Self-Supervised Texture Image Anomaly Detection By Fusing Normalizing Flow and Dictionary Learning

A common study area in anomaly identification is industrial images anomaly detection based on texture background. The interference of texture images and the minuteness of texture anomalies are the main reasons why many existing models fail to detect anomalies. We propose a strategy for anomaly detection that combines dictionary learning and normalizing flow based on the aforementioned questions. The two-stage anomaly detection approach already in use is enhanced by our method. In order to improve baseline method, this research add normalizing flow in representation learning and combines deep learning and dictionary learning. Improved algorithms have exceeded 95$\%$ detection accuracy on all MVTec AD texture type data after experimental validation. It shows strong robustness. The baseline method's detection accuracy for the Carpet data was 67.9%. The article was upgraded, raising the detection accuracy to 99.7%

Financial Incentives in Health Care Reform: Evaluating Payment Reform in Accountable Care Organizations and Competitive Bidding in Medicare

Amidst mounting federal debt, slowing the growth of health care spending is one of the nation’s top domestic priorities. This dissertation evaluates three current policy ideas: (1) global payment within an accountable care contracting model, (2) physician fee cuts, and (3) expanding the role of competitive bidding in Medicare. Chapter one studies the effect of global payment and pay-for-performance on health care spending and quality in accountable care organizations. I evaluate the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract (AQC), which was implemented in 2009 with seven provider organizations comprising 380,000 enrollees. Using claims and quality data in a quasi-experimental difference-in-differences design, I find that the AQC was associated with a 1.9 percent reduction in medical spending and modest improvements in quality of chronic care management and pediatric care in year one. Chapter two studies Medicare’s elimination of payments for consultations in the 2010 Medicare Physician Fee Schedule. This targeted fee cut (largely to specialists) was accompanied by a fee increase for office visits (billed more often by primary care physicians). Using claims data for 2.2 million Medicare beneficiaries, I test for discontinuities in spending, volume, and coding of outpatient physician encounters with an interrupted time series design. I find that spending on physician encounters increased 6 percent after the policy, largely due to a coding effect and higher office visit fees. Slightly more than half of the increase was accounted for by primary care physician visits, with the rest by specialist visits. Chapter three examines competitive bidding, which is at the center of several proposals to reform Medicare into a premium support program. In competitive bidding, private plans submit prices (bids) they are willing to accept to insure a Medicare beneficiary. In perfect competition, plans bid costs and thus bids are insensitive to the benchmark. Under imperfect competition, bids may move with the benchmark. I study the effect of benchmark changes on plan bids using Medicare Advantage data in a longitudinal market-level model. I find that a $1 increase in the benchmark leads to about a$0.50 increase in bids among Medicare managed care plans

Payment Reform in Massachusetts: Health Care Spending and Quality in Accountable Care Organizations Four Years into Global Payment

