Multihospital System Affiliation as a Survival Strategy for Rural Hospitals Under the Prospective Payment System

The introduction of Medicare's Prospective Payment System (PPS) has disproportionately increased financial pressures on rural hospitals and posed challenges to the survival of these institutions. Increasingly, rural hospitals are seeking strategies that can enhance their chances for survival in a turbulent and hostile environment. This study examined the survival effects of one such strategy, multihospital system affiliation. Specifically, we assessed: (1) whether and how different types of system affiliation in the post-PPS era affect the likelihood of rural hospital survival; (2) whether particular structural, environmental and hospital performance characteristics moderate the effects of system affiliation on rural hospital survival; and (3) whether systematic selection by rural hospitals into multihospital systems potentially accounts for observed relationships between system affiliation and survival. Proportional hazards analyses indicate that system affiliation with investor-owned systems significantly reduces survival probabilities of rural hospitals. Affiliation with not-for-profit systems or system affiliation under contract management arrangements does not affect survival probabilities of rural hospitals. These general findings are moderated by the effects of hospital ownership and size at the time of affiliation. Finally, study findings indicated that systematic selection by poor performing rural hospitals into investor-owned systems has occurred in the post-PPS era. No evidence of selection into not-for-profit systems was discovered.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73618/1/j.1748-0361.1992.tb00334.x.pd

Organic molecular and inorganic isotope records of Cenozoic topography, ecosystem and climate evolution of the Southern Central Andes

The Andes are part of the longest mountain range on earthand their evolution has influenced global climate,weathering, and ecosystems since the Cretaceous. Weanalyzed the distribution and δ2H and δ13C of plant-derivedorganic biomarkers, the δ2H of volcanic glass, and thedistribution of soil-derived glycerol dialkyl glyceroltetraethers from Cenozoic sediments in the Malargüe Basinof Argentina (~35°S). Organic molecular and inorganic datawere measured to reconstruct Cenozoic changes inprecipitation isotopes, temperature, moisture deficit, andecosystems on the eastern flank of the Southern CentralAndes. Two variables (precipitation isotopes andtemperature) are strongly related to the topography of anorogen through isotopic distillation of precipitation duringrainout and changes in temperature with elevation.However, molecular biomarkers also provide keyinformation about climate and aridity through time. Weshow that organic biomarker and volcanic glass δ2H datafrom the Malargüe basin record late Cenozoic reduction oforographic lifting of airmasses associated with localdowndrop of the basin. In addition, molecular data reflectlong-term shifts in moisture deficit and plant water stressthat are consistent with regional patterns of changingclimate and aridity due to late Cenozoic cooling. Soilderivedtetraether lipid records mirror the patterns observedin organic molecular and inorganic isotope data, yet recordtemperatures that are unrealistic. These data highlight thecomplexity of universally applying the soil GDGT proxy toall terrestrial systems. In total, combined organic andinorganic data highlight the importance of multi-proxyrecords to produce a coherent representation of long-termecosystem and climate change in a region impacted byevolving climatic and tectonic boundary conditions.Fil: Hren, Michael. University of Connecticut; Estados UnidosFil: Brandon, Mark Thomas. University of Yale; Estados UnidosFil: Fennell, Lucas Martín. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Estudios Andinos "Don Pablo Groeber". Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Estudios Andinos "Don Pablo Groeber"; ArgentinaFil: Smolen, Jonathan. University of Connecticut; Estados UnidosFil: Super, James. University of Yale; Estados UnidosGoldschmidt MeetingEstados UnidosGeochemical SocietyEuropean Association of Geochemistr

Physiological and Molecular Characterisation of Lucerne (Medicago sativa L.) Germplasm with Improved Seedling Freezing Tolerance

