The Grand Experiment in Regulatory Reporting

This paper evaluates a grand regulatory experiment, the first of its kind in the world, aimed at providing an objective and comprehensive characterization of the costs and benefits of U.S. federal regulation as well as identifying opportunities for reform. This experiment, if successful, could have important implications for reviewing the impact of regulation across the world. Five government reports on the costs and benefits of regulation are now complete. We offer a critical evaluation of these reports, using an approach that scores the reports on various dimensions. By and large, the reports represent a significant step forward in providing insights into the regulatory process and in providing information on the costs and benefits of regulation. But they also illustrate the shortcomings of having a government agency do the analysis. We recommend that the Office of Management and Budget require agencies to issue a scorecard evaluating each agency regulation; that OMB summarize the strengths and weaknesses of regulations using this scorecard; that OMB include not only executive agencies, but also independent agencies in its analysis; and that Congress create an agency or office outside of the executive branch to perform a regulatory evaluation function similar to that of OMB. While we are highly critical of some aspects of these important reports, we are guardedly optimistic about their potential to improve regulation and the regulatory process.

An evaluation of delay to reinforcement and variant responding

Children with Autism Spectrum Disorders and other developmental disabilities often exhibit invariant responding (i.e., restricted behavioral repertoires), deficits in communication, and challenging behavior. A variety of interventions have targeted increasing variant responding such as extinction, lag schedules of reinforcement, and percentile schedules of reinforcement. An additional variation studied in the basic literature entails the inclusion of a delay to reinforcement. Results of basic studies indicate that the inclusion of a delay to reinforcement leads to an increase in the variety of responses. The purpose of the current study was to evaluate the effects of a delay to reinforcement on the variability of communication responses during functional communication training with children with developmental disabilities with histories of engagement in challenging behavior. Results indicated that the delay to reinforcement increased variant communicative responding with all four participants.Educational Psycholog

Matrix-free multigrid block-preconditioners for higher order Discontinuous Galerkin discretisations

Efficient and suitably preconditioned iterative solvers for elliptic partial differential equations (PDEs) of the convection-diffusion type are used in all fields of science and engineering. To achieve optimal performance, solvers have to exhibit high arithmetic intensity and need to exploit every form of parallelism available in modern manycore CPUs. The computationally most expensive components of the solver are the repeated applications of the linear operator and the preconditioner. For discretisations based on higher-order Discontinuous Galerkin methods, sum-factorisation results in a dramatic reduction of the computational complexity of the operator application while, at the same time, the matrix-free implementation can run at a significant fraction of the theoretical peak floating point performance. Multigrid methods for high order methods often rely on block-smoothers to reduce high-frequency error components within one grid cell. Traditionally, this requires the assembly and expensive dense matrix solve in each grid cell, which counteracts any improvements achieved in the fast matrix-free operator application. To overcome this issue, we present a new matrix-free implementation of block-smoothers. Inverting the block matrices iteratively avoids storage and factorisation of the matrix and makes it is possible to harness the full power of the CPU. We implemented a hybrid multigrid algorithm with matrix-free block-smoothers in the high order DG space combined with a low order coarse grid correction using algebraic multigrid where only low order components are explicitly assembled. The effectiveness of this approach is demonstrated by solving a set of representative elliptic PDEs of increasing complexity, including a convection dominated problem and the stationary SPE10 benchmark.Comment: 28 pages, 10 figures, 10 tables; accepted for publication in Journal of Computational Physic

On the Edge : Assessing Fish Habitat Use Across the Boundary between Pacific Oyster Aquaculture and Eelgrass in Willapa Bay, WA

Estuaries are an important ecological link between terrestrial, freshwater, and marine systems, but are also subject to a variety of human pressures. Along the West Coast of the United States, shellfish aquaculture is one extensive use of estuarine tidelands. Specifically, Pacific oyster (Crassostrea gigas) aquaculture has been practiced for almost 100 years, significantly contributing to the culture and economy of the region. However, this activity does not exist in isolation. Oyster aquaculture commonly occurs in intertidal areas where native eelgrass (Zostera marina) is also present. Seagrasses provide valuable nursery habitat for many commercially-harvested species (e.g. salmonids, English sole, and Dungeness crab) and have recently garnered more conservation interest because they are declining in many locations. For these reasons, eelgrass is protected as “essential fish habitat” under the Magnuson-Stevens Fishery Conservation and Management Act. This protection restricts or prohibits oyster aquaculture within or near eelgrass. To help inform management decisions around this issue, questions were addressed regarding the use of both aquaculture and eelgrass as habitat for fish and crabs. Specifically, I was interested in quantifying and distinguishing whether the edge between these two habitats supported a different number of fauna. Information about edge effects could help elucidate potential consequences of aquaculture expansion at the scale of the whole estuary. Due to a recent shift towards off-bottom culture methods, in part to protect seagrasses, this comparison was made in both long-line and on-bottom aquaculture. Direct (underwater video) and indirect (e.g. predation tethering units) measures of fish and invertebrate community composition and behavior were used to quantify effects along a transect that ran between aquaculture and eelgrass in each type of aquaculture. Results suggest that species use long-line oyster aquaculture and eelgrass habitats similarly with minimal effect of the edge. However, habitat use of the on-bottom aquaculture was less than both the long-line aquaculture and eelgrass beds. This is consistent with an expected positive relationship between faunal abundance and the amount of vertical structure within a habitat. These conclusions add to the best available science regarding aquaculture and eelgrass interactions and provide valuable insight to managers and permitting agencies as they consider requests to expand culture operations

Keeping Time: Implementing Appointment-based Family-centered Rounds.

