Search

Before the COVID-19 pandemic, for-profit nursing homes’ revenue generally covered their costs, whereas not-for-profit nursing homes often needed donations and other nonpatient revenue to cover expenses. The unprecedented challenges presented by the pandemic caused the industry to report operating losses that were larger among not-for-profits and facilities relying on agency staff. COVID-19 public health emergency funding allowed nursing homes to remain profitable through 2021. By 2022, as these public health emergency funds were cut back, for-profit nursing homes had overall net incomes of $1.68 per resident day, whereas not-for-profit nursing homes lost $31.18 per resident day. Without public health emergency funds, for-profit and not-for-profit nursing homes would have had losses of $7.47 and $42.35 per resident day, respectively, in 2022. These results indicate that as public health emergency funds are entirely withdrawn, the long-term financial viability of nursing homes, especially not-for-profits, will be seriously challenged.

When nursing homes experience a shortage in directly employed nursing staff, they may rely on temporary workers from staffing agencies to fill this gap. This article examines trends in the use of staffing agencies among nursing homes during the prepandemic and COVID-19 pandemic era (2018–22). In 2018, 23 percent of nursing homes used agency nursing staff, accounting for about 3 percent of all direct care nursing hours worked. When used, agency staff were commonly present for ninety or fewer days in a year. By 2022, almost half of all nursing homes used agency staff, accounting for 11 percent of all direct care nursing staff hours. Agency staff were increasingly used to address chronic staffing shortages, with 13.8 percent of nursing homes having agency staff present every day. Agency staff were 50–60 percent more expensive per hour than directly employed nursing staff, and nursing homes that used agency staff often had lower five-star ratings. Policy makers need to consider postpandemic changes to the nursing home workforce as part of nursing home reform, as increased reliance on agency staff may reduce the financial resources available to increase nursing staff levels and improve the quality of care.

We present images and initial results from our extensive Spitzer Space Telescope imaging survey of the W5 H II region with the Infrared Array Camera (IRAC) and Multiband Imaging Photometer for Spitzer (MIPS). We detect dense clusters of stars, centered on the O stars HD 18326, BD +60 586, HD 17505, and HD 17520. At 24 mm, substantial extended emission is visible, presumably from heated dust grains that survive in the strongly ionizing environment of the H II region. With photometry of more than 18,000 point sources, we analyze the clustering properties of objects classified as young stars by their IR spectral energy distributions (a total of 2064 sources) across the region using a minimal-spanning-tree algorithm. We find ~40%-70% of infrared excess sources belong to clusters with [?]10 members. We find that within the evacuated cavities of the H II regions that make up W5, the ratio of Class II to Class I sources is ~7 times higher than for objects coincident with molecular gas as traced by 12CO emission and near-IR extinction maps. We attribute this contrast to an age difference between the two locations and postulate that at least two distinct generations of star formation are visible across W5. Our preliminary analysis shows that triggering is a plausible mechanism to explain the multiple generations of star formation in W5 and merits further investigation.

We present Spitzer IRAC, NOAO 2.1 m Flamingos, Keck NIRC, and FCRAO SEQUOIA observations of the massive star-forming complex S254-S258, covering an area of 25' x 20'. Using a combination of the IRAC and NIR data, we identify and classify the young stellar objects (YSOs) in the complex. We detect 510 sources with near- or mid-IR excess, and we classify 87 Class I and 165 Class II sources. The YSOs are found in clusters surrounded by isolated YSOs in a low-density distributed population. The ratio of clustered to total YSOs is 0.8. We identify six new clusters in the complex. One of them, G192.63-00, is located around the ionizing star of the H II region S255. We hypothesize that the ionizing star of S255 was formed in this cluster. We also detect a southern component of the cluster in H II region S256. The cluster G192.54-0.15, located inside H II region S254 has a VLSR of 17 km s[?]1 with respect to the main cloud, and we conclude that it is located in the background of the complex. The structure of the molecular cloud is examined using 12CO and 13CO , as well as a near-IR extinction map. The main body of the molecular cloud has VLSR between 5 and 9 km s[?]1. The arc-shaped structure of the molecular cloud following the border of the H II regions and the high column density in the border of the H II regions support the idea that the material has been swept up by the expansion of the H II regions.

