Bundling Payment for Episodes of Hospital Care: Issues and Recommendations for the New Pilot Program in Medicare

Outlines the 2010 healthcare reform's provision to launch a pilot project for bundling Medicare payments around hospitalization episodes of care, the rationale for hospital episode bundling, and guidance on designing an effective pilot program

Computation of steady and unsteady quasi-one-dimensional viscous/inviscid interacting internal flows at subsonic, transonic, and supersonic Mach numbers

Computations of viscous-inviscid interacting internal flowfields are presented for steady and unsteady quasi-one-dimensional (Q1D) test cases. The unsteady Q1D Euler equations are coupled with integral boundary-layer equations for unsteady, two-dimensional (planar or axisymmetric), turbulent flow over impermeable, adiabatic walls. The coupling methodology differs from that used in most techniques reported previously in that the above mentioned equation sets are written as a complete system and solved simultaneously; that is, the coupling is carried out directly through the equations as opposed to coupling the solutions of the different equation sets. Solutions to the coupled system of equations are obtained using both explicit and implicit numerical schemes for steady subsonic, steady transonic, and both steady and unsteady supersonic internal flowfields. Computed solutions are compared with measurements as well as Navier-Stokes and inverse boundary-layer methods. An analysis of the eigenvalues of the coefficient matrix associated with the quasi-linear form of the coupled system of equations indicates the presence of complex eigenvalues for certain flow conditions. It is concluded that although reasonable solutions can be obtained numerically, these complex eigenvalues contribute to the overall difficulty in obtaining numerical solutions to the coupled system of equations

Promoting Team-Based Exercise Among African American Breast Cancer Survivors

Physical activity benefits the health and well-being of breast cancer survivors (BCS). Yet, many African American survivors do not routinely exercise and have increased risk of poor outcomes. The purpose of this mixed-method study was to identify motivational factors compelling African American BCS to participate in a 14-week team walking program and to intend to continue exercise after the intervention concluded. Focus groups were held with participants (n = 12) before and after training. Content analysis discovered themes before the intervention: Not wanting to go at it alone, exercise not a life or treatment priority, cancer treatment affected activity, advocates to exercise, and can exercise really help? Four themes postintervention themes included: In the same boat, changed mind-set, improved weight and activity, and overcoming barriers. Physical data verified improvements. Results suggest that a team-based exercise training program may assist in overcoming a sedentary behavior tendency and subsequently improve health among survivors

Survivors Speak: A Qualitative Analysis of Motivational Factors Influencing Breast Cancer Survivors’ Participation in a Sprint Distance Triathlon

Aims and Objectives To examine motivational factors influencing breast cancer survivors to participate in triathlon training, complete a triathlon and maintain an exercise thereafter. Background Routine exercise has been shown to improve quality of life and reduce recurrence for breast cancer survivors. Yet physical and psychological factors present barriers for initiating and maintaining an exercise routine. Research is limited in exploring factors of exercise motivation from the survivor\u27s perspective. Design Qualitative design using focus groups and individual follow-up phone interviews to explore motivation for exercise initiation and maintenance. Methods One to two weeks after completing a triathlon, 11 breast cancer survivors who trained together participated in one of three focus groups to discuss their experience. Five months post triathlon 6 of the 11 participants were successfully contacted and phone interviews were conducted to explore exercise maintenance. Focus groups and interviews were analysed using content and thematic analysis. Results Five themes emerged (1) Champion for Exercise, (2) Part of a Team, (3) Everyone Had a Story, (4) Not Really Exercise and (5) What Do We Do Now? Overall, survivors recognised their need for lifestyle change (e.g. moving from a sedentary lifestyle to a more active one). More importantly, they identified the team approach to exercise initiation was crucial in their success in sustaining a behavioural change. Conclusions Emphasis needed on developing team exercise training programmes for survivors. Nurses can play a critical role in discussing with survivors, the benefits of exercise initiation and maintenance. Relevance to clinical practice Breast cancer survivors are hesitant to initiate routine exercise. Training with women who share a common lived experience increases the likelihood of success. Nurses are in a position to encourage breast cancer survivors to participate in group exercise programmes as a way to improve quality of life

