The Leading Edge Accelerating change: Fostering innovation in healthcare delivery at academic medical centers

a b s t r a c t Academic medical centers (AMCs) have the potential to be leaders in the era of healthcare delivery reform, but most have yet to display a commitment to delivery innovation on par with their commitment to basic research. Several institutional factors impede delivery innovation including the paucity of adequate training in design and implementation of new delivery models and the lack of established pathways for academic career advancement outside of research. This paper proposes two initiatives to jumpstart disruptive innovation at AMCs: an institutional "innovation incubator" program and a clinician-innovator career track coupled with innovation training programs

Dependence of progeny abundance for summer chum salmon (<i>Oncorhynchys keta</i>) in the Amur River on the parents abundance

For almost the century the landings of summer chum salmon in the Amur were approximately in 5 times lower that the landings of fall chum salmon, in spite on almost the same fishing efforts. However, its catches were very high in the 1990-2000s, even higher that for the fall chum salmon, that contradicts to conceptions on its lower absolute fecundity, smaller spawning grounds, and higher vulnerability of its reproduction on unfavorable external factors. Relationship of mature progeny abundance for summer chum salmon with number of their parents is analyzed. The data on the parents and progeny abundance were calculated from fishery statistics, including cited data, considering annual catch as 50 % of the stock. The highest recruitment of summer chum salmon is estimated as 19.08 · 106 ind. that is comparable with the strength of the fall chum salmon year-classes. The spawning stock of 1.94 · 106 ind. is enough to produce this progeny, but the population growth is much lower with the lower spawning stock, that is a real reason for slow recovery of the summer chum salmon stock, though potentially both races could be equally abundant. To maintain the stock of summer chum salmon at the highest level, an optimal number of parents should be passed to the spawning grounds, within rather narrow range, that is difficult to control in conditions of the big river

Dependence of progeny abundance for fall chum salmon ( <i>Oncorhynchys keta</i>) in the Amur River on the parents abundance

The stock of the Amur fall chum salmon ( Oncorhynchys keta ) was low in 2000-2005 (annual catches varied in the range of 500-1300 t) but began to increase since 2006 and the catch exceeded 22000 t in 2014. The increasing was accompanied by gradual decrease of abundance for downstream-migrant juveniles of this species. This opposite effect could be related both with excessive fishing pressure and lack of producers or with excess of the producers number over an optimum, i.e. overloading of spawning grounds - that determines strategy of fishery management. To understand the juveniles lowering, the progeny-parents relationship is considered. It is described by original equation for the difference between the number of spawners and number of progeny. The optimal value of the spawners number is defined as approximately 4.5 · 106 ind. Recently the number of producers regularly exceeds the optimum. So, recent catch values are not excessive, but insufficient, in spite of low number of downstream-migrant juveniles. This conclusion is consistent with conception on harm of spawning grounds overloading for salmons reproduction. Possible consequences of this local stock management on the base of strategy of constant exploitation coefficient and permanent residue are discussed

Analysis of Mechanical Safety of Stadiums for the World Cup 2018

It is obvious that contemporary design and construction of unique buildings and structures is unthinkable without mathematical (numerical) and computer modelling and advanced analysis ofload-bearing structures under various kinds ofloads and impacts. One of the most ambitious and important construction projects is the uniquelarge-span structures. These are, in particular, stadiums, sports palaces and water parks, shopping malls, pedestrian, road and railway bridges of various design solutions. The distinctive paper is devoted to theoretical foundations and results of mathematical (numerical) modeling of the state (in terms of the analysis of stress-strain state, strength and stability) of football stadiums built for the 2018 FIFA World Cup in Russia. Finite element method is used for approximation and high-precision numerical solution of corresponding boundary problems of structural mechanics. It is the most universal and powerful numerical method of mechanics. The paper, in particular, describes some features of development of finite element models and the main results of the analysis of the mechanical (structural) safety of three- dimensionallarge-span systems "soil foundation - reinforced concrete structures of foundations and stands - steel structures of the coating and facades" of these football stadiums with the basic and specialload combinations. In addition, the key procedures of scientific support during the corresponding expertise and assessments are outlined. Generally, socially significant and knowledge-intensive problem of providing mechanical (constructive) safety of unique combined objects of construction (three-dimensional systems "foundation - reinforced concrete structures of foundations and stands - steel structures of coating and facades") has been solved at a new level as a result of the performed complex of research works

Toward a Consensus on Guiding Principles for Health Systems Strengthening

Based upon a review of the literature, Robert Chad Swanson and colleagues present a set of guiding principles for health systems strengthening

Coherent-Mode Representations in Optics

This book provides you with a single source of information on the problem of coherent-mode representations in optics, including new perspectives on its potential applications. In particular, the &quot;light string&quot; and the &quot;light capillary&quot; beams may be advantageously used in communications, measurements, laser microtechnology, and microsurgery; application of the fast algorithm for bilinear transforms can significantly reduce the computer effort needed to simulate optical systems with partially coherent illumination

Opportunities for CMS to improve healthcare access and equity through advancing technology-enabled startups and digital health innovations

Historically, the Centers for Medicare and Medicaid Services (CMS) has formed partnerships with select private sector entities, including large traditional hospital and health system networks, nursing homes, and payer groups. However, innovations from technology-enabled services companies and digital technology companies are uniquely poised to aid CMS in addressing key barriers toward advancing its mission of improving healthcare access and equity. There are four pivotal opportunity areas where partnerships with technology businesses and tools would enhance the work of CMS: (1) improving consumer awareness about CMS programs, (2) mitigating access gaps through virtual care programs, (3) streamlining the complexity of different payer plan models, and (4) using technology-enabled services to address social risk factors without imposing additional burdens on providers. We offer examples of digital and technology-enabled solutions that improve patient access to care and close equity gaps, as well as propose specific recommendations for CMS to advance and expand the reach and impact of these solutions. Namely, these recommendations include partnerships with private sector companies that can educate and support consumers about their benefits, the extension of telehealth reimbursement parity for virtual care solutions, allowing for cross-state licensure across plans and reimbursement for care coordination services that alleviate provider burden to screen and address patients’ social determinants of health needs. We argue that CMS has an imperative role in leveraging the innovations of technology-enabled services and digital health technologies to lower healthcare access barriers, mitigate provider burden, stimulate innovation, and close equity gaps at the patient, provider, and innovator levels

Analytical Study of Neighborhood Discovery and Link Management in OLSR

Abstract—In mobile ad-hoc networks (MANETs), neighborhood discovery and link management (NDLM) mechanism is used by each node to determine the set of its neighbors, or in other words, to establish one-hop links. Values of this mechanism parameters dramatically affect network performance, especially when real-time traffic is transmitted with proactive routing protocols, which imposes constraints on link quality, i.e. reliability, stability and decision-making latency. The efficiency of NDLM mechanisms is usually evaluated by simulation. The core contribution of this paper is an analytical study of NDLM mechanism defined in OLSR protocol specification. With the developed analytical model of the mechanism, we find the set of parameter values which allow to meet the constraints on link quality indices. By simulation, we show that the usage of these values improves the performance of the network loaded with voice traffic