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Competing Interests: Declaration of interests All authors declare that they have no conflicts of interest

Food insecurity has been a persistent problem in the U.S., and yet over the past three decades, federally funded food programs have become more restrictive. Scholars and policymakers have inquired whether the nonprofit sector is increasing its food provision activities to address this unmet need. This study analyzes data from the U.S. Census and a nationally representative survey of religious congregations in the U.S. to examine trends in food insecurity and congregation-based food provision between 1998 and 2012. The objective of the study is to investigate the extent to which congregation-based food provision fluctuated with national food insecurity prevalence for the overall population, and for subgroups vulnerable to this condition. Results show an over-time correspondence between the prevalence of food-insecure households and the prevalence of congregations that provide food. Parallel patterns are observed between food insecurity in disproportionately affected subpopulations (e.g., African-Americans and immigrants) and food provision in the congregations likely to serve those households. These findings indicate that congregations are helping meet the needs of food-insecure households. However, research suggests that congregations and nonprofits are not an adequate substitute for federally funded programs. Policy recommendations include expanding access to federally funded programs like the Supplemental Nutrition Assistance Program (SNAP) to more immigrants and other groups vulnerable to food insecurity, as well as providing more systematic financial or federal support and quality control of congregation-based efforts.

The purpose of this research was to develop a psychometrically sound survey for use with the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Services (OAS CAHPS) survey. Both an exploratory pilot and a confirmatory pilot were conducted in hospital outpatient departments and freestanding ambulatory surgery centers eligible for participation in the OAS CAHPS program. Analyses indicated an internally consistent and valid 18-item survey with 6 measures, including Access, Moving Through the Visit, Nurses, Anesthesiologist, Doctor, and Coordinated Care. The measures are small, maximizing the number that can be used along with the OAS CAHPS survey, given Centers for Medicare & Medicaid Services restrictions.

Objective: This study assessed the prevalence of and factors associated with congregation-based programming in support of people with mental illness., Methods: To estimate the proportion of congregations that provide mental health programming, this study reports analyses of survey responses from the 2012 National Congregations Study, a nationally representative survey of religious congregations in the United States (N=1,327). The analysis used multivariate logistic regression to identify congregational characteristics associated with the provision of mental health programming., Results: Nearly one in four U.S. congregations (23%) provided some type of programming to support people with mental illness. Approximately 31% of all attendees belonged to a congregation that provided mental health programming. Congregational characteristics associated with providing mental health programming included having more members and having members with higher incomes, employing staff for social service programs, and providing health-focused programs. Other significant predictors included engaging with the surrounding community (that is, conducting community needs assessments and hosting speakers from social service organizations) and being located in a predominantly African-American community., Conclusions: Greater coordination between mental health providers and congregations with programs that support people with mental illness could foster more integrated and holistic care, which in turn may lead to improved recovery outcomes.

Angular distributions of the elastic, inelastic, and breakup cross sections of the halo nucleus ^{11}Be on ^{197}Au were measured at energies below (E_{lab}=31.9  MeV) and around (39.6 MeV) the Coulomb barrier. These three channels were unambiguously separated for the first time for reactions of ^{11}Be on a high-Z target at low energies. The experiment was performed at TRIUMF (Vancouver, Canada). The differential cross sections were compared with three different calculations: semiclassical, inert-core continuum-coupled-channels and continuum-coupled-channels ones with including core deformation. These results show conclusively that the elastic and inelastic differential cross sections can only be accounted for if core-excited admixtures are taken into account. The cross sections for these channels strongly depend on the B(E1) distribution in ^{11}Be, and the reaction mechanism is sensitive to the entanglement of core and halo degrees of freedom in ^{11}Be.

