Understanding the organizational barriers of promoting electronic delivery options in the United States healthcare system: an insurer’s perspective

Consumer-driven technologies are rapidly transforming how industries conduct business both internally and externally. From online banking to retail, the broad adoption of smart devices, internet access, and wearables amongst consumers has shifted the way enterprises develop software and conduct information technology (IT) operations. Although successful adoption of consumer-driven technologies is a reality for many industries, the healthcare platform is lagging. The promotion and adoption of online patient engagement is widely perceived to be one of the biggest hurdles faced by healthcare organizations (Carr, 2014). While setting up patient portals and electronic delivery options can be relatively simple, promoting consumer utilization and achieving widespread use of these portals use has posed challenges. The healthcare paradigm has shifted in recent decades from viewing the patient as incidental to the delivery of healthcare to a more patient-centric approach. The previous model of indirectly funding Medicare, Medicaid, or employers has been noted as one of the greatest flaws of the healthcare system by contributing to cost inflation (Carr, 2014). Recent trends have promoted patient-empowered care, but have generally transferred the burden of cost to the individual. The Affordable Care Act (ACA) stimulated this shift by creating insurance exchanges which allow insurers to directly reach consumers; however, these readily-available healthcare options now require higher monthly premium payments from shoppers. This new model proposes that as patients become increasingly financially liable, they become more invested in their healthcare trajectories

Dynamical Interactions and the Black Hole Merger Rate of the Universe

Binary black holes can form efficiently in dense young stellar clusters, such as the progenitors of globular clusters, via a combination of gravitational segregation and cluster evaporation. We use simple analytic arguments supported by detailed N-body simulations to determine how frequently black holes born in a single stellar cluster should form binaries, be ejected from the cluster, and merge through the emission of gravitational radiation. We then convolve this ``transfer function'' relating cluster formation to black hole mergers with (i) the distribution of observed cluster masses and (ii) the star formation history of the universe, assuming that a significant fraction gcl of star formation occurs in clusters and that a significant fraction gcand of clusters undergo this segregation and evaporation process. We predict future ground--based gravitational wave (GW) detectors could observe ~500 (gcl/0.5) (gcand/0.1) double black hole mergers per year, and the presently operating LIGO interferometer would have a chance (50%) at detecting a merger during its first full year of science data. More realistically, advanced LIGO and similar next-generation gravitational wave observatories provide unique opportunities to constrain otherwise inaccessible properties of clusters formed in the early universe.Comment: 4 pages, 2 figures. To appear in PRD Rapid Communication

Isobaric multiplet yrast energies and isospin non-conserving forces

The isovector and isotensor energy differences between yrast states of isobaric multiplets in the lower half of the $pf$ region are quantitatively reproduced in a shell model context. The isospin non-conserving nuclear interactions are found to be at least as important as the Coulomb potential. Their isovector and isotensor channels are dominated by J=2 and J=0 pairing terms, respectively. The results are sensitive to the radii of the states, whose evolution along the yrast band can be accurately followed.Comment: 4 pages, 4 figures. Superseeds second part of nucl-th/010404

Time Reversal and n-qubit Canonical Decompositions

For n an even number of qubits and v a unitary evolution, a matrix decomposition v=k1 a k2 of the unitary group is explicitly computable and allows for study of the dynamics of the concurrence entanglement monotone. The side factors k1 and k2 of this Concurrence Canonical Decomposition (CCD) are concurrence symmetries, so the dynamics reduce to consideration of the a factor. In this work, we provide an explicit numerical algorithm computing v=k1 a k2 for n odd. Further, in the odd case we lift the monotone to a two-argument function, allowing for a theory of concurrence dynamics in odd qubits. The generalization may also be studied using the CCD, leading again to maximal concurrence capacity for most unitaries. The key technique is to consider the spin-flip as a time reversal symmetry operator in Wigner's axiomatization; the original CCD derivation may be restated entirely in terms of this time reversal. En route, we observe a Kramers' nondegeneracy: the existence of a nondegenerate eigenstate of any time reversal symmetric n-qubit Hamiltonian demands (i) n even and (ii) maximal concurrence of said eigenstate. We provide examples of how to apply this work to study the kinematics and dynamics of entanglement in spin chain Hamiltonians.Comment: 20 pages, 3 figures; v2 (17pp.): major revision, new abstract, introduction, expanded bibliograph

The changing pattern of domestic cannabis cultivation in the UK and its impact on the cannabis market

