So Many Hospitals, So Little Information: How Hospital Value Based Purchasing is a Game of Chance

As part of the Patient Protection and Affordable Care Act, participating Medicare hospitals have part of their Medicare reimbursements withheld and then redistributed based on quality performance. The Hospital Value Based Purchasing reimbursement plan relies partly on ordinal rankings of hospitals to determine how money is distributed. We analyze the quality metric distributions used for payment and show that there is not enough information to reliably differentiate hospitals from one another near the payment cutoffs; and conclude that a large part of the payment formula is driven by sampling variability rather than true quality information. Alternative reimbursement plans are developed

Moderate Resolution Spitzer Infrared Spectrograph (IRS) Observations of M, L, and T Dwarfs

We present 10 - 19 um moderate resolution spectra of ten M dwarfs, one L dwarf, and two T dwarf systems obtained with the Infrared Spectrograph (IRS) onboard the Spitzer Space Telescope. The IRS allows us to examine molecular spectroscopic features/lines at moderate spectral resolution in a heretofore untapped wavelength regime. These R~600 spectra allow for a more detailed examination of clouds, non-equilibrium chemistry, as well as the molecular features of H2O, NH3, and other trace molecular species that are the hallmarks of these objects. A cloud-free model best fits our mid-infrared spectrum of the T1 dwarf epsilon Indi Ba, and we find that the NH3 feature in epsilon Indi Bb is best explained by a non-equilibrium abundance due to vertical transport in its atmosphere. We examined a set of objects (mostly M dwarfs) in multiple systems to look for evidence of emission features, which might indicate an atmospheric temperature inversion, as well as trace molecular species; however, we found no evidence of either.Comment: 19 pages, 7 figures, accepted ApJ 1/12/0

High Temperature Photochemistry in the Atmosphere of HD189733b

Recent infrared spectroscopy of hot exoplanets is beginning to reveal their atmospheric composition. Deep with in the planetary atmosphere, the composition is controlled by thermochemical equilibrium. Photochemistry becomes important higher in the atmosphere, at levels above ~1 bar. These two chemistries compete between ~1-10 bars in hot Jupiter-like atmospheres, depending on the strength of the eddy mixing and temperature. HD189733b provides an excellent laboratory in which to study the consequences of chemistry of hot atmospheres. The recent spectra of HD189733b and HD209458b contain signatures of CH4, CO2, CO and H2O. Here we identify the primary chemical pathways that govern the abundances of CH4, CO2, CO and H2O in the cases of thermochemical equilibrium chemistry, photochemistry, and their combination. Our results suggest that the abundance of these species can be photochemically enhanced above or below the thermochemical equilibrium value, so some caution must be taken when assuming that an atmosphere is in strict thermochemical equilibrium

PARENTS' SATISFACTION AND DISSATISFACTION WITH THEIR CHILDREN'S DENTIST *

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66344/1/j.1752-7325.1973.tb03989.x.pd

The hearing of fitness to practice cases by the General Medical Council: Current trends and future research agendas

Over the last three decades a risk-based model of medical regulation has emerged in the United Kingdom. To promote a risk-averse operational culture of transparency and professional accountability the regulatory state has intervened in medical governance and introduced best-evidenced practice frameworks, audit and performance appraisal, Against this background the paper analyses descriptive statistical data pertaining to the General Medical Council’s management of the process by which fitness to practice complaints against doctors are dealt with from initial receipt through to subsequent investigative and adjudication stages. Statistical trends are outlined regarding complaint data in relation to a doctor’s gender and race and ethnicity. The data shows that there has been an increase in rehabilitative and/or punitive action against doctors. In light of its findings the paper considers what the long-term consequences may be, for both patients and doctors, of the increasing use of risk-averse administrative systems to reform medical regulation and ensure professional accountability

Disequilibrium Carbon, Oxygen, and Nitrogen Chemistry in the Atmospheres of HD 189733b and HD 209458b

We have developed 1-D photochemical and thermochemical kinetics and diffusion models for the transiting exoplanets HD 189733b and HD 209458b to study the effects of disequilibrium chemistry on the atmospheric composition of "hot Jupiters." Here we investigate the coupled chemistry of neutral carbon, hydrogen, oxygen, and nitrogen species, and we compare the model results with existing transit and eclipse observations. We find that the vertical profiles of molecular constituents are significantly affected by transport-induced quenching and photochemistry, particularly on cooler HD 189733b; however, the warmer stratospheric temperatures on HD 209458b can help maintain thermochemical equilibrium and reduce the effects of disequilibrium chemistry. For both planets, the methane and ammonia mole fractions are found to be enhanced over their equilibrium values at pressures of a few bar to less than a mbar due to transport-induced quenching, but CH4 and NH3 are photochemically removed at higher altitudes. Atomic species, unsaturated hydrocarbons (particularly C2H2), some nitriles (particularly HCN), and radicals like OH, CH3, and NH2 are enhanced overequilibrium predictions because of quenching and photochemistry. In contrast, CO, H2O, N2, and CO2 more closely follow their equilibrium profiles, except at pressures < 1 microbar, where CO, H2O, and N2 are photochemically destroyed and CO2 is produced before its eventual high-altitude destruction. The enhanced abundances of HCN, CH4, and NH3 in particular are expected to affect the spectral signatures and thermal profiles HD 189733b and other, relatively cool, close-in transiting exoplanets. We examine the sensitivity of our results to the assumed temperature structure and eddy diffusion coefficientss and discuss further observational consequences of these models.Comment: 40 pages, 16 figures, accepted for publication in Astrophysical Journa

The ethics of practical reasoning : exploring the terrain

Social work has been under sustained scrutiny regarding the quality of decision-making. The assumption is that social workers make poor quality decisions. And yet our knowledge and understanding of how social workers make decisions is, at best, partial. In our view, examination of practitioner decision-making will be enhanced by considering the role that ethics plays in practical judgement in practice. Although there has been significant work regarding the role of values and ethics in practice, this work tends to idealise morality setting up external standards by which practice is judged. In this paper, we will argue that ethics in practice needs to be understood as more than simply operationalise ideal standards, ethics also entails critical engagement with social and ethical issues and can challenge idealised statements of values. We outline the idea of the ethical dimension of practical reasoning, consider its relationship to professional discretion, judgments and decision-making in order to provide a clear focus for this research agenda, and identify the practical challenges researching ethics in professional decision-making entails

Managerialism: an ideal type

Managerialism pervades the higher education literature in much the same way it is said to have pervaded universities themselves. Yet, despite its ubiquity and importance, managerialism remains an under-theorized and elusive concept that has multiple definitions and blurred boundaries. This article addresses this lack of conceptual clarity by first ‘locating’ managerialism in relation to the cognate concepts of neoliberalism and New Public Management and then elucidating its core principles in an ideal-type theoretical model. This ideal type provides a focal point for theoretical debate and critique and, via the development of empirical indicators for each ideological tenet, permits comparison of theory with organizational practice. A worked example is provided of how the model was used to shed light on the nature of managerialism as ideology in a university setting. However, it is anticipated that the model should have explanatory power and utility in a range of organizational contexts