Medicaid Policy Changes in Kentucky Under the Deficit Reduction Act of 2005: Implementation Issues and Remaining Challenges

Describes the implementation and impact of 2006 reforms, including targeted benefit packages, increased cost sharing, soft service limits, rewarding healthy behaviors, premium assistance, and disease management. Outlines contributing factors and barriers

L’appropriation des technologies de l’Internet et ses facteurs critiques de succès : Un défi de plus pour les PME ?

Divisée en deux volets, une étude exploratoire a été réalisée dans quatre PME de la région de la Mauricie au Québec. Premièrement, à l’aide d’une représentation conceptuelle basée sur les construits de compétences de l’utilisateur (Munro et al., 1997), de sentiment d’efficacité personnelle eu égard aux technologies (Compeau, Higgins et Huff, 1999 ; Compeau et Higgins, 1995) et d’absorption cognitive (Agarwal et Karahanna, 2000), une collecte de données auprès de 30 utilisateurs d’applications de l’Internet a permis d’évaluer leur utilisation et leur appropriation en contexte de PME. Dans cette perspective de l’appropriation technologique, les résultats démontrent que les compétences et le sentiment d’efficacité personnelle par rapport à ces applications peuvent jouer un rôle important, tout en étant liés de façon significative.Deuxièmement, la réalisation d’entrevues semi-dirigées auprès des gestionnaires responsables des systèmes et des technologies de l’information a permis une analyse qualitative des facteurs contribuant ou non à encourager l’utilisation et l’appropriation des applications de l’Internet dans les PME. Il a alors été constaté que l’importance des mesures de sécurité, la consultation des futurs utilisateurs, la formulation et la diffusion d’objectifs clairs, le soutien et l’encouragement à l’utilisation de la part de l’équipe dirigeante, la disponibilité des ressources ainsi que les mécanismes de gestion des problèmes et des crises survenant inévitablement sont autant de facteurs ne trouvant pas nécessairement écho auprès des gestionnaires de PME. Ces derniers sont autant d’éléments qui risquent d’affecter le degré d’appropriation technologique des utilisateurs, et ce, de plusieurs manières. Notamment, par leurs effets, directs ou indirects, sur le niveau de compétences des utilisateurs et leur sentiment d’efficacité personnelle eu égard aux technologies.Divided into two sections, an exploratory study was carried out in four SMEs of the area of Mauricie in Quebec. Initially, using a conceptual framework based on three concepts : user competence (Munro et al., 1997), computer self-efficacy (Compeau, Higgins et Huff, 1999 ; Compeau and Higgins, 1995) and cognitive absorption (Agarwal and Karahanna, 2000), a data acquisition on 30 end-users of the Internet made it possible to evaluate their use and their appropriation in context of SME. From this point of view of the technological appropriation, the results show that competences and computer self-efficacy can play an important role, while being significantly dependant.Secondly, the realization of semi-directed interviews on the managers responsible for the systems and information technologies, allowed a qualitative analysis of the factors contributing or not to encourage the use and the appropriation of the Internet in SME. It was then noted that the importance of the security measures, the consultation of the future users, the formulation and the diffusion of clear objectives, the support and the encouragement with the use made on behalf of the executive team, the availability of resources as well as the mechanisms of management of problems and crisis inevitably occurring, are as many factors that are not necessarily taken in care by the managers of SME. These are as many elements which are likely to affect the technological level of appropriation of the users, and this by several manners. In particular, by their effects, direct or indirect, on the qualification level of the end-users and their computer self-efficacy.Un estudio exploratorio, dividido en dos apartados, ha sido realizado en cuatro PyMEs de la región de Mauricia en Quebec. En primer lugar, una colecta de datos a treinta usuarios de aplicaciones de Internet, evaluó su uso y su apropiación en el contexto de la PyME mediante una representación conceptual basada en la construcción de competencias por el usuario (Munro et al., 1997), en el sentimiento de eficacia personal frente a las tecnologías (Compeau, Higgins et Huff, 1999 ; Compeau e Higgins, 1995) y en la absorción cognoscitiva (Agarwal y Karahanna, 2000). En esta perspectiva de la apropiación tecnológica, los resultados demuestran que las competencias y el sentimiento de eficacia personal frente a estas aplicaciones pueden desempeñar un papel importante, estando relacionados de manera significativa.En segundo lugar, la realización de entrevistas semi-directivas a los responsables de los sistemas y tecnologías de la información, permitió efectuar un análisis cualitativo de los factores que contribuyen, o no, a motivar la utilización y la apropiación de las aplicaciones de Internet en las PyMEs. De esta manera, se comprobó que la importancia de las medidas de seguridad, la consulta de los futuros usuarios, la formulación y la difusión de objetivos claros, el apoyo y estímulo para su uso por parte del equipo dirigente, la disponibilidad de los recursos así como los mecanismos de gestión de los problemas y de las crisis que sobrevienen inevitablemente, son factores que no son necesariamente atendidos por los gerentes de la PyME. Sin embargo, estos últimos elementos pueden afectar el nivel de apropiación tecnológica de los usuarios de diversas maneras. En particular, por sus efectos, directos o indirectos, sobre el nivel de competencias de los usuarios y su sentimiento de eficacia personal frente a las tecnologías.In vier kleinen und mittleren Unternehmen der Region Mauricie in Québec wurde eine zweistufige explorative Studie realisiert. Die begriffliche Darstellung basiert auf den Konzepten der Nutzer-Kompetenzen (Munro et al., 1997), der Effizienz-Empfindung von Personen gegenüber Technologien (Compeau et al., 1999 ; Compeau et Higgins, 1995) und dem kognitiven Aufnahmevermögen (Agarwal et Karahanna, 2000). Diese Konzepte erlaubten in einer ersten Phase, eine Erhebung bei dreissig Nutzern von Internet-Applikationen durchzuführen und erste Auswertungen bezüglich der Anwendung und Aneignung im KMU-Kontext durchzuführen. Die Resultate belegen, dass aus der Perspektive der technologischen Aneignung, die Kompetenzen und das persönliche Effizienz-Empfinden eine wichtige Rolle spielen können und auch signifikante Beziehungen untereinander bestehen.In einer zweiten Phase wurde mittels semi-strukturierten Interviews bei Verantwortlichen von Informations-Systemen und-Technologien eine qualitative Analyse durchgeführt. Dabei wurden die Faktoren untersucht, die zur (Nicht)-Begünstigung der Anwendung und Aneignung von Internetapplikationen in KMU führen können. Es wurde festgestellt, dass folgende Punkte nicht unbedingt ausreichend Aufmerksamkeit von den KMU-Verantwortlichen erfahren : Wichtigkeit der Sicherheitsmassnahmen, Hinzuziehung der zukünftigen Anwender, die Formulierung und Bekanntmachung klarer Ziele, die Unterstützung und Förderung zur Nutzung von Anwendungen von Seite der Unternehmensführung, die Verfügbarkeit von Ressourcen sowie die Mechanismen zur Bewältigung von Problemen und unerwarteten Krisen. Die Führungsverantwortlichen sind es auch, die das Niveau der technologischen Anwendung der Nutzer beeinflussen. Namentlich durch direkte und indirekte Effekte beeinflussen sie das Kompetenzniveau der Anwender und ihr persönliches Effizienz-Empfinden gegenüber Technologien

