HMO employment and African-American physicians.

OBJECTIVES: To assess the level and determinants of African-American physicians' employment in health maintenance organizations (HMOs), particularly early in their careers. METHODS: We analyzed data from the 1991 and 1996 Young Physicians Surveys to assess racial differences in the likelihood of HMO employment (n = 3,705). Using multinomial logistic regression, we evaluated four explanations for an observed relationship between African-American physicians and HMO employment: human capital stratification among organizations, race-based affinity between physicians and patients, financial constraints due to debt burden, and different organizational hiring practices. Using binomial logistic regression, we also evaluated differences in the odds of being turned down for a prior practice position, of subsequently leaving the current practice organization and of later having career doubts. RESULTS: Without any controls, African-American physicians were 4.52 times more likely to practice in HMOs than Caucasian physicians. After controlling for human capital stratification, racial concordance and financial constraints, African-American physicians remained 2.48 times more likely to practice in HMOs than Caucasian physicians. In addition, 19.2% of African-American physicians in HMOs reported being turned down for another job, far more than any other racial/ethnic group in the HMO setting and any racial/ethnic group, including African-American physicians in the non-HMO setting (including all other practice locations). Five years later, those same African-American physicians from HMOs also reported significantly more turnover (7.50 times more likely than non-HMO African-American physicians to leave their current practice) and doubt about their careers (2.17 times more likely than non-HMO African-American physicians to express serious career doubts). CONCLUSIONS: African-American physicians were disproportionately hired into HMO settings, impacting their subsequent careers

Hanging Together or Hanged Separately: The Strategic Power of Coalitions where Bargaining Occurs with Incomplete Information

What is the strategic role of membership in an intergovernmental group with unanimity requirements if the group negotiates with an external player in a setting with incomplete information? Being in such a group has a strategic effect compared to negotiating as a stand-alone player and reduces the demands of the outside player. Group membership lends additional bargaining power. Negotiating as a group may also cause more inefficiencies due to bargaining failure, and this may harm also the intergovernmental group. We uncover the role of preference alignment and preference independence between members of the coalition group for equilibrium payoffs and welfare effects. In this analysis, we also distinguish between coalition groups with and without side payments. Overall, coalition groups tend to perform well for the members of the coalition group in comparison to fully decentralized negotiations, particularly if the objectives of the members of the coalition group are not always perfectly aligned

Factors Associated with the Income Distribution of Full-Time Physicians: A Quantile Regression Approach: Income Distribution of Full-Time Physicians

Physician income is generally high, but quite variable; hence, physicians have divergent perspectives regarding health policy initiatives and market reforms that could affect their incomes. We investigated factors underlying the distribution of income within the physician population

CFHTLenS: Co-evolution of galaxies and their dark matter haloes

Galaxy-galaxy weak lensing is a direct probe of the mean matter distribution around galaxies. The depth and sky coverage of the CFHT Legacy Survey yield statistically significant galaxy halo mass measurements over a much wider range of stellar masses ($10^{8.75}$ to $10^{11.3} M_{\odot}$) and redshifts ($0.2 < z < 0.8$) than previous weak lensing studies. At redshift $z \sim 0.5$, the stellar-to-halo mass ratio (SHMR) reaches a maximum of $4.0\pm0.2$ percent as a function of halo mass at $\sim 10^{12.25} M_{\odot}$. We find, for the first time from weak lensing alone, evidence for significant evolution in the SHMR: the peak ratio falls as a function of cosmic time from $4.5 \pm 0.3$ percent at $z \sim 0.7$ to $3.4 \pm 0.2$ percent at $z \sim 0.3$, and shifts to lower stellar mass haloes. These evolutionary trends are dominated by red galaxies, and are consistent with a model in which the stellar mass above which star formation is quenched "downsizes" with cosmic time. In contrast, the SHMR of blue, star-forming galaxies is well-fit by a power law that does not evolve with time. This suggests that blue galaxies form stars at a rate that is balanced with their dark matter accretion in such a way that they evolve along the SHMR locus. The redshift dependence of the SHMR can be used to constrain the evolution of the galaxy population over cosmic time.Comment: 18 pages, MNRAS, in pres

