Martin de Barcos: Grace, Predestination, and Jansenism

Martin de Barcos’s posthumously published Exposition de la foy de l’Eglise romaine touchant la grâce et la prédestination is an important restatement of what he takes to be St Augustine’s doctrine on these matters. The first edition (1697) was condemned by the Archbishop of Paris, Louis-Antoine de Noailles, as a restatement of Jansenist doctrine, which, broken down into five key propositions, had been condemned by Innocent X in 1653. The ‘Remarques’ published with the second edition of 1700 argue that the Exposition by no means endorses the doctrines contained in the Five Propositions, and that the papal condemnation of these is thus irrelevant. This claim is assessed in a detailed analysis of the ‘Remarques’ and of the main text of the Exposition. In conclusion there is a brief discussion of the relationship of Barcos’s account of grace to Pascal’s and of the attempt to distinguish their views from those of the Calvinists.This is the accepted version of an article originally published in Seventeenth-Century French Studies. The final version is available from Maney Online at http://www.maneyonline.com/doi/abs/10.1179/0265106813Z.00000000031?journalCode=sfs

The Role of End-of-Course Exams and Minimum Competency Exams in Standards-Based Reforms

[Excerpt] Educational reformers and most of the American public believe that most teachers ask too little of their pupils. These low expectations, they believe, result in watered down curricula and a tolerance of mediocre teaching and inappropriate student behavior. The result is that the prophecy of low achievement becomes self-fulfilling. Although research has shown that learning gains are substantially larger when students take more demanding courses2, only a minority of students enroll in these courses. There are several reasons for this. Guidance counselors in many schools allow only a select few into the most challenging courses. While most schools give students and parents the authority to overturn counselor recommendations, many families are unaware they have that power or are intimidated by the counselor’s prediction of failure in the tougher class. As one student put it: “African-American parents, they settle for less, not knowing they can get more for their students.

The modern experience of care: patient satisfaction as a quality metric after the Affordable Care Act

The Hospital Value-Based Purchasing Program (HVBP), created by Section 3001 of the Patient Protection and Affordable Care Act passed in 2010, enacted a major industry shift in Medicare towards "pay for performance," or paying for high marks on a variety quality metrics rather than the traditional reliance on volume of care delivered. This study examines one of these quality metrics in particular: patient satisfaction. The trajectory of this paper begins with an overview of the current focus on patient satisfaction as a modern quality metric in American healthcare, contextualizes this emphasis on satisfaction within the intellectual movement of "patient-centered care," and moves on to a review of the relevant scholarship that attempts to explain the numerous determinants of patient satisfaction scores (with special attention to the inpatient hospital setting), as well as the robust academic debate over whether satisfaction is even an appropriate quality metric at all relative to clinical outcomes in care. The second half of my discourse moves on to more practical applications - first I break down the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and the impact of its methodology on providers, then the Medicare HVBP program itself and its various directions towards the value-based care model. I conclude with a quantitative analysis of trends in patient satisfaction over time between 1) HVBP-participating providers (as of FY2014) and 2) those providers who have not opted in (including those ineligible to do so). My comparison aims to study the strength of the HVBP incentives to improve patient satisfaction in those subject to the financial incentive relative to those who are not. Additionally, I preface this analysis whether patient satisfaction scores are associated with either clinical process of care scores or outcome scores in the HVBP program. My research questions aim to shed light on the academic debate between patient satisfaction and more traditional clinical outcomes - are they related in the context of FY2014 HVBP? Are the new incentives to improve patient satisfaction actually doing so in a meaningful way among providers newly accountable to these incentives? Finally, in a market defined by zero-sum resources, is there evidence that a financial incentives around patient satisfaction are channeling resources and by extension improvement away from clinical outcome performance? I believe this last question is the true concern of patient satisfaction skeptics, and hope to address it with applicable data. By providing a thorough qualitative grounding in the topic followed by current quantitative analysis, my goal is to create an informed perspective on the use of patient satisfaction as a quality metric in U.S. healthcare, which can be applied meaningfully from policy, provider, and consumer vantage points. With patient satisfaction becoming increasingly more internalized in the value-based care model, these analyses of the initial results in HVBP potentially serve as predictive insight into provider behavior in this area moving forward

