Multihospital System Affiliation as a Survival Strategy for Rural Hospitals Under the Prospective Payment System

The introduction of Medicare's Prospective Payment System (PPS) has disproportionately increased financial pressures on rural hospitals and posed challenges to the survival of these institutions. Increasingly, rural hospitals are seeking strategies that can enhance their chances for survival in a turbulent and hostile environment. This study examined the survival effects of one such strategy, multihospital system affiliation. Specifically, we assessed: (1) whether and how different types of system affiliation in the post-PPS era affect the likelihood of rural hospital survival; (2) whether particular structural, environmental and hospital performance characteristics moderate the effects of system affiliation on rural hospital survival; and (3) whether systematic selection by rural hospitals into multihospital systems potentially accounts for observed relationships between system affiliation and survival. Proportional hazards analyses indicate that system affiliation with investor-owned systems significantly reduces survival probabilities of rural hospitals. Affiliation with not-for-profit systems or system affiliation under contract management arrangements does not affect survival probabilities of rural hospitals. These general findings are moderated by the effects of hospital ownership and size at the time of affiliation. Finally, study findings indicated that systematic selection by poor performing rural hospitals into investor-owned systems has occurred in the post-PPS era. No evidence of selection into not-for-profit systems was discovered.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73618/1/j.1748-0361.1992.tb00334.x.pd

Policy instruments in the Common Agricultural Policy

Policy changes in the Common Agricultural Policy (CAP) can be explained in terms of the exhaustion and long-term contradictions of policy instruments. Changes in policy instruments have reoriented the policy without any change in formal Treaty goals. The social and economic efficacy of instruments in terms of evidence-based policy analysis was a key factor in whether they were delegitimized. The original policy instruments were generally dysfunctional, but reframing the policy in terms of a multifunctionality paradigm permitted the development of more efficacious instruments. A dynamic interaction takes place between the instruments and policy informed by the predominant discourses

Quantifying the radiation belt seed population in the 17 March 2013 electron acceleration event

Abstract We present phase space density (PSD) observations using data from the Magnetic Electron Ion Spectrometer instrument on the Van Allen Probes for the 17 March 2013 electron acceleration event. We confirm previous results and quantify how PSD gradients depend on the first adiabatic invariant. We find a systematic difference between the lower-energy electrons (1-MeV with a source region within the radiation belts. Our observations show that the source process begins with enhancements to the 10s-100s-keV energy seed population, followed by enhancements to the \u3e1-MeV population and eventually leading to enhancements in the multi-MeV electron population these observations provide the clearest evidence to date of the timing and nature of the radial transport of a 100s keV electron seed population into the heart of the outer belt and subsequent local acceleration of those electrons to higher radiation belt energies. Key Points Quantification of phase space density gradients inside geostationary orbit Clear differences between the source of low energy and relativistic electrons Clear observations of how the acceleration process evolves in energy

Evaluation of Volatile Metabolites Emitted In-Vivo from Cold-Hardy Grapes during Ripening Using SPME and GC-MS: A Proof-of-Concept

In this research, we propose a novel concept for a non-destructive evaluation of volatiles emitted from ripening grapes using solid-phase microextraction (SPME). This concept is novel to both the traditional vinifera grapes and the cold-hardy cultivars. Our sample models are cold-hardy varieties in the upper Midwest for which many of the basic multiyear grape flavor and wine style data is needed. Non-destructive sampling included a use of polyvinyl fluoride (PVF) chambers temporarily enclosing and concentrating volatiles emitted by a whole cluster of grapes on a vine and a modified 2 mL glass vial for a vacuum-assisted sampling of volatiles from a single grape berry. We used SPME for either sampling in the field or headspace of crushed grapes in the lab and followed with analyses on gas chromatography-mass spectrometry (GC-MS). We have shown that it is feasible to detect volatile organic compounds (VOCs) emitted in-vivo from single grape berries (39 compounds) and whole clusters (44 compounds). Over 110 VOCs were released to headspace from crushed berries. Spatial (vineyard location) and temporal variations in VOC profiles were observed for all four cultivars. However, these changes were not consistent by growing season, by location, within cultivars, or by ripening stage when analyzed by multivariate analyses such as principal component analysis (PCA) and hierarchical cluster analyses (HCA). Research into aroma compounds present in cold-hardy cultivars is essential to the continued growth of the wine industry in cold climates and diversification of agriculture in the upper Midwestern area of the U.S

Biogenic Volatiles Emitted from Four Cold-Hardy Grape Cultivars During Ripening

In this research dataset, we summarize for the first time volatile organic compounds (VOCs) emitted in vivo from ripening wine grapes. We studied four cold-hardy cultivars grown in the Midwestern U.S.: St. Croix, Frontenac, Marquette, and La Crescent. These cultivars have gained popularity among local growers and winemakers, but still very little is known about their performance compared with long-established V. vinifera grapes. Volatiles were collected using two novel approaches: biogenic emissions from grape clusters on a vine and single grape berries. A third approach was headspace collection of volatiles from crushed grapes. Solid-phase microextraction (SPME) was used to collect volatiles. Vacuum-assisted SPME was used in the case of single grape berry. Collected VOCs were analyzed using separation and identification on a gas chromatograph mass spectrometer (GC-MS). More than 120 VOCs were identified using mass spectral libraries. The dataset provides evidence that detecting biogenic emissions from growing grapes is feasible. The dataset provides a record of temporal and spatial variability of VOCs, many of which could potentially impart aroma and flavor in the wine. The number of VOCs detected followed the order from single berry (the least) to crushed berry (the most). Thus, more information for potential use in harvesting in order to obtain the desired flavor is found in data from crushed grapes

Spin Dynamics at Very Low Temperature in Spin Ice Dy2_2Ti2_2O7_7

We have performed AC susceptibility and DC magnetic relaxation measurements on the spin ice system Dy$_2$Ti$_2$O$_7$ down to 0.08 K. The relaxation time of the magnetization has been estimated below 2 K down to 0.08 K. The spin dynamics of Dy$_2$Ti$_2$O$_7$ is well described by using two relaxation times ($\tau_{\rm S}$ (short time) and $\tau_{\rm L}$ (long time)). Both $\tau_{\rm S}$ and $\tau_{\rm L}$ increase on cooling. Assuming the Arrhenius law in the temperature range 0.5-1 K, we obtained an energy barrier of 9 K. Below 0.5 K, both $\tau_{\rm S}$ and $\tau_{\rm L}$ show a clear deviation from the thermal activated dynamics toward temperature independent relaxation, suggesting a quantum dynamics.Comment: 4 page