Background: The United States health care system faces two fundamental challenges: a high growth rate of health care spending and deficiencies in quality of care. The growth rate of health care spending is the dominant driver of our nation’s long-term federal debt, while the inconsistent quality of care hinders the ability of the health care system to maximize value for patients. To address both of these challenges, public and private payers are increasingly changing the way they pay providers—moving away from fee-for-service towards global payment contracts for groups of providers coming together as accountable care organizations. This thesis evaluates the change in health care spending and in quality of care associated with moving to global payment for accountable care organizations in Massachusetts in the first 4 years. This thesis studies the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract (AQC), a global payment contract that provider organizations in Massachusetts began to enter in 2009. The AQC pays provider organizations a risk-adjusted global budget for the entire continuum of care for a defined population of enrollees insured by Blue Cross Blue Shield of Massachusetts. It also awards substantial pay-for-performance incentives for organizations meeting performance thresholds on quality measures. This work assesses its effect on spending and quality through the first 4 years of the contract. Methods: Enrollee-level claims data from 2006-2012 were used with a difference-in-differences design to evaluate the changes in spending and quality associated with the Alternative Quality Contract over the first 4 years. The study population consisted of enrollees in Blue Cross Blue Shield of Massachusetts plans (intervention group) and enrollees in commercial employer-sponsored plans across 5 comparison states (control group). Unadjusted and adjusted results are reported for each comparison between intervention and control. Changes in spending for all 4 AQC cohorts relative to control were evaluated. In adjusted analyses of spending, I used a multivariate linear model at the enrollee-quarter level, controlling for age, sex, risk score, indicators for intervention, quarters of the study period, the post-intervention period, and the appropriate interactions. For analyses of quality, an analogous model at the enrollee-year level was used. Process and outcome quality were evaluated. Results: Seven provider organizations joined the AQC in 2009, with a total of 490,167 individuals who were enrolled for at least 1 calendar year in the study period. The control group had 966,813 unique individuals enrolled for at least 1 year during the study period. Average age, sex, and risk scores before and after the AQC were similar between the two groups. In the 2009 cohort, claims spending grew on average $62.21 per enrollee per quarter less than control over 4 years (p<0.001), a 6.8$4.57, p=0.86), suggesting savings were not driven by inherently different trajectories of spending. No differences in coding intensity were found. In sensitivity analyses, estimates were robust to alterations in the model, variables, and sample. Notably, claims savings were exceeded by incentive payments to providers (shared savings and quality bonuses) in 2009-2011, but exceeded incentives payments in 2012, generating net savings. Improvements in quality among intervention cohorts generally exceeded New England and national comparisons. Quality performance on chronic care measures increased from 79.6% pre-intervention to 84.5% post-intervention in the 2009 cohort, compared to 79.8% to 80.8% for the HEDIS national average, a 3.9 percentage-point relative increase over the 4 years. Analogously, preventive care and pediatric care measures increased 2.7 and 2.4 percentage points relative to control, respectively. On outcome measures, achievement of hemoglobin A1c, LDL cholesterol, and blood pressure control grew by 2.1 percentage points per year in the 2009 cohort after the AQC, while HEDIS averages remained largely unchanged (Figure). Conclusion: After 4 years, physician organizations in the AQC had lower spending growth relative to control and generally outperformed national averages on quality measures. Shared savings coupled with quality bonuses can exceed savings on claims in initial years, but over time, savings on claims may outgrow incentive payments. Incentive payments themselves may serve meaningful purposes, as quality measures may protect against stinting and shared savings may help ease providers into risk contracts. Changes in utilization suggest that this payment model can help modify underlying care patterns, a likely prerequisite for sustainable reform. The AQC experience may be useful to policymakers, insurers, and providers embarking on payment reform. Combining global budgets with pay-for- performance may encourage organizations to embark on the delivery system reforms necessary to slow spending and improve quality

Visualizing Morphogenesis through Instability Formation in 4-D Printing.

Heterogeneous growth in a myriad of biological systems can lead to the formation of distinct morphologies during the maturation processes of different species. We demonstrate that the distinct circumferential buckling observed in pumpkins can be reproduced by a core-shell barrel structure using four-dimensional (4D) printing, taking advantage of digital light processing (DLP)-based three-dimensional (3D) printing and stimulus-responsive hydrogels. The mechanical mismatch between the stiff core and compliant shell results in buckling instability on the surface. The initiation and development of the buckling are governed by the ratio of core/shell radius, the ratio of core/shell swelling ratios, and the mismatch between the core and shell in stiffness. Furthermore, the rigid core not only acts as a source of circumferential confinement but also sets a boundary at the poles of the entire structure. The heterogeneous structures with controllable buckling geometrically and structurally behave much like plants' fruits. This replicates the biological morphologic change and elucidates the general mechanism and dynamics of the complex instability formation of heterogeneous 3D objects

Highly active air electrode catalysts for Zn‐air batteries: Catalytic mechanism and active center from obfuscation to clearness

Carbon‐based materials have been found to accelerate the sluggish kinetic reaction and are largely subject to the overall Zn‐air batteries (ZABs) property, while their full catalytic mechanism is still not excavated because of the indistinct internal structure and immature in‐situ technology. Up to now, systematic methods have been utilized to study and design promising high‐performance carbon‐based catalysts. To resolve the real active units and catalytic mechanism, developing molecular catalyst is a significant strategy. Herein, the review will initiate to briefly introduce the working principle and composition of ZABs. An important statement is correspondingly provided about the typical structure and catalytic mechanisms for the air cathode material. It also presents the tremendous endeavors on the catalytic performance and stability of carbon‐based material. Furthermore, combined with theoretical calculation, the self‐defined active sites are analyzed to understand the catalytic character, where the molecular catalyst is subsequently summarized and discussed through highlighting the unambiguous and controllable structure, in the hope of surfacing the optimum catalyst. Building on the fundamental understanding of carbon‐based and molecular catalysts, this review is expected to provide guidance and direction toward designing future mechanistic studies and ORR electrocatalysts

