Healthcare Price Transparency: Policy Approaches and Estimated Impacts on Spending

Healthcare price transparency discussions typically focus on increasing patients' access to information about their out-of-pocket costs, but that focus is too narrow and should include other audiences -- physicians, employers, health plans and policymakers -- each with distinct needs and uses for healthcare price information. Greater price transparency can reduce U.S. healthcare spending.For example, an estimated $100 billion could be saved over the next 10 years if three select interventions were undertaken. However, most of the projected savings come from making price information available to employers and physicians, according to an analysis by researchers at the former Center for Studying Health System Change (HSC). Based on the current availability and modest impact of plan-based transparency tools, requiring all private plans to provide personalized out-of-pocket price data to enrollees would reduce total health spending by an estimated$18 billion over the next decade. While $18 billion is a substantial dollar amount, it is less than a tenth of a percent of the$40 trillionin total projected health spending over the same period. In contrast, using state all-payer claims databases to gather and report hospital-specific prices might reduce spending by an estimated $61 billion over 10 years.The effects of price transparency depend critically on the intended audience, the decision-making context and how prices are presented. And the impact of price transparency can be greatly amplified if target audiences are able and motivated to act on the information. Simply providing prices is insufficient to control spending without other shifts in healthcare financing, including changes in benefit design to make patients more sensitive to price differences among providers and alternative treatments. Other reforms that can amplify the impact of price transparency include shifting from fee-for-service payments that reward providers for volume to payment methods that put providers at risk for spending for episodes of care or defined patient populations. While price transparency alone seems unlikely to transform the healthcare system, it can play a needed role in enabling effective reforms in value-based benefit design and provider payment

ISO-LWS grating spectroscopy: the case of R CrA star forming region

We present the far infrared spectra of the R CrA star forming region obtained with ISO-LWS. We collected a pointed observation on the Herbig Ae star R CrA and a raster scan covering the surrounding region, where HH100 (with its exciting source) and the pre-Main Sequence star T CrA are located. The OI 63μm and the CII 158μm lines have been detected in all the pointed positions, with a ratio consistent with PDR excitation. CO rotational lines (between Jup=14 and Jup=19) are detected on R CrA; from their intensities we derived, using a LVG model, the density and temperature of the emitting region. Other molecular transitions (OH and H2O) have been detected on the investigated objects; the derived cooling of all the molecular species is in agreement with C-shock as the likely excitation mechanism. The continuum emission of R CrA peaks around 100μm (as expected for a Herbig star) while the other sources (T CrA, HH100) show increasing continua up to ~200μm, indicating that they are probably less evolved sources

Strong H₂O and high-<i>J</i> CO emission towards the Class 0 protostar L1448-mm

The spectrum of the Class 0 source L1448-mm has been measured over the wavelength range extending from 6 to 190 μm with the Long Wavelength Spectrometer (LWS) and the Short Wavelength Spectrometer (SWS) on the Infrared Space Observatory (ISO). The far infrared spectrum is dominated by strong emission from gaseous H2O and from CO transitions with rotational quantum numbers J ≥ 14; in addition, the H2 pure rotational lines S(3), S(4) and S(5), the OH fundamental line at 119 μm, as well as emission from [O I]63 μm and [C II] 158 μm are also observed. The strong CO and water emission can be consistently explained as originating in a warm gas component at T ~ 700-1400 K and nH2~(3-50) 104cm-3 , which fills about 0.2-2% of the ~ 75" LWS field of view (corresponding, assuming a single emitting region, to a physical size of about (3-12)" or (0.5-2) 10-2 pc at d = 300 pc). We derive an H2O/CO abundance ratio ~ 5, which, assuming a standard CO/H2 abundance of 10-4, corresponds to H2O/H2 ~ 5 10-4. This value implies that water is enhanced by about a factor ~ 103 with respect to its expected abundance in the ambient gas. This is consistent with models of warm shocked regions which predict that most of the free atomic oxygen will be rapidly converted into water once the temperature of the post-shocked gas exceeds ~ 300 K. The relatively high density and compact size inferred for this emission may suggest an origin in the shocked region along the molecular jet traced by SiO and EHV CO millimeter line emission. Further support is given by the fact that the observed enhancement in H2O can be explained by shock conditions similar to those expected to produce the abundant SiO observed in the region. L1448-mm shows the largest water abundance so far observed by ISO amongst young sources displaying outflow activity; we argue that the occurrence of multiple shocks over a relatively short interval of time, like that evidenced in the surroundings of L1448-mm, could have contributed to enrich the molecular jet with a high H2O column density

Reducing prolonged sedentary time using a treadmill desk acutely improves cardiometabolic risk markers in male and female adults

The objectives of this study were to evaluate the acute effects of interrupting prolonged sitting with an accumulated 2 h of light-intensity walking on postprandial cardiometabolic risk markers. In this randomised crossover trial, 24 participants (twelve males) aged 18-55 years took part in two, 6.5 h conditions: 1) prolonged sitting (SIT) and 2) sitting interrupted hourly with 20 min light-intensity treadmill desk walking at between 1.2-3.5 km/h-1 (INT-SIT). Standardized meals were provided at 0 h and 3 h. Blood samples and blood pressure measures were taken hourly. Statistical analyses were completed using linear mixed models. Postprandial incremental area under the curve responses (mmol/L∙6.5 h) for glucose (4.52 [3.47, 5.56] and 6.66 [5.62, 7.71] for INT-SIT and SIT, respectively) and triglycerides (1.96 [0.96, 2.96] and 2.71 [1.70, 3.71] mmol/L∙6.5 h, for INT-SIT and SIT, respectively) were significantly lower in INT-SIT than SIT. Mean systolic and diastolic blood pressure responses were lower by 3% and 4%, respectively, in INT-SIT than SIT (P0.05). These findings suggest that interrupting sitting with an accumulated 2 h of light-intensity walking acutely improves cardiometabolic risk levels in males and females compared with prolonged sitting