We conducted greenhouse experiments to compare 14 lucerne (alfalfa, Medicago sativa L.) germplasms for their survival following freezing. Some are collections adapted to the Grand River National Grasslands in South Dakota. We hypothesised that these collections might have developed a tolerance to survive the frigid growth conditions common there. Two of these collections, River side (RS) and Foster ranch (FR), showed greater freezing tolerance than the other germplasms tested, based on their consistent survival rates with or without cold acclimation. In multiple freezing studies, RS and FR had average survival rates of 74% and 79%, respectively, in contrast to the commercial cultivars Apica and CUF-101 (CUF) (64% and 24%, respectively). The average temperature at which 50% of ions in plant tissues leak out (LT50) by freezing based on leaf electrolyte leakage was closely correlated with survival rates. Leaf LT50 improved 2–3-fold after 3 days of cold acclimation, based on leaf electrolyte leakage analysis, reaching −18°C, –9.6°C, –8.5°C, and −5°C for RS, FR, Apica, and CUF, respectively. Comparison of total soluble sugars and relative water content in shoots before and after cold acclimation showed that they were not well correlated with freezing tolerance and could not explain the superior responses of RS and FR during cold acclimation. Transcript analysis of cold-responsive MsCBF1, MsCBF2 and CAS15B genes showed that RS, FR, Apica and CUF exhibited distinct patterns of cold induction. Although RS, FR and Apica showed a rapid or greater increase in expression level of one or two of these genes, CUF showed only a moderate induction in MsCBF2 and CAS15B transcripts, suggesting that expression of these genes may be a good molecular marker for freezing tolerance in lucerne. The findings provide evidence that freezing tolerance in lucerne is a complex trait and that a combination of different mechanisms may greatly improve freezing tolerance. RS and FR are potential resources in breeding for improving freezing tolerance in lucerne

Eocene to modern topographic evolution of an Andean retroarc foreland basin (35°S) from stable isotope paleoaltimetry: implications for tectonic and geodynamic models

Andean basins contain a unique sedimentary record reflecting mountain building processes along thewestern margin of South America throughout its entire Meso-Cenozoic evolution (Horton, 2018). Inparticular, the retroarc foreland basins in west-central Argentina contain an archive of sedimentaccumulation rates, provenance, paleodrainage and deformation timings related to the growth of theSouthern Central Andes (27°-46°30?S; Ramos, 1999). However, this dataset has non-unique tectonicinterpretations, resulting in contrasting geodynamic scenarios. During the last decade, paleoaltimetrystudies using proxies to obtain the stable isotopic composition of paleoprecipitation have proved to be apowerful tool when assessing such contrasting scenarios, not only by reconstructing topography, butalso by adding a key element towards understanding changes in regional climate and biologicaldiversification (Mulch, 2016).The stable isotopic composition of precipitation reflects the degree of isotopic distillation during rainoutas an airmass moves across a landscape. Thus, materials that record this geochemical variable canprovide an indication of the present or past elevations along a moisture transport pathway. As volcanicashes are deposited on a landscape, they readily hydrate, providing a record of the isotopic compositionof ambient water over a timescale of 1-10 thousand years. Following hydration, water uptake ceasesand this initial signature is preserved, providing a long-term record of stable hydrogen isotopes (ID) ofpaleo-precipitation. Therefore, given that the activity of the Andean magmatic arc has resulted in anear-continuous production of felsic ashes for more than 65 million years, the stable isotope content ofhydrated volcanic glass from the Malargüe foreland basin (35°S) was extracted to analyze itstopographic evolution and compare it to the geological record.The ID of volcanic glasses preserved within strata of the Malargüe basin suggest high-standingtopography since at least 55 Ma, along with an increase in orographic fractionation during middleEocene to Oligocene times, followed by a decrease between the middle Miocene and the Pliocene.While the first event coincides with low accumulation rates during lacustrine and distal fluvial depositionin the basin, the second episode overlaps with high accumulation rates and proximal fluvial and alluvialsedimentation. These results support the hypothesis of a pre-Neogene orographic barrier and could bereflecting topographic changes associated with deep mantle processes that have been affecting theSouth American continent throughout most of the Cenozoic (Flament et al., 2015).Flament, N., Gurnis, M., Müller, R.D., Bower, D.J., and Husson, L., 2015. Influence of subduction history on South American topography. Earth andPlanetary Science Letters, 430, 9-18.Horton, B.K., 2018. Sedimentary record of Andean mountain building. Earth-Science Reviews, 178, 279-309.Mulch, A., 2016. Stable isotope paleoaltimetry and the evolution of landscapes and life. Earth and Planetary Science Letters, 433, 180-191.Ramos, V.A., 1999. Plate tectonic setting of the Andean Cordillera. Episodes, 22(3), 183-190.Fil: Fennell, Lucas Martín. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Estudios Andinos "Don Pablo Groeber". Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Estudios Andinos "Don Pablo Groeber"; ArgentinaFil: Hren, Michael. University of Connecticut; Estados UnidosFil: Brandon, Mark. University of Yale; Estados UnidosFil: Colwyn, David. State University of Colorado at Boulder; Estados UnidosFil: Martos, Federico Exequiel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Estudios Andinos "Don Pablo Groeber". Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Estudios Andinos "Don Pablo Groeber"; ArgentinaFil: Lewis, Amelia. Oberlin College; Estados UnidosFil: Folguera Telichevsky, Andres. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Estudios Andinos "Don Pablo Groeber". Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Estudios Andinos "Don Pablo Groeber"; Argentina8th International Symposium on Andean GeodynamicsQuitoEcuadorEscuela Politécnica NacionalInstitut de Recherche pour le Développemen

