Supply sensitive services in Swiss ambulatory care: An analysis of basic health insurance records for 2003-2007

<p>Abstract</p> <p>Background</p> <p>Swiss ambulatory care is characterized by independent, and primarily practice-based, physicians, receiving fee for service reimbursement. This study analyses supply sensitive services using ambulatory care claims data from mandatory health insurance. A first research question was aimed at the hypothesis that physicians with large patient lists decrease their intensity of services and bill less per patient to health insurance, and vice versa: physicians with smaller patient lists compensate for the lack of patients with additional visits and services. A second research question relates to the fact that several cantons are allowing physicians to directly dispense drugs to patients ('self-dispensation') whereas other cantons restrict such direct sales to emergencies only. This second question was based on the assumption that patterns of rescheduling patients for consultations may differ across channels of dispensing prescription drugs and therefore the hypothesis of different consultation costs in this context was investigated.</p> <p>Methods</p> <p>Complete claims data paid for by mandatory health insurance of all Swiss physicians in own practices were analyzed for the years 2003-2007. Medical specialties were pooled into six main provider types in ambulatory care: primary care, pediatrics, gynecology & obstetrics, psychiatrists, invasive and non-invasive specialists. For each provider type, regression models at the physician level were used to analyze the relationship between the number of patients treated and the total sum of treatment cost reimbursed by mandatory health insurance.</p> <p>Results</p> <p>The results show non-proportional relationships between patient numbers and total sum of treatment cost for all provider types involved implying that treatment costs per patient increase with higher practice size. The related additional costs to the health system are substantial. Regions with self-dispensation had lowest treatment cost for primary care, gynecology, pediatrics and for psychiatrists whereas "prescription only" areas had lowest cost for specialists with non-invasive and invasive activities.</p> <p>Conclusions</p> <p>The results indicate that payment methods for services and for prescription drugs are associated with variations in treatment cost that are unlikely warranted by different medical needs of patients alone. Promoting physician accountability of care by linking reimbursements to quality, not quantity, of services are important policy measures to be considered for health care in Switzerland.</p

Resposta fisiológica de ovinos da raça Santa Inês alimentados com diferentes níveis de farelo de manga em substituição ao milho.

O experimento foi delineado para avaliar o efeito da substituição do milho por farelo de manga e medir os efeitos das condições climáticas ao longo do dia sobre os parâmetros fisiológicos: temperatura retal (TR), temperatura Superficial (TS) e freqüência respiratória (FR), em ovinos da raça Santa Inês, criados em confinamento em clima semi-árido. Ovinos machos castrados (n = 16) foram submetidos a quatro dietas com diferentes níveis de substituição do milho por farelo de manga. A TR, TS e FR foram medidas a cada hora durante dois períodos de 24 horas. Adotou-se o delineamento de blocos casualizados, com quatro repetições, em esquema fatorial 4 x 12 (níveis de inclusão de farelo de manga x horários de avaliação dos parâmetros fisiológicos). Não foi observado influência da dieta na TR, TS e FR dos ovinos, entretanto observou-se a influência das condições climáticas

Precision Measurement of the Neutron Spin Asymmetry A1nA_1^n and Spin-Flavor Decomposition in the Valence Quark Region

We have measured the neutron spin asymmetry $A_1^n$ with high precision at three kinematics in the deep inelastic region at $x=0.33$, 0.47 and 0.60, and $Q^2=2.7$, 3.5 and 4.8 (GeV/c)$^2$, respectively. Our results unambiguously show, for the first time, that $A_1^n$ crosses zero around $x=0.47$ and becomes significantly positive at $x=0.60$. Combined with the world proton data, polarized quark distributions were extracted. Our results, in general, agree with relativistic constituent quark models and with perturbative quantum chromodynamics (pQCD) analyses based on the earlier data. However they deviate from pQCD predictions based on hadron helicity conservation.Comment: 5 pages, 2 figures, this is the final version appeared in Phys. Rev. Let

Precision Measurement of the Neutron Spin Asymmetries and Spin-dependent Structure Functions in the Valence Quark Region

We report on measurements of the neutron spin asymmetries $A_{1,2}^n$ and polarized structure functions $g_{1,2}^n$ at three kinematics in the deep inelastic region, with $x=0.33$, 0.47 and 0.60 and $Q^2=2.7$, 3.5 and 4.8 (GeV/c)$^2$, respectively. These measurements were performed using a 5.7 GeV longitudinally-polarized electron beam and a polarized $^3$He target. The results for $A_1^n$ and $g_1^n$ at $x=0.33$ are consistent with previous world data and, at the two higher $x$ points, have improved the precision of the world data by about an order of magnitude. The new $A_1^n$ data show a zero crossing around $x=0.47$ and the value at $x=0.60$ is significantly positive. These results agree with a next-to-leading order QCD analysis of previous world data. The trend of data at high $x$ agrees with constituent quark model predictions but disagrees with that from leading-order perturbative QCD (pQCD) assuming hadron helicity conservation. Results for $A_2^n$ and $g_2^n$ have a precision comparable to the best world data in this kinematic region. Combined with previous world data, the moment $d_2^n$ was evaluated and the new result has improved the precision of this quantity by about a factor of two. When combined with the world proton data, polarized quark distribution functions were extracted from the new $g_1^n/F_1^n$ values based on the quark parton model. While results for $\Delta u/u$ agree well with predictions from various models, results for $\Delta d/d$ disagree with the leading-order pQCD prediction when hadron helicity conservation is imposed.Comment: A typing error in A_\parallel(3He) at x=0.47 in Table VII of Phys. Rev. C has been noticed and correcte

