Paying for Quality: Understanding and Assessing Physician Pay-for-Performance Initiatives

Reviews the structure, prevalence, measurement issues, perception, and impact of current quality incentive programs, and discusses how much and under what circumstances they will improve quality of care. Includes descriptions of select programs

Rip Current Generation, Flow Characteristics and Implications for Beach Safety in South Florida

Rip currents are the most dangerous hazard at surf beaches. Rip currents in South Florida have previously not been studied. Beach profiles for three Florida beaches (Miami Beach, Lido Beach, Sarasota, and Pensacola Beach) and one Georgia beach (South Cumberland Island) were chosen for surveying because of their variable sand bar heights. Rip current hazard at each beach was assessed by lifeguard rip rescue and drowning statistics. A relationship was found between sand bar height, beach slope and rip current hazard. Rip current measurements in South Florida, which involved utilizing GPS drifters, laser rangefinder and drone-imaged fluorescent tracer dye, showed that the speed ranged from 0.1-0.5 m/s, which is fairly slow compared to such measurements undertaken in California and Australia. The effect of rip currents on swimmers was analyzed based on the drag force acting on swimmers and the power they generate to overcome the currents when swimming against them. The drag force and power increase quadratically and cubically, respectively, with the increase of rip current and swimming speeds. Hence, even rip currents of low velocity can be dangerous and swimming against the current should be avoided if possible. Strong rips in California have been shown to exhibit a circulatory pattern, which could bring a floater back to the safety of a shallow sand bar. Field measurements of rip currents in South Florida clearly defined the flow characteristics of a nearly straight-line current, sometimes deflected to the east-southeast. Therefore, the traditional approach of swimming left or right, parallel to the shore is the best escape strategy, but not against the longshore current if present. A logistic regression analysis was conducted to predict the occurrence of rip currents based on beach conditions. The logistic model showed that wave height, wave period and wind speed were statistically significant factors in rip generation. Rips were found to be most commonly generated by relatively small, non-threatening waves (e.g., 0.6 to 0.9m in height). These physical factors, along with social and safety considerations, pose a significant problem for coastal management

Insects of Western North America. 2. The cicadas of Colorado (Homoptera: Cicadidae, Tibicinidae)

May 15, 2002

How is rape a weapon of war?: feminist international relations, modes of critical explanation and the study of wartime sexual violence

Rape is a weapon of war. Establishing this now common claim has been an achievement of feminist scholarship and activism and reveals wartime sexual violence as a social act marked by gendered power. But the consensus that rape is a weapon of war obscures important, and frequently unacknowledged, differences in ways of understanding and explaining it. This article opens these differences to analysis. Drawing on recent debates regarding the philosophy of social science in IR and social theory, it interprets feminist accounts of wartime sexual violence in terms of modes of critical explanation – expansive styles of reasoning that foreground particular actors, mechanisms, reasons and stories in the formulation of research. The idea of a mode of critical explanation is expanded upon through a discussion of the role of three elements (analytical wagers, narrative scripts and normative orientations) which accomplish the theoretical work of modes. Substantive feminist accounts of wartime sexual violence are then differentiated in terms of three modes – of instrumentality, unreason and mythology – which implicitly structure different understandings of how rape might be a weapon of war. These modes shape political and ethical projects and so impact not only on questions of scholarly content but also on the ways in which we attempt to mitigate and abolish war rape. Thinking in terms of feminist modes of critical explanation consequently encourages further work in an unfolding research agenda. It clarifes the ways in which an apparently commonality of position can conceal meaningful disagreements about human action. Exposing these disagreements opens up new possibilities for the analysis of war rape

Deriving the number of jobs in proximity services from the number of inhabitants in French rural municipalities

We use a minimum requirement approach to derive the number of jobs in proximity services per inhabitant in French rural municipalities. We first classify the municipalities according to their time distance to the municipality where the inhabitants go the most frequently to get services (called MFM). For each set corresponding to a range of time distance to MFM, we perform a quantile regression estimating the minimum number of service jobs per inhabitant, that we interpret as an estimation of the number of proximity jobs per inhabitant. We observe that the minimum number of service jobs per inhabitant is smaller in small municipalities. Moreover, for municipalities of similar sizes, when the distance to the MFM increases, we find that the number of jobs of proximity services per inhabitant increases.Comment: 6 pages, 5 figure

Correlates of Snake Entanglement in Erosion Control Blankets

In road construction projects across the United States, erosion control methods (e.g., erosion control blankets [ECBs]), are mandated to stimulate seedbed regeneration and prevent soil loss. Previous reports have suggested that snakes are vulnerable to entanglement in ECBs. We conducted a literature review, field surveys, and an entanglement experiment to examine what factors increase a snake’s risk of ECB entanglement. Our literature review produced reports of 175 reptiles entangled in mesh products, 89.1% of which were snakes, with 43.6% of snake entanglements occurring in erosion control products. During our field surveys, we found 10 entangled snakes (n = 2 alive; n = 8 dead). From our experiment, we found that ECBs that contain fixed‐intersection, small‐diameter mesh consisting of polypropylene were significantly more likely to entangle snakes compared with ECBs with larger diameter polypropylene mesh or ECBs that have woven mesh made of natural fibers. Snake body size was also associated with entanglement; for every 1‐mm increase in body circumference, the probability of entanglement increased 4%. These results can help construct a predictive framework to determine those species and individuals that are most vulnerable to entanglement

