Review of Quality Measures of the Most Integrated Health Care Settings for Children and the Need for Improved Measures: Recommendations for Initial Core Measurement Set for CHIPRA

AbstractObjectiveTo identify, assess, and make recommendations for inclusion of measures that assess the domain of “most integrated health care setting,” with a specific focus on measures of the medical home, one particular mechanism for integrating care, to identify gaps in measurement; and to make recommendations for new measure development.MethodsWe developed a conceptual framework for care integration and reviewed literature on measures assessing the presence and quality of the medical home to determine their validity, reliability, and feasibility as a proxy for care integration.ResultsWe identified 2 broad approaches to assessing the extent to which patients receive care that fulfills the aims of the medical home: 1) organizational assessment of practice systems and processes thought associated with achieving these desired aims (viz, the National Committee for Quality Assurance Physician Practice Connections—Patient Centered Medical Home measure and the Medical Home Index, and 2) direct assessment by patients/families of their experience of care in targeted dimensions. Based on concerns about the absence of reliability data and the feasibility of applying the practice audit/self-assessment approach on a population level for the purpose of state reporting, as well as the limited data linking performance on the specific measures with important child outcomes, we did not recommend any of the measures of organizational assessments of practice systems for inclusion in the core set as an indicator of care integration. In contrast, measures of the medical home based on items from the National Survey of Child Health on a population level of or the Consumer Assessment of Healthcare Providers and Systems for practice- and state-level assessment are more feasible, have known reliability and performance characteristics, and more closely reflect the aims of the medical home, including care integration.ConclusionsMeasures of health care integration as captured by the experience of care in a medical home can best be assessed for state-level performance through patient/family experience surveys. Better measures of care integration, care coordination, and integration of mental, developmental, and physical health into a comprehensive care system are high-priority topics for measure development

Development of an Intelligent Monitoring and Control System for a Heterogeneous Numerical Propulsion System Simulation

The NASA Numerical Propulsion System Simulation (NPSS) project is exploring the use of computer simulation to facilitate the design of new jet engines. Several key issues raised in this research are being examined in an NPSS-related research project: zooming, monitoring and control, and support for heterogeneity. The design of a simulation executive that addresses each of these issues is described. In this work, the strategy of zooming, which allows codes that model at different levels of fidelity to be integrated within a single simulation, is applied to the fan component of a turbofan propulsion system. A prototype monitoring and control system has been designed for this simulation to support experimentation with expert system techniques for active control of the simulation. An interconnection system provides a transparent means of connecting the heterogeneous systems that comprise the prototype

A Large, Uniform Sample of X-ray Emitting AGN from the ROSAT All-Sky and Sloan Digital Sky Surveys: the Data Release 5 Sample

We describe further results of a program aimed to yield ~10^4 fully characterized optical identifications of ROSAT X-ray sources. Our program employs X-ray data from the ROSAT All-Sky Survey (RASS), and both optical imaging and spectroscopic data from the Sloan Digital Sky Survey (SDSS). RASS/SDSS data from 5740 deg^2 of sky spectroscopically covered in SDSS Data Release 5 (DR5) provide an expanded catalog of 7000 confirmed quasars and other AGN that are probable RASS identifications. Again in our expanded catalog, the identifications as X-ray sources are statistically secure, with only a few percent of the SDSS AGN likely to be randomly superposed on unrelated RASS X-ray sources. Most identifications continue to be quasars and Seyfert 1s with 15<m<21 and 0.01<z<4; but the total sample size has grown to include very substantial numbers of even quite rare AGN, e.g., now including several hundreds of candidate X-ray emitting BL Lacs and narrow-line Seyfert 1 galaxies. In addition to exploring rare subpopulations, such a large total sample may be useful when considering correlations between the X-ray and the optical, and may also serve as a resource list from which to select the "best" object (e.g., X-ray brightest AGN of a certain subclass, at a preferred redshift or luminosity) for follow-on X-ray spectral or alternate detailed studies.Comment: Accepted for publication in AJ; 32 pages, including 11 figures, and 6 example table

