Accountable Care Organizations in California: Promise and Performance

California has more accountable care organizations (ACOs) than any other state in the country, with particularly rapid growth over the past two years. This report introduces new evidence that ACOs improve the quality of care, increase patient satisfaction, and may reduce costs

Contemporary outcome measures in acute stroke research: choice of primary outcome measure

BACKGROUND AND PURPOSE: The diversity of available outcome measures for acute stroke trials is challenging and implies that the scales may be imperfect. To assist researchers planning trials and to aid interpretation, this article reviews and makes recommendations on the available choices of scales. The aim is to identify an approach that will be universally accepted and that should be included in most acute trials, without seeking to restrict options for special circumstances. METHODS: The article considers outcome measures that have been widely used or are currently advised. It examines desirable properties for outcome measures such as validity, relevance, responsiveness, statistical properties, availability of training, cultural and language issues, resistance to comorbidity, as well as potential weaknesses. Tracking and agreement among outcomes are covered. RESULTS: Typical ranges of scores for the common scales are described, along with their statistical properties, which in turn influence optimal analytic techniques. The timing of recovery on scores and usual practice in trial design are considered. CONCLUSIONS: The preferred outcome measure for acute trials is the modified Rankin Scale, assessed at 3 months after stroke onset or later. The interview should be conducted by a certified rater and should involve both the patient and any relevant caregiver. Incremental benefits at any level of the modified Rankin Scale may be acceptable. The modified Rankin Scale is imperfect but should be retained in its present form for comparability with existing treatment comparisons. No second measure should be required, but correlations with supporting scales may be used to confirm consistency in direction of effects on other measures

Design discharge estimation from urban catchments - a comparison between ARR1987 and ARR2016

Australian Rainfall and Runoff (ARR) is a national guideline to assist engineers and practitioners in estimating design flood characteristics in Australia. ARR is pivotal to the safety and sustainability of Australian infrastructure, communities and the environment. The guidelines and data included in the 3rd edition of the guideline (ARR1987) have been used by the civil engineering industry for many years. However, since the development of ARR1987, there have been major advancements in technology, the availability of rainfall data, the industry’s understanding of rainfall patterns, ground infiltration characteristics and rainfall-runoff routing procedures. In response to these advancements, the 4th edition of Australian Rainfall and Runoff (ARR2016) has recently been released and includes recommended updates to flood estimation methods. This paper presents a comparison of the practical application of ARR1987 and ARR2016 in the regional Queensland city of Bundaberg, focusing on three major updates within ARR2016 which are likely to influence the peak design discharge: updated intensity frequency duration (IFD) data, rainfall temporal patterns (including methodology for application) and climate change recommendations

Conchoidal transform of two plane curves

The conchoid of a plane curve $C$ is constructed using a fixed circle $B$ in the affine plane. We generalize the classical definition so that we obtain a conchoid from any pair of curves $B$ and $C$ in the projective plane. We present two definitions, one purely algebraic through resultants and a more geometric one using an incidence correspondence in \PP^2 \times \PP^2. We prove, among other things, that the conchoid of a generic curve of fixed degree is irreducible, we determine its singularities and give a formula for its degree and genus. In the final section we return to the classical case: for any given curve $C$ we give a criterion for its conchoid to be irreducible and we give a procedure to determine when a curve is the conchoid of another.Comment: 18 pages Revised version: slight title change, improved exposition, fixed proof of Theorem 5.3 Accepted for publication in Appl. Algebra Eng., Commun. Comput

