N.C. Medicaid Reform: A Bipartisan Path Forward

The North Carolina Medicaid program currently constitutes 32% of the state budget and provides insurance coverage to 18% of the state’s population. At the same time, 13% of North Carolinians remain uninsured, and even among the insured, significant health disparities persist across income, geography, education, and race. The Duke University Bass Connections Medicaid Reform project gathered to consider how North Carolina could use its limited Medicaid dollars more effectively to reduce the incidence of poor health, improve access to healthcare, and reduce budgetary pressures on the state’s taxpayers. This report is submitted to North Carolina’s policymakers and citizens. It assesses the current Medicaid landscape in North Carolina, and it offers recommendations to North Carolina policymakers concerning: (1) the construction of Medicaid Managed Care markets, (2) the potential and dangers of instituting consumer-driven financial incentives in Medicaid benefits, (3) special hotspotting strategies to address the needs and escalating costs of Medicaid\u27s high-utilizers and dual-eligibles, (4) the emerging benefits of pursuing telemedicine and associated reforms to reimbursement, regulation, and Graduate Medical Education programs that could fuel telemedicine solutions to improve access and delivery. The NC Medicaid Reform Advisory Team includes: Deanna Befus, Duke School of Nursing, PhD ‘17Madhulika Vulimiri, Duke Sanford School of Public Policy, MPP ‘18Patrick O’Shea, UNC School of Medicine/Fuqua School of Business, MD/MBA \u2717Shanna Rifkin, Duke Law School, JD ‘17Trey Sinyard, Duke School of Medicine/Fuqua School of Business, MD/MBA \u2717Brandon Yan, Duke Public Policy, BA \u2718Brooke Bekoff, UNC Political Science, BA \u2719Graeme Peterson, Duke Public Policy, BA ‘17Haley Hedrick, Duke Psychology, BS ‘19Jackie Lin, Duke Biology, BS \u2718Kushal Kadakia, Duke Biology and Public Policy, BS ‘19Leah Yao, Duke Psychology, BS ‘19Shivani Shah, Duke Biology and Public Policy, BS ‘18Sonia Hernandez, Duke Economics, BS \u2719Riley Herrmann, Duke Public Policy, BA \u271

Statistical analysis of EQ-5D profiles: does the use of value sets bias inference?

Health state profile data, such as those provided by the EQ-5D, are widely collected in clinical trials, population surveys and a growing range of other important health sector applications. However, these profile data are difficult to summarise to give an overall view of the health of a given population that can be analysed for differences between groups or within groups over time. A common way of short-cutting this problem is to transform profiles into a single number, or index, using sets of weights, often elicited from the general public in the form of values. Are there any problems with this procedure? In this paper we demonstrate the underlying effects of the use of value sets as a means of weighting profile data. We show that any set of weights introduces an exogenous source of variance to health profile data. These can distort findings about the significance of changes in health between groups or over time. No set of weights is neutral its effect. If a summary of patient reported outcomes is required, it may be better to use an instrument that yields this directly – such as the EQ VAS – along with the descriptive instrument. If this is not possible, researchers should have a clear rationale for their choice of weights; and be aware that those weighs may exert a non-trivial effect on their analysis. This paper focuses on the EQ-5D, but the arguments and their implications for statistical analysis are relevant to all health state descriptive systems

Fresnel concentrating collector

An advanced point focusing solar technology demonstrated potential for near term commercialization as a renewable energy technology. The design features combine to produce a highly efficient, low cost, safe, adaptable, durable system which is simple to manufacture, install and maintain

Field-free molecular orientation by THz laser pulses at high temperature

We investigate to which extend a THz laser pulse can be used to produce field-free molecular orientation at high temperature. We consider laser pulses that can be implemented with the state of the art technology and we show that the efficiency of the control scheme crucially depends on the parameters of the molecule. We analyze the temperature effects on molecular dynamics and we demonstrate that, for some molecules, a noticeable orientation can be achieved at high temperature.Comment: 13 pages, 7 figure

Measured acoustic properties of variable and low density bulk absorbers

Experimental data were taken to determine the acoustic absorbing properties of uniform low density and layered variable density samples using a bulk absober with a perforated plate facing to hold the material in place. In the layered variable density case, the bulk absorber was packed such that the lowest density layer began at the surface of the sample and progressed to higher density layers deeper inside. The samples were placed in a rectangular duct and measurements were taken using the two microphone method. The data were used to calculate specific acoustic impedances and normal incidence absorption coefficients. Results showed that for uniform density samples the absorption coefficient at low frequencies decreased with increasing density and resonances occurred in the absorption coefficient curve at lower densities. These results were confirmed by a model for uniform density bulk absorbers. Results from layered variable density samples showed that low frequency absorption was the highest when the lowest density possible was packed in the first layer near the exposed surface. The layers of increasing density within the sample had the effect of damping the resonances

Investigation of radiometric properties of the LANDSAT-4 multispectral scanner

The radiometric data quality of the LANDSAT 4 multispectral scanner (MSS) was examined using several LANDSAT 4 frames. It was found that LANDSAT 4 MSS produces high-quality data of the caliber experienced with previous LANDSATS. For example, the detector equalization procedure worked well, leaving a residual banding effect of about 0.3 digital counts RMS, close to the theoretical minimum value of quantization error. Nevertheless, artifacts of the data were found, two of which were not experienced in previous MSS data. A low-level coherent noise effect was observed in all bands, with a magnitude of about 0.5 digital counts and a frequency of approximately 28 KHz (representing a wavelength of about 3.6 pixels); a substantial increase in processing complexity would be required to reduce this artifact in the data. Also, a substantial scan-length variation (of up to six pixels) was noted in MSS data when the TM sensor was operating; the LANDSAT 4 correction algorithms being applied routinely by the EROS Data Center to produce a p-type data should remove most of this variation. Between-satellite calibrations were examined in paired LANDSAT 3 and LANDSAT 4 MSS data sets, which were closely matched in acquisition time and place. Radiometric comparisons showed that all bands were highly linear in digital counts, and a well-determined linear transformation between the MSS's was established

A theoretical approach to sound propagation and radiation for ducts with suppressors

The several phenomena involved in theoretical prediction of the far-field sound radiation attenuation from an acoustically lined duct were studied. These include absorption by the suppressor, termination reflections, and far-field radiation. Extensive parametric studies show that the suppressor absorption performance can be correlated with mode cut-off ratio or angle of propagation. The other phenomena can be shown to depend explicitly upon mode cut-off ratio. A complete system can thus be generated which can be used to evaluate aircraft sound suppressors and which can be related to the sound source through the cut-off ratio-acoustic power distribution. Although the method is most fully developed for inlet suppressors, several aft radiated noise phenomena are also discussed. This simplified suppressor design and evaluation method is summarized, the recent improvements in the technique are presented, and areas where further refinement is necessary are discussed. Noise suppressor data from engine experiments are compared with the theoretical calculations