Transport of Cosmic Rays in Chaotic Magnetic Fields

The transport of charged particles in disorganised magnetic fields is an important issue which concerns the propagation of cosmic rays of all energies in a variety of astrophysical environments, such as the interplanetary, interstellar and even extra-galactic media, as well as the efficiency of Fermi acceleration processes. We have performed detailed numerical experiments using Monte-Carlo simulations of particle propagation in stochastic magnetic fields in order to measure the parallel and transverse spatial diffusion coefficients and the pitch angle scattering time as a function of rigidity and strength of the turbulent magnetic component. We confirm the extrapolation to high turbulence levels of the scaling predicted by the quasi-linear approximation for the scattering frequency and parallel diffusion coefficient at low rigidity. We show that the widely used Bohm diffusion coefficient does not provide a satisfactory approximation to diffusion even in the extreme case where the mean field vanishes. We find that diffusion also takes place for particles with Larmor radii larger than the coherence length of the turbulence. We argue that transverse diffusion is much more effective than predicted by the quasi-linear approximation, and appears compatible with chaotic magnetic diffusion of the field lines. We provide numerical estimates of the Kolmogorov length and magnetic line diffusion coefficient as a function of the level of turbulence. Finally we comment on applications of our results to astrophysical turbulence and the acceleration of high energy cosmic rays in supernovae remnants, in super-bubbles, and in jets and hot spots of powerful radio-galaxies.Comment: To be published in Physical Review D, 20 pages 9 figure

