Creating a performance-driven system

The New York City public school system is in the process of creating the nation's first performance-driven system. Such a system promotes competition, maintains quality, and emphasizes a consistently high level of achievement. The goal of a performance-driven system is to set clear standards and to align resources, policies, and practices with the support that students need to hit the target. The following management principles are used at all levels of the organization: define clear standards, articulate educational strategies designed to enable all students to meet the standards, align all resources, policies, and practices to carry out strategies, track results, and use the data to drive continuous improvement and to hold the entire system accountable for school performance. Sources of value in the system includes standards, the arts, technology, uniforms, and a longer day and a longer year.Education ; New York (N.Y.)

Florida: Round 1 - State-Level Field Network Study of the Implementation of the Affordable Care Act

This report is part of a series of 21 state and regional studies examining the rollout of the ACA. The national network -- with 36 states and 61 researchers -- is led by the Rockefeller Institute of Government, the public policy research arm of the State University of New York, the Brookings Institution, and the Fels Institute of Government at the University of Pennsylvania.Florida's governor and legislative leadership declined to participate in setting up an Affordable Care Act (ACA) exchange and, indeed, refused or returned federal grants awarded to facilitate exchange planning. Instead, the state provided funding for an existing state-funded exchange for small business and individuals unrelated to the ACA that opened with limited services in spring 2014. Florida led the way in opposition to the ACA. Its then attorney general, Republican Bill McCollum, filed suit against the Obama administration aiming to have the law blocked as unconstitutional in both its individual mandate and its requirement for Medicaid expansion

Disseminated cutaneous gout: a rare manifestation of a common disease

Disseminated cutaneous gout is a rare atypical cutaneous manifestation of gout in which widespread dermal and subcutaneous tophi develop at extra-articular body sites. Given the lack of joint involvement that is typically a feature in tophaceous gout, the diagnosis may not be initially suspected. We present the case of a 50-year-old Hispanic man with poorly controlled gout who was evaluated for several years of firm papulonodules over the trunk and upper and lower extremities, sparing the joints; histopathology confirmed, the diagnosis of disseminated cutaneous gout. Per our literature review, disseminated cutaneous gout presents with polymorphous papules and nodules that can mimic other, more common cutaneous diseases. There is a preponderance of cases in males, Asians, and patients with longstanding gout. The lower extremities are involved in nearly all reports. Uric acid-lowering therapy with allopurinol has been reported to decrease the size and number of lesions in a minority of treated patients

Pulmonary outcomes following specialized respiratory management for acute cervical spinal cord injury: a retrospective analysis.

Study designRetrospective analysis.ObjectivesTo identify multivariate interactions of respiratory function that are sensitive to spinal cord injury level and pharmacological treatment to promote strategies that increase successful liberation from mechanical ventilation.SettingUnited States regional spinal cord injury (SCI) treatment center.MethodsRetrospective chart review of patients consecutively admitted to Santa Clara Valley Medical Center between May 2013 and December 2014 for ventilator weaning with C1-C5 American Spinal Injury Association Impairment Scale (AIS) A or B SCI, <3 months from injury and who had a tracheostomy in place. A nonlinear, categorical principal component analysis (NL-PCA) was performed to test the multivariate interaction of respiratory outcomes from patients (N=36) being weaned off ventilator support after acute SCI with (N=15) or without (N=21) theophylline treatment.ResultsIn total, 36 patients met inclusion criteria (2 C1, 5 C2, 11 C3, 14 C4 and 4 C5). The NL-PCA returned three independent components that accounted for 95% of the variance in the data set. Multivariate general linear models hypothesis tests revealed a significant syndromic interaction between theophylline treatment and SCI level (Wilks' Lambda, P=0.028, F (12,64)=2.116, η2=0.256, 1-β=0.838), with post hoc testing demonstrating a significant interaction on PC1, explained by a positive correlation between improved forced vital capacity and time it took to reach 16 h of ventilator-free breathing. Thirty-three patients (92%) achieved 16 h of ventilator-free breathing (VFB) and 30 patients (83%) achieved 24 h of VFB.ConclusionsWe suspect that some portion of the high success rate of ventilator weaning may be attributable to theophylline use in higher cervical SCI, in addition to our aggressive regimen of high volume ventilation, medication optimization and pulmonary toilet (positive pressure treatments and mechanical insufflation-exsufflation)

Free Space Optical Link Utilizing a Modulated Retro-Reflector Intended for Planetary Duplex Communication Links Between an Orbiter and Surface Unit

Presented are simulation and experimental results that provide duplex optical-free space communication links with minimal power and pointing requirements by using a modulated retro-reflector (MRR) for planetary communications. The design is the MRR resides on the surface of a planet or moon, where energy is scarce, while the source of the communication laser resides on an orbiter to achieve satellite-to-ground communications. Also, a simulated scenario using the Mars Reconnaissance Orbiter (MRO) is provided for real world potential results. The information sent through this communication path can range from raw scientific data to multimedia files such as videos and pictures. Bidirectional communications is established with the MRR by using a nested pulse position modulation (PPM) structure. This modulation scheme is then evaluated for its validity in a proof-of-concept experiment. Initial results indicate a promising return-link performance of at least 300 kbps in the nested arrangement