The most intensively star-forming galaxies are extremely luminous at far-infrared (FIR) wavelengths, highly obscured at optical and ultraviolet wavelengths, and lie at z ≥ 1-3. We present a programme ...of FIR spectroscopic observations with the SPIRE FTS, as well as photometric observations with PACS, both on board Herschel, towards a sample of 45 gravitationally lensed, dusty starbursts across z ∼ 1-3.6. In total, we detected 27 individual lines down to 3 σ, including nine C II 158 μm lines with confirmed spectroscopic redshifts, five possible C II lines consistent with their FIR photometric redshifts, and in some individual sources a few O III 88 μm, O III 52 μm, O I 145 μm, O I 63 μm, N II 122 μm and OH 119 μm (in absorption) lines. To derive the typical physical properties of the gas in the sample, we stack all spectra weighted by their intrinsic luminosity and by their 500μm flux densities, with the spectra scaled to a common redshift. In the stacked spectra, we detect emission lines of C II 158 μm, N II 122 μm, O III 88 μm, O III 52 μm, O I 63 μm and the absorption doublet of OH at 119 μm, at high fidelity. We find that the average electron densities traced by the N II and O III lines are higher than the average values in local star-forming galaxies and ULIRGs, using the same tracers. From the N II/C II and O I/C II ratios, we find that the C II emission is likely dominated by the photodominated regions (PDR), instead of by ionized gas or large-scale shocks.
Under the Affordable Care Act of 2010, a variety of transitional care programs and services have been established to improve quality and reduce costs. These programs help hospitalized patients with ...complex chronic conditions-often the most vulnerable-transfer in a safe and timely manner from one level of care to another or from one type of care setting to another. We conducted a systematic review of the research literature and summarized twenty-one randomized clinical trials of transitional care interventions targeting chronically ill adults. We identified nine interventions that demonstrated positive effects on measures related to hospital readmissions-a key focus of health reform. Most of the interventions led to reductions in readmissions through at least thirty days after discharge. Many of the successful interventions shared similar features, such as assigning a nurse as the clinical manager or leader of care and including in-person home visits to discharged patients. Based on these findings, we recommend several strategies to guide the implementation of transitional care under the Affordable Care Act, such as encouraging the adoption of the most effective interventions through such programs as the Community-Based Care Transitions Program and Medicare shared savings and payment bundling experiments. PUBLICATION ABSTRACT
Andersen's Expanded Behavioral Model of Health Services Use describes factors associated with the use of long-term services and supports (LTSS). This model, however, has only been tested on the ...intent to use such services among African-American and White older adults and not the actual use. Given the increasing diversity of older adults in the U.S., the ability to conceptualize factors associated with actual use of LTSS across racial/ethnic groups is critical.
We applied Andersen's Expanded model in the analysis of 2006-2010 qualitative data using multiple methods to understand both the relevancy of factors for older adults who currently use LTSS vs. those who intend to use LTSS (as described in Andersen's original exploration). We additionally explored differences in these factors across racial/ethnic groups and included Hispanic older adults in our analyses.
Four additional constructs linked with actual LTSS use emerged: losses and changes, tangible support, capability to provide informal support, and accessibility of informal support. Racial differences were seen in level of participation in decisions to use nursing home services (Not involved: 45% African-Americans vs. 24% Whites). Reports of LTSS use to avoid burdening one's family were greater among White older adults compared to African-American older adults.
Findings around decision-making and burden along with other constructs enhance our understanding of determinants that influence actual LTSS use and require targeted interventions.
Transitional care (TC) has received widespread attention from researchers, health system leaders, clinicians, and policy makers as they attempt to improve health outcomes and reduce preventable ...hospital readmissions, yet little is known about the critical elements of effective TC and how they relate to patients’ and caregivers’ needs and experiences. To address this gap, the Patient‐Centered Outcomes Research Institute (PCORI) funded a national study, Achieving patient‐centered Care and optimized Health In care transitions by Evaluating the Value of Evidence (Project ACHIEVE). A primary aim of the study is the identification of TC components that yield desired patient and caregiver outcomes. Project ACHIEVE established a multistakeholder workgroup to recommend essential TC components for vulnerable Medicare beneficiaries. Guided by a review of published evidence, the workgroup identified and defined a preliminary set of components and then analyzed how well the set aligned with real‐world patients' and caregivers' experiences. Through this process, the workgroup identified eight TC components: patient engagement, caregiver engagement, complexity and medication management, patient education, caregiver education, patients' and caregivers' well‐being, care continuity, and accountability. Although the degree of attention given to each component will vary based on the specific needs of patients and caregivers, workgroup members agree that health systems need to address all components to ensure optimal TC for all Medicare beneficiaries.
Despite a growing body of evidence that adaptations of evidence-based interventions (EBI) are ubiquitous, few studies have examined the nature and rationale for modifications to the components of ...these interventions. The primary aim of this study was to describe and classify common local adaptations of the Transitional Care Model (TCM), an EBI comprised of 10 components that has been proven in multiple clinical trials to improve the care and outcomes of chronically ill older adults transitioning from hospitals to home. Guided by Stirman's System of Classifying Adaptations, 582 transitional care clinicians in health systems and community-based organizations throughout the U.S. completed a survey between September 2014 and January 2015; interviews were then conducted with a subset of survey respondents (N = 24) between April and December 2015. A total of 342 survey respondents (59%) reported implementation of the TCM in distinct organizations. Of this group, 96% reported a mean of 4.4 adaptations to the 10 TCM components (40%, one to three; 43%, four to six; and 17%, seven to nine). Nine of ten respondents (94%) reported contextual adaptations while content adaptations were less frequently reported (58%). The top three reported adaptations all related to context (i.e., delivering services from hospital to home, relying on advance practice nurses, and fostering care continuity); interviews clarified a diverse set of reasons for such modifications. Findings reinforce the need for investment in adaptation science and suggest hypotheses to guide rigorous examination of the association between adaptations of TCM components and desired outcomes.