Velocity anisotropy induced by MHD turbulence is investigated using computational simulations and molecular line observations of the Taurus molecular cloud. A new analysis method is presented to evaluate the degree and angle of velocity anisotropy using spectroscopic imaging data of interstellar clouds. The efficacy of this method is demonstrated on model observations derived from three-dimensional velocity and density fields from the set of numerical MHD simulations that span a range of magnetic field strengths. The analysis is applied to 12CO J = 1-0 imaging of a subfield within the Taurus molecular cloud. Velocity anisotropy is identified that is aligned within ~10deg of the mean local magnetic field direction derived from optical polarization measurements. Estimated values of the field strength based on velocity anisotropy are consistent with results from other methods. When combined with new column density measurements for Taurus, our magnetic field strength estimate indicates that the envelope of the cloud is magnetically subcritical. These observations favor strong MHD turbulence within the low-density, subcritical, molecular gas substrate of the Taurus cloud.

We present a 21 cm line H I self-absorption (HISA) survey of cold atomic gas within Galactic longitudes l = 75deg to 146deg and latitudes b = -3deg to +5deg. We identify HISA as spatially and spectrally confined dark H I features and extract it from the surrounding H I emission in the arcminute-resolution Canadian Galactic Plane Survey (CGPS). We compile a catalog of the most significant features in our survey and compare our detections against those in the literature. Within the parameters of our search, we find nearly all previously detected features and identify many new ones. The CGPS shows HISA in much greater detail than any prior survey and allows both new and previously discovered features to be placed into the larger context of Galactic structure. In space and radial velocity, faint HISA is detected virtually everywhere that the H I emission background is sufficiently bright. This ambient HISA population may arise from small turbulent fluctuations of temperature and velocity in the neutral interstellar medium. By contrast, stronger HISA is organized into discrete complexes, many of which follow a longitude-velocity distribution that suggests that they have been made visible by the velocity reversal of the Perseus arm's spiral density wave. The cold H I revealed in this way may have recently passed through the spiral shock and be on its way to forming molecules and, eventually, new stars. This paper is the second in a series examining HISA at high angular resolution. A companion paper (Paper III) describes our HISA search and extraction algorithms in detail.

We describe algorithms that detect 21 cm line H I self-absorption (HISA) in large data sets and extract it for analysis. Our search method identifies HISA as spatially and spectrally confined dark H I features that appear as negative residuals after removing larger scale emission components with a modified CLEAN algorithm. Adjacent HISA volume-pixels (voxels) are grouped into features in (l,b,v) space, and the H I brightness of voxels outside the three-dimensional feature boundaries is smoothly interpolated to estimate the absorption amplitude and the unabsorbed H I emission brightness. The reliability and completeness of our HISA detection scheme have been tested extensively with model data. We detect most features over a wide range of sizes, line widths, amplitudes, and background levels, with poor detection only where the absorption brightness temperature amplitude is weak, the absorption scale approaches that of the correlated noise, or the background level is too faint for HISA to be distinguished reliably from emission gaps. False detection rates are very low in all parts of the parameter space except at sizes and amplitudes approaching those of noise fluctuations. Absorption measurement biases introduced by the method are generally small and appear to arise from cases of incomplete HISA detection. This paper is the third in a series examining HISA at high angular resolution. A companion paper (Paper II) uses our HISA search and extraction method to investigate the cold atomic gas distribution in the Canadian Galactic Plane Survey.

The scaling of velocity fluctuation dv as a function of spatial scale L in molecular clouds can be measured from size-line width relations, principal component analysis, or line centroid variation. Differing values of the power-law index of the scaling relation [?]dv2[?]1/2 [?] Limg1.gif in three dimensions are given by these different methods: the first two give g3D [?] 0.5, while line centroid analysis gives g3D [?] 0. This discrepancy has previously not been fully appreciated, as the variation of projected velocity line centroid fluctuations ([?]dvimg2.gif[?]1/2 [?] Limg3.gif) is indeed described, in two dimensions, by g2D [?] 0.5. However, if projection smoothing is accounted for, this implies, in three dimensions, that g3D [?] 0. We suggest that a resolution of this discrepancy can be achieved by accounting for the effect of density inhomogeneity on the observed g2D obtained from velocity line centroid analysis. Numerical simulations of compressible turbulence are used to show that the effect of density inhomogeneity statistically, but not identically, reverses the effect of projection smoothing in the case of driven turbulence, so that velocity line centroid analysis does indeed predict that g2D [?] g3D [?] 0.5. For decaying turbulence, the effect of density inhomogeneity on the velocity line centroids diminishes with time so that at late times, g2D [?] g3D + 0.5 as a result of projection smoothing alone. Deprojecting the observed line centroid statistics thus requires some knowledge of the state of the flow. This information can be inferred from the spectral slope of the column density power spectrum and a measure of the standard deviation in column density relative to the mean. Using our numerical results, we can restore consistency between line centroid analysis, principal component analysis, and size-line width relations, and we derive g3D [?] 0.5, corresponding to shock-dominated (Burgers) turbulence, which also describes the simulations of driven turbulence at scales on which numerical dissipation is negligible. We find that this consistency requires that molecular clouds are continually driven on large scales or are only recently formed.