Measurements of fiducial and differential cross sections for Higgs boson production in the diphoton decay channel at s√=8 TeV with ATLAS

Measurements of fiducial and differential cross sections are presented for Higgs boson production in proton-proton collisions at a centre-of-mass energy of s√=8 TeV. The analysis is performed in the H → γγ decay channel using 20.3 fb−1 of data recorded by the ATLAS experiment at the CERN Large Hadron Collider. The signal is extracted using a fit to the diphoton invariant mass spectrum assuming that the width of the resonance is much smaller than the experimental resolution. The signal yields are corrected for the effects of detector inefficiency and resolution. The pp → H → γγ fiducial cross section is measured to be 43.2 ±9.4(stat.) − 2.9 + 3.2 (syst.) ±1.2(lumi)fb for a Higgs boson of mass 125.4GeV decaying to two isolated photons that have transverse momentum greater than 35% and 25% of the diphoton invariant mass and each with absolute pseudorapidity less than 2.37. Four additional fiducial cross sections and two cross-section limits are presented in phase space regions that test the theoretical modelling of different Higgs boson production mechanisms, or are sensitive to physics beyond the Standard Model. Differential cross sections are also presented, as a function of variables related to the diphoton kinematics and the jet activity produced in the Higgs boson events. The observed spectra are statistically limited but broadly in line with the theoretical expectations

Measurement of χ c1 and χ c2 production with s√ = 7 TeV pp collisions at ATLAS

The prompt and non-prompt production cross-sections for the χ c1 and χ c2 charmonium states are measured in pp collisions at s√ = 7 TeV with the ATLAS detector at the LHC using 4.5 fb−1 of integrated luminosity. The χ c states are reconstructed through the radiative decay χ c → J/ψγ (with J/ψ → μ + μ −) where photons are reconstructed from γ → e + e − conversions. The production rate of the χ c2 state relative to the χ c1 state is measured for prompt and non-prompt χ c as a function of J/ψ transverse momentum. The prompt χ c cross-sections are combined with existing measurements of prompt J/ψ production to derive the fraction of prompt J/ψ produced in feed-down from χ c decays. The fractions of χ c1 and χ c2 produced in b-hadron decays are also measured

Search for right-handed W bosons in top quark decay

We present a measurement of the fraction f+ of right-handed W bosons produced in top quark decays, based on a candidate sample of $t\bar{t}$ events in the lepton+jets decay mode. These data correspond to an integrated luminosity of 230pb^-1, collected by the DO detector at the Fermilab Tevatron $p\bar{p}$ Collider at sqrt(s)=1.96 TeV. We use a constrained fit to reconstruct the kinematics of the $t\bar{t}$ and decay products, which allows for the measurement of the leptonic decay angle $\theta^*$ for each event. By comparing the $\cos\theta^*$ distribution from the data with those for the expected background and signal for various values of f+, we find f+=0.00+-0.13(stat)+-0.07(syst). This measurement is consistent with the standard model prediction of f+=3.6x10^-4.Comment: Submitted to Physical Review D Rapid Communications 7 pages, 3 figure

Measurement of the production of a W boson in association with a charm quark in pp collisions at √s = 7 TeV with the ATLAS detector

The production of a W boson in association with a single charm quark is studied using 4.6 fb−1 of pp collision data at s√ = 7 TeV collected with the ATLAS detector at the Large Hadron Collider. In events in which a W boson decays to an electron or muon, the charm quark is tagged either by its semileptonic decay to a muon or by the presence of a charmed meson. The integrated and differential cross sections as a function of the pseudorapidity of the lepton from the W-boson decay are measured. Results are compared to the predictions of next-to-leading-order QCD calculations obtained from various parton distribution function parameterisations. The ratio of the strange-to-down sea-quark distributions is determined to be 0.96+0.26−0.30 at Q 2 = 1.9 GeV2, which supports the hypothesis of an SU(3)-symmetric composition of the light-quark sea. Additionally, the cross-section ratio σ(W + +c¯¯)/σ(W − + c) is compared to the predictions obtained using parton distribution function parameterisations with different assumptions about the s−s¯¯¯ quark asymmetry

Measurement of Semileptonic Branching Fractions of B Mesons to Narrow D** States

Using the data accumulated in 2002-2004 with the DO detector in proton-antiproton collisions at the Fermilab Tevatron collider with centre-of-mass energy 1.96 TeV, the branching fractions of the decays B -> \bar{D}_1^0(2420) \mu^+ \nu_\mu X and B -> \bar{D}_2^{*0}(2460) \mu^+ \nu_\mu X and their ratio have been measured: BR(\bar{b}->B) \cdot BR(B-> \bar{D}_1^0 \mu^+ \nu_\mu X) \cdot BR(\bar{D}_1^0 -> D*- pi+) = (0.087+-0.007(stat)+-0.014(syst))%; BR(\bar{b}->B)\cdot BR(B->D_2^{*0} \mu^+ \nu_\mu X) \cdot BR(\bar{D}_2^{*0} -> D*- \pi^+) = (0.035+-0.007(stat)+-0.008(syst))%; and (BR(B -> \bar{D}_2^{*0} \mu^+ \nu_\mu X)BR(D2*0->D*- pi+)) / (BR(B -> \bar{D}_1^{0} \mu^+ \nu_\mu X)\cdot BR(\bar{D}_1^{0}->D*- \pi^+)) = 0.39+-0.09(stat)+-0.12(syst), where the charge conjugated states are always implied.Comment: submitted to Phys. Rev. Let