Quality of Maximum Likelihood Estimates of Parameters in a Log-Linear Rate Model

The authors address four sources of indeterminacy in maximum likelihood estimation (MLE) for multivariate modeling of change using panel data: censoring, caused by changes that occur after the observation period ends; small sample size; interacting censoring with sample size; and collinearity among causal variables. They explore the issues with simulations and conclude that MLE estimates are generally efficient except when censoring is extreme, and efficiency is only slightly affected by collinearity among independent variables. Related publications include Tuma and Hannan (1979) and Tuma, Hannan, and Groeneveld (1979)

Targeted next-generation sequencing of a cancer transcriptome enhances detection of sequence variants and novel fusion transcripts

Combining next-generation sequencing with capture of sequences from a relevant subset of a transcriptome produces an enhanced view of this subse

Supporting Inclusive Design of Mobile Devices with a Context Model

The aim of inclusive product design is to successfully integrate a broad range of diverse human factors in the product development process with the intention of making products accessible to and usable by the largest possible group of users. However, the main barriers for adopting inclusive product design include technical complexity, lack of time, lack of knowledge and techniques, and lack of guidelines. Although manufacturers of consumer products are nowadays more likely to invest efforts in user studies, consumer products in general only nominally fulfill, if at all, the accessibility requirements of as many users as they potentially could. The main reason is that any user-centered design prototyping or testing aiming to incorporate real user input, is often done at a rather late stage of the product development process. Thus, the more progressed a product design has evolved - the more time-consuming and costly it will be to alter the design. This is increasingly the case for contemporary mobile devices such as mobile phones or remote controls

RNA-SeQC: RNA-seq metrics for quality control and process optimization

Summary: RNA-seq, the application of next-generation sequencing to RNA, provides transcriptome-wide characterization of cellular activity. Assessment of sequencing performance and library quality is critical to the interpretation of RNA-seq data, yet few tools exist to address this issue. We introduce RNA-SeQC, a program which provides key measures of data quality. These metrics include yield, alignment and duplication rates; GC bias, rRNA content, regions of alignment (exon, intron and intragenic), continuity of coverage, 3′/5′ bias and count of detectable transcripts, among others. The software provides multi-sample evaluation of library construction protocols, input materials and other experimental parameters. The modularity of the software enables pipeline integration and the routine monitoring of key measures of data quality such as the number of alignable reads, duplication rates and rRNA contamination. RNA-SeQC allows investigators to make informed decisions about sample inclusion in downstream analysis. In summary, RNA-SeQC provides quality control measures critical to experiment design, process optimization and downstream computational analysis