We generate synthetic observations of three-dimensional, self-gravitating MHD simulations of the interstellar medium (ISM) to evaluate the ability of principal component analysis (PCA) to measure the scale dependence of turbulent velocity fluctuations in molecular clouds. Scaling exponents, a, observationally obtained from the coupled characteristic scales for line profile variability in velocity, dv, and in space, L, where dv [?] La, are compared with the intrinsic scaling exponents of the MHD velocity fields. We determine the approximate structure function order at which PCA operates in order to then verify a previously established calibration of the PCA method. We also analyze the statistical properties of projected velocity line centroid fields, including effects of intermittent velocity fluctuations, density inhomogeneity, and opacity, and examine the relationship of the projected two-dimensional statistics to the intrinsic three-dimensional statistics. Using PCA, we infer steep three-dimensional energy spectra in the molecular ISM, generally steeper than can be accounted for by Kolmogorov turbulence or possibly even shock-dominated turbulence.

The turbulent energy spectrum of molecular clouds in a variety of environments is measured via principal component analysis (PCA) of spectral line imaging observations at millimeter wavelengths. Molecular clouds with known distances have been previously shown to accurately obey a universal scale dependence of turbulent velocity dispersion over spatial scales of 1-50 pc, via both standard object-based analysis and, more recently, PCA. The PCA-based spectrum is accurately obeyed such that it may be used as a distance estimator for molecular clouds with ~30% accuracy, where the error budget is contributed to strongly by input H II region distances used for the calibration. The use of 13CO spectral line data for distance estimation is examined and compared to the distance calibration established for 12CO observations. We show that distances estimated using 13CO are in good agreement with those obtained using 12CO, with a possible ~10% distance overestimation for 13CO relative to the 12CO calibration. Several molecular clouds with known distances are subjected to PCA, and we demonstrate that the universal spectrum is closely respected by all clouds; PCA-based distances estimated under the assumption of exact adherence to the universal spectrum are derived and are shown to be in excellent agreement with optically estimated distances. We examine the possibility that the PCA distance estimation method may be used to solve the kinematic distance ambiguity in the inner Galaxy. We establish how PCA may be used to diagnose severe blending of near/far emission and, in cases of little or no blending, to accurately establish the near or far distance. The inner Galaxy results provide initial support for the global validity of the universal PCA spectrum previously demonstrated for the outer Galaxy only. In conjunction with the accurate velocity information provided by millimeter wavelength spectral line data, PCA can provide useful information for studies of Galactic structure and kinematics.

Principal component analysis of 12CO (J = 1-0) emission is used to diagnose the presence of large-scale, global velocity fluctuations in molecular clouds. We search for, and find, large-scale flows of atomic material in which the globally turbulent molecular clouds are embedded. This is consistent with the picture of molecular clouds existing as short-lived, turbulent density fluctuations within larger scale atomic flows. Large-scale driving of turbulence in molecular clouds, by converging flows of atomic material, can reconcile recent numerical determinations of the dissipation rate of turbulent energy with the observations, that otherwise, for small-scale driving, leads to unacceptably high cloud luminosities. On the other hand, lack of large-scale shock signatures in the molecular gas, as expected for large-scale driving, may, if not due to an observational bias, require that the large-scale flows are themselves driven by energy injection occurring on smaller scales within molecular clouds.

We demonstrate the capability of principal component analysis (PCA) as applied by Heyer & Schloerb to extract the statistics of turbulent interstellar velocity fields as measured by the energy spectrum, E(k) ~ k-b. Turbulent velocity and density fields with known statistics are generated from fractional Brownian motion simulations. These fields are translated to the observational domain, T(x,y,v), considering the excitation of molecular rotational energy levels and radiative transfer. Using PCA and the characterization of velocity and spatial scales from the eigenvectors and eigenimages, respectively, a relationship is identified that describes the magnitude of line profile differences, dv, and the scale, L, over which these differences occur, dv ~ La. From a series of models with varying values of b, we find a = 0.33b - 0.05 for 1 < b < 3. This provides the basic calibration between the intrinsic velocity field statistics to observational measures and a diagnostic for turbulent flows in the interstellar medium. We also investigate the effects of noise, line opacity, and finite resolution on these results.

