Defect-driven antiferromagnetic domain walls in CuMnAs films.

Efficient manipulation of antiferromagnetic (AF) domains and domain walls has opened up new avenues of research towards ultrafast, high-density spintronic devices. AF domain structures are known to be sensitive to magnetoelastic effects, but the microscopic interplay of crystalline defects, strain and magnetic ordering remains largely unknown. Here, we reveal, using photoemission electron microscopy combined with scanning X-ray diffraction imaging and micromagnetic simulations, that the AF domain structure in CuMnAs thin films is dominated by nanoscale structural twin defects. We demonstrate that microtwin defects, which develop across the entire thickness of the film and terminate on the surface as characteristic lines, determine the location and orientation of 180∘ and 90∘ domain walls. The results emphasize the crucial role of nanoscale crystalline defects in determining the AF domains and domain walls, and provide a route to optimizing device performance.

Tunable Spin Injection in High-Quality Graphene with One-Dimensional Contacts.

Spintronics involves the development of low-dimensional electronic systems with potential use in quantum-based computation. In graphene, there has been significant progress in improving spin transport characteristics by encapsulation and reducing impurities, but the influence of standard two-dimensional (2D) tunnel contacts, via pinholes and doping of the graphene channel, remains difficult to eliminate. Here, we report the observation of spin injection and tunable spin signal in fully encapsulated graphene, enabled by van der Waals heterostructures with one-dimensional (1D) contacts. This architecture prevents significant doping from the contacts, enabling high-quality graphene channels, currently with mobilities up to 130 000 cm2 V-1 s-1 and spin diffusion lengths approaching 20 µm. The nanoscale-wide 1D contacts allow spin injection both at room and at low temperature, with the latter exhibiting efficiency comparable with 2D tunnel contacts. At low temperature, the spin signals can be enhanced by as much as an order of magnitude by electrostatic gating, adding new functionality.

Examining variation in state spending on medicaid long-term services and supports for older adults.

State Medicaid programs are the largest source of funding for long-term services and supports (LTSS). We characterized states across quartiles of mean LTSS spending for individuals ≥65 and used the Health and Retirement Study to examine the demographic, functional, and caregiving characteristics across these quartiles. Individuals in states with lower Medicaid spending on LTSS reported more family and friend caregiving hours and were more likely to be from racial and ethnic minority groups. Continued work is needed to improve Medicaid LTSS policy to better support vulnerable populations, particularly in lower quartile states.

Prior Presentations: Abstract accepted for poster presentation at the Presidential Poster Session at the American Geriatrics Society National Conference 2020, Long Beach, CA.

Monitoring of land surface subsidence using persistent scatterer interferometry techniques and ground truth data in arid and semi-arid regions, the case of Remah, UAE.

The United Arab Emirates (UAE) is located in an arid desert climate with very limited water resources and scarce rainfall. Along with the fast development of the country, the water demand for agriculture, industrial, and domestic purposes increased and led to diminishing groundwater resources. In this study, we explore the land surface deformations due to groundwater overexploitation in the agricultural area of Remah by analyzing Sentinel-1 data between 2015 and 2019 with the novel Parallelized-Persistent Scatterer Interferometry (P-PSI) technique. The detected land surface deformations have been correlated to the recorded groundwater levels at nearby water wells. This study detected land surface deformations in a form of an extensive subsidence bowl (with 28.5 km in diameter) with a maximum subsidence rate of 40 mm/year and a standard deviation within the bowl of less than 2 mm/year. The detected subsidence was associated with a 12 m drop in the water table level within the study area. The Persistent Scatterers with the highest deformations rate were spatially correlated with the depression cone of the groundwater level. These findings provide useful insights in understanding the groundwater regime of the area and have an important role in assessing regional hazards and driving mitigation measures towards managing uncontrolled groundwater overexploitation for sustainable management of groundwater resources.

Implications of 2020 Skilled Home Healthcare Payment Reform for Persons with Dementia.