The Effect of Bundled Payment on Emergency Department Use: Alternative Quality Contract Effects After Year One

ObjectivesThe objective was to identify the effect of the Alternative Quality Contract (AQC), a global payment system implemented by Blue Cross Blue Shield (BCBS) of Massachusetts in 2009, on emergency department (ED) presentations.MethodsBlue Cross Blue Shield of Massachusetts claims from 2006 through 2009 for 332,624 enrollees whose primary care physicians (PCPs) enrolled in the AQC, and 1,296,399 whose PCPs were not enrolled in the AQC, were evaluated. A pre–post, intervention–control, propensity‐scored difference‐in‐difference approach was used to isolate the AQC effect on ED visits. The analysis adjusted for age, sex, health status, and secular trends to compare ED use between the treatment and control groups.ResultsOverall, secular trends showed that the number of ED visits decreased slightly for both treatment and control groups. The adjusted analysis of the AQC group showed decreases from 0.131 to 0.127 visits per member/quarter, and the control group decreased from 0.157 to 0.152 visits per member/quarter. The difference‐in‐difference analysis showed the AQC had no statistically significant effect on total ED use compared to the control group.ConclusionsIn the first year of this AQC, we did not find evidence of change in aggregate ED use. Similar global budget programs may not alter ED use in the initial implementation period.ResumenEfecto del Pago Combinado en el Uso del Servicio de Urgencias: Los Efectos del Alternative Quality Contract tras un AñoObjetivosIdentificar el efecto del Alternative Quality Contract (AQC), un sistema de pago global implementado por el Blue Cross Blue Shield de Massachusetts en 2009, en las visitas a los servicios de urgencias (SU).MetodologíaSe evaluaron los 332.624 miembros cuyo médico de atención primaria (MAP) estaba incluido en el AQC y los 1.296.399 cuyo MAP no estaba incluido en el AQC del Blue Cross Blue Shield de Massachusetts de 2006 hasta 2009. Para identificar el efecto del AQC en las visitas al SU, se utilizó un diseño pre‐post, intervención‐control, con una aproximación por puntuación de propensión diferencia en diferencia. El análisis se ajustó por edad, sexo, estado de salud y tendencias seculares para comparar el uso del SU entre los grupos tratamiento y control.ResultadosDel total, las tendencias seculares mostraron que el número de visitas al SU descendió discretamente tanto para el grupo tratamiento como control. El análisis ajustado del grupo AQC mostró un descenso de 0,131 a 0,127 visitas por miembro/cuartil, y el grupo control descendió de 0,157 a 0,152 visitas por miembro/cuartil. El análisis de diferencia en diferencia mostró que el AQC no tuvo efecto estadísticamente significativo en el uso total del SU en comparación con el grupo control.ConclusionesEn su primer año, el AQC no tuvo un efecto significativo en el uso del SU. PLos programas económicos globales similares pueden no alterar la utilización del SU en el periodo inicial de implementación.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/112205/1/acem12205-sup-0001-DataSupplementS1.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/112205/2/acem12205.pd