The new Felsenkeller 5 MV underground accelerator

The field of nuclear astrophysics is devoted to the study of the creation of the chemical elements. By nature, it is deeply intertwined with the physics of the Sun. The nuclear reactions of the proton-proton cycle of hydrogen burning, including the 3He({\alpha},{\gamma})7Be reaction, provide the necessary nuclear energy to prevent the gravitational collapse of the Sun and give rise to the by now well-studied pp, 7Be, and 8B solar neutrinos. The not yet measured flux of 13N, 15O, and 17F neutrinos from the carbon-nitrogen-oxygen cycle is affected in rate by the 14N(p,{\gamma})15O reaction and in emission profile by the 12C(p,{\gamma})13N reaction. The nucleosynthetic output of the subsequent phase in stellar evolution, helium burning, is controlled by the 12C({\alpha},{\gamma})16O reaction. In order to properly interpret the existing and upcoming solar neutrino data, precise nuclear physics information is needed. For nuclear reactions between light, stable nuclei, the best available technique are experiments with small ion accelerators in underground, low-background settings. The pioneering work in this regard has been done by the LUNA collaboration at Gran Sasso/Italy, using a 0.4 MV accelerator. The present contribution reports on a higher-energy, 5.0 MV, underground accelerator in the Felsenkeller underground site in Dresden/Germany. Results from {\gamma}-ray, neutron, and muon background measurements in the Felsenkeller underground site in Dresden, Germany, show that the background conditions are satisfactory for nuclear astrophysics purposes. The accelerator is in the commissioning phase and will provide intense, up to 50{\mu}A, beams of 1H+, 4He+ , and 12C+ ions, enabling research on astrophysically relevant nuclear reactions with unprecedented sensitivity.Comment: Submitted to the Proceedings of the 5th International Solar Neutrino Conference, Dresden/Germany, 11-14 June 2018, to appear on World Scientific -- updated version (Figure 2 and relevant discussion updated, co-author A. Domula added

A rural-urban comparative study of nonphysician providers in community and migrant health centers.

This is a study of the employment of nonphysician providers--nurse practitioners, physician assistants, and certified nurse midwives--in both rural and urban Community and Migrant Health Centers and of factors associated with their employment, based on a 1991 national survey of 383 Centers. Results of the survey suggest that nonphysician providers, in particular nurse practitioners and certified nurse midwives, primarily serve as physician substitutes, and are more likely to be employed by Centers that are larger and have affiliations with nonphysician provider training programs. Rural or urban location is not significantly related to the employment of nonphysician providers after controlling for center size. The fact that rural centers employ fewer nonphysician providers than urban centers can primarily be accounted for by their relatively small size, rather than a lack of interest. These findings demonstrate that the use of nonphysician providers is an important way both to achieve cost containment and improve access to primary care for those residing in medically underserved areas

Physicians' Perceptions of Factors Influencing Adherence to Antibiotic Prophylaxis in Children with Sickle Cell Disease

Background: Children with sickle cell disease (SCD) aged Staphylococcus pneumoniae and Haemophilus influenzae due to the inability of their spleen to protect against infection

Healthcare Utilization and Costs in Sepsis Survivors in Germany-Secondary Analysis of a Prospective Cohort Study

Background: Survivors of sepsis often face long-term sequelae after intensive care treatment. Compared to the period of hospitalization, little is known about the ambulatory healthcare utilization in sepsis patients. The study evaluated healthcare utilization and associated costs of sepsis care including allied health professions after initial hospitalization. Methods: Secondary analysis was performed on data in 210 sepsis patients prospectively enrolled from nine intensive care study centers across Germany. Data was collected via structured surveys among their Primary care (Family-) physicians (PCPs) within the first month after discharge from ICU (baseline) and again at 6, 12 and 24 months after discharge, each relating to the period following the last survey. Costs were assessed by standardized cost unit rates from a health care system’s perspective. Changes in healthcare utilization and costs over time were calculated using the Wilcoxon rank-sum test. Results: Of the 210 patients enrolled, 146 (69.5%) patients completed the 24 months follow-up. In total, 109 patients were hospitalized within the first 6 months post-intensive care. Mean total direct costs per patient at 0–6 months were €17,531 (median: €6047), at 7–12 months €9029 (median: €3312), and at 13–24 months €18,703 (median: €12,828). The largest contributor to the total direct costs within the first 6 months was re-hospitalizations (€13,787 (median: €2965). After this first half year, we observed a significant decline in inpatient care costs for re-hospitalizations (p ≤ 0.001). PCPs were visited by more than 95% of patients over 24 months. Conclusions: Sepsis survivors have high health care utilization. Hospital readmissions are frequent and costly. Highest costs and hospitalizations were observed in more than half of patients within the first six months post-intensive care. Among all outpatient care providers, PCPs were consulted most frequently. Clinical impact: Sepsis survivors have a high healthcare utilization and related costs which persist after discharge from hospital. Within outpatient care, possible needs of sepsis survivors as physiotherapy or psychotherapy seem not to be met appropriately. Development of sepsis aftercare programs for early detection and treatment of complications should be prioritized

A Configurational Approach to the Relationship between High-Performance Work Practices and Frontline Health Care Worker Outcomes

To identify high-performance work practices (HPWP) associated with high frontline health care worker (FLW) job satisfaction and perceived quality of care