With improvements in both technology and information cannabis is being increasingly grown indoors for domestic use, rather than being imported. This study examines 50 cannabis farms detected by an English police force, and examines the characteristics of the 61 suspects associated with them. The study highlights a UK pattern in domestic cultivation, that is moving away from large scale commercial cultivation, at times co-ordinated by South East Asian organised crime groups, to increased cultivation within residential premises by British citizens. Offenders range from those who have no prior criminal history to those who are serious and persistent offenders. The ramifications for law enforcement agencies and policy formers are discussed

Combined data analysis of fossil and living mammals: a Paleogene sister taxon of Placentalia and the antiquity of Marsupialia

The Cretaceous–Paleogene (KPg) boundary, one of Earth’s five major extinction events, occurred just before the appearance of Placentalia in the fossil record. The Gobi Desert, Mongolia and the Western Interior of North America have important fossil mammals occurring just before and after the KPg boundary (e.g. Prodiacodon, Deltatheridium) that have yet to be phylogenetically tested in a character-rich context with molecular data. We present here phylogenetic analyses of >6000 newly scored anatomical observations drawn from six untested fossils and added to the largest existing morphological matrix for mammals. These data are combined with sequence data from 27 nuclear genes. Results show the existence of a new eutherian sister clade to Placentalia, which we name and characterize. The extinct clade Leptictidae is part of this placental sister clade, indicating that the sister clade survived the KPg event to co-exist in ancient ecosystems during the Paleogene radiation of placentals. Analysing the Cretaceous metatherian Deltatheridium in this character-rich context reveals it is a member of Marsupialia, a finding that extends the minimum age of Marsupialia before the KPg boundary. Numerous shared-derived features from multiple anatomical systems support the assignment of Deltatheridium to Marsupialia. Computed tomography scans of exquisite new specimens better document the marsupial-like dental replacement pattern of Deltatheridium. The new placental sister clade has both Asian and North American species, and is ancestrally characterized by shared derived features such as a hind limb modified for saltatorial locomotion

Band termination in the N=Z Odd-Odd Nucleus 46V

High spin states in the odd-odd N=Z nucleus 46V have been identified. At low spin, the T=1 isobaric analogue states of 46Ti are established up to I = 6+. Other high spin states, including the band terminating state, are tentatively assigned to the same T=1 band. The T=0 band built on the low-lying 3+ isomer is observed up to the 1f7/2-shell termination at I=15. Both signatures of a negative parity T=0 band are observed up to the terminating states at I = 16- and I = 17-, respectively. The structure of this band is interpreted as a particle-hole excitation from the 1d3/2 shell. Spherical shell model calculations are found to be in excellent agreement with the experimental results.Comment: 5 pages, 4 figure

Risk Factors for West Nile Virus Neuroinvasive Disease, California, 2005

In 2005, 880 West Nile virus cases were reported in California; 305 case-patients exhibited neuroinvasive disease, including meningitis, encephalitis, or acute flaccid paralysis. Risk factors independently associated with developing neuroinvasive disease rather than West Nile fever included older age, male sex, hypertension, and diabetes mellitus

Progression of Carotid Artery Intima-Media Thickness During 12 Years in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study

OBJECTIVE This study investigated the long-term effects of intensive diabetic treatment on the progression of atherosclerosis, measured as common carotid artery intima-media thickness (IMT). RESEARCH DESIGN AND METHODS A total of 1,116 participants (52% men) in the Epidemiology of Diabetes Interventions and Complications (EDIC) trial, a long-term follow-up of the Diabetes Control and Complications Trial (DCCT), had carotid IMT measurements at EDIC years 1, 6, and 12. Mean age was 46 years, with diabetes duration of 24.5 years at EDIC year 12. Differences in IMT progression between DCCT intensive and conventional treatment groups were examined, controlling for clinical characteristics, IMT reader, and imaging device. RESULTS Common carotid IMT progression from EDIC years 1 to 6 was 0.019 mm less in intensive than in conventional (P < 0.0001), and from years 1 to 12 was 0.014 mm less (P = 0.048); but change from years 6 to 12 was similar (intensive − conventional = 0.005 mm, P = 0.379). Mean A1C levels during DCCT and DCCT/EDIC were strongly associated with progression of IMT, explaining most of the differences in IMT progression between DCCT treatment groups. Albuminuria, older age, male sex, smoking, and higher systolic blood pressure were significant predictors of IMT progression. CONCLUSIONS Intensive treatment slowed IMT progression for 6 years after the end of DCCT but did not affect IMT progression thereafter (6–12 years). A beneficial effect of prior intensive treatment was still evident 13 years after DCCT ended. These differences were attenuated but not negated after adjusting for blood pressure. These results support the early initiation and continued maintenance of intensive diabetes management in type 1 diabetes to retard atherosclerosis