The New Politics of US Health Care Prices: Institutional Reconfiguration and the Emergence of All-Payer Claims Databases

Prices are a significant driver of health care cost in the United States. Existing research on the politics of health system reform has emphasized the limited nature of policy entrepreneurs’ efforts at solving the problem of rising prices through direct regulation at the state level. Yet this literature fails to account for how change agents in the states gradually reconfigured the politics of prices, forging new, transparency-based policy instruments called all-payer claims databases (APCDs), which are designed to empower consumers, purchasers, and states to make informed market and policy choices. Drawing on pragmatist institutional theory, this article shows how APCDs emerged as the dominant model for reforming health care prices. While APCD advocates faced significant institutional barriers to policy change, we show how they reconfigured existing ideas, tactical repertoires, and legal-technical infrastructures to develop a politically and technologically robust reform. Our analysis has important implications for theories of how change agents overcome structural barriers to health reform

Changing Adolescents\u27 Attitudes About Relational and Physical Aggression: An Early Evaluation of a School-Based Intervention

A pilot study evaluating the Second Step, Middle School/Junior High®program was conducted to determine its effect on students’ attitudes regarding aggression and perceived difficulty of performing social skills. Sixth-through eighth-grade students (N = 714) were surveyed before and after the pro-gram was implemented by teachers in intervention classrooms. Second Step students were taught curricular modules corresponding to their year in middle/junior high school. Program effects were tested using a repeated measures design. Relative to nonparticipants, Second Step students in their second year of school de-creased in their overall endorsement of aggression and perceived difficulty of per-forming social skills. Program effects were less consistent for those in their first year of middle/junior high school. Additional research is needed to investigate program effects under varying conditions (e.g., lesson quality, pacing of lessons) and with long-term exposure

Polarization of Broad Absorption Line QSOs I. A Spectropolarimetric Atlas

We present a spectropolarimetric survey of 36 broad absorption line quasi-stellar objects (BAL QSOs). The continuum, absorption trough, and emission line polarization of BAL QSOs yield clues about their structure. We confirm that BAL QSOs are in general more highly polarized than non-BAL QSOs, consistent with a more equatorial viewing direction for the former than the latter. We have identified two new highly-polarized QSOs in our sample (1232+1325 and 1333+2840). The polarization rises weakly to the blue in most objects, perhaps due to scattering and absorption by dust particles. We find that a polarization increase in the BAL troughs is a general property of polarized BAL QSOs, indicating an excess of scattered light relative to direct light, and consistent with the unification of BAL QSOs and non-BAL QSOs. We have also discovered evidence of resonantly scattered photons in the red wing of the C IV broad emission lines of a few objects. In most cases, the broad emission lines have lower polarization and a different position angle than the continuum. The polarization characteristics of low-ionization BAL QSOs are similar to those of high-ionization BAL QSOs, suggesting a similar BAL wind geometry.Comment: 39 pages, 6 figures (20 .gif files), accepted for publication in The Astrophysical Journal Supplement

A "superstorm": When moral panic and new risk discourses converge in the media

This is an Author's Accepted Manuscript of an article published in Health, Risk and Society, 15(6), 681-698, 2013, copyright Taylor & Francis, available online at: http://www.tandfonline.com/10.1080/13698575.2013.851180.There has been a proliferation of risk discourses in recent decades but studies of these have been polarised, drawing either on moral panic or new risk frameworks to analyse journalistic discourses. This article opens the theoretical possibility that the two may co-exist and converge in the same scare. I do this by bringing together more recent developments in moral panic thesis, with new risk theory and the concept of media logic. I then apply this theoretical approach to an empirical analysis of how and with what consequences moral panic and new risk type discourses converged in the editorials of four newspaper campaigns against GM food policy in Britain in the late 1990s. The article analyses 112 editorials published between January 1998 and December 2000, supplemented with news stories where these were needed for contextual clarity. This analysis shows that not only did this novel food generate intense media and public reactions; these developed in the absence of the type of concrete details journalists usually look for in risk stories. Media logic is important in understanding how journalists were able to engage and hence how a major scare could be constructed around convergent moral panic and new risk type discourses. The result was a media ‘superstorm’ of sustained coverage in which both types of discourse converged in highly emotive mutually reinforcing ways that resonated in a highly sensitised context. The consequence was acute anxiety, social volatility and the potential for the disruption of policy and social change

