Payment Changes Necessary to Catalyze Higher-Quality, Lower-Cost Care

The article reports on the standards of Mayo Clinic to achieve high-value health care which include value, coordinated care, a reformed payment system, and insurance coverage for all. The overutilization of more and expensive therapies reportedly contributes to the rising health care costs. That incentives should be changed to reward providers that provide higher quality at lower-cost care and to shift to value-based reimbursement is discussed

Mass and angular-momentum inequalities for axi-symmetric initial data sets I. Positivity of mass

We extend the validity of Brill's axisymmetric positive energy theorem to all asymptotically flat initial data sets with positive scalar curvature on simply connected manifolds.Comment: 33 pages in A

The Instability of Charged Black Strings and p-Branes

We investigate the evolution of small perturbations around charged black strings and branes which are solutions of low energy string theory. We give the details of the analysis for the uncharged case which was summarized in a previous paper. We extend the analysis to the small charge case and give also an analysis for the generic case, following the behavior of unstable modes as the charge is modified. We study specifically a magnetically charged black 6-brane, but show how the instability is generic, and that charge does not in general stabilise black strings and p-branes.Comment: 41 pages plain TeX, 6 figures appended at end of file, DAMTP/R-94/7,LA-UR-93-447

Effects of forest management practices on treefrog oviposition site choice

Abstract only availableGlobally, amphibian populations are declining faster than those of birds or mammals. Habitat destruction is considered the primary cause of these declines; however, what remains partly unexplored is the idea that some species may be more greatly affected than others by deforestation. Treefrogs (Family: Hylidae), because of their mobility, may be expected to circumvent disturbed habitats; however, because of their dependency on arboreal habitat, they may be adversely affected by different forms of forest management. As part of the LEAP (Land-Use Effects on Amphibian Populations) study, four forest management practices—clearcut with coarse woody debris (CWD) removed, clearcut with CWD retained, thinning of 25% basal area, and uncut forest—were implemented at four wetlands at the Savannah River Site. In May 2005, we placed wading pools 25 m into each treatment and allowed them to fill with rainwater. To monitor time to first oviposition event and to determine the number of events per treatment, pools were checked daily, eggs were counted, and tadpoles were raised to confirm that all eggs were indeed those of hylids. We measured water depth, canopy cover, and surrounding vegetation. These data will be analyzed to determine if suitable calling/breeding habitat (microhabitat) is a more reliable predictor of oviposition than treatment (macrohabitat). At three of the four wetlands, first oviposition events occurred in the thinning treatments, and second events occurred in the clearcuts with CWD retained. We found that more oviposition events also occurred in the thinning treatments (43%) and the clearcuts with CWD retained (33%) than in the clearcuts with CWD removed (13%) or the uncut forest controls (10%). One explanation for these findings is that hylids have evolved to locate openings in the forest canopy which could indicate a wetland or a fallen tree whose uprooting has caused an ephemeral pool to form.Life Sciences Undergraduate Research Opportunity Progra

Developing approaches to the collection and use of evidence of patient experience below the level of national surveys

National approaches to collecting patient feedback provide trust level information which although can provide a benchmark for trusts often doesn’t provide information about specific services or patients experiences of pathways of care. This more granular level of data could be more informative for local service development and improvement. This research explored the feasibility and usefulness of such approaches. A conceptual model and standard questionnaire of patient experience was developed that might work across a range of services and pathways of care. Seven trusts were recruited as collaborating sites in which the model and survey instrument was tested. These were from different geographical locations and settings. The impact of the pilot and survey results on the improvement and development of services was evaluated. The service- line approach to capturing patient feedback was generally more feasible and considered of value for service improvement. The collection of patients’ experiences across pathways of care was more challenging in terms of the development of the survey and interpretation of results. However, many sites identified specific actionable areas for improvement. This study has shown that it is possible to develop and apply a standardised survey in a range of services and provides evidence that a consistent unified approach to monitoring patient experiences is feasible. However several methodological problems are acknowledged such as the availability of resources and capacity for improvements to services and care. Evidence is now particularly needed to establish how best to produce positive impact from patient feedback