Stringy K-theory and the Chern character

For a finite group G acting on a smooth projective variety X, we construct two new G-equivariant rings: first the stringy K-theory of X, and second the stringy cohomology of X. For a smooth Deligne-Mumford stack Y we also construct a new ring called the full orbifold K-theory of Y. For a global quotient Y=[X/G], the ring of G-invariants of the stringy K-theory of X is a subalgebra of the full orbifold K-theory of the the stack Y and is linearly isomorphic to the ``orbifold K-theory'' of Adem-Ruan (and hence Atiyah-Segal), but carries a different, ``quantum,'' product, which respects the natural group grading. We prove there is a ring isomorphism, the stringy Chern character, from stringy K-theory to stringy cohomology, and a ring homomorphism from full orbifold K-theory to Chen-Ruan orbifold cohomology. These Chern characters satisfy Grothendieck-Riemann-Roch for etale maps. We prove that stringy cohomology is isomorphic to Fantechi and Goettsche's construction. Since our constructions do not use complex curves, stable maps, admissible covers, or moduli spaces, our results simplify the definitions of Fantechi-Goettsche's ring, of Chen-Ruan's orbifold cohomology, and of Abramovich-Graber-Vistoli's orbifold Chow. We conclude by showing that a K-theoretic version of Ruan's Hyper-Kaehler Resolution Conjecture holds for symmetric products. Our results hold both in the algebro-geometric category and in the topological category for equivariant almost complex manifolds.Comment: Exposition improved and additional details provided. To appear in Inventiones Mathematica

Calibration of <i>Herschel</i> SPIRE FTS observations at different spectral resolutions

The SPIRE Fourier Transform Spectrometer on-board the Herschel Space Observatory had two standard spectral resolution modes for science observations: high resolution (HR) and low resolution (LR), which could also be performed in sequence (H+LR). A comparison of the HR and LR resolution spectra taken in this sequential mode revealed a systematic discrepancy in the continuum level. Analysing the data at different stages during standard pipeline processing demonstrates that the telescope and instrument emission affect HR and H+LR observations in a systematically different way. The origin of this difference is found to lie in the variation of both the telescope and instrument response functions, while it is triggered by fast variation of the instrument temperatures. As it is not possible to trace the evolution of the response functions using housekeeping data from the instrument subsystems, the calibration cannot be corrected analytically. Therefore, an empirical correction for LR spectra has been developed, which removes the systematic noise introduced by the variation of the response functions

Euler characteristic of coherent sheaves on simplicial torics via the Stanley-Reisner ring

We combine work of Cox on the total coordinate ring of a toric variety and results of Eisenbud-Mustata-Stillman and Mustata on cohomology of toric and monomial ideals to obtain a formula for computing the Euler characteristic of a Weil divisor D on a complete simplicial toric variety in terms of graded pieces of the Cox ring and Stanley-Reisner ring. The main point is to use Alexander duality to pass from the toric irrelevant ideal, which appears in the computation of the Euler characteristic of D, to the Stanley-Reisner ideal of the fan, which is used in defining the Chow ring. The formula also follows from work of Maclagan-Smith.Comment: 9 pages 1 figur

Improving the Efficacy of Web-Based Educational Outreach in Ecology

Scientists are increasingly engaging the web to provide formal and informal science education opportunities. Despite the prolific growth of web-based resources, systematic evaluation and assessment of their efficacy remains limited. We used clickstream analytics, a widely available method for tracking website visitors and their behavior, to evaluate 60,000 visits over three years to an educational website focused on ecology. Visits originating from search engine queries were a small proportion of the traffic, suggesting the need to actively promote websites to drive visitation. However, the number of visits referred to the website per social media post varied depending on the social media platform and the quality of those visits (e.g., time on site and number of pages viewed) was significantly lower than visits originating from other referring websites. In particular, visitors referred to the website through targeted promotion (e.g., inclusion in a website listing classroom teaching resources) had higher quality visits. Once engaged in the site’s core content, visitor retention was high; however, visitors rarely used the tutorial resources that serve to explain the site’s use. Our results demonstrate that simple changes in website design, content and promotion are likely to increase the number of visitors and their engagement. While there is a growing emphasis on using the web to broaden the impacts of biological research, time and resources remain limited. Clickstream analytics provides an easily accessible, relatively fast and quantitative means by which those engaging in educational outreach can improve upon their efforts