Identifying, Monitoring, and Assessing Promising Innovations: Using Evaluation to Support Rapid-Cycle Change

Examines the new Center for Medicare and Medicaid Innovation's mission, critical issues, and challenges in finding effective ways to raise healthcare quality and lower costs, documenting innovation, and providing evidence to support broad policy change

Harnessing Health Care Markets for the Public Interest: Insights for U.S. Health Reform From the German and Dutch Multipayer Systems

Outlines how the German and Dutch systems offer universal coverage via competing insurance plans and promote effective and efficient care. Highlights insurance exchanges, multipayer policies and group purchasing, information systems, and public reporting

The Group Employed Model as a Foundation for Health Care Delivery Reform

Outlines group employed models, with salaried primary and specialty care physicians and quality of care- and satisfaction-based incentives as high-quality, low-cost alternatives to fee-for-service; elements of success; and implications beyond Medicare

Stochastic thermodynamic bounds on logical circuit operation

Using a thermodynamically consistent, mesoscopic model for modern complementary metal-oxide-semiconductor transistors, we study an array of logical circuits and explore how their function is constrained by recent thermodynamic uncertainty relations when operating near thermal energies. For a single NOT gate, we find operating direction-dependent dynamics, and an optimal trade-off between dissipated heat and operation time certainty. For a memory storage device, we find an exponential relationship between the memory retention time and energy required to sustain that memory state. For a clock, we find that the certainty in the cycle time is maximized at biasing voltages near thermal energy, as is the trade-off between this certainty and the heat dissipated per cycle. We demonstrate that a simple control mechanism for the clock leads to a monotonic increase in cycle time certainty with biasing voltage alleviating its degradation at large biasing voltages. These results provide a framework for assessing thermodynamic costs of realistic computing devices, allowing for circuits to be designed and controlled for thermodynamically optimal operation.Comment: 6 pages, 3 figure

Neurosteroid Influences on Sensitivity to Ethanol

This review will highlight a variety of mechanisms by which neurosteroids affect sensitivity to ethanol, including physiological states associated with activity of the hypothalamic–pituitary–adrenal (HPA) and hypothalamic–pituitary–gonadal (HPG) axes, and the effects of chronic exposure to ethanol, in addition to behavioral implications. To date, γ-aminobutyric acid (GABAA) receptor mechanisms are a major focus of the modulation of ethanol effects by neuroactive steroids. While NMDA receptor mechanisms are gaining prominence in the literature, these complex data would be best discussed separately. Accordingly, GABAA receptor mechanisms are emphasized in this review with brief mention of some NMDA receptor mechanisms to point out contrasting neuroactive steroid pharmacology. Overall, the data suggest that neurosteroids are virtually ubiquitous modulators of inhibitory neurotransmission. Neurosteroids appear to affect sensitivity to ethanol in specific brain regions and, consequently, specific behavioral tests, possibly related to the efficacy and potency of ethanol to potentiate the release of GABA and increase neurosteroid concentrations. Although direct interaction of ethanol and neuroactive steroids at common receptor binding sites has been suggested in some studies, this proposition is still controversial. It is currently difficult to assign a specific mechanism by which neuroactive steroids could modulate the effects of ethanol in particular behavioral tasks

Health reform requires policy capacity

Health reform requires policy capacity Pierre-Gerlier Forest 1 * , Jean-Louis Denis 2 , Lawrence D. Brown 3 , David Helms 4 Abstract Among the many reasons that may limit the adoption of promising reform ideas, policy capacity is the least recognized. The concept itself is not widely understood. Although policy capacity is concerned with the gathering of information and the formulation of options for public action in the initial phases of policy consultation and development, it also touches on all stages of the policy process, from the strategic identification of a problem to the actual development of the policy, its formal adoption, its implementation, and even further, its evaluation and continuation or modification. Expertise in the form of policy advice is already widely available in and to public administrations, to well-established professional organizations like medical societies and, of course, to large private-sector organizations with commercial or financial interests in the health sector. We need more health actors to join the fray and move from their traditional position of advocacy to a fuller commitment to the development of policy capacity, with all that it entails in terms of leadership and social responsibilit

Development of Ecogeomorphological (EGM) Stream Design and Assessment Tools for the Piedmont of Alabama, USA

Regional data needed for effective stream restoration include hydraulic geometry relationships (i.e., regional curves) and reference channel morphology parameters. Increasingly ecological conditions are being considered when designing, implementing, and assessing restoration efforts. We provide morphology relationships and associated ecological endpoint curves for reference streams in the Alabama piedmont. Twenty-one reference stream reaches were identified in the Tallapoosa drainage of Alabama, ranging from 0.2 to 242 km2 drainage area. Geomorphic surveys were conducted in each stream to measure riffle cross-sections and longitudinal profiles and related to drainage area to develop regional curves. Fish, crayfish, and benthic macroinvertebrates were collected from each surveyed reach and related to drainage area and geomorphic data to provide associated biological community endpoints. Bankfull channel cross-section area, width, mean depth, and estimated discharge were strongly correlated to watershed drainage area, similar to efforts in other areas of the Piedmont ecoregion. Multiple measures of fish assemblages and crayfish size were strongly predicted by drainage area and geomorphic dimensions. Macroinvertebrates showed no taxonomic and limited functional relationships with drainage area and geomorphic dimension. These tools, which integrate geomorphological and ecological conditions, can result in improved stream evaluations and designs increasing the effectiveness of stream restoration projects

The Mechanical Properties of Individual, Electrospun Fibrinogen Fibers

We used a combined atomic force microscope (AFM)/fluorescence microscope technique to study the mechanical properties of individual, electrospun fibrinogen fibers in aqueous buffer. Fibers (average diameter 208 nm) were suspended over 12 μm-wide grooves in a striated, transparent substrate. The AFM, situated above the sample, was used to laterally stretch the fibers and to measure the applied force. The fluorescence microscope, situated below the sample, was used to visualize the stretching process. The fibers could be stretched to 2.3 times their original length before breaking; the breaking stress was 22·106 Pa. We collected incremental stress-strain curves to determine the viscoelastic behavior of these fibers. The total stretch modulus was 16·106 Pa and the relaxed, elastic modulus was 6.7·106 Pa. When held at constant strain, electrospun fibrinogen fibers showed a fast and slow stress relaxation time of 3 and 56 seconds. Our fibers were spun from the typically used 90% 1,1,1,3,3,3-hexafluoro-2-propanol (90-HFP) electrospinning solution and resuspended in aqueous buffer. Circular dichroism spectra indicate that alpha-helical content of fibrinogen is ~70% higher in 90-HFP than in aqueous solution. These data are needed to understand the mechanical behavior of electrospun fibrinogen structures. Our technique is also applicable to study other, nanoscopic fibers