Association of Insurance Expansion With Surgical Management of Thyroid Cancer

Importance: To our knowledge, thyroid cancer incidence is increasing faster than any other cancer type and is currently the fifth most common cancer among women. While this rise is likely multifactorial, there has been scarce consideration of the effect of insurance statuses on the treatment of thyroid cancer. Objective: We evaluate the association of insurance expansion with thyroid cancer treatment using the 2006 Massachusetts health reform, which serves as a unique natural experiment. Design, Setting, and Participants: We used the Agency for Healthcare Research and Quality State Inpatient Databases to identify patients with government-subsidized or self-pay insurance or private insurance who were admitted to a hospital with thyroid cancer and underwent a thyroidectomy between 2001 and 2011 in Massachusetts (n = 8534) and 3 control states (n = 48 047). Difference-in-differences models were used to evaluate an association between the 2006 Massachusetts health care reform and thyroid cancer treatment, and participants were controlled for age, sex, comorbidities, and secular trends. Main Outcomes and Measures: Change in the thyroidectomy rate for thyroid cancer treatment was the primary outcome evaluated. Results: The Massachusetts cohort consisted of 6443 women (75.5%) and 2091 men (24.5%), of whom 6388 (79.6%) were white, 391 (4.9%) were black, 527 (6.6%) were Hispanic, 424 (5.3%) were Asian/Pacific Islander, 63 (0.8%) were Native American, and 228 (2.8%) were other. The participants from control states included 36 818 women (76.6%) and 11 229 men (23.4%), of whom 30 432 (65.5%) were white, 3818 (8.2%) were black, 6462 (13.9%) were Hispanic, 2591 (5.6%) were Asian/Pacific Islander, 211 (0.5%) were Native American, and 2947 (6.3%) were other. Before the 2006 Massachusetts insurance expansion, patients with government-subsidized or self-pay insurance had lower thyroidectomy rates for thyroid cancer in Massachusetts and the control states compared with patients with private insurance. The Massachusetts insurance expansion was associated with a 26% increased rate of undergoing a thyroidectomy (incident rate ratio, 1.26; 95% CI, 1.04-1.52; P = .02) and a 22% increased rate of neck dissection (incident rate ratio, 1.22; 95% CI, 1.07-1.37; P = .002) for treating cancer compared with control states. Conclusions and Relevance: The 2006 Massachusetts health reform, which is a model for the Affordable Care Act, was associated with a 26% increased rate of thyroidectomy for treating thyroid cancer. Our study suggests that insurance expansion may be associated with increased access to the surgical management of thyroid cancer. Further studies need to be conducted to evaluate the effect of healthcare expansion at a national level

QuantumSEA: In-Time Sparse Exploration for Noise Adaptive Quantum Circuits

Parameterized Quantum Circuits (PQC) have obtained increasing popularity thanks to their great potential for near-term Noisy Intermediate-Scale Quantum (NISQ) computers. Achieving quantum advantages usually requires a large number of qubits and quantum circuits with enough capacity. However, limited coherence time and massive quantum noises severely constrain the size of quantum circuits that can be executed reliably on real machines. To address these two pain points, we propose QuantumSEA, an in-time sparse exploration for noise-adaptive quantum circuits, aiming to achieve two key objectives: (1) implicit circuits capacity during training - by dynamically exploring the circuit's sparse connectivity and sticking a fixed small number of quantum gates throughout the training which satisfies the coherence time and enjoy light noises, enabling feasible executions on real quantum devices; (2) noise robustness - by jointly optimizing the topology and parameters of quantum circuits under real device noise models. In each update step of sparsity, we leverage the moving average of historical gradients to grow necessary gates and utilize salience-based pruning to eliminate insignificant gates. Extensive experiments are conducted with 7 Quantum Machine Learning (QML) and Variational Quantum Eigensolver (VQE) benchmarks on 6 simulated or real quantum computers, where QuantumSEA consistently surpasses noise-aware search, human-designed, and randomly generated quantum circuit baselines by a clear performance margin. For example, even in the most challenging on-chip training regime, our method establishes state-of-the-art results with only half the number of quantum gates and ~2x time saving of circuit executions. Codes are available at https://github.com/VITA-Group/QuantumSEA.Comment: IEEE International Conference on Quantum Computing and Engineering (QCE 2023

Research on the relationship between carbon performance and financial performance of electric power enterprises under the background of “dual carbon”

Under the background of “dual carbon,” the power industry, as a pillar industry of the national economy, is ushering in changes. Based on the data of listed companies in the electric power production and supply industry from 2010 to 2020, this paper takes the operating income corresponding to each unit of carbon emission as the substitute variable of carbon performance (CP). After dimensionality reduction of 12 financial indicators through factor analysis, this paper establishes a comprehensive indicator of financial performance (FP), and establishes panel data to explore the relationship between CP and FP of electric power enterprises. To mitigate the endogeneity problem, 2SLS regression was performed using instrumental variables. The results show that CP has a positive and sustainable impact on the FP, which indicates that power enterprises need to pay attention to the long-term management of carbon emission reduction, so that the improvement of FP of enterprises can achieve sustainable development, which is in line with the expectations of Porter’s hypothesis and stakeholder theory. In addition, firm size plays a negative moderating role in the relationship between CP and FP. The research results provide a path and basis for encouraging power enterprises to improve CP and help China achieve the goal of “dual carbon” as soon as possible