The masses of the millisecond pulsar J1012+5307 and its white-dwarf companion

We report on spectroscopy of the white-dwarf companion of the millisecond radio pulsar PSR J1012+5307. We find strong Balmer absorption lines, as would be expected for a cool DA white dwarf. The profiles are much narrower than usual, however, and lines are seen up to H12, indicating that the companion has a low gravity and hence a low mass. This is consistent with the expectation---based on evolutionary considerations and on the mass function---that it is a low-mass white dwarf with a helium core. By comparing the spectra to model atmospheres, we derive an effective temperature $T_{\rm{}eff}=8550\pm25\,$K and a surface gravity $\log{}g=6.75\pm0.07$ (cgs units). Using the Hamada-Salpeter mass-radius relation for helium white dwarfs, with an approximate correction for finite-temperature effects, we infer a mass \mwd=0.16\pm0.02\,\msun. This is the lowest mass among all spectroscopically identified white dwarfs. We determine radial velocities from our spectra, and find a radial-velocity amplitude of 280\pm15\,\kms. With the pulsar's radial-velocity amplitude, the mass ratio \mpsr/\mwd=13.3\pm0.7. From all constraints, we find that with 95\% confidence 1.5<\mpsr/\msun<3.2.Comment: 6 pages of text and figures. Refereed version, resubmitted to ApJL. Needs aas2pp4.sty, epsf.st

Evidence for a companion to BM Gem, a silicate carbon star

Balmer and Paschen continuum emission as well as Balmer series lines of P Cygni-type profile from H_gamma through H_23 are revealed in the violet spectra of BM Gem, a carbon star associated with an oxygen-rich circumstellar shell (`silicate carbon star') observed with the high dispersion spectrograph (HDS) on the Subaru telescope. The blue-shifted absorption in the Balmer lines indicates the presence of an outflow, the line of sight velocity of which is at least 400 km s^-1, which is the highest outflow velocity observed to date in a carbon star. We argue that the observed unusual features in BM Gem are strong evidence for the presence of a companion, which should form an accretion disk that gives rise to both an ionized gas region and a high velocity, variable outflow. The estimated luminosity of ~0.2 (0.03-0.6) L_sun for the ionized gas can be maintained by a mass accretion rate to a dwarf companion of ~10^-8 M_sun yr^-1, while ~10^-10 M_sun yr^-1 is sufficient for accretion to a white dwarf companion. These accretion rates are feasible for some detached binary configurations on the basis of the Bond-Hoyle type accretion process. We concluded that the carbon star BM Gem is in a detached binary system with a companion of low mass and low luminosity. However, we are unable to determine whether this companion object is a dwarf or a white dwarf. The upper limits for binary separation are 210 AU and 930 AU for a dwarf and a white dwarf, respectively. We also note that the observed features of BM Gem mimic those of Mira (omi Cet), which may suggest actual similarities in their binary configurations and circumstellar structures.Comment: 11 pages, 2 figures, 1 table, accepted for publication in Ap

The Apache Point Observatory Galactic Evolution Experiment (APOGEE) Spectrographs

We describe the design and performance of the near-infrared (1.51--1.70 micron), fiber-fed, multi-object (300 fibers), high resolution (R = lambda/delta lambda ~ 22,500) spectrograph built for the Apache Point Observatory Galactic Evolution Experiment (APOGEE). APOGEE is a survey of ~ 10^5 red giant stars that systematically sampled all Milky Way populations (bulge, disk, and halo) to study the Galaxy's chemical and kinematical history. It was part of the Sloan Digital Sky Survey III (SDSS-III) from 2011 -- 2014 using the 2.5 m Sloan Foundation Telescope at Apache Point Observatory, New Mexico. The APOGEE-2 survey is now using the spectrograph as part of SDSS-IV, as well as a second spectrograph, a close copy of the first, operating at the 2.5 m du Pont Telescope at Las Campanas Observatory in Chile. Although several fiber-fed, multi-object, high resolution spectrographs have been built for visual wavelength spectroscopy, the APOGEE spectrograph is one of the first such instruments built for observations in the near-infrared. The instrument's successful development was enabled by several key innovations, including a "gang connector" to allow simultaneous connections of 300 fibers; hermetically sealed feedthroughs to allow fibers to pass through the cryostat wall continuously; the first cryogenically deployed mosaic volume phase holographic grating; and a large refractive camera that includes mono-crystalline silicon and fused silica elements with diameters as large as ~ 400 mm. This paper contains a comprehensive description of all aspects of the instrument including the fiber system, optics and opto-mechanics, detector arrays, mechanics and cryogenics, instrument control, calibration system, optical performance and stability, lessons learned, and design changes for the second instrument.Comment: 81 pages, 67 figures, PASP, accepte