26Al is an important radioisotope in astrophysics that provides evidence of ongoing nucleosynthesis in the Galaxy. The 23Na(α, p)26Mg reaction has been identified by a sensitivity study as being one of the most important reactions for the production of 26Al in the convective C/Ne burning shell of massive stars. Owing to large uncertainties in previous experimental data, model calculations are used for the reaction rate of 23Na(α, p)26Mg in this sensitivity study. Current experimental data suggest a reaction rate a factor of ∼40 higher than model calculations. However, a new measurement of this reaction cross section has been made in inverse kinematics in the energy range E(c.m.)=1.28-3.15  MeV at TRIUMF, and found to be in reasonable agreement with the model calculation. A new reaction rate is calculated and tight constraints on the uncertainty in the production of 26Al, due to this reaction, are determined.

Purpose: Identify and compare predictors of the existence of congregational human immunodeficiency virus (HIV) and other health programs., Design: Cross-sectional study., Setting: United States., Subjects: A nationally representative sample of 1506 U.S. congregations surveyed in the National Congregations Study (2006-2007)., Measures: Key informants at each congregation completed in-person and telephone interviews on congregational HIV and other health programs and various congregation characteristics (response rate = 78%). County-level HIV prevalence and population health data from the Robert Wood Johnson Foundation's 2007 County Health Rankings were linked to the congregational data., Analysis: Multinomial logistic regression was used to assess factors that predict congregational health programs relative to no health programs; and of HIV programs relative to other health activities., Results: Most congregations (57.5%) had at least one health-related program; many fewer (5.7%) had an HIV program. Predictors of health vs. HIV programs differed. The number of adults in the congregation was a key predictor of health programs, while having an official statement welcoming gay persons was a significant predictor of HIV programs (p < .05). Other significant characteristics varied by size of congregation and type of program (HIV vs. other health)., Conclusion: Organizations interested in partnering with congregations to promote health or prevent HIV should consider congregational size as well as other factors that predict involvement. Results of this study can inform policy interventions to increase the capacity of religious congregations to address HIV and health.

The rate of the 18F(p,γ)19Ne reaction affects the final abundance of the γ-ray observable radioisotope 18F, produced in novae. However, no successful measurement of this reaction exists and the rate used is calculated from incomplete information on the contributing resonances. Of the two resonances thought to play a significant role, one has a radiative width estimated from the assumed analogue state in the mirror nucleus, 19F. The second does not have an analogue state assignment at all, resulting in an arbitrary radiative width being assumed. Here, we report the first successful direct measurement of the 18F(p,γ)^19Ne reaction. The strength of the 665 keV resonance (Ex=7.076  MeV) is found to be over an order of magnitude weaker than currently assumed in nova models. Reaction rate calculations show that this resonance therefore plays no significant role in the destruction of ^{18}F at any astrophysical energy.

The inclusive breakup for the (11)Li + (208)Pb reaction at energies around the Coulomb barrier has been measured for the first time. A sizable yield of (9)Li following the (11)Li dissociation has been observed, even at energies well below the Coulomb barrier. Using the first-order semiclassical perturbation theory of Coulomb excitation it is shown that the breakup probability data measured at small angles can be used to extract effective breakup energy as well as the slope of B(E1) distribution close to the threshold. Four-body continuum-discretized coupled-channels calculations, including both nuclear and Coulomb couplings between the target and projectile to all orders, reproduce the measured inclusive breakup cross sections and support the presence of a dipole resonance in the (11)Li continuum at low excitation energy.

The (18)F(p,α)(15)O reaction rate is crucial for constraining model predictions of the γ-ray observable radioisotope (18)F produced in novae. The determination of this rate is challenging due to particular features of the level scheme of the compound nucleus, (19)Ne, which result in interference effects potentially playing a significant role. The dominant uncertainty in this rate arises from interference between J(π)=3/2(+) states near the proton threshold (S(p)=6.411 MeV) and a broad J(π)=3/2(+) state at 665 keV above threshold. This unknown interference term results in up to a factor of 40 uncertainty in the astrophysical S-factor at nova temperatures. Here we report a new measurement of states in this energy region using the (19)F((3)He,t)(19)Ne reaction. In stark contrast to previous assumptions we find at least 3 resonances between the proton threshold and E(cm)=50 keV, all with different angular distributions. None of these are consistent with J(π)=3/2(+) angular distributions. We find that the main uncertainty now arises from the unknown proton width of the 48 keV resonance, not from possible interference effects. Hydrodynamic nova model calculations performed indicate that this unknown width affects (18)F production by at least a factor of two in the model considered.