Can altered production of interleukin-1β, interleukin-6, transforming growth factor-β and prostaglandin E2 by isolated human subchondral osteoblasts identify two subgroups of osteoarthritic patients

AbstractObjective To determine the capacity of human subchondral osteoarthritic osteoblasts (Ob) to produce interleukin (IL)-1β, IL-6, transforming growth factor-β (TGF-β) and prostaglandin E2 (PGE2), and determine if a relationship exists between IL-1β, TGF-β, PGE2 and IL-6 production.Methods We measured the abundance of IL-1β, IL-6, TGF-β and PGE2 using very sensitive ELISA in conditioned-media of human primary subchondral Ob from normal individuals and osteoarthritic patients. Selective inhibition of IL-6 or IL-6 receptor signaling was performed to determine its effect on PGE2 production whereas the inhibiton of PGE2 production was performed to determine its effect on IL-6 production. The expression of bone cell markers and urokinase plasminogen activator (uPA) activity was also determined.Results Osteoarthritic Ob produced all these factors with greater variability than normal cells. Interestingly, the production of IL-6 and PGE2 by osteoarthritic Ob separated patients into two subgroups, those whose Ob produced levels comparable to normal (low producers) and those whose Ob produced higher levels (high producers). In those cells classified as high osteoarthritic Ob, PGE2 and IL-6 levels were increased two- to three-fold and five- to six-fold, respectively, compared with normal. In contrast, while using their IL-6 and PGE2 production to separate osteoarthritic Ob into low and high producers, we found that IL-1β levels were similar in normal and all osteoarthritic Ob. Using the same criteria, TGF-β levels were increased in all osteoarthritic Ob compared with normal. Reducing PGE2 synthesis by Indomethacin [a cyclo-oxygenase (COX) -1 and -2 inhibitor] reduced IL-6 levels in all osteoarthritic Ob, whereas Naproxen (a more selective COX-2 inhbitor) reduced PGE2 and IL-6 levels only in the high osteoarthritic group. Conversely, PGE2 addition to osteoarthritic Ob enhanced IL-6 production in both groups. Moreover, the addition of parathyroid hormone also stimulated IL-6 production to similar normal levels in both osteoarthritic groups. In contrast, using an antibody against IL-6 or IL-6 receptors did not reduce PGE2 levels in either group. The evaluation of alkaline phosphatase activity, osteocalcin release, collagen type I and uPA activity in osteoarthritic Ob failed to show any differences between these cells regardless to which subgroup they were assigned.Conclusions These results indicate that IL-6 and PGE2 production by subchondral Ob can discriminate two subgroups of osteoarthritic patients that cannot otherwise be separated by their expression of cell markers, and that endogenous PGE2 levels influence IL-6 synthesis in osteoarthritic Ob. Copyright 2002 OsteoArthritis Research Society International. Published by Elsevier Science Ltd. All rights reserved

Fractional Hamiltonian Monodromy from a Gauss-Manin Monodromy

Fractional Hamiltonian Monodromy is a generalization of the notion of Hamiltonian Monodromy, recently introduced by N. N. Nekhoroshev, D. A. Sadovskii and B. I. Zhilinskii for energy-momentum maps whose image has a particular type of non-isolated singularities. In this paper, we analyze the notion of Fractional Hamiltonian Monodromy in terms of the Gauss-Manin Monodromy of a Riemann surface constructed from the energy-momentum map and associated to a loop in complex space which bypasses the line of singularities. We also prove some propositions on Fractional Hamiltonian Monodromy for 1:-n and m:-n resonant systems.Comment: 39 pages, 24 figures. submitted to J. Math. Phy