The Qualitative and Quantitative Effects of Patient Centered Medical Home in the Veterans Health Administration

Since the 1990’s, the Veteran’s Health Administration (VHA) has implemented a system of primary care that has been considered some of the best care that can be offered (Klein, 2011). The Patient Center Medical Home (PCMH) Model, also called “Patient Aligned Care Team” (PACT) in the VHA, has been coordinating and integrating services which ensure optimal health outcomes at an acceptable value (Bidassie, Davies, Stark, & Boushon, 2014). PACT was created in 2010, building on 20 years of the VHA transforming from a loosely based system of inpatient services to a provider of outpatient primary care for veterans. From 2010 until 2011, their primary care staff levels decreased from 2.3 Full Time Equivalents (FTE) to 3.0 FTE, and in there was a reduction in face to face encounters as it was increased telephone consultations and electronic messaging (Trivedi et al., 2011). The VHA meets all five core functions under the PACT system, notably with the Peer to Peer toolkit, which permits the PCP to coordinate care with multiple specialists, and allows the exchange of electronic health records, which meets the requirements for accessible services, comprehensive care, patient centered, and coordination of care with one system (Luck, 2014). Quality metrics are hard to come by because most PCPs under the pact program see quality metrics to be a hindrance to the spirit of the PACT program, because responding to the performance metrics consume time and resources, and these quality metrics do not take into account the spirt of PCMH (Kansagara et al, 2014). The purpose of this research was to analyze the effects of PACT on the VHA to determine expenditures and the overall outcome of patient care

Optical Lattice Induced Light Shifts in an Yb Atomic Clock

We present an experimental study of the lattice induced light shifts on the 1S_0-3P_0 optical clock transition (v_clock~518 THz) in neutral ytterbium. The ``magic'' frequency, v_magic, for the 174Yb isotope was determined to be 394 799 475(35)MHz, which leads to a first order light shift uncertainty of 0.38 Hz on the 518 THz clock transition. Also investigated were the hyperpolarizability shifts due to the nearby 6s6p 3P_0 - 6s8p 3P_0, 6s8p 3P_2, and 6s5f 3F_2 two-photon resonances at 759.708 nm, 754.23 nm, and 764.95 nm respectively. By tuning the lattice frequency over the two-photon resonances and measuring the corresponding clock transition shifts, the hyperpolarizability shift was estimated to be 170(33) mHz for a linear polarized, 50 uK deep, lattice at the magic wavelength. In addition, we have confirmed that a circularly polarized lattice eliminates the J=0 - J=0 two-photon resonance. These results indicate that the differential polarizability and hyperpolarizability frequency shift uncertainties in a Yb lattice clock could be held to well below 10^-17.Comment: Accepted to PR

Frequency evaluation of the doubly forbidden 1S0→3P0^1S_0\to ^3P_0 transition in bosonic 174^{174}Yb

We report an uncertainty evaluation of an optical lattice clock based on the $^1S_0\leftrightarrow^3P_0$ transition in the bosonic isotope $^{174}$Yb by use of magnetically induced spectroscopy. The absolute frequency of the $^1S_0\leftrightarrow^3P_0$ transition has been determined through comparisons with optical and microwave standards at NIST. The weighted mean of the evaluations is $\nu$($^{174}$Yb)=518 294 025 309 217.8(0.9) Hz. The uncertainty due to systematic effects has been reduced to less than 0.8 Hz, which represents $1.5\times10^{-15}$ in fractional frequency.Comment: 4 pages, 3 figure -Submitted to PRA Rapid Communication