Impact of super absorbent polymers on early age behavior of ultra-high performance concrete walls

Early age cracking, a common problem for Ultra-High Performance Concrete (UHPC), is caused by Autogenous Shrinkage (AS) and self-desiccation arising from the chemical shrinkage during the cement hydration reactions when the deformation is restrained. However, to avoid the crack development initiated by AS, several solutions can be adopted; one example is the addition of a promising material, considered as an internal curing agent, the Super Absorbent Polymers (SAP) which limits the capillary depressions that can enhance the formation of the crack. In this study the main goal is to mitigate the shrinkage using SAPs in infrastructure under severe conditions. Therefore, a demonstrator wall was built simulating a typical case with high risk of cracking. With the help of fiber optic SOFO sensors embedded in the wall, real-time deformations are recorded and compared the demountable mechanical strain gauges (DEMEC) measurements to further investigate the behavior of SAPs in real scale infrastructure. The amount of extra water (in SAP) needed to mitigate shrinkage was determined by performing chemical shrinkage tests on different cement paste combinations. Tests of autogenous shrinkage were performed on mortars using corrugated tubes and showed that SAPs reduce to some extent the AS. Under restrained conditions via ring tests, SAP specimens did not crack. Therefore, SAPs were found promising towards mitigating the shrinkage and enhancing the early age behavior of concrete for a better durability

Invasive crayfish impacts on native fish diet and growth vary with fish life stage

Assessing the impacts of invasive organisms is a major challenge in ecology. Some widespread invasive species such as crayfish are potential competitors and reciprocal predators of ecologically and recreationally important native fish species. Here, we examine the effects of signal crayfish (Pacifastacus leniusculus) on the growth, diet, and trophic position of the chub (Squalius cephalus) in four rivers in Britain. Growth rates of 0+ chub were typically lower in sympatric populations with signal crayfish compared with allopatric populations, and this effect could be traced through to 2+ chub in one river. However, growth rates of older chub (5+ to 6+) were typically higher in the presence of crayfish. Sympatry with crayfish resulted in lower chub length-at-age and mass-at-age in half of the rivers sampled, with no change detected in the other rivers. Stable isotope analyses (δ13C and δ15N) revealed that both chub and crayfish were omnivorous, feeding at multiple trophic levels and occupying similar trophic positions. We found some evidence that chub trophic position was greater at invaded sites on one river, with no difference detected on a second river. Mixing models suggested crayfish were important food items for both small and large chub at invaded sites. This study provides evidence that invasive species can have both positive and negative effects on different life stages of a native species, with the net impact likely to depend on responses at the population level

Model Transformation for a System of Systems Dependability Safety Case

Software plays an increasingly larger role in all aspects of NASA's science missions. This has been extended to the identification, management and control of faults which affect safety-critical functions and by default, the overall success of the mission. Traditionally, the analysis of fault identification, management and control are hardware based. Due to the increasing complexity of system, there has been a corresponding increase in the complexity in fault management software. The NASA Independent Validation & Verification (IV&V) program is creating processes and procedures to identify, and incorporate safety-critical software requirements along with corresponding software faults so that potential hazards may be mitigated. This Specific to Generic ... A Case for Reuse paper describes the phases of a dependability and safety study which identifies a new, process to create a foundation for reusable assets. These assets support the identification and management of specific software faults and, their transformation from specific to generic software faults. This approach also has applications to other systems outside of the NASA environment. This paper addresses how a mission specific dependability and safety case is being transformed to a generic dependability and safety case which can be reused for any type of space mission with an emphasis on software fault conditions

Spectral characteristics and the extent of paleosols of the Palouse formation

Three spectral models defining the spatial distribution of soil areas by levels of amorphous iron, organic carbon, and the ratio of amorphous iron to organic carbon were developed and field verification studies were conducted. The models used particular Thematic Mapper band ratios selected by statistical correlation with soil chemical data. The ability of the models to indicate erosion severity and to differentiate between iron enriched and carbonate paleosols is discussed. In addition, the effect of vegetation cover on paleosols is addressed