Paying hospitals for quality: can we buy better care?

Economic theory predicts that changing financial rewards will change behaviour. This is valid in terms of service use; higher costs reduce health care use. It should follow that paying more for quality should improve quality; however, the research evidence thus far is equivocal, particularly in terms of better health outcomes. One reason is that "financial incentives" encompass a range of payment types and sizes of reward. The design of financial incentives should take into account the desired change and the context of existing payment structures, as well as other strategies for improving quality; further, financial incentives should be fair in rewarding effort. Financial incentives may have unintended consequences, including rewarding hospitals for selecting patients with lower risks, diverting attention from the overall patient population to specific conditions, gaming, and "crowding out" or displacing intrinsic motivation. Managers and clinicians can only respond to financial incentives if they have the data, tools and skills to effect changes. Australia should not adopt widespread use of financial incentives for improving quality in health care without careful consideration of their design and context, the potential for unintended effects (particularly beyond their immediate targets), and evaluation of outcomes. The relative cost-effectiveness of financial incentives compared with, or in concert with, other strategies should also be considered

Brief communication: Changes to cow behaviour when transitioning from twice a day to a 3-in-2 milking schedule

The objective of this study was to assess changes to cow behaviour when decreasing milking frequency from twice a day (TAD) to three milkings in two days (3-in-2). CowManager SensOor™ ear tags were attached to cows (n=29) for 15 days before, and 30 days after, transitioning to 3-in-2. To investigate general trends, paired t-tests were used to compare means between activity types (time spent active, highly active, not active, eating or ruminating) and milking frequency. After transitioning to 3-in-2 milking, the total time active was greater (+32.3 mins/cow/day; SEM 6.46), whilst the time spent eating (-16.2 mins/cow/day; SEM 7.57) and ruminating (-12.7 mins/cow/day; SEM 3.59) decreased. These differences were inconsistent between daylight and dark hours. These results indicate that the extra time spent in the paddock by the cows due to a 3-in-2 milking schedule was spent active, potentially due to social interaction and feed-searching behaviours, with a decrease in rumination and eating behaviours

Informal care and home-based palliative care: The health-related quality of life of carers

Health is an important factor in the capacity of family and friends (informal carers) to continue providing care for palliative care patients at home. This study investigates associations between the health-related quality of life (HRQOL) of current informal carers and characteristics of the carers and their caregiving situation, in a sample of Australian carers of palliative care patients. The cross-sectional study used the Short Form-36 Health Survey to measure HRQOL. It found carers to have better physical health and worse mental health than the general population. Of 178 carers, 35% reported their health to be worse than it was one year ago. Multiple regression analyses found that the HRQOL of carers whose health had deteriorated in the previous year was associated with the patient's care needs but not the carer's time input, unlike the carers reporting stable health. Clinicians caring for palliative care patients should be alert to the potential health impairments of informal carers and ensure that they are adequately supported in their caregiving role and have access to appropriate treatment and preventive health care. © 2010 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc

Froggatt-Nielsen models from E8 in F-theory GUTs

This paper studies F-theory SU(5) GUT models where the three generations of the standard model come from three different curves. All the matter is taken to come from curves intersecting at a point of enhanced E8 gauge symmetry. Giving a vev to some of the GUT singlets naturally implements a Froggatt-Nielsen approach to flavour structure. A scan is performed over all possible models and the results are filtered using phenomenological constraints. We find a unique model that fits observations of quark and lepton masses and mixing well. This model suffers from two drawbacks: R-parity must be imposed by hand and there is a doublet-triplet splitting problem.Comment: 42 pages; v2:journal version; v3:corrected typo in neutrino masse

Influence of spark plasma sintering parameters on magnetic properties of FeCo alloy

Equiatomic FeCo alloys with average particle size of 24 μm were sintered using spark plasma sintering (SPS) system at sintering temperatures of 1100, 800, and 850 °C for heating rates 50, 100, 300 °C/min by applying pressure of 50 MPa instantly at room temperature for sintering time of 5 and 15 minutes. The highest saturation induction was achieved at SPS conditions of 50 MPa, 50 °C/min, 1100 °C, without dwelling, of value 2.39 T. The saturation induction was improved with extending sintering time, the coercivity was higher in samples sintered at a fast heating rate in comparison to the slowest heating rate

Duration of shedding of respiratory syncytial virus in a community study of Kenyan children