Background:Family-centered rounds (FCRs) provide many benefits over traditional rounds, including higher patient satisfaction, and shared mental models among staff. These benefits can only be achieved when key members of the care team are present and engaged. We aimed to improve patient engagement and satisfaction with our existing bedside rounds by designing a new FCR process. Methods:We conducted a needs assessment and formed a multidisciplinary FCR committee that identified appointment-based family-centered rounds (aFCRs) as a primary intervention. We designed, implemented, and iteratively refined an aFCR process. We tracked process metrics (rounds attendance by key participants), a balancing metric (time per patient), and outcome metrics (patient satisfaction domains) during the intervention and follow-up periods. Results:After implementing aFCR, 65% of patients reported positive experience with rounds and communication. Rounds duration per patient was similar (9 versus 9.4 min). Nurse, subspecialist, and interpreter attendance on rounds was 72%, 60%, and 90%, respectively. We employed a Rounding Coordinator to complete the scheduling and communication required for successful aFCR. Discussion:We successfully improved our rounding processes through the introduction of aFCR with the addition of a rounding coordinator. Our experience demonstrates one method to increase multidisciplinary team member attendance on rounds and patient satisfaction with physician communication in the inpatient setting

Characterising the types of paediatric adverse events detected by the global trigger tool - CareTrack Kids

Introduction A common method of learning about adverse events (AEs) is by reviewing medical records using the global trigger tool (GTT). However, these studies generally report rates of harm. The aim of this study is to characterise paediatric AEs detected by the GTT using descriptive and qualitative approaches. Methods Medical records of children aged 0–15 were reviewed for presence of harm using the GTT. Records from 2012–2013 were sampled from hospital inpatients, emergency departments, general practice and specialist paediatric practices in three Australian states. Nurses undertook a review of each record and if an AE was suspected a doctor performed a verification review of a summary created by the nurse. A qualitative content analysis was undertaken on the summary of verified AEs. Results A total of 232 AEs were detected from 6,689 records reviewed. Over four-fifths of the AEs (193/232, 83%) resulted in minor harm to the patient. Nearly half (112/232, 48%) related to medication/intravenous (IV) fluids. Of these, 83% (93/112) were adverse drug reactions. Problems with medical devices/equipment were the next most frequent with nearly two-thirds (32/51, 63%) of these related to intravenous devices. Problems associated with clinical processes/procedures comprise one in six AEs (38/232, 16%), of which diagnostic problems (12/38, 32%) and procedural complications (11/38, 29%) were the most frequent. Conclusion Adverse drug reactions and issues with IVs are frequently identified AEs reflecting their common use in paediatrics. The qualitative approach taken in this study allowed AE types to be characterised, which is a prerequisite for developing and prioritising improvements in practice

Point to point multispectral light projection applied to cultural heritage

Use of new of light sources based on LED technology should allow the develop of systems that combine conservation and exhibition requirements and allow to make these art goods available to the next generations according to sustainability principles. The goal of this work is to develop light systems and sources with an optimized spectral distribution for each specific point of the art piece. This optimization process implies to maximize the color fidelity reproduction and the same time to minimize the photochemical damage. Perceived color under these sources will be similar (metameric) to technical requirements given by the restoration team uncharged of the conservation and exhibition of the goods of art. Depending of the fragility of the exposed art objects (i.e. spectral responsivity of the material) the irradiance must be kept under a critical level. Therefore, it is necessary to develop a mathematical model that simulates with enough accuracy both the visual effect of the illumination and the photochemical impact of the radiation. Spectral reflectance of a reference painting The mathematical model is based on a merit function that optimized the individual intensity of the LED-light sources taking into account the damage function of the material and color space coordinates. Moreover the algorithm used weights for damage and color fidelity in order to adapt the model to a specific museal application. In this work we show a sample of this technology applied to a picture of Sorolla (1863-1923) an important Spanish painter title “woman walking at the beach”

Relationships of the Location and Content of Rounds to Specialty, Institution, Patient-Census, and Team Size

OBJECTIVE: Existing observational data describing rounds in teaching hospitals are 15 years old, predate duty-hour regulations, are limited to one institution, and do not include pediatrics. We sought to evaluate the effect of medical specialty, institution, patient-census, and team participants upon time at the bedside and education occurring on rounds. METHODS AND PARTICIPANTS: Between December of 2007 and October of 2008 we performed 51 observations at Lucile Packard Children's Hospital, Seattle Children's Hospital, Stanford University Hospital, and the University of Washington Medical Center of 35 attending physicians. We recorded minutes spent on rounds in three location and seven activity categories, members of the care team, and patient-census. RESULTS: Results presented are means. Pediatric rounds had more participants (8.2 vs. 4.1 physicians, p<.001; 11.9 vs. 2.4 non-physicians, p<.001) who spent more minutes in hallways (96.9 min vs. 35.2 min, p<.001), fewer minutes at the bedside (14.6 vs. 38.2 min, p = .01) than internal medicine rounds. Multivariate regression modeling revealed that minutes at the bedside per patient was negatively associated with pediatrics (-2.77 adjusted bedside minutes; 95% CI -4.61 to -0.93; p<.001) but positively associated with the number of non-physician participants (0.12 adjusted bedside minutes per non physician participant; 95% CI 0.07 to 0.17; p = <.001). Education minutes on rounds was positively associated with the presence of an attending physician (2.70 adjusted education minutes; 95% CI 1.27 to 4.12; p<.001) and with one institution (1.39 adjusted education minutes; 95% CI 0.26 to 2.53; p = .02). CONCLUSIONS: Pediatricians spent less time at the bedside on rounds than internal medicine physicians due to reasons other than patient-census or the number of participants in rounds. Compared to historical data, internal medicine rounds were spent more at the bedside engaged in patient care and communication, and less upon educational activities