18 to 97 years of age performed different versions of 13 cognitive tests in three separate sessions. Substantial within-person variability was apparent across 13 different cognitive variables, and there were also large individual differences in the magnitude of within-person variability. Because people differ in the amount of short-term variability, we propose that this variability might provide a meaningful basis for calibrating change in longitudinal research. Correlations among the measures of within-person variability were very low, even after we adjusted for reliability, and there was little evidence that increased age was associated with a larger amount of within-person variability.
We present a detailed report on sterile neutrino oscillation and 235Uν¯e energy spectrum measurement results from the PROSPECT experiment at the highly enriched High Flux Isotope Reactor (HFIR) at ...Oak Ridge National Laboratory. In 96 calendar days of data taken at an average baseline distance of 7.9 m from the center of the 85 MW HFIR core, the PROSPECT detector has observed more than 50,000 interactions of νe produced in beta decays of 235U fission products. New limits on the oscillation of ν¯e to light sterile neutrinos have been set by comparing the detected energy spectra of ten reactor-detector baselines between 6.7 and 9.2 meters. Measured differences in energy spectra between baselines show no statistically significant indication of ν¯e to sterile neutrino oscillation and disfavor the reactor antineutrino anomaly best-fit point at the 2.5σ confidence level. The reported 235U ν¯e energy spectrum measurement shows excellent agreement with energy spectrum models generated via conversion of the measured 235U beta spectrum, with a χ2/d.o.f. of 31/31. PROSPECT is able to disfavor at 2.4σ confidence level the hypothesis that 235U ν¯e are solely responsible for spectrum discrepancies between model and data obtained at commercial reactor cores. A data-model deviation in PROSPECT similar to that observed by commercial core experiments is preferred with respect to no observed deviation, at a 2.2σ confidence level.
This Letter reports the first measurement of the 235U $\bar{ν}$e energy spectrum by PROSPECT, the Precision Reactor Oscillation and Spectrum experiment, operating 7.9 m from the 85 MWth highly ...enriched uranium (HEU) High Flux Isotope Reactor. With a surface-based, segmented detector, PROSPECT has observed 31678±304(stat) $\bar{ν}$e-induced inverse beta decays, the largest sample from HEU fission to date, 99% of which are attributed to 235U. Despite broad agreement, comparison of the Huber 235U model to the measured spectrum produces a χ2/ndf=51.4/31, driven primarily by deviations in two localized energy regions. The measured 235U spectrum shape is consistent with a deviation relative to prediction equal in size to that observed at low-enriched uranium power reactors in the $\bar{ν}$e energy region of 5–7 MeV.
Critical requirements for the hypothesis that executive functioning is a potential mediator of age-related effects on cognitive functioning are that variables assumed to reflect executive functioning ...represent a distinct construct and that age-related effects on other types of cognitive functioning are reduced when measures of executive functioning are statistically controlled. These issues were investigated in a study involving 261 adults between 18 and 84 years of age. Although age-related effects on various cognitive abilities were substantially reduced after statistical control of the variance in measures hypothesized to represent executive functioning, there was only weak evidence for the existence of distinct constructs corresponding to executive functioning or to aspects of executive control concerned with inhibition, updating, or time sharing.
Reactor neutrino experiments have seen major improvements in precision in recent years. With the experimental uncertainties becoming lower than those from theory, carefully considering all sources of ...ν¯e is important when making theoretical predictions. One source of ν¯e that is often neglected arises from the irradiation of the nonfuel materials in reactors. The ν¯e rates and energies from these sources vary widely based on the reactor type, configuration, and sampling stage during the reactor cycle and have to be carefully considered for each experiment independently. In this article, we present a formalism for selecting the possible ν¯e sources arising from the neutron captures on reactor and target materials. We apply this formalism to the High Flux Isotope Reactor (HFIR) at Oak Ridge National Laboratory, the ν¯e source for the the Precision Reactor Oscillation and Spectrum Measurement (PROSPECT) experiment. Overall, we observe that the nonfuel ν¯e contributions from HFIR to PROSPECT amount to 1% above the inverse β decay threshold with a maximum contribution of 9% in the 1.8–2.0 MeV range. Nonfuel contributions can be particularly high for research reactors like HFIR because of the choice of structural and reflector material in addition to the intentional irradiation of target material for isotope production. We show that typical commercial pressurized water reactors fueled with low-enriched uranium will have significantly smaller nonfuel ν¯e contribution.
The “woodwork effect”, the concern that increasing access to home and community based options (HCBS), seen as more desirable than institutional care, may result in significantly more eligible ...individuals seeking access to tax payer supported long-term services and supports (LTSS), has long been a concern for those interested in LTSS policy (Kemper, Applebaum & Harrigan, 1987). One aspect of LTSS policy where there is concern over a potential woodwork effect is re-balancing efforts between institutional long-term care and HCBS. If a significant woodwork effect does occur, any cost savings pursued through diverting consumers from costlier institutional care to less costly HCBS care may go unrealized or payer expenses may even grow. Evidence to support a woodwork effect has been mixed (Kaye, LaPlante, & Harrington, 2009; Eiken, Burwell & Sredl, 2013; Grabowski, 2006; Weissert & Frederick, 2013). As documented over a 22-year, longitudinal, statewide survey of long-term care, Ohio has made considerable progress toward balancing its long-term care system, going from 91% of older Ohioans receiving Medicaid LTSS services in institutional settings and 9% HCBS in 1993 to 50% institutional and 50% HCBS by 2011 (Mehdizadeh & Applebaum, 2013). The data, however, has not shown evidence of a woodwork effect. Analysis of this longitudinal data set has shown that detecting the presence, absence or opposite of a woodwork effect depends on the measurement technique and time interval used. Implications of the presence or absence of a woodwork effect for US and international policy on LTSS are also examined.
Background radiation measurements at high power research reactors Ashenfelter, J.; Balantekin, B.; Baldenegro, C.X. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
01/2016, Letnik:
806
Journal Article
Recenzirano
Odprti dostop
Research reactors host a wide range of activities that make use of the intense neutron fluxes generated at these facilities. Recent interest in performing measurements with relatively low event ...rates, e.g. reactor antineutrino detection, at these facilities necessitates a detailed understanding of background radiation fields. Both reactor-correlated and naturally occurring background sources are potentially important, even at levels well below those of importance for typical activities. Here we describe a comprehensive series of background assessments at three high-power research reactors, including γ-ray, neutron, and muon measurements. For each facility we describe the characteristics and identify the sources of the background fields encountered. The general understanding gained of background production mechanisms and their relationship to facility features will prove valuable for the planning of any sensitive measurement conducted therein.
To make a convincing argument that cognitive stimulation moderates age trends in cognition there must be (a) a negative relation between age and level of cognitive stimulation, (b) a positive ...relation between level of cognitive stimulation and level of cognitive functioning, and (c) evidence of an interaction between age and cognitive stimulation in the prediction of cognitive functioning. These conditions were investigated in a study in which 204 adults between 20 and 91 years of age completed an activity inventory and performed a variety of cognitive tasks. Only the 1st condition received empirical support, and, thus, the results of this study provide little evidence for the hypothesis that cognitive stimulation preserves or enhances cognitive functioning that would otherwise decline.
PDF
