Quality of care: analyzing the relationship between hospital quality score and total hospital costs

As healthcare costs and premiums have increased in the recent past, hospitals are forced to try to provide healthcare on tight budgets. In many cases, quality is often sacrificed in an effort to manage patient wait-times and costs. This research attempted to add to the existing body of knowledge of quality of care by defining a relationship between quality of care provided and total hospital costs. This study used the 2006 American Hospital Association’s Annual Survey Database and the 2006 Hospital Compare dataset to meet the data requirements for the study. A log-log, as well as a translog, cost function was used to estimate the relationship between quality of care provisioned for community acquired pneumonia and heart failure and total hospital costs. Regressors for the cost function included hospital outputs, inputs and wages as well as variables for patient-mix, case-mix, ownership status and medical school affiliation. Ultimately this study concluded that by increasing the quality of care score associated with community-acquired pneumonia by ten percent would decrease total hospital costs by 2.44 percent. However, several improvements were found that would improve the ability of the quality of care data and estimation methodologies to more comprehensively represent quality

Localization and Coherence in Nonintegrable Systems

We study the irreversible dynamics of nonlinear, nonintegrable Hamiltonian oscillator chains approaching their statistical asympotic states. In systems constrained by more than one conserved quantity, the partitioning of the conserved quantities leads naturally to localized and coherent structures. If the phase space is compact, the final equilibrium state is governed by entropy maximization and the final coherent structures are stable lumps. In systems where the phase space is not compact, the coherent structures can be collapses represented in phase space by a heteroclinic connection to infinity.Comment: 41 pages, 15 figure

Oyster Aquaculture Site Selection Using Landsat 8-Derived Sea Surface Temperature, Turbidity, and Chlorophyll a

Remote sensing data is useful for selection of aquaculture sites because it can provide water-quality products mapped over large regions at low cost to users. However, the spatial resolution of most ocean color satellites is too coarse to provide usable data within many estuaries. The Landsat 8 satellite, launched February 11, 2013, has both the spatial resolution and the necessary signal to noise ratio to provide temperature, as well as ocean color derived products along complex coastlines. The state of Maine (USA) has an abundance of estuarine indentations (∼3,500 miles of tidal shoreline within 220 miles of coast), and an expanding aquaculture industry, which makes it a prime case- study for using Landsat 8 data to provide products suitable for aquaculture site selection. We collected the Landsat 8 scenes over coastal Maine, flagged clouds, atmospherically corrected the top-of-the-atmosphere radiances, and derived time varying fields (repeat time of Landsat 8 is 16 days) of temperature (100 m resolution), turbidity (30 m resolution), and chlorophyll a (30 m resolution). We validated the remote-sensing-based products at several in situ locations along the Maine coast where monitoring buoys and programs are in place. Initial analysis of the validated fields revealed promising new areas for oyster aquaculture. The approach used is applicable to other coastal regions and the data collected to date show potential for other applications in marine coastal environments, including water quality monitoring and ecosystem management

Complexity-based learning and teaching: a case study in higher education

This paper presents a learning and teaching strategy based on complexity science and explores its impacts on a higher education game design course. The strategy aimed at generating conditions fostering individual and collective learning in educational complex adaptive systems, and led the design of the course through an iterative and adaptive process informed by evidence emerging from course dynamics. The data collected indicate that collaboration was initially challenging for students, but collective learning emerged as the course developed, positively affecting individual and team performance. Even though challenged, students felt highly motivated and enjoyed working on course activities. Their perception of progress and expertise were always high, and the academic performance was on average very good. The strategy fostered collaboration and allowed students and tutors to deal with complex situations requiring adaptation

The politics of accelerating low-carbon transitions: towards a new research agenda