•Describes adaptations of an evidence-based intervention (EBI).•Advances the case for investment in adaptation science.•Reinforces need to achieve balance between fidelity and adaptation.•Offers hypotheses to assess effects of an EBI in the health care sector.
The Herschel Spectral and Photometric REceiver (SPIRE) instrument consists of an imaging photometric camera and an imaging Fourier Transform Spectrometer (FTS), both operating over a frequency range ...of ∼450–1550 GHz. In this paper, we briefly review the FTS design, operation, and data reduction, and describe in detail the approach taken to relative calibration (removal of instrument signatures) and absolute calibration against standard astronomical sources. The calibration scheme assumes a spatially extended source and uses the Herschel telescope as primary calibrator. Conversion from extended to point-source calibration is carried out using observations of the planet Uranus. The model of the telescope emission is shown to be accurate to within 6 per cent and repeatable to better than 0.06 per cent and, by comparison with models of Mars and Neptune, the Uranus model is shown to be accurate to within 3 per cent. Multiple observations of a number of point-like sources show that the repeatability of the calibration is better than 1 per cent, if the effects of the satellite absolute pointing error (APE) are corrected. The satellite APE leads to a decrement in the derived flux, which can be up to ∼10 per cent (1 σ) at the high-frequency end of the SPIRE range in the first part of the mission, and ∼4 per cent after Herschel operational day 1011. The lower frequency range of the SPIRE band is unaffected by this pointing error due to the larger beam size. Overall, for well-pointed, point-like sources, the absolute flux calibration is better than 6 per cent, and for extended sources where mapping is required it is better than 7 per cent.
(Ultra) luminous infrared galaxies ((U)LIRGs) are objects characterized by their extreme infrared (8-1000 mu m) luminosities (L sub(LIRG) > 10 super(11) L sub(middot in circle) and L sub(ULIRG) > 10 ...super(12)L sub(middot in circle)). The Herschel Comprehensive ULIRG Emission Survey (PI: van der Werf) presents a representative flux-limited sample of 29 (U)LIRGs that spans the full luminosity range of these objects (10 super(11)L sub(middo t in circle) < or =, slant L sub(IR) < or =, slant 10 super(13) L sub(middot in circle)). With the Herschel Space Observatory, we observe CII 157 mu m, OI 63 mu m, and OI 145 mu m line emission with Photodetector Array Camera and Spectrometer, CO J = 4-3 through J = 13-12, CI 370 mu m, and CI 609 mu m with SPIRE, and low-J CO transitions with ground-based telescopes. The CO ladders of the sample are separated into three classes based on their excitation level. In 13 of the galaxies, the OI 63 mu m emission line is self absorbed. Comparing the CO excitation to the InfraRed Astronomical Satellite 60/100 mu m ratio and to far infrared luminosity, we find that the CO excitation is more correlated to the far infrared colors. We present cooling budgets for the galaxies and find fine-structure line flux deficits in the CII, SiII, OI, and CI lines in the objects with the highest far IR fluxes, but do not observe this for CO 4 < or =, slant J sub(upp) < or =, slant 13. In order to study the heating of the molecular gas, we present a combination of three diagnostic quantities to help determine the dominant heating source. Using the CO excitation, the CO J = 1-0 linewidth, and the active galactic nucleus (AGN) contribution, we conclude that galaxies with large CO linewidths always have high-excitation CO ladders, and often low AGN contributions, suggesting that mechanical heating is important.
The evidence base of what works in chronic care management programs is underdeveloped. To fill the gap, we pooled and reanalyzed data from ten randomized clinical trials of heart failure care ...management programs to discern how program delivery methods contribute to patient outcomes. We found that patients enrolled in programs using multi-disciplinary teams and in programs using in-person communication had significantly fewer hospital readmissions and readmission days than routine care patients had. Our study offers policymakers and health plan administrators important guideposts for developing an evidence base on which to build effective policy and programmatic initiatives for chronic care management.
Dust grains play a key role in the physics of star-forming regions, even though they constitute only ∼1 per cent of the mass of the interstellar medium. The derivation of accurate dust parameters ...such as temperature (T
d), emissivity spectral index (β) and column density requires broad-band continuum observations at far-infrared wavelengths. We present Herschel-Spectral and Photometric Imaging Receiver Array (SPIRE) Fourier Transform Spectrometer (FTS) measurements of three starless cores: L1521E, L1521F and L1689B, covering wavelengths between 194 and 671 μm. This paper is the first to use our recently updated SPIRE-FTS intensity calibration, yielding a direct match with SPIRE photometer measurements of extended sources. In addition, we carefully assess the validity of calibration schemes depending on-source extent and on the strength of background emission. The broad-band far-infrared spectra for all three sources peak near 250 μm. Our observations therefore provide much tighter constraints on the spectral energy distribution (SED) shape than measurements that do not probe the SED peak. The spectra are fitted using modified blackbody functions, allowing both T
d and β to vary as free parameters. This yields T
d of 9.8±0.2, 15.6±0.5 and 10.9±0.2 K and corresponding β of 2.6∓0.9, 0.8∓0.1 and 2.4∓0.8 for L1521E, L1521F and L1689B, respectively. The derived core masses are 1.0±0.1, 0.10±0.01 and 0.49±0.05 M⊙, respectively. The core mass/Jeans mass ratios for L1521E and L1689B exceed unity indicating that they are unstable to gravitational collapse, and thus pre-stellar cores. By comparison, the elevated temperature and gravitational stability of L1521F support previous arguments that this source is more evolved and likely a protostar.
PDF
