The formation of physician patient sharing networks in medicare: Exploring the effect of hospital affiliation

This study explores the forces that drive the formation of physician patient sharing networks. In particular, I examine the degree to which hospital affiliation drives physicians\u27 sharing of Medicare patients. Using a revealed preference framework where observed network links are taken to be pairwise stable, I estimate the physicians\u27 pair‐specific values using a tetrad maximum score estimator that is robust to the presence of unobserved physician specific characteristics. I also control for a number of potentially confounding patient sharing channels, such as (a) common physician group or hospital system affiliation, (b) physician homophily, (c) knowledge complementarity, (d) patient side considerations related to both geographic proximity and insurance network participation, and (e) spillover from other collaborations. Focusing on the Chicago hospital referral region, I find that shared hospital affiliation accounts for 36.5% of the average pair‐specific utility from a link. Implications for reducing care fragmentation are discussed

Generating natural language specifications from UML class diagrams

Early phases of software development are known to be problematic, difficult to manage and errors occurring during these phases are expensive to correct. Many systems have been developed to aid the transition from informal Natural Language requirements to semistructured or formal specifications. Furthermore, consistency checking is seen by many software engineers as the solution to reduce the number of errors occurring during the software development life cycle and allow early verification and validation of software systems. However, this is confined to the models developed during analysis and design and fails to include the early Natural Language requirements. This excludes proper user involvement and creates a gap between the original requirements and the updated and modified models and implementations of the system. To improve this process, we propose a system that generates Natural Language specifications from UML class diagrams. We first investigate the variation of the input language used in naming the components of a class diagram based on the study of a large number of examples from the literature and then develop rules for removing ambiguities in the subset of Natural Language used within UML. We use WordNet,a linguistic ontology, to disambiguate the lexical structures of the UML string names and generate semantically sound sentences. Our system is developed in Java and is tested on an independent though academic case study

The just-noticeable difference in speech-to-noise ratio

Just-noticeable differences (JNDs) have been measured for various features of sounds, but despite its importance to communication, there is no benchmark for what is a just-noticeable—and possibly meaningful—difference in speech-to-noise ratio (SNR). SNR plays a crucial role in speech communication for normal-hearing and hearing-impaired listeners. Difficulty hearing speech in background noise—a poor SNR—often leads to dissatisfaction with hearing-assistance devices. While such devices attempt through various strategies to address this problem, it is not currently known how much improvement in SNR is needed to provide a noticeable benefit. To investigate what is a noticeable benefit, we measured the JND in SNR for both normal-hearing and hearing-impaired listeners. Here, we report the SNR JNDs of 69 participants of varying hearing ability, estimated using either an adaptive or fixed-level procedure. The task was to judge which of the two intervals containing a sentence in speech-spectrum noise presented over headphones was clearer. The level of each interval was roved to reduce the influence of absolute level cues. The results of both procedures showed an average SNR JND of 3 dB that was independent of hearing ability. Further experiments using a subset of normal-hearing listeners showed that level roving does elevate threshold. These results suggest that noise reduction schemes may need to achieve a benefit greater than 3 dB to be reliably discriminable

981-46 Impact of a Comprehensive Management Program on the Hospitalization Rate for Patients with Advanced Heart Failure

