A Search for Intrinsic Polarization in O Stars with Variable Winds

New observations of 9 of the brightest northern O stars have been made with the Breger polarimeter on the 0.9~m telescope at McDonald Observatory and the AnyPol polarimeter on the 0.4~m telescope at Limber Observatory, using the Johnson-Cousins UBVRI broadband filter system. Comparison with earlier measurements shows no clearly defined long-term polarization variability. For all 9 stars the wavelength dependence of the degree of polarization in the optical range can be fit by a normal interstellar polarization law. The polarization position angles are practically constant with wavelength and are consistent with those of neighboring stars. Thus the simplest conclusion is that the polarization of all the program stars is primarily interstellar. The O stars chosen for this study are generally known from ultraviolet and optical spectroscopy to have substantial mass loss rates and variable winds, as well as occasional circumstellar emission. Their lack of intrinsic polarization in comparison with the similar Be stars may be explained by the dominance of radiation as a wind driving force due to higher luminosity, which results in lower density and less rotational flattening in the electron scattering inner envelopes where the polarization is produced. However, time series of polarization measurements taken simultaneously with H-alpha and UV spectroscopy during several coordinated multiwavelength campaigns suggest two cases of possible small-amplitude, periodic short-term polarization variability, and therefore intrinsic polarization, which may be correlated with the more widely recognized spectroscopic variations.Comment: LaTeX2e, 22 pages including 11 tables; 12 separate gif figures; uses aastex.cls preprint package; accepted by The Astronomical Journa

Aiming Higher: Results from a Scorecard on State Health System Performance, 2015 Edition

The fourth Commonwealth Fund Scorecard on State Health System Performance tells a story that is both familiar and new. Echoing the past three State Scorecards, the 2015 edition finds extensive variation among states in people's ability to access care when they need it, the quality of care they receive, and their likelihood of living a long and healthy life. However, this Scorecard—the first to measure the effects of the Affordable Care Act's 2014 coverage expansions—also finds broad-based improvements. On most of the 42 indicators, more states improved than worsened. By tracking performance measures across states, this Scorecard can help policymakers, health system leaders, and the public identify opportunities and set goals for improvement. The 50 states and the District of Columbia are measured and ranked on 42 indicators grouped into five domains: access and affordability, prevention and treatment, avoidable hospital use and cost, healthy lives, and equity. Individual indicators measure things like rates of children or adults who are uninsured, hospital patients who get information about how to handle their recovery at home, hospital admissions for children with asthma, and breast and colorectal cancer deaths, among many others

2018 Scorecard on State Health System Performance

Hawaii, Massachusetts, Minnesota, Vermont, and Utah are the top-ranked states according to the Commonwealth Fund's 2018 Scorecard on State Health System Performance, which assesses all 50 states and the District of Columbia on more than 40 measures of access to health care, quality of care, efficiency in care delivery, health outcomes, and income-based health care disparities.The 2018 Scorecard reveals that states are losing ground on key measures related to life expectancy. On most other measures, performance continues to vary widely across states; even within individual states, large disparities are common.Still, on balance, the Scorecard finds more improvement than decline between 2013 and 2016 in the functioning of state health care systems. This represents a reversal of sorts from the first decade of the century, when stagnating or worsening performance was the norm

Aiming Higher: Results from the Commonwealth Fund Scorecard on State Health System Performance, 2017 Edition

Issue: States are a locus of policy and leadership for health system performance.Goal: To compare and evaluate trends in health care access, quality, avoidable hospital use and costs, health outcomes, and health system equity across all 50 states and the District of Columbia.Methods: States are ranked on 44 performance measures using recently available data. Key findings: Nearly all states improved more than they worsened between 2013 and 2015. The biggest gains were in health insurance coverage and the ability to access care when needed, with states that had expanded their Medicaid programs under the Affordable Care Act experiencing the most improvement. There were also widespread state improvements on key indicators of treatment quality and patient safety; hospital patient readmissions also fell in many states. However, premature deaths crept up in almost two-thirds of states, reversing a long period of decline. Wide variations in performance across states persisted, as did disparities experienced by vulnerable populations within states.Conclusion: If every state achieved the performance of top-ranked states, their residents and the country as a whole would realize dramatic gains in health care access, quality, efficiency, and health outcomes

Changing experience with dual chamber (DDD) pacemakers

Dual chamber (DDD) or “universal” pacemakers have had a significant impact on the advancement of artificial pacemakers by providing a more physiologic approach to cardiac pacing. However, with the early generation of DDD pacemakers (pacemakers that sense and pace in both the atrium and the ventricle), a significant number of patients experienced pacemaker-mediated tachycardia because intact ventriculoatrial conduction was sensed in the atrium and a reentrant tachycardia was induced. Newer generation DDD pacemakers have provided longer atrial refractory periods, which should correct this problem.In this study the first and second years of a 2 year experience with DDD pacemakers were compared to determine if the newer generation devices have allowed maintenance of pacing in the DDD mode as opposed to reprogramming to some alternate mode because of pacemaker-mediated tachycardia or other pacing problems. The results showed a significant decrease in pacemaker-mediated tachycardia during the second year and continuation of pacing in the DDD mode in a higher percent of patients. This improvement is attributed to improvement in the pulse generator as well as better patient selection

Closing the Gap: Past Performance of Health Insurance in Reducing Racial and Ethnic Disparities in Access to Care Could Be an Indication of Future Results

This historical analysis shows that in the years just prior to the Affordable Care Act's expansion of health insurance coverage, black and Hispanic working-age adults were far more likely than whites to be uninsured, to lack a usual care provider, and to go without needed care because of cost. Among insured adults across all racial and ethnic groups, however, rates of access to a usual provider were much higher, and the proportion of adults going without needed care because of cost was much lower. Disparities between groups were narrower among the insured than the uninsured, even after adjusting for income, age, sex, and health status. With surveys pointing to a decline in uninsured rates among black and Hispanic adults in the past year, particularly in states extending Medicaid eligibility, the ACA's coverage expansions have the potential to reduce, though not eliminate, racial and ethnic disparities in access to care