Intuitionistc probability and the Bayesian objection to dogmatism

Given a few assumptions, the probability of a conjunction is raised, and the probability of its negation is lowered, by conditionalising upon one of the conjuncts. This simple result appears to bring Bayesian confirmation theory into tension with the prominent dogmatist view of perceptual justification – a tension often portrayed as a kind of ‘Bayesian objection’ to dogmatism. In a recent paper, David Jehle and Brian Weatherson observe that, while this crucial result holds within classical probability theory, it fails within intuitionistic probability theory. They conclude that the dogmatist who is willing to take intuitionistic logic seriously can make a convincing reply to the Bayesian objection. In this paper, I argue that this conclusion is premature – the Bayesian objection can survive the transition from classical to intuitionistic probability, albeit in a slightly altered form. I shall conclude with some general thoughts about what the Bayesian objection to dogmatism does and doesn’t show

Widespread association between the ericoid mycorrhizal fungus Rhizoscyphus ericae and a leafy liverwort in the maritime and sub-Antarctic

A recent study identified a fungal isolate from the Antarctic leafy liverwort Cephaloziella varians as the ericoid mycorrhizal associate Rhizoscyphus ericae. However, nothing is known about the wider Antarctic distribution of R. ericae in C. varians, and inoculation experiments confirming the ability of the fungus to form coils in the liverwort are lacking. Using direct isolation and baiting with Vaccinium macrocarpon seedlings, fungi were isolated from C. varians sampled from eight sites across a 1875-km transect through sub- and maritime Antarctica. The ability of an isolate to form coils in aseptically grown C. varians was also tested. Fungi with 98–99% sequence identity to R. ericae internal transcribed spacer (ITS) region and partial large subunit ribosomal (r)DNA sequences were frequently isolated from C. varians at all sites sampled. The EF4/Fung5 primer set did not amplify small subunit rDNA from three of five R. ericae isolates, probably accounting for the reported absence of the fungus from C. varians in a previous study. Rhizoscyphus ericae was found to colonize aseptically-grown C. varians intracellularly, forming hyphal coils. This study shows that the association between R. ericae and C. varians is apparently widespread in Antarctica, and confirms that R. ericae is at least in part responsible for the formation of the coils observed in rhizoids of field-collected C. varians

Magneto-optical spectra of closely spaced magnetite nanoparticles

The Faraday rotation spectrum of composites containing magnetite nanoparticles is found to be dependent on the interparticle spacing of the constituent nanoparticles. The composite materials are prepared by combining chemically synthesized Fe 3O4 smagnetited nanoparticles s8-nm diameterd and polysmethylmethacrylated . Composites are made containing a range of nanoparticle concentrations. The peak of the main spectral feature depends on nanoparticle concentration; this peak is observed to shift from approximately 470 nm for sdilute compositesd to 540 nm concentrated . We present a theory based on the discrete-dipole approximation which accounts for optical coupling between magnetite particles. Qualitative correlations between theoretical calculations and experimental data suggest that the shifts in spectral peak position depend on both interparticle distance and geometrical configuratio

Male frequent attenders of general practice and their help seeking preferences

Background: Low rates of health service usage by men are commonly linked to masculine values and traditional male gender roles. However, not all men conform to these stereotypical notions of masculinity, with some men choosing to attend health services on a frequent basis, for a variety of different reasons. This study draws upon the accounts of male frequent attenders of the General Practitioner's (GP) surgery, examining their help-seeking preferences and their reasons for choosing services within general practice over other sources of support. Methods: The study extends thematic analysis of interview data from the Self Care in Primary Care study (SCinPC), a large scale multi-method evaluation study of a self care programme delivered to frequent attenders of general practice. Data were collected from 34 semi-structured interviews conducted with men prior to their exposure to the intervention. Results: The ages of interviewed men ranged from 16 to 72 years, and 91% of the sample (n= 31) stated that they had a current health condition. The thematic analysis exposed diverse perspectives within male help-seeking preferences and the decision-making behind men's choice of services. The study also draws attention to the large variation in men's knowledge of available health services, particularly alternatives to general practice. Furthermore, the data revealed some men's lack of confidence in existing alternatives to general practice. Conclusions: The study highlights the complex nature of male help-seeking preferences, and provides evidence that there should be no 'one size fits all' approach to male service provision. It also provides impetus for conducting further studies into this under researched area of interest. © 2011 WPMH GmbH

Elasticity model of a supercoiled DNA molecule

Within a simple elastic theory, we study the elongation versus force characteristics of a supercoiled DNA molecule at thermal equilibrium in the regime of small supercoiling. The partition function is mapped to the path integral representation for a quantum charged particle in the field of a magnetic monopole with unquantized charge. We show that the theory is singular in the continuum limit and must be regularised at an intermediate length scale. We find good agreement with existing experimental data, and point out how to measure the twist rigidity accurately.Comment: Latex, 4 pages. The figure contains new experimental data, giving a new determination of the twist rigidit