Patients with advanced heart failure have a course that is often characterized by frequent hospitalizations and progressive deterioration. These patients are commonly referred to specialized centers for consideration of heart transplantation (Tx). To assess the impact of the changes in therapy made in conjunction with heart transplantation evaluation on patient outcomes, we assessed the hospitalization rate and patient's functional status in the 6 months prior to referral compared to the 6 months after referral. Since 1/91, 214 patients were evaluated, accepted for Tx, and discharged having undergone adjustments in medical therapy and a comprehensive patient education program. At time of referral patients had mean LVEF 0.21, NYHA class 3.3, VO2 max 11.0ml/kg, and had undergone a total of 429 hospitalizations in the previous 6 months. During evaluation patients had their ACE inhibitor dose increased by a mean 91.5mg/day of captopril or the equivalent, were diuresed a mean 4.2 liters, were placed on a flexible regimen of loop diuretics, and were counseled on dietary management and home based progressive aerobic exercise. After 6 months of follow-up there were only 63 hospitalizations required (mean hospitalization rate per patient over the 6 months pre-evaluation 2.00±1.45 vs post-evaluation 0.29±0.53 p<0.00001). Patient's NYHA class improved to 2.4 (p<0.0001) and VO2 max increased to 15.2 (p<0.001). Excluding the 12 elective status Tx, 14 urgent status Tx, and 9 deaths within 6 months yielded similar results (344 pre vs 34 post-evaluation hospitalizations). 64 patients (30%) improved their functional status to the point that transplantation was deferred in favor of sustained medical therapy.Referral to a heart failure specialty program is associated with a dramatic occurred between day 10±1 and 3 month. 4 patients died after hospital discharge (no death directly related to thromboembolic disease). Thus no higher risk of PE can be seen in patients with free floating prox-DVT and anticoagulant therapy should be efficient to prevent recurrent PE in such patient

Final State Interactions and CP Violation in KL→π+π−e+e−K_L \to \pi^+ \pi^- e^+ e^-

Using chiral perturbation theory we calculate the imaginary parts of the $K_L \rightarrow \pi^+ \pi^- e^+ e^-$ form factors that arise from $\pi \pi \rightarrow \pi^+ \pi^-$ and $\pi \pi \rightarrow \pi^+ \pi^- \gamma^*$ rescattering. We discuss their influence on CP violating variables in $K_L \rightarrow \pi^+ \pi^- e^+ e^-$.Comment: ; 12 pages, 2 figures, TeX format; uses epsf.tex, tables.tex, and phyzzx.te

Bistability of Slow and Fast Traveling Waves in Fluid Mixtures

The appearence of a new type of fast nonlinear traveling wave states in binary fluid convection with increasing Soret effect is elucidated and the parameter range of their bistability with the common slower ones is evaluated numerically. The bifurcation behavior and the significantly different spatiotemporal properties of the different wave states - e.g. frequency, flow structure, and concentration distribution - are determined and related to each other and to a convenient measure of their nonlinearity. This allows to derive a limit for the applicability of small amplitude expansions. Additionally an universal scaling behavior of frequencies and mixing properties is found. PACS: 47.20.-k, 47.10.+g, 47.20.KyComment: 4 pages including 5 Postscript figure

Measurement of two-halo neutron transfer reaction p(11^{11}Li,9^{9}Li)t at 3AA MeV

The p(\nuc{11}{Li},\nuc{9}{Li})t reaction has been studied for the first time at an incident energy of 3$A$ MeV delivered by the new ISAC-2 facility at TRIUMF. An active target detector MAYA, build at GANIL, was used for the measurement. The differential cross sectionshave been determined for transitions to the \nuc{9}{Li} ground andthe first excited states in a wide range of scattering angles. Multistep transfer calculations using different \nuc{11}{Li} model wave functions, shows that wave functions with strong correlations between the halo neutrons are the most successful in reproducing the observation.Comment: 6 pages, 3 figures, submitted to Physical Review Letter

Lifetimes of states in 19Ne above the 15 O + alpha breakup threshold

The 15O(alpha,gamma)19Ne reaction plays a role in the ignition of Type I x-ray bursts on accreting neutron stars. The lifetimes of states in 19Ne above the 15O + alpha threshold of 3.53 MeV are important inputs to calculations of the astrophysical reaction rate. These levels in 19Ne were populated in the 3He(20Ne,alpha)19Ne reaction at a 20Ne beam energy of 34 MeV. The lifetimes of six states above the threshold were measured with the Doppler shift attenuation method (DSAM). The present measurements agree with previous determinations of the lifetimes of these states and in some cases are considerably more precise