Rethinking the Poverty-disease Nexus: the Case of HIV/AIDS in South Africa

While it is well-established that poverty and disease are intimately connected, the nature of this connection and the role of poverty in disease causation remains contested in scientific and social studies of disease. Using the case of HIV/AIDS in South Africa and drawing on a theoretically grounded analysis, this paper reconceptualises disease and poverty as ontologically entangled. In the context of the South African HIV epidemic, this rethinking of the poverty-disease dynamic enables an account of how social forces such as poverty become embodied in the very substance of disease to produce ontologies of HIV/AIDS unique to South Africa

Financial impact of reducing door-to-balloon time in ST-elevation myocardial infarction: a single hospital experience

<p>Abstract</p> <p>Background</p> <p>The impact of reducing door-to-balloon time on hospital revenues, costs, and net income is unknown.</p> <p>Methods</p> <p>We prospectively determined the impact on hospital finances of (1) emergency department physician activation of the catheterization lab and (2) immediate transfer of the patient to an immediately available catheterization lab by an in-house transfer team consisting of an emergency department nurse, a critical care unit nurse, and a chest pain unit nurse. We collected financial data for 52 consecutive ST-elevation myocardial infarction patients undergoing emergency percutaneous intervention from October 1, 2004–August 31, 2005 and compared this group to 80 consecutive ST-elevation myocardial infarction patients from September 1, 2005–June 26, 2006 after protocol implementation.</p> <p>Results</p> <p>Per hospital admission, insurance payments (hospital revenue) decreased ($35,043 ±$36,670 vs. $25,329 ±$16,185, P = 0.039) along with total hospital costs ($28,082 ±$31,453 vs. $18,195 ±$9,242, P = 0.009). Hospital net income per admission was unchanged ($6962 vs.$7134, P = 0.95) as the drop in hospital revenue equaled the drop in costs. For every $1000 reduction in total hospital costs, insurance payments (hospital revenue) dropped$1077 for private payers and $1199 for Medicare/Medicaid. A decrease in hospital charges ($70,430 ± $74,033 vs.$53,514 ± $23,378, P = 0.059), diagnosis related group relative weight (3.7479 ± 2.6731 vs. 2.9729 ± 0.8545, P = 0.017) and outlier payments with hospital revenue>$100,000 (7.7% vs. 0%, P = 0.022) all contributed to decreasing ST-elevation myocardial infarction hospitalization revenue. One-year post-discharge financial follow-up revealed similar results: Insurance payments: $49,959 ±$53,741 vs. $35,937 ±$23,125, P = 0.044; Total hospital costs: $39,974 ±$37,434 vs. $26,778 ±$15,561, P = 0.007; Net Income: $9984 vs.$9159, P = 0.855.</p> <p>Conclusion</p> <p>All of the financial benefits of reducing door-to-balloon time in ST-elevation myocardial infarction go to payers both during initial hospitalization and after one-year follow-up.</p> <p>Trial Registration</p> <p><b>ClinicalTrials.gov ID</b>: NCT00800163</p

Obliteration of radical cavities with autogenous cortical bone; long-term results

<p>Abstract</p> <p>Background</p> <p>To evaluate the long-term surgical outcome(s) in patients who have undergone canal-wall-down operation with mastoid and epitympanic obliteration using autologous cortical bone chips, bone pate and meatally-based musculoperiosteal flap technique.</p> <p>Method</p> <p>Retrospective evaluation of seventy patients operated during 1986–1991 due to a cholesteatoma. An otomicroscopy was performed to evaluate the postoperative outer ear canal configuration with a modified Likert scale (1 – 4). The outer ear canal physical volume was assessed by tympanometry. The hearing outcome and a patient-filled questionnaire were also analyzed.</p> <p>Results</p> <p>The posterior wall results were 1.8 (± 0.9 SD) and the attic region 1.8 (± 0.9 SD) (ns., p > 0.05). These values show either no cavity formation or minor formation of a cavity, with a good functional result. The mean volume of the operated ear canal was 1.7 (± 0.5 SD) ml. The volume of the contralateral ear canal was 1.2 (± 0.3 SD) ml (*** p < 0.0001). A comparison of the current mean ABG to the preoperative mean ABG and to the ABG at one-year postoperatively, 5-years postoperatively or 10-years postoperatively showed no statistical significance (p > 0.05).</p> <p>Conclusion</p> <p>ABG does not significantly change in the long-term. The configuration of the cavity tends to change, however, the obliteration material is stable in the long-term and clinically significant cavitation rarely occurs.</p

Andalusia, Spain: An Assessment of Coastal Scenery

The 1101 km length of the Andalusian coast (Spain) was assessed for coastal scenery at 45 specific locations. Selected areas covered resort (3), urban (19), village (8), rural (10) and remote (5) bathing areas. Scenery was analyzed for physical and human parameters via 26 selected parameters. These parameters were obtained by interviews of 4500 people on European beaches. Each parameter was assessed via a one-to-five-point attribute scale, which essentially ranged from presence/absence or poor quality (1), to excellent/outstanding (5). Results were subsequently weighted by interviewing 4600 bathing area users (not all 26 parameters have equal weight) and subjected to fuzzy logic mathematics in order to reduce recorder subjectivity. High weighted averages for attributes 4 and 5 (excellent/outstanding) reflected high scenic quality, vice versa for attributes 1 and 2. Sites were classified into five classes ranging from Class 1 sites having top grade scenery to Class 5, poor scenery. Seven sites each were found in Classes 1 and 2; 10 sites each in Classes 3 and 5; 11 sites in Class 4. The finest coastal scenery was found in remote areas whilst urban areas scored mainly as Class 3 or 4. Three out of the ten rural sites had Class 3 and 4 values assigned them whereas the rest scored as Class 1 and 2; village sites invariably had scores within Class 3 and 4. Of the three resort sites investigated, one scored as a Class 1 site, the others as Class 3