Social/health maintenance organization and fee-for-service health outcomes over time.

Evaluating the performance of long-term care (LTC) demonstrations requires longitudinal assessment of multiple outcomes where selective mortality and disenrollment, if not accounted for, can give the appearance of reduced (or enhanced) efficacy. We assessed outcomes in social/health maintenance organizations (S/HMOs) and Medicare fee-for-service (FFS) care using a multivariate model to estimate active life expectancy (ALE). S/HMO enrollees and samples of FFS clients in four sites were analyzed and outcome differences assessed for a 3-year period. Results provide insights into S/HMO performance under different conditions and, more generally, into evaluating LTC demonstrations without randomized client and control groups

Does Barack Obama Support Socialized Medicine?

Democratic presidential nominee Sen. Barack Obama (IL) has proposed an ambitious plan to restructure America's health care sector. Rather than engage in a detailed critique of Obama's health care plan, many critics prefer to label it "socialized medicine." Is that a fair description of the Obama plan and similar plans? Over the past year, prominent media outlets and respectable think tanks have investigated that question and come to a unanimous answer: no. Those investigations leave much to be desired. Indeed, they are little more than attempts to convince the public that policies generally considered socialist really aren't. A reasonable definition of socialized medicine is possible. Socialized medicine exists to the extent that government controls medical resources and socializes the costs. Notice that under this definition, it is irrelevant whether we describe medical resources (e.g., hospitals, employees) as "public" or "private." What matters-what determines real as opposed to nominal ownership-is who controls the resources. By that definition, America's health sector is already more than half socialized, and Obama's health care plan would socialize medicine even further. Reasonable people can disagree over whether Obama's health plan would be good or bad. But to suggest that it is not a step toward socialized medicine is absurd

Human Resource Information Systems for Competitive Advantage: Interviews with Ten Leaders

[Excerpt] Increasingly, today\u27s organizations use computer technology to manage human resources (HR). Surveys confirm this trend (Richards-Carpenter, 1989; Grossman and Magnus, 1988; Human Resource Systems Professionals 1988; KPMGPeat Marwick, 1988). HR professionals and managers routinely have Personnel Computers (PCs) or computer terminals on their desks or in their departments. HR computer applications, once confined to payroll and benefit domains, now encompass incentive compensation, staffing, succession planning, and training. Five years ago, we had but a handful of PC-based software applications for HR management. Today, we find a burgeoning market of products spanning a broad spectrum of price, sophistication, and quality (Personnel Journal, 1990). Top universities now consider computer literacy a basic requirement for students of HR, and many consulting firms and universities offer classes designed to help seasoned HR professionals use computers in their work (Boudreau, 1990). Changes in computer technology offer expanding potential for HR management (Business Week, 1990; Laudon and Laudon, 1988)

Advancing functional connectivity research from association to causation

Cognition and behavior emerge from brain network interactions, such that investigating causal interactions should be central to the study of brain function. Approaches that characterize statistical associations among neural time series-functional connectivity (FC) methods-are likely a good starting point for estimating brain network interactions. Yet only a subset of FC methods ('effective connectivity') is explicitly designed to infer causal interactions from statistical associations. Here we incorporate best practices from diverse areas of FC research to illustrate how FC methods can be refined to improve inferences about neural mechanisms, with properties of causal neural interactions as a common ontology to facilitate cumulative progress across FC approaches. We further demonstrate how the most common FC measures (correlation and coherence) reduce the set of likely causal models, facilitating causal inferences despite major limitations. Alternative FC measures are suggested to immediately start improving causal inferences beyond these common FC measures

Insights from quantitative and mathematical modelling on the proposed 2030 goal for gambiense human African trypanosomiasis (gHAT)

Gambiense human African trypanosomiasis (gHAT) is a parasitic, vector-borne neglected tropical disease that has historically affected populations across West and Central Africa and can result in death if untreated. Following from the success of recent intervention programmes against gHAT, the World Health Organization (WHO) has defined a 2030 goal of global elimination of transmission (EOT). The key proposed indicator to measure achievement of the goal is to have zero reported cases. Results of previous mathematical modelling and quantitative analyses are brought together to explore both the implications of the proposed indicator and the feasibility of achieving the WHO goal. Whilst the indicator of zero case reporting is clear and measurable, it is an imperfect proxy for EOT and could arise either before or after EOT is achieved. Lagging reporting of infection and imperfect diagnostic specificity could result in case reporting after EOT, whereas the converse could be true due to underreporting, lack of coverage, and cryptic human and animal reservoirs. At the village-scale, the WHO recommendation of continuing active screening until there are three years of zero cases yields a high probability of local EOT, but extrapolating this result to larger spatial scales is complex. Predictive modelling of gHAT has consistently found that EOT by 2030 is unlikely across key endemic regions if current medical-only strategies are not bolstered by improved coverage, reduced time to detection and/or complementary vector control. Unfortunately, projected costs for strategies expected to meet EOT are high in the short term and strategies that are cost-effective in reducing burden are unlikely to result in EOT by 2030. Future modelling work should aim to provide predictions while taking into account uncertainties in stochastic dynamics and infection reservoirs, as well as assessment of multiple spatial scales, reactive strategies, and measurable proxies of EOT

Multi-channel Hybrid Access Femtocells: A Stochastic Geometric Analysis

For two-tier networks consisting of macrocells and femtocells, the channel access mechanism can be configured to be open access, closed access, or hybrid access. Hybrid access arises as a compromise between open and closed access mechanisms, in which a fraction of available spectrum resource is shared to nonsubscribers while the remaining reserved for subscribers. This paper focuses on a hybrid access mechanism for multi-channel femtocells which employ orthogonal spectrum access schemes. Considering a randomized channel assignment strategy, we analyze the performance in the downlink. Using stochastic geometry as technical tools, we model the distribution of femtocells as Poisson point process or Neyman-Scott cluster process and derive the distributions of signal-to-interference-plus-noise ratios, and mean achievable rates, of both nonsubscribers and subscribers. The established expressions are amenable to numerical evaluation, and shed key insights into the performance tradeoff between subscribers and nonsubscribers. The analytical results are corroborated by numerical simulations.Comment: This is the final version, which was accepted in IEEE Transactions on Communication