Search for Yukawa Production of a Light Neutral Higgs Boson at LEP

Within a Two-Higgs-Doublet Model (2HDM) a search for a light Higgs boson in the mass range of 4-12 GeV has been performed in the Yukawa process e+e- -> b bbar A/h -> b bbar tau+tau-, using the data collected by the OPAL detector at LEP between 1992 and 1995 in e+e- collisions at about 91 GeV centre-of-mass energy. A likelihood selection is applied to separate background and signal. The number of observed events is in good agreement with the expected background. Within a CP-conserving 2HDM type II model the cross-section for Yukawa production depends on xiAd = |tan beta| and xihd = |sin alpha/cos beta| for the production of the CP-odd A and the CP-even h, respectively, where tan beta is the ratio of the vacuum expectation values of the Higgs doublets and alpha is the mixing angle between the neutral CP-even Higgs bosons. From our data 95% C.L. upper limits are derived for xiAd within the range of 8.5 to 13.6 and for xihd between 8.2 to 13.7, depending on the mass of the Higgs boson, assuming a branching fraction into tau+tau- of 100%. An interpretation of the limits within a 2HDM type II model with Standard Model particle content is given. These results impose constraints on several models that have been proposed to explain the recent BNL measurement of the muon anomalous magnetic moment.Comment: 24 pages, 9 figures, Submitted to Euro. Phys. J.

Search for the Standard Model Higgs Boson with the OPAL Detector at LEP

This paper summarises the search for the Standard Model Higgs boson in e+e- collisions at centre-of-mass energies up to 209 GeV performed by the OPAL Collaboration at LEP. The consistency of the data with the background hypothesis and various Higgs boson mass hypotheses is examined. No indication of a signal is found in the data and a lower bound of 112.7GeV/C^2 is obtained on the mass of the Standard Model Higgs boson at the 95% CL.Comment: 51 pages, 21 figure

A Measurement of Semileptonic B Decays to Narrow Orbitally-Excited Charm Mesons

The decay chain b -> Bbar -> D^{**0} l nu X, D^{**0} -> D^{*+} pi^-, D^{*+} -> D^0 pi^+, D^0 ->(Kpi or K3pi) is identified in a sample of 3.9 million hadronic Z decays collected with the OPAL detector at LEP. The branching ratio BR (b -> Bbar) x BR (Bbar -> D^0_1 l nu X) x BR (D^0_1 -> D^{*+} pi^-) is measured to be (2.64 +- 0.79 (stat) +- 0.39 (syst)) X 10^-3 for the J^P = 1^+ (D^0_1) state. For decays into the J^P = 2^+ (D^{*0}_2) state, an upper limit of 1.4 X 10^-3 is placed on the branching ratio at the 95% confidence level.Comment: 20 pages, 6 figure

Measurement of the Hadronic Cross-Section for the Scattering of Two Virtual Photons at LEP

The interaction of virtual photons is investigated using the reaction e+e- -> e+e- hadrons based on data taken by the OPAL experiment at e+e- centre-of-mass energies sqrt(s_ee)=189-209 GeV, for W>5 GeV and at an average Q^2 of 17.9 GeV^2. The measured cross-sections are compared to predictions of the Quark Parton Model (QPM), to the Leading Order QCD Monte Carlo model PHOJET to the NLO prediction for the reaction e+e- -> e+e-qqbar, and to BFKL calculations. PHOJET, NLO e+e- -> e+e-qqbar, and QPM describe the data reasonably well, whereas the cross-section predicted by a Leading Order BFKL calculation is too large.Comment: 30 pages, 10 figures, Submitted to Eur.Phys.J.

Measurement of triple gauge boson couplings from WW production at LEP energies up to 189 GeV

A measurement of triple gauge boson couplings is presented, based on W-pair data recorded by the OPAL detector at LEP during 1998 at a centre-of-mass energy of 189 GeV with an integrated luminosity of 183 pb^-1. After combining with our previous measurements at centre-of-mass energies of 161-183 GeV we obtain k_g=0.97 +0.20 -0.16, g_1^z=0.991 +0.060 -0.057 and lambda_g=-0.110 +0.058 -0.055, where the errors include both statistical and systematic uncertainties and each coupling is determined by setting the other two couplings to their SM values. These results are consistent with the Standard Model expectations.Comment: 28 pages, 8 figures, submitted to Eur. Phys. J.

Search for Nearly Mass-Degenerate Charginos and Neutralinos at LEP

A search was performed for charginos with masses close to the mass of the lightest neutralino in e+e- collisions at centre-of-mass energies of 189-209 GeV recorded by the OPAL detector at LEP. Events were selected if they had an observed high-energy photon from initial state radiation, reducing the dominant background from two-photon scattering to a negligible level. No significant excess over Standard Model expectations has been observed in the analysed data set corresponding to an integrated luminosity of 570pb-1. Upper limits were derived on the chargino pair-productin cross-section, and lower limits on the chargino mass were derived in the context of the Minimal Supersymmetric Extension of the Standard Model for the gravity and anomaly mediated Supersymmetry breaking scenarios.Comment: 26 pages, 9 figure