The first measurement of the elastic scattering of the halo nucleus 11Li and its core 9Li on 208Pb at energies near the Coulomb barrier is presented. The 11Li+208Pb elastic scattering shows a strong reduction with respect to the Rutherford cross section, even at energies well below the barrier and down to very small scattering angles. This drastic change of the elastic differential cross section observed in 11Li+208Pb is the consequence of the halo structure of 11Li, as it is not observed in the elastic scattering of its core 9Li at the same energies. Four-body continuum-discretized coupled-channels calculations, based on a three-body model of the 11Li projectile, are found to explain the measured angular distributions and confirm that the observed reduction is mainly due to the strong Coulomb coupling to the dipole states in the low-lying continuum of 11Li. These calculations suggest the presence of a low-lying dipole resonance in 11Li close to the breakup threshold.

The 18Ne(α,p) 21Na reaction provides one of the main HCNO-breakout routes into the rp process in x-ray bursts. The 18Ne(α,p0) 21Na reaction cross section has been determined for the first time in the Gamow energy region for peak temperatures T∼2  GK by measuring its time-reversal reaction 21Na(p,α) 18Ne in inverse kinematics. The astrophysical rate for ground-state to ground-state transitions was found to be a factor of 2 lower than Hauser-Feshbach theoretical predictions. Our reduced rate will affect the physical conditions under which breakout from the HCNO cycles occurs via the 18Ne(α,p) 21Na reaction.

Objective: The objective of this study was to investigate how domains of patient satisfaction in hospitals predict Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) global rating scores to support hospital administrators in dealing with reimbursement changes., Background: Medicare's inpatient value-based purchasing program ties a portion of hospital payments to scores on the HCAHPS survey., Methods: Logistical regression analysis of patient-level satisfaction domain scores from a standard, commercially available survey and HCAHPS top-box scores controlled for potential confounding variables., Results: Each 1-point increase in the nursing domain score increased the odds of achieving an HCAHPS top-box score by 4.9%. Increases in other domain scores also affected top-box odds, although to a smaller extent., Conclusions: Hospital administrators wishing to maximize Medicare reimbursement will realize the greatest impact by improving patient satisfaction with nursing care.

The current evaluation of the triple-α reaction rate assumes that the α decay of the 7.65 MeV, 0+ state in 12C, commonly known as the Hoyle state, proceeds sequentially via the ground state of 8Be. This assumption is challenged by the recent identification of two direct α-decay branches with a combined branching ratio of 17(5)%. If correct, this would imply a corresponding reduction in the triple-α reaction rate with important astrophysical consequences. We have used the 11B(3He,d) reaction to populate the Hoyle state and measured the decay to three α particles in complete kinematics. We find no evidence for direct α-decay branches, and hence our data do not support a revision of the triple-α reaction rate. We obtain an upper limit of 5×10(-3) on the direct α decay of the Hoyle state at 95% C.L., which is 1 order of magnitude better than a previous upper limit.

Despite concerns and disagreements about the impact of hospitalist models on health care, hospitalists are becoming the dominant means of providing inpatient care, and models continue to diversify. Understanding their impact and the factors that influence their adoption is essential. This study examined hospitalists' impact on patient satisfaction, considering a host of characteristics. Cross-sectional data received in calendar year 2008, aggregated to the facility level, represent 1777 hospitals (41% of which employed hospitalists) and 2 648 275 patients. Press Ganey's psychometrically sound inpatient satisfaction survey consists of 38 items (10 sections) rated on a 5-point Likert-type scale. Findings suggest that facilities with hospitalists may have an advantage regarding satisfaction with nursing and personal issues (eg, privacy, emotional needs, response to complaints), both of which may be related to broader communication issues. Moreover, teaching (overall satisfaction) and large facilities (satisfaction with admissions, nursing, and tests/treatments) might especially benefit from the presence of hospitalists. Exploring how specific hospitalist functions influence patient satisfaction may reap rewards.