BACKGROUND/OBJECTIVES: The Medicare home health benefit provides episodic skilled home-based clinical care to the growing population of community-dwelling persons with dementia. As of January 1, 2020, home health payment changed: episodes shortened from 60 to 30 days, and episodes initiated in the community are now reimbursed at lower rates than episodes following institutional stays. We aim to assess the potential impact of these policy changes on this population. DESIGN/SETTING: Cross-sectional study using the Medicare claims-linked National Health and Aging Trends Study (NHATS). PARTICIPANTS: A total of 1,867 NHATS respondents who received home health between 2011 and 2017. MEASUREMENTS: Dementia was defined through both self-report and a validated cognitive assessment through NHATS. We described the demographic, socioeconomic, and health characteristics of older adults with dementia receiving home health compared with those without dementia. We then assessed the association of dementia with both receiving community-initiated home health (vs postinstitutional) and visit timing during the home health episode. RESULTS: Over a follow-up period of just over 4 years, 50.2% of persons with dementia used home health compared with 15.3% of persons without dementia. Most home health provided to persons with dementia was initiated in the community (61%), compared with 37% of episodes provided to persons without dementia. Persons with dementia were more likely to receive care in days 31 to 60 of the episode compared with those without dementia. CONCLUSIONS: Shortening episodes and reimbursing community-initiated episodes at lower rates may disproportionately impact the highly vulnerable population of older adults with dementia, who receive more community-initiated care over longer time periods. Our work highlights the need to better understand the unique role of home health in meeting gaps in both acute- and long-term care systems for older adults with dementia. J Am Geriatr Soc 68:2303-2309, 2020.

Residential Setting and the Cumulative Financial Burden of Dementia in the 7 Years Before Death.

OBJECTIVES: Care for older adults with dementia during the final years of life is costly, and families shoulder much of this burden. We aimed to assess the financial burden of care for those with and without dementia, and to explore differences across residential settings. DESIGN: Using the Health and Retirement Study (HRS) and linked claims, we examined total healthcare spending and proportion by payer-Medicare, Medicaid, out-of-pocket, and calculated costs of informal caregiving-over the last 7 years of life, comparing those with and without dementia and stratifying by residential setting. SETTING: The HRS is a nationally representative longitudinal study of older adults in the United States. PARTICIPANTS: We sampled HRS decedents from 2004 to 2015. To ensure complete data, we limited the sample to those 72 years or older at death who had continuous fee-for-service Medicare Parts A and B coverage during the 7-year period (n = 2909). MEASUREMENTS: We compared decedents with dementia at last HRS assessment with those without dementia across annual and cumulative 7-year spending measures, and personal characteristics. We present annual and cumulative spending by payer, and the changing proportion of spending by payer over time, comparing those with and without dementia and stratifying results by residential setting. RESULTS: We found that, consistent with prior studies, people with dementia experience significantly higher costs, with a disproportionate share falling on patients and families. This pattern is most striking among community residents with dementia, whose families shoulder 64% of total expenditures (including $176,180 informal caregiving costs and $55,550 out-of-pocket costs), compared with 43% for people with dementia residing in nursing homes ($60,320 informal caregiving costs and $105,590 out-of-pocket costs). CONCLUSION: These findings demonstrate disparities in financial burden shouldered by families of those with dementia, particularly among those residing in the community. They highlight the importance of considering the residential setting in research, programs, and policies. J Am Geriatr Soc 68:1319-1324, 2020.

Patients' and Nurses' Perceptions of Post-Coronary Artery Bypass Graft Learning Needs in Two Omani Hospitals.

OBJECTIVES: Little is known about nurses' and patients' perceptions of learning needs following coronary artery bypass graft (CABG) surgery in Oman. This study aimed to identify patients' and nurses' perceptions of post-CABG learning needs. METHODS: This cross-sectional study was conducted in two cardiac units in Oman between February and April 2018. Participants were from step-down units and perceptions of post-CABG learning needs were collected using a modified version of the Cardiac Patients Learning Need Inventory (MCPLNI) questionnaire. Data were analysed using descriptive and inferential statistics. RESULTS: A total of 90 patients and 90 nurses were included in this study (response rate: 100%). Nurses perceived information about chest and leg wound care, medications and complications as patients' most important learning needs (4.89 ± 0.31, 4.84 ± 0.33 and 4.78 ± 0.45, respectively). Similarly, patients perceived a need for post-CABG learning related to chest and leg wound care, complications and medication, while learning related to physical activity received a moderate priority (4.92 ± 0.20, 4.80 ± 0.45, 4.85 ± 0.26 and 3.50 ± 1.34, respectively). CONCLUSION: Before discharging patients, they should be provided with specific information related to post-CABG care. It is essential to assess patients' learning needs and incorporate those learning needs into discharge plans.

