A National Survey of the arrangements managed-care plans make with physicians

Abstract Background. Despite the growth of managed care in the United States, there is little information about the arrangements managed-care plans make with physicians. Methods. In 1994 we surveyed by telephone 138 managed-care plans that were selected from 20 metropolitan areas nationwide. Of the 108 plans that responded, 29 were group-model or staff-model health maintenance organizations (HMOs), 50 were network or independentpractice–association (IPA) HMOs, and 29 were preferred-provider organizations (PPOs). Results. Respondents from all three types of plan said they emphasized careful selection of physicians, although the group or staff HMOs tended to have more demanding requirements, such as board certification or eligibility. Sixty-one percent of the plans responded that physicians’ previous patterns of costs or utilization of resources had little influence on their selection; 26 percent said these factors had a moderate influence; and 13 percent said they had a large influence. Some risk sharing with physicians was typical in the HMOs but rare in the PPOs. Fiftysix percent of the network or IPA HMOs used capitation as the predominant method of paying primary care physicians, as compared with 34 percent of the group or staff HMOs and 7 percent of the PPOs. More than half the HMOs reported adjusting payments according to utilization or cost patterns, patient complaints, and measures of the quality of care. Ninety-two percent of the network or IPA HMOs and 61 percent of the group or staff HMOs required their patients to select a primary care physician, who was responsible for most referrals to specialists. About three quarters of the HMOs and 31 percent of the PPOs reported using studies of the outcomes of medical care as part of their quality-improvement programs. Conclusions. Managed-care plans, particularly HMOs, have complex systems for selecting, paying, and monitoring their physicians. Hybrid forms are common, and the differences between group or staff HMOs and network or IPA HMOs are less extensive than is commonly assumed. (N Engl J Med 1995;333:1678-83.

The nature of slow dynamics in a minimal model of frustration-limited domains

We present simulation results for the dynamics of a schematic model based on the frustration-limited domain picture of glass-forming liquids. These results are compared with approximate theoretical predictions analogous to those commonly used for supercooled liquid dynamics. Although model relaxation times increase by several orders of magnitude in a non-Arrhenius manner as a microphase separation transition is approached, the slow relaxation is in many ways dissimilar to that of a liquid. In particular, structural relaxation is nearly exponential in time at each wave vector, indicating that the mode coupling effects dominating liquid relaxation are comparatively weak within this model. Relaxation properties of the model are instead well reproduced by the simplest dynamical extension of a static Hartree approximation. This approach is qualitatively accurate even for temperatures at which the mode coupling approximation predicts loss of ergodicity. These results suggest that the thermodynamically disordered phase of such a minimal model poorly caricatures the slow dynamics of a liquid near its glass transition

Biology, incidence and host susceptibility of Pineus boerneri (Hemiptera : Adelgidae) in Colombian pine plantations

Adelgids (Hemiptera) in the genus Pineus have been reported as introduced insect pests causing serious losses to Pinus plantations worldwide. In 2008, Pineus boerneri was recorded for the first time in Colombia, with infestations noted on Pinus kesiya, P. tecunumanii, P. maximinoi and P. oocarpa. The lack of information on this insect in Colombia prompted investigations of its life cycle and infestation levels as well as host susceptibility of the main Pinus species planted in Colombia. In addition, the possibility of using a Ceraeochrysa species, an already established predator of adelgids in Colombia for biological control, was considered. Results showed that P. boerneri in Colombia has an anholocyclic life cycle comprised of four instars with a complete duration between 49 and 97 days. Infestations were higher in the middle and upper part of trees. Pinus kesiya and P. maximinoi had the highest levels of susceptibility in field as well as in greenhouse trials. A survey of naturally infested trees showed P. tecunumanii to be moderately susceptible while P. patula and P. oocarpa had low levels of susceptibility in a greenhouse trial but were not susceptible in the field. Investigations considering the impact of predation of Ceraeochrysa species showed a high predation rate of up to 140 P. boerneri consumed per day by a single Ceraeochrysa individual. Other predators of P. boerneri were recorded but were not sufficiently common to warrant detailed study.Smurfit Kappa Cartón de Colombia and the National Research Foundation (NRF) of South Africa.http://www.tandfonline.com/loi/tsfs20hb201

Time and length scales in supercooled liquids

We numerically obtain the first quantitative demonstration that development of spatial correlations of mobility as temperature is lowered is responsible for the ``decoupling'' of transport properties of supercooled liquids. This result further demonstrates the necessity of a spatial description of the glass formation and therefore seriously challenges a number of popular alternative theoretical descriptions.Comment: 4 pages, 4 figs; improved version: new refs and discussion

Nitric Oxide and Other Molecules: Molecular Modeling and Low-frequency Exploration Using the Murchison Widefield Array

We present new molecular modeling for 14NO and 15NO and a deep, blind molecular line survey at low radio frequencies (99-129 MHz). This survey is the third in a series completed with the Murchison Widefield Array (MWA), but in comparison with the previous surveys, uses 4 times more data (17 hr versus 4 hr) and is 3 times better in angular resolution (1′ versus 3′). The new molecular modeling for nitric oxide and its main isotopologue has seven transitions within the MWA frequency band (although we also present the higher-frequency transitions). Although we did not detect any new molecular lines at a limit of 0.21 Jy beam-1, this work is an important step in understanding the data processing challenges for the future Square Kilometre Array and places solid limits on what is expected in the future of low-frequency surveys. The modeling can be utilized for future searches of nitric oxide

Growing Correlation Length on Cooling Below the Onset of Caging in a Simulated Glass-Forming Liquid

We present a calculation of a fourth-order, time-dependent density correlation function that measures higher-order spatiotemporall correlations of the density of a liquid. From molecular dynamics simulations of a glass-forming Lennard-Jones liquid, we find that the characteristic length scale of this function has a maximum as a function of time which increases steadily beyond the characteristic length of the static pair correlation function $g(r)$ in the temperature range approaching the mode coupling temperature from above

N-body simulations of gravitational dynamics

We describe the astrophysical and numerical basis of N-body simulations, both of collisional stellar systems (dense star clusters and galactic centres) and collisionless stellar dynamics (galaxies and large-scale structure). We explain and discuss the state-of-the-art algorithms used for these quite different regimes, attempt to give a fair critique, and point out possible directions of future improvement and development. We briefly touch upon the history of N-body simulations and their most important results.Comment: invited review (28 pages), to appear in European Physics Journal Plu

Unexpected circular radio objects at high Galactic latitude

Large scale structure and cosmolog