The ambivalent response of many black churches to current social issues has caused some scholars to question the centrality of black churches within African-American communities. Using a nationally representative sample of black congregations, this study engages the debate about the institutional centrality of black churches by focusing on their response to HIV/AIDS. Although many congregational studies treat black churches as a monolithic whole, this analysis identifies heterogeneity among black churches that shapes their responsiveness to social issues. Contrary to prior claims, a congregation's liberal-conservative ideological orientation does not significantly affect its likelihood of having an HIV/AIDS program. Beyond assessing churches’ internal characteristics, this study uses institutional theory to analyze churches as open systems that can be influenced by their surrounding environment. It demonstrates that externally engaged congregations are significantly more likely to have a program. These results indicate that black churches maintain institutional centrality by engaging their external environment.

With the considerable number of quality improvement options available, it is difficult to determine which are right for your organization. As the award-winning outpatient organizations and the research literature cited in this article demonstrate, improving the quality of communication both directly and indirectly increases a patient's opinion of an organization. Specifically, the extent and quality of communication with the patient and among healthcare team members, both during and after the patient's visit, are key drivers of the patient's increased likelihood to recommend the organization. Better communication increases not only patient satisfaction, but also the patient's adherence to post-visit guidelines and medication, which is associated with increased quality of life. Thus, communication-type initiatives are central to improving service quality. Rather than offering a guide to implementing one of the many communication-focused initiatives available, this article offers an empirically based conceptual framework to help the reader consider the broader effects of these initiatives.

Introduction: Dementia Care Mapping (DCM) was originally developed as a clinical tool but has attracted interest as a potential observational measure of quality of life (QOL) and well-being of long-term care residents with dementia. DCM coding involves continuous observation over a 6-h period, with observers recording a Behavior Category Code (BCC, a recording of activity/interaction) and a Well/Ill Being (WIB) score at 5 min intervals., Method: Descriptive data from several different research teams on the distribution and psychometric properties of DCM data were compiled and summarized., Results: Issues and problems identified include: complex scoring algorithms, inter-rater reliability of the BCCs, limited variability of WIB values, associations between resident characteristics and DCM assessments, rater time burden, and comparability of results across study settings., Conclusions: Despite the identified limitations, DCM has promise as a research measure, as it may come closer to rating QOL from the perspective of persons with dementia than other available measures. Its utility will depend on the manner in which it is applied and an appreciation of the measure's strength and limitations. Possible changes that might improve the reliability, validity, and practicality of DCM as a research tool include coding the predominant event (rather than the 'best' event), shortening the observation period, and adding '0' as a neutral WIB coding option., (Copyright 2006 John Wiley & Sons, Ltd.)

This study aimed to identify the information and service needs of persons with Alzheimer's disease (AD) and their family caregivers living in rural communities and to assess differences and similarities in each partner's perspective. In an outpatient clinic setting, a self-report survey was completed by 100 caregivers, while a similar survey was used to interview 100 persons with mild to moderate AD. The survey assessed respondents' interest in information or services related to 22 topics about AD and various aspects of coping with the disease. Although more caregivers than persons with AD reported interest in each topic, 8 of the top 10 topics endorsed by each group of respondents were the same. However, analysis of responses by dyads revealed substantial disagreement in terms of each partner's interest in information and services. Patient and family education, as well as referrals for services, must take into account each partner's unique perspective and needs.

Dementia Care Mapping (DCM) is an observational tool that provides rich data about the quality of life and quality of care of persons with dementia in group care settings. The method is time-consuming and thus costly to implement in practice. This paper presents an attempt to 'streamline' DCM for the sake of simplifying it and reducing the financial resources required to implement it. Data were collected for 166 persons with dementia in three types of care settings. Seven streamlined time-sampling models were tested against the original DCM model. In general, results support the use of certain models for specific purposes. The strengths and limitations of these streamlined models are discussed and recommendations are made.

