Incremental Cost Estimates for the Patient-Centered Medical Home

Based on data from thirty-five primary care practices, analyzes the costs associated with the medical home model, in which primary care practices also provide care coordination, patient education, and related services. Considers implications

Numerical study of the influence of surface reaction probabilities on reactive species in an rf atmospheric pressure plasma containing humidity

International audienceThe quantification and control of reactive species (RS) in atmospheric pressure plasmas (APPs) is of great interest for their technological applications, in particular in biomedicine. Of key importance in simulating the densities of these species are fundamental data on their production and destruction. In particular, data concerning particle-surface reaction probabilities in APPs are scarce, with most of these probabilities measured in low-pressure systems. In this work, the role of surface reaction probabilities, gamma, of reactive neutral species (H, O and OH) on neutral particle densities in a He-H2O radio-frequency micro APP jet (COST-mu APPJ) are investigated using a global model. It is found that the choice of gamma, particularly for low-mass species having large diffusivities, such as H, can change computed species densities significantly. The importance of gamma even at elevated pressures offers potential for tailoring the RS composition of atmospheric pressure microplasmas by choosing different wall materials or plasma geometries

Does higher cost mean better quality? evidence from highly-regarded adolescent drug treatment programs

We conducted a survey to examine whether reimbursement levels are associated with the quality of adolescent substance use treatment programs in the United States. Between March and September 2005, telephone and written surveys were administered to program, clinical, and finance directors of previously surveyed highly regarded programs. Differences in quality scores were compared for programs with above versus below median reimbursement levels and examined in multivariate regression models constructed separately for programs offering residential and outpatient treatment. In residential treatment multivariate regression models, higher quality scores were associated with higher reimbursement, but this relationship was not observed for outpatient treatment. Even the highest level of outpatient reimbursement received may be too low to support quality improvement initiatives. Our results suggest that higher reimbursement may be a necessary component of quality improvement for residential adolescent drug treatment programs, and emphasize the need for further research to determine what levels of reimbursement and insurance coverage policies will encourage the expansion of high quality outpatient programs

Power coupling mode transitions induced by tailored voltage waveforms in capacitive oxygen discharges

Low-pressure capacitively coupled radio frequency discharges operated in O 2 and driven by tailored voltage waveforms are investigated experimentally and by means of kinetic simulations. Pulse-type (peaks/valleys) and sawtooth-type voltage waveforms that consist of up to four consecutive harmonics of the fundamental frequency are used to study the amplitude asymmetry effect as well as the slope asymmetry effect at different fundamental frequencies (5, 10, and 15 MHz) and at different pressures (50-700 mTorr). Values of the DC self-bias determined experimentally and spatio-temporal excitation rates derived from phase resolved optical emission spectroscopy measurements are compared with particle-in-cell/Monte Carlo collisions simulations. The spatio-temporal distributions of the excitation rate obtained from experiments are well reproduced by the simulations. Transitions of the discharge electron heating mode from the drift-ambipolar mode to the μ-mode are induced by changing the number of consecutive harmonics included in the driving voltage waveform or by changing the gas pressure. Changing the number of harmonics in the waveform has a strong effect on the electronegativity of the discharge, on the generation of the DC self-bias and on the control of ion properties at the electrodes, both for pulse-type, as well as sawtooth-type driving voltage waveforms The effect of the surface quenching rate of oxygen singlet delta metastable molecules on the spatio-temporal excitation patterns is also investigated

Two methods for estimating limits to large-scale wind power generation

Wind turbines remove kinetic energy from the atmospheric flow, which reduces wind speeds and limits generation rates of large wind farms. These interactions can be approximated using a vertical kinetic energy (VKE) flux method, which predicts that the maximum power generation potential is 26% of the instantaneous downward transport of kinetic energy using the preturbine climatology. We compare the energy flux method to the Weather Research and Forecasting (WRF) regional atmospheric model equipped with a wind turbine parameterization over a 105 km2 region in the central United States. The WRF simulations yield a maximum generation of 1.1 We⋅m−2, whereas the VKE method predicts the time series while underestimating the maximum generation rate by about 50%. Because VKE derives the generation limit from the preturbine climatology, potential changes in the vertical kinetic energy flux from the free atmosphere are not considered. Such changes are important at night when WRF estimates are about twice the VKE value because wind turbines interact with the decoupled nocturnal low-level jet in this region. Daytime estimates agree better to 20% because the wind turbines induce comparatively small changes to the downward kinetic energy flux. This combination of downward transport limits and wind speed reductions explains why large-scale wind power generation in windy regions is limited to about 1 We⋅m−2, with VKE capturing this combination in a comparatively simple way

Vibrational kinetics in repetitively pulsed atmospheric pressure nitrogen discharges : average-power-dependent switching behaviour