Spousal Caregivers Are Caregiving Alone In The Last Years Of Life.

Caregiving in the last years of life is associated with increased depression and negative health outcomes for surviving spouses, many of whom are themselves in poor health. Yet it is unclear how often spouses are caregiving alone, how they differ from supported spouses, and whether lack of support affects postbereavement outcomes. We hypothesized that spouses who were solo caregivers-that is, the only caregivers (paid or unpaid) who provided assistance with a spouse's self-care or household activities-would experience more depression after bereavement than supported spouses would. Using information from the Health and Retirement Study, we found that 55 percent of the spouses of community-dwelling married people with disability were solo caregivers. Solo caregiving was even common among people who cared for spouses with dementia and those with adult children living close by. Bereavement outcomes did not differ between solo and supported caregiving spouses. Caregiving spouses are often isolated and may benefit from greater support, particularly during the final years before bereavement. While some state and federal policy proposals aim to systematically recognize and assess caregivers, further innovations in care delivery and reimbursement are needed to adequately support seriously ill older adults and their caregivers. Ultimately, the focus of serious illness care must be expanded from the patient to the family unit.

An Examination of Downstream Effects of Bereavement on Healthcare Utilization for Surviving Spouses in a National Sample of Older Adults.

BACKGROUND: While bereavement is associated with increased mortality, it is unclear how bereaved families utilize the healthcare system after the death of their loved ones. OBJECTIVE: The aim of this study was to examine the association between bereavement and healthcare expenditures for surviving spouses. METHODS: We used data from the Health and Retirement Study, a nationally representative cohort study of older adults linked to Medicare claims. We determined a spouse's total Medicare expenditures 2 years before and after their partner's death across six biennial interview waves. Using coarsened exact matching, we created a comparison group of non-bereaved dyads. Costs were wage index- and inflation-adjusted to 2017 dollars. We used generalized linear models and difference-in-differences (DID) analysis to calculate the average marginal effects of bereavement on Medicare spending by gender. We also examined subgroup differences based on caregiver status, cause of death, and length of terminal illness. RESULTS: Our sample consisted of 941 bereaved dyads and a comparison group of 8899 matched dyads. Surviving female spouses (68% of the sample) had a $3500 increase in spending 2 years after death (p < 0.05). Using DID analyses, bereavement was associated with a $625 quarterly increase in Medicare expenditures over 2 years for women. There was no significant increase in post-death spending for male bereaved surviving spouses. Results were consistent for spouses who survived at least 2 years after the death of their spouse (70% of the sample) CONCLUSIONS: Bereavement is associated with increased healthcare spending for women regardless of their caregiving status, the cause of death, or length of terminal illness. Further study is required to examine why men and women have different patterns of healthcare spending relative to the death of their spouses.

Factors That Impact Family Perception of Goal-Concordant Care at the End of Life.

Background: Goal-concordant care (GCC)-care aligned with a patient's known goals and values-is a measure of the quality of end-of-life (EOL) care that can be assessed by surveying family members after a patient's death. It is unknown whether patient characteristics affect this measure. Objective: The objective of the article was to examine family report of GCC and its associations with patient characteristics. Methods: Using the Health and Retirement Study, which is a nationally representative, longitudinal cohort of adults over age 50, we sampled decedents whose family completed the 2014 postdeath interview. Families reported frequency of GCC at the EOL. A multivariable regression model assessed the associations between family report of GCC and decedent characteristics. Results: Of 1175 respondents, 76% reported that the decedent "usually" or "always" received GCC. Proxy report of GCC was independently associated with age (adjusted odds ratio [AOR] 1.02, 95% confidence interval [CI] 1.01-1.03), having three or more chronic medical conditions (AOR 1.34, CI 1.02-1.77), the presence of written or verbal advance care planning (ACP) (AOR 1.38, CI 1.02-1.88), and an interaction term of race and ability to participate in EOL decision making (AOR 3.83, CI 1.02-14.40). African American race was not independently associated with GCC (AOR 0.73, CI 0.5-1.06). Conclusion: Family's report of GCC is associated with ACP, age, and multimorbidity. Being African American and perceived as able to participate in EOL decision making was significantly associated with report of GCC. Bringing the patient's voice into EOL care discussions through upstream ACP with likely surrogates may be particularly important to improving GCC for African Americans.