The multivariate tool of principal component analysis (PCA) is applied to 23 fields in the FCRAO CO Survey of the Outer Galaxy. PCA enables the identification of line profile differences, which are assumed to be generated from fluctuations within a turbulent velocity field. The variation of these velocity differences with spatial scale within a molecular region is described by a singular power law, dv = cLa, which can be used as a powerful diagnostic to turbulent motions. For the ensemble of 23 fields, we find a mean valueimg1.gif = 0.62 +- 0.11. From a recent calibration of this method using fractal Brownian motion simulations (Brunt & Heyer), the measured velocity difference-size relationship corresponds to an energy spectrum, E(k), which varies as k-b, where b = 2.17 +- 0.31. We compare our results to both decaying and forced hydrodynamic simulations of turbulence. We conclude that energy must be continually injected into the regions to replenish that lost by dissipative processes such as shocks. The absence of large, widely distributed shocks within the targeted fields suggests that the energy is injected at spatial scales less than several parsecs.

We present new, high-resolution 1420 and 408 MHz continuum images and H I and 12CO (J = 1-0) spectral line maps of the diffuse supernova remnant (SNR) CTB 104A (G93.7-0.3). Analysis of the complex continuum emission reveals no significant spectral index variations across the remnant. Three prominences around CTB 104A are found to be related to the SNR, while one extension to the east is identified as an H II region associated with a background molecular shell. Small-scale polarization and rotation measure (RM) structures are turbulent in nature, but we find a well-ordered RM gradient across the remnant, extending from southeast to northwest. This gradient does not agree with the direction of the global Galactic magnetic field but does agree with a large-scale RM anomaly inferred from RM data by Clegg et al. We show that the observed morphology of CTB 104A is consistent with expansion in a uniform magnetic field, and this is supported by the observed RM distribution. By modeling the RM gradient with a simple compression model we have determined the magnetic field strength within the remnant as B0 [?] 2.3 mG. We have identified signatures of the interaction of CTB 104A with the surrounding neutral material and determined its distance, from the kinematics of the H I structure encompassing the radio emission, as 1.5 kpc. We also observed clear breaks in the H I shell that correspond well to the positions of two of the prominences, indicating regions where hot gas is escaping from the interior of the SNR.

The poem “The Metaphysician Calls His Mother from Jail" by Christopher Brunt is presented. First Line: Mama can't you see the night is a dragon wing, Last Line: isn't real. I'm sorry you have a son who is.

The poem “Waterclocks and Whirling Buckets" by Christopher Brunt is presented. First Line: What is the difference between thought and feeling; Last Line: everyone you have ever been begins to rain.

We present an implementation of the iterative flux-conserving Lucy-Richardson (L-R) deconvolution method of image restoration for maps produced by the Balloon-borne Large Aperture Submillimeter Telescope (BLAST). Compared to the direct Fourier transform method of deconvolution, the L-R operation restores images with better-controlled background noise and increases source detectability. Intermediate iterated images are useful for studying extended diffuse structures, while the later iterations truly enhance point sources to near the designed diffraction limit of the telescope. The L-R method of deconvolution is efficient in resolving compact sources in crowded regions while simultaneously conserving their respective flux densities. We have analyzed its performance and convergence extensively through simulations and cross-correlations of the deconvolved images with available high-resolution maps. We present new science results from two BLAST surveys, in the Galactic regions K3-50 and IC 5146, further demonstrating the benefits of performing this deconvolution. We have resolved three clumps within a radius of 4.'5 inside the star-forming molecular cloud containing K3-50. Combining the well-resolved dust emission map with available multi-wavelength data, we have constrained the spectral energy distributions (SEDs) of five clumps to obtain masses (M), bolometric luminosities (L), and dust temperatures (T). The L-M diagram has been used as a diagnostic tool to estimate the evolutionary stages of the clumps. There are close relationships between dust continuum emission and both 21 cm radio continuum and 12CO molecular line emission. The restored extended large-scale structures in the Northern Streamer of IC 5146 have a strong spatial correlation with both SCUBA and high-resolution extinction images. A dust temperature of 12 K has been obtained for the central filament. We report physical properties of ten compact sources, including six associated protostars, by fitting SEDs to multi-wavelength data. All of these compact sources are still quite cold (typical temperature below [?] 16 K) and are above the critical Bonner-Ebert mass. They have associated low-power young stellar objects. Further evidence for starless clumps has also been found in the IC 5146 region.