Background: Our understanding of the transmission dynamics of respiratory syncytial virus (RSV) infection will be better informed with improved data on the patterns of shedding in cases not limited only to hospital admissions. Methods: In a household study, children testing RSV positive by direct immunofluorescent antibody test (DFA) were enrolled. Nasal washings were scheduled right away, then every three days until day 14, every 7 days until day 28 and every 2 weeks until a maximum of 16 weeks, or until the first DFA negative RSV specimen. The relationship between host factors, illness severity and viral shedding was investigated using Cox regression methods. Results: From 151 families a total of 193 children were enrolled with a median age of 21 months (range 1-164 months), 10% infants and 46% male. The rate of recovery from infection was 0.22/person/day (95% CI 0.19-0.25) equivalent to a mean duration of shedding of 4.5 days (95%CI 4.0-5.3), with a median duration of shedding of 4 days (IQR 2-6, range 1-14). Children with a history of RSV infection had a 40% increased rate of recovery i.e. shorter duration of viral shedding (hazard ratio 1.4, 95% CI 1.01-1.86). The rate of cessation of shedding did not differ significantly between males and females, by severity of infection or by age. Conclusion: We provide evidence of a relationship between the duration of shedding and history of infection, which may have a bearing on the relative role of primary versus re-infections in RSV transmission in the community

Bino Dark Matter and Big Bang Nucleosynthesis in the Constrained E6SSM with Massless Inert Singlinos

We discuss a new variant of the E6 inspired supersymmetric standard model (E6SSM) in which the two inert singlinos are exactly massless and the dark matter candidate has a dominant bino component. A successful relic density is achieved via a novel mechanism in which the bino scatters inelastically into heavier inert Higgsinos during the time of thermal freeze-out. The two massless inert singlinos contribute to the effective number of neutrino species at the time of Big Bang Nucleosynthesis, where the precise contribution depends on the mass of the Z' which keeps them in equilibrium. For example for mZ' > 1300 GeV we find Neff \approx 3.2, where the smallness of the additional contribution is due to entropy dilution. We study a few benchmark points in the constrained E6SSM with massless inert singlinos to illustrate this new scenario.Comment: 24 pages, revised for publication in JHE

Natural parasitism of the Citrus Leafminer (Lepidoptera: Gracillariidae) over eight years in seven citrus regions of São Paulo, Brazil

The citrus leafminer (CLM) Phyllocnists citrella Stainton (Lepidoptera: Gracillariidae) was frst recorded in Brazil in 1996. In 1998, the parasitoid Ageniaspis citricola Logvinovskaya (Hymenoptera: Encyrtdae) was introduced and established in many regions of the country. In this study, 130 onehour-samplings of sweet orange leaves (Citrus sinensis [L.] Osbeck) hostng CLM pupal chambers were carried out to estmate the CLM parasitsm rate (%) by its parasitoids in 7 regions of São Paulo State between 2000 and 2008. The sample sizes varied from 10 to 275 leaves (mean = 65). The most abundant parasitoid was the encyrtd A. citricola (found in 91.8% of the samplings). The highest level of CLM parasitsm by A. citricola was recorded in the southern region (Botucatu), 70.2 ± 6.6 (mean ± SEM), and the lowest level was recorded in the northern region (Barretos), 12.8 ± 5.7%. CLM parasitsm by A. citricola and by natve parasitoids (Galeopsomyia fausta LaSalle, Cirrospilus spp. and Elasmus sp.) did not differ between seasons. The 6-fold increase in the use of insectcides in citrus groves, afer 2004 when the Huanglongbing (HLB) disease was found in São Paulo State, did not reduce the level of CLM parasitsm. The level of parasitsm was 50.8 ± 4.2% before the advent of HLB (2000–2004) and 56.0 ± 4.4% thereafer (2005–2008), indicatng adaptaton of A. citricola in a disturbed agroecosystem.A minadora das folhas dos citros (MFC), Phyllocnistis citrella Stainton (Lepidoptera: Gracillariidae), foi encontrada pela primeira vez no Brasil em 1996. Em 1998, o parasitoide Ageniaspis citricola Logvinovskaya (Hymenoptera: Encyrtidae) foi introduzido e se estabeleceu em várias regiões do país. Nesse estudo, foram feitas130 amostragens, de uma hora, de folhas de laranjeiras doces [Citrus sinensis (L.) Osbeck] com câmaras pupais da MFC, para se estimar o parasitismo da MFC em 7 regiões do estado de São Paulo, entre 2000 e 2008. O tamanho das amostras variou de 10 a 275 folhas (média = 65). O parasitoide mais abundante foi o encirtídeo A. citricola (encontrado em 91.8% das amostragens). O maior parasitismo da MFC por A. citricola foi observado na região sul do estado (Botucatu), 70,2 ± 6,6 (média ± EPM), e o menor parasitismo na região norte (Barretos), 12,8 ± 5,7%. O parasitismo da MFC por A. citricola e seus parasitoides nativos (Galeopsomyia fausta LaSalle, Cirrospilus spp. and Elasmus sp.) não diferiram entre as estações do ano. O aumento de seis vezes no uso de inseticidas nos pomares de citros, após 2004, quando o Huanglongbing (HLB) foi encontrado no estado de São Paulo, não reduziu o nível de parasitismo da MFC. O nível médio de parasitismo foi de 50,8 ± 4,2%, antes do HLB (2000-2004), e 56,0 ± 4,4%, após o HLB (2005-2008), indicando a adaptação de A. citricola a um agroecossistema perturbado.info:eu-repo/semantics/publishedVersio