Descriptions, truth value intuitions, and questions

International audienceSince the famous debate between Russell (Mind 14: 479–493, 1905, Mind 66: 385–389, 1957) and Strawson (Mind 59: 320–344, 1950; Introduction to logical theory, 1952; Theoria, 30: 96–118, 1964) linguistic intuitions about truth values have been considered notoriously unreliable as a guide to the semantics of definite descriptions. As a result, most existing semantic analyses of definites leave a large number of intuitions unexplained. In this paper, I explore the nature of the relationship between truth value intuitions and non-referring definites. Inspired by comments in Strawson (Introduction to logical theory, 1964), I argue that given certain systematic considerations, one can provide a structured explanation of conflicting intuitions. I show that the intuitions of falsity, which proponents of a Russellian analysis often appeal to, result from evaluating sentences in relation to specific questions in context. This is shown by developing a method for predicting when sentences containing non-referring definites elicit intuitions of falsity. My proposed analysis draws importantly on Roberts (in: Yoon & Kathol (eds.) OSU working papers in Linguistics: vol. 49: Papers in Semantics 1998; in: Horn & Ward (eds.) Handbook of pragmatics, 2004) and recent research in the semantics and pragmatics of focus

Presupposition projection as proof construction

Even though Van der Sandt's presuppositions as anaphora approach is empirically successful, it fails to give a formal account of the interaction between world-knowledge and presuppositions. In this paper, an algorithm is sketched which is based on the idea of presuppositions as anaphora. It improves on this approach by employing a deductive system, Constructive Type Theory (CTT), to get a formal handle on the way world-knowledge influences presupposition projection. In CTT, proofs for expressions are explicitly represented as objects. These objects can be seen as a generalization of DRT's discourse markers. They are useful in dealing with presuppositional phenomena which require world-knowledge, such as Clark's bridging examples and Beaver's conditional presuppositions

Atomic Parity Violation : Principles, Recent Results, Present Motivations

We review the progress made in the determination of the weak charge, Q\_w, of the cesium nucleus which raises the status of Atomic Parity Violation measurements to that of a precision electroweak test. Not only is it necessary to have a precision measurement of the electroweak asymmetry in the highly forbidden 6S-7S transition, but one also needs a precise calibration procedure. The 1999 precision measurement by the Boulder group implied a 2.5 sigma deviation of Q\_w from the theoretical prediction. This triggered many particle physicist suggestions as well as examination by atomic theoretical physicists of several sources of corrections. After about three years the disagreement was removed without appealing to "New Physics". Concurrently, an original experimental approach was developed in our group for more than a decade. It is based on detection by stimulated emission with amplification of the left- right asymmetry. We present our decisive, recent progress together with our latest results. We emphasize the important impact for electroweak theory, of future measurements in cesium possibly pushed to the 0.1% level. Other possible approaches are currently explored in several atoms

Impossible worlds

Impossible worlds are representations of impossible things and impossible happenings. They earn their keep in a semantic or metaphysical theory if they do the right theoretical work for us. As it happens, a worlds-based account provides the best philosophical story about semantic content, knowledge and belief states, cognitive significance and cognitive information, and informative deductive reasoning. A worlds-based story may also provide the best semantics for counterfactuals. But to function well, all these accounts need use of impossible and as well as possible worlds. So what are impossible worlds? Graham Priest claims that any of the usual stories about possible worlds can be told about impossible worlds, too. But far from it. I'll argue that impossible worlds cannot be genuine worlds, of the kind proposed by Lewis, McDaniel or Yagisawa. Nor can they be ersatz worlds on the model proposed by Melia or Sider. Constructing impossible worlds, it turns out, requires novel metaphysical resources

Probabilities, causation, and logic programming in conditional reasoning: reply to Stenning and Van Lambalgen (2016)

Oaksford and Chater (2014, Thinking and Reasoning, 20, 269–295) critiqued the logic programming (LP) approach to nonmonotonicity and proposed that a Bayesian probabilistic approach to conditional reasoning provided a more empirically adequate theory. The current paper is a reply to Stenning and van Lambalgen's rejoinder to this earlier paper entitled ‘Logic programming, probability, and two-system accounts of reasoning: a rejoinder to Oaksford and Chater’ (2016) in Thinking and Reasoning. It is argued that causation is basic in human cognition and that explaining how abnormality lists are created in LP requires causal models. Each specific rejoinder to the original critique is then addressed. While many areas of agreement are identified, with respect to the key differences, it is concluded the current evidence favours the Bayesian approach, at least for the moment