Heat pipe cooled heat rejection subsystem modelling for nuclear electric propulsion

NASA LeRC is currently developing a FORTRAN based computer model of a complete nuclear electric propulsion (NEP) vehicle that can be used for piloted and cargo missions to the Moon or Mars. Proposed designs feature either a Brayton or a K-Rankine power conversion cycle to drive a turbine coupled with rotary alternators. Both ion and magnetoplasmodynamic (MPD) thrusters will be considered in the model. In support of the NEP model, Rocketdyne is developing power conversion, heat rejection, and power management and distribution (PMAD) subroutines. The subroutines will be incorporated into the NEP vehicle model which will be written by NASA LeRC. The purpose is to document the heat pipe cooled heat rejection subsystem model and its supporting subroutines. The heat pipe cooled heat rejection subsystem model is designed to provide estimate of the mass and performance of the equipment used to reject heat from Brayton and Rankine cycle power conversion systems. The subroutine models the ductwork and heat pipe cooled manifold for a gas cooled Brayton; the heat sink heat exchanger, liquid loop piping, expansion compensator, pump and manifold for a liquid loop cooled Brayton; and a shear flow condenser for a K-Rankine system. In each case, the final heat rejection is made by way of a heat pipe radiator. The radiator is sized to reject the amount of heat necessary

Hearing on American International Group

Testimony to the Congress of the United States Congressional Oversight Panel by Deputy Superintendent Michael Moriarty of the New York State Insurance Departmen

Caregiving, volunteering or both? Comparing effects health and mortality using census-based records from almost 250,000 people aged 65 and over

BackgroundThe health impacts of caregiving and volunteering are rarely studied concurrently, despite the potential for both synergies and conflicts. This population-based study examines the association of these activities on health and subsequent mortality. Method A census-based record linkage study of 244,429 people aged sixty-five and over, with cohort characteristics, caregiving and volunteering status, and presence of chronic health conditions derived from the Census returns. Mortality risk was assessed over the following forty-five months with adjustment for baseline characteristics. Results Caregivers and volunteers were individually more mobile than those undertaking neither activity; caregivers who also volunteered were more mobile than those who did not volunteer, but no less likely to suffer from poor mental health. Both caregiving and volunteering were separately associated with reduced mortality risk (HR=0.74: 95%CIs=0.71, 0.77 and HR=0.76: 0.73, 0.81 respectively); the lowest mortality was found amongst light caregivers who also volunteered (HR=0.53: 95%CIs 0.45, 0.62), compared to those engaged in neither. There was no evidence of a multiplicative effect of caregiving and volunteering at more intense levels of caregiving. ConclusionThere is a large overlap in caregiving and volunteering activities with complex associations with health status. There is some evidence that combining caregiving and volunteering activities, for those involved in less intense levels of caregiving, may be associated with lower mortality risk than associated with either activity alone. Further research is needed to understand which aspects of caregiving and volunteering are best and for whom and in which circumstances. <br/

Protostellar Outflows in L1340

We have searched the L1340 A, B, and C clouds for shocks from protostellar outflows using the H_2 2.122 μm near-infrared line as a shock tracer. Substantial outflow activity has been found in each of the three regions of the cloud (L1340 A, L1340 B, and L1340 C). We find 42 distinct shock complexes (16 in L1340 A, 11 in L1340 B, and 15 in L1340 C). We were able to link 17 of those shock complexes into 12 distinct outflows and identify candidate source stars for each. We examine the properties (A_V, T_(bol), and L_(bol)) of the source protostars and compare them to the properties of the general population of Class 0/I and flat spectral energy distribution protostars and find that there is an indication, albeit at low statistical significance, that the outflow-driving protostars are drawn from a population with lower A_V, higher L_(bol), and lower T_(bol) than the general population of protostars