Meeting the climate change targets in the Paris Agreement implies a substantial and rapid acceleration of low-carbon transitions. Combining insights from political science, policy analysis and socio-technical transition studies, this paper addresses the politics of deliberate acceleration by taking stock of emerging examples, mobilizing relevant theoretical approaches, and articulating a new research agenda. Going beyond routine appeals for more ‘political will’, it organises ideas and examples under three themes: 1) the role of coalitions in supporting and hindering acceleration; 2) the role of feedbacks, through which policies may shape actor preferences which, in turn, create stronger policies; and 3) the role of broader contexts (political economies, institutions, cultural norms, and technical systems) in creating more (or less) favourable conditions for deliberate acceleration. We discuss the importance of each theme, briefly review previous research and articulate new research questions. Our concluding section discusses the current and potential future relationship between transitions theory and political science

Metastatic squamous cell carcinoma to the colon arising from a mature cystic ovarian teratoma

Malignant transformation of a mature cystic teratoma is extremely rare, occurring in 0.17-2% of cases.1 The most common malignant degeneration is squamous cell carcinoma (SCC) arising from the ectoderm. Approximately half of all cases of SCC of the ovary are confined to the ovary at time diagnosis.1,2 Secondary to its absolute rarity and the relative infrequency of cases with metastatic spread the optimal treatment of advanced stage disease is unknown. Outcomes for locally advanced and widespread disease have historically been very poor. Ford and Timmons recently reported on a patient with stage IIC SCC arising in a mature cystic teratoma treated with multimodal therapy who has been free of disease for more than five years.3 Herein we report on a woman with stage IIIC SCC arising within a mature cystic teratoma treated with directed chemoradiation who subsequently developed metastatic SCC to the colon

Fluvial architecture in actively deforming salt basins : Chinle Formation, Paradox Basin, Utah

Support for this work was provided by the ‘J’ Block consortium: ConocoPhillips, BG and ENI and is gratefully acknowledged.Peer reviewedPostprintPostprin

Characterization of Coding Synonymous and Non-Synonymous Variants in ADAMTS13 Using Ex Vivo and In Silico Approaches

Synonymous variations, which are defined as codon substitutions that do not change the encoded amino acid, were previously thought to have no effect on the properties of the synthesized protein(s). However, mounting evidence shows that these “silent” variations can have a significant impact on protein expression and function and should no longer be considered “silent”. Here, the effects of six synonymous and six non-synonymous variations, previously found in the gene of ADAMTS13, the von Willebrand Factor (VWF) cleaving hemostatic protease, have been investigated using a variety of approaches. The ADAMTS13 mRNA and protein expression levels, as well as the conformation and activity of the variants have been compared to that of wild-type ADAMTS13. Interestingly, not only the non-synonymous variants but also the synonymous variants have been found to change the protein expression levels, conformation and function. Bioinformatic analysis of ADAMTS13 mRNA structure, amino acid conservation and codon usage allowed us to establish correlations between mRNA stability, RSCU, and intracellular protein expression. This study demonstrates that variants and more specifically, synonymous variants can have a substantial and definite effect on ADAMTS13 function and that bioinformatic analysis may allow development of predictive tools to identify variants that will have significant effects on the encoded protein

Metaphor as a mechanism of global climate change governance: a study of international policies, 1992–2012

This paper explores the emergence of a global climate change mitigation regime through an analysis of the language employed in international science-policy reports. We assume that a global climate regime can only operate effectively on the basis of a shared understanding of climate change which is itself based on a shared language of governance. We therefore carried out an in-depth thematic and metaphor analysis of 63 policy documents published between 1992 and 2012. Results show that global climate science-policy discourses universalise the myriad impacts of a changing climate into a single dichotomous impacted/not-impacted scenario and aim to govern this world according to economic principles of cost–benefit analysis. These discourses use metaphors that draw on narrative structures prevalent in the wider culture to produce and legitimate a reductionist representation of climate change. This representation undermines public understanding of and engagement with climate change by marginalising subordinate policy framings which do not align with the prevailing dichotomous framing. The types of documents we analyse in this paper represent important sources for journalists reporting on climate change. We therefore suggest that any attempt to improve public communication of climate change should include revisions to these organisational discourses