The breaking of the N=8 shell-model magic number in the 12Be ground state has been determined to include significant occupancy of the intruder d-wave orbital. This is in marked contrast with all other N=8 isotones, both more and less exotic than 12Be. The occupancies of the [FORMULA: SEE TEXT]orbital and the [FORMULA: SEE TEXT], intruder orbital were deduced from a measurement of neutron removal from a high-energy 12Be beam leading to bound and unbound states in 11Be.

Purpose: This exploratory study compared three methods of assessing dementia specific quality of life, corresponding to the perspectives of residents, staff members, and trained observers., Design and Methods: We collected data on 172 residents with dementia in four special care nursing facilities and three assisted living facilities. Analyses assessed the relationship of each quality-of-life method or perspective to the others and to resident characteristics such as cognitive and functional status., Results: The relationship of staff quality-of-life measures to resident characteristics varied by care setting while no significant relationships were found for resident quality-of-life measures. Staff and observational measures were moderately correlated in both settings. Moderate correlations of resident measures with staff and observational measures were found in the assisted living sample., Implications: Each perspective is relatively independent and somewhat unique. Measures that focus on specific aspects of quality of life may be more appropriate to use with assisted living residents than with residents of special care facilities.

In the centres of stars where the temperature is high enough, three alpha-particles (helium nuclei) are able to combine to form 12C because of a resonant reaction leading to a nuclear excited state. (Stars with masses greater than approximately 0.5 times that of the Sun will at some point in their lives have a central temperature high enough for this reaction to proceed.) Although the reaction rate is of critical significance for determining elemental abundances in the Universe, and for determining the size of the iron core of a star just before it goes supernova, it has hitherto been insufficiently determined. Here we report a measurement of the inverse process, where a 12C nucleus decays to three alpha-particles. We find a dominant resonance at an energy of approximately 11 MeV, but do not confirm the presence of a resonance at 9.1 MeV (ref. 3). We show that interference between two resonances has important effects on our measured spectrum. Using these data, we calculate the triple-alpha rate for temperatures from 10(7) K to 10(10) K and find significant deviations from the standard rates. Our rate below approximately 5 x 10(7) K is higher than the previous standard, implying that the critical amounts of carbon that catalysed hydrogen burning in the first stars are produced twice as fast as previously believed. At temperatures above 10(9) K, our rate is much less, which modifies predicted nucleosynthesis in supernovae.

Quality of life (QOL) for people with dementia has become a major focus over the past decade. Dementia care mapping (DCM) is an observational measure of quality of care given by staff in formal care settings, as well as a measure of QOL that has been used in many studies of people with dementia in residential care settings. However, the method itself has not been rigorously studied in a scientific manner. For this report, mapping data were collected for 166 persons with dementia in three types of care settings: special care facilities that are licensed nursing homes, assisted living facilities, and adult day centers. The relationships between DCM and several independent variables including cognitive status, functional status, care setting, depression, length of stay, and co-morbid illnesses were assessed. Both cognitive status and functional status were found to be associated with DCM scores. Moreover, DCM was sensitive in differentiating among persons with four levels of cognitive impairment. Implications for practice are discussed.

Understanding the processes which create and destroy 22Na is important for diagnosing classical nova outbursts. Conventional 22Na(p,gamma) studies are complicated by the need to employ radioactive targets. In contrast, we have formed the particle-unbound states of interest through the heavy-ion fusion reaction, 12C(12C,n)23Mg and used the Gammasphere array to investigate their radiative decay branches. Detailed spectroscopy was possible and the 22Na(p,gamma) reaction rate has been reevaluated. New hydrodynamical calculations incorporating the upper and lower limits on the new rate suggest a reduction in the yield of 22Na with respect to previous estimates, implying a reduction in the maximum detectability distance for 22Na gamma rays from novae.