Characterisation of the vibrational kinetics in nitrogen-based plasmas at atmospheric pressure is crucial for understanding the wider plasma chemistry, which is important for a variety of biomedical, agricultural and chemical processing applications. In this study, a 0-dimensional plasma chemical-kinetics model has been used to investigate vibrational kinetics in repetitively pulsed, atmospheric pressure plasmas operating in pure nitrogen, under application-relevant conditions (average plasma powers of 0.23–4.50 W, frequencies of 1–10 kHz, and peak pulse powers of 23–450 W). Simulations predict that vibrationally excited state production is dominated by electron-impact processes at lower average plasma powers. When the average plasma power increases beyond a certain limit, due to increased pulse frequency or peak pulse power, there is a switch in behaviour, and production of vibrationally excited states becomes dominated by vibrational energy transfer processes (vibration–vibration (V–V) and vibration–translation (V–T) reactions). At this point, the population of vibrational levels up to $v\,\leqslant\,40$ increases significantly, as a result of V–V reactions causing vibrational up-pumping. At average plasma powers close to where the switching behaviour occurs, there is potential to control the energy efficiency of vibrational state production, as small increases in energy deposition result in large increases in vibrational state densities. Subsequent pathways analysis reveals that energy in the vibrational states can also influence the wider reaction chemistry through vibrational–electronic (V–E) linking reactions (N + N$_2(40\,\leqslant\,v\,\leqslant\,45) \rightarrow$ N$(^2D)$ + N$_2(A)$ and N + N$_2(39\,\leqslant\,v\,\leqslant\,45) \rightarrow$ N + N$_2(a^{\prime})$), which result in increased Penning ionisation and an increased average electron density. Overall, this study investigates the potential for delineating the processes by which electronically and vibrationally excited species are produced in nitrogen plasmas. Therefore, potential routes by which nitrogen-containing plasma sources could be tailored, both in terms of chemical composition and energy efficiency, are highlighted

‘Dominant ethnicity’ and the ‘ethnic-civic’ dichotomy in the work of A. D. Smith

This article considers the way in which the work of Anthony Smith has helped to structure debates surrounding the role of ethnicity in present-day nations. Two major lines of enquiry are evident here. First, the contemporary role of dominant ethnic groups within 'their' nations and second, the interplay between ethnic and civic elements in nationalist argument. The two processes are related, but maintain elements of distinctiveness. Smith's major contribution to the dominant ethnicity debate has been to disembed ethnicity from the ideologically-charged and/or anglo-centric discourse of ethnic relations and to place it in historical context, thereby opening up space for dominant group ethnicity to be considered as a distinct phenomenon. This said, Smith's work does not adequately account for the vicissitudes of dominant ethnicity in the contemporary West. Building on the classical works of Hans Kohn and Friedrich Meinecke, Anthony Smith has also made a seminal contribution to the debate on civic and ethnic forms of national identity and nationalist ideology. As well as freeing this debate from the strong normative overtones which it has often carried, he has continued to insist that the terms civic and ethnic should be treated as an ideal-typical distinction rather than a scheme of classification

Plasma Vitamin C and Cancer Mortality in Kidney Transplant Recipients

There is a changing trend in mortality causes in kidney transplant recipients (KTR), with a decline in deaths due to cardiovascular causes along with a relative increase in cancer mortality rates. Vitamin C, a well-known antioxidant with anti-inflammatory and immune system enhancement properties, could offer protection against cancer. We aimed to investigate the association of plasma vitamin C with long-term cancer mortality in a cohort of stable outpatient KTR without history of malignancies other than cured skin cancer. Primary and secondary endpoints were cancer and cardiovascular mortality, respectively. We included 598 KTR (mean age 51 +/- 12 years old, 55% male). Mean (SD) plasma vitamin C was 44 +/- 20 mu mol/L. At a median follow-up of 7.0 (IQR, 6.2-7.5) years, 131 patients died, of which 24% deaths were due to cancer. In Cox proportional hazards regression analyses, vitamin C was inversely associated with cancer mortality (HR 0.50; 95%CI 0.34-0.74; p <0.001), independent of potential confounders, including age, smoking status and immunosuppressive therapy. In secondary analyses, vitamin C was not associated with cardiovascular mortality (HR 1.16; 95%CI 0.83-1.62; p = 0.40). In conclusion, plasma vitamin C is inversely associated with cancer mortality risk in KTR. These findings underscore that relatively low circulating plasma vitamin C may be a meaningful as yet overlooked modifiable risk factor of cancer mortality in KTR

Disrupting the spatio-temporal symmetry of the electron dynamics in atmospheric pressure plasmas by voltage waveform tailoring

Single frequency, geometrically symmetric Radio-Frequency (RF) driven atmospheric pressure plasmas exhibit temporally and spatially symmetric patterns of electron heating, and consequently, charged particle densities and fluxes. Using a combination of phase-resolved optical emission spectroscopy and kinetic plasma simulations, we demonstrate that tailored voltage waveforms consisting of multiple RF harmonics induce targeted disruption of these symmetries. This confines the electron heating to small regions of time and space and enables the electron energy distribution function to be tailored