On the very idea of a recovery model for mental health

Both in the UK and internationally, the ‘recovery model’ has been promoted to guide mental healthcare in reaction against what is perceived to be an overly narrow traditional bio-medical model. It has also begun to have an influence in thinking more broadly about mental health both for individuals and for communities and in the latter case has been linked to policies to promote social inclusion. In this widening application, however, there is a risk that the model becomes too broad to count as a model and thus to compete with other models such as a bio-medical model of health or illness. In this short paper we sketch some of the competing views of illness and health in order to locate and articulate a possible recovery model for mental health. We suggest that a distinct recovery model could be based on a view that places values at the centre of an analysis of mental health. Our aim, however, is to clarify the options rather than defend the model that emerges. We do, however, caution against one possible version of a recovery model. Thus if a recovery model were to be defended along the line we sketch we think that it would be better to construe the values involved on eudaimonic rather than hedonic lines

Competition Without Chaos

California heralded the New Year with a wave of rolling blackouts, spiraling wholesale electricity prices, and at least one utility bankruptcy. California, which symbolizes the electronic age and represents an eighth of the U.S. economy and its population, faces electricity supply issues not seen since the Great Depression and the collapse of the great utility holding companies. To what extent is California the bellwether for the restructured electric industry in the United States? We do not believe that the recent crisis in California is a signal that competition and deregulation have failed. Indeed, it remains our firm belief that market-oriented restructuring of the electric industry remains the best opportunity to provide consumer benefits and to develop reliable new sources of supply. After all, a major impetus for introducing competition into the generation and marketing of electricity has been the previous failures in long-term planning decisions made by public utilities and their regulators. The regulated monopoly regime simply did not provide the correct economic incentives for a company to provide electric service efficiently. To what extent can other states that have restructured their electric industries expect to see California-like dramatic sustained price increases and supply shortages resulting in rolling blackouts? The root cause of California's problems was its long-term failure to build generating plants during the most sustained economic boom in the state's history. California's most significant restructuring problem was also a local issue. The California restructuring law required utilities collecting stranded costs to retain fixed price obligations to retail customers, while preventing them from hedging their price risk in the wholesale market by entering into long-term supply contracts. The California market design flaws have been avoided in the restructuring legislation enacted by the twenty-four states and the District of Columbia that have restructured electricity markets. Among these states are Pennsylvania and Illinois, the states where Exelon conducts public utility businesses. The restructuring efforts in these other states are generally yielding results quite different from those in California and demonstrate that thoughtful, market-oriented, evolutionary restructuring can work well for all parties. This is not a reason, however, for complacency. Government agencies, utilities and all market stakeholders must work hard to make sure this answer remains valid a few years hence. This work includes establishing appropriate pricing and incentives to encourage the building of new supply and the development of demand-side management programs; establishing regional transmission organizations in order to support the expansion of and appropriate pricing for transmission; establishing appropriate rules and pricing regarding the utilities provider of last resort or default supply obligation. The default supply issue is one of the most significant challenges to the transition to competition. If the delivery companies retain primary responsibility for arranging supply and thus lock up most of the generation sources, the result is reliable service and stable rates for customers. However, new market entrants' access to supply sources will be limited and at high prices, making it difficult for them to compete. To resolve this dilemma, we propose a bifurcated approach to default service offerings and pricing. For large customers, who have the most desirable service characteristics to competitive suppliers and thus more opportunity to hedge their price risk, the utilities' only default service obligation would be unbundled energy at a market price. For mass market customers, who lack hedging ability because of limited, if any, market development, the utilities would provide a fixed price, multi-year energy supply offering. The price for both offerings must include a risk premium adequate to compensate the utility for the risk it assumes and to avoid rates that are too low to allow alternative suppliers to compete. We believe our default supply resolution will achieve the competing goals of price stability, reliability, and the development of a mature competitive market. The California experience is not an accident or the product of bad luck. It is the product of choices, long-term choices about siting generation and transmission, and the more recent choice of a market design that imposed asymmetric risks on utilities to the ultimate detriment of all. If other states make similar choices, similar consequences can be expected to follow. In short, the California experience is no reason to reject restructuring; it is rather a forceful lesson on the importance of doing it right.

Electronic fraud detection in the U.S. Medicaid Healthcare Program: lessons learned from other industries

It is estimated that between $600 and$850 billion annually is lost to fraud, waste, and abuse in the US healthcare system,with $125 to$175 billion of this due to fraudulent activity (Kelley 2009). Medicaid, a state-run, federally-matchedgovernment program which accounts for roughly one-quarter of all healthcare expenses in the US, has been particularlysusceptible targets for fraud in recent years. With escalating overall healthcare costs, payers, especially government-runprograms, must seek savings throughout the system to maintain reasonable quality of care standards. As such, the need foreffective fraud detection and prevention is critical. Electronic fraud detection systems are widely used in the insurance,telecommunications, and financial sectors. What lessons can be learned from these efforts and applied to improve frauddetection in the Medicaid health care program? In this paper, we conduct a systematic literature study to analyze theapplicability of existing electronic fraud detection techniques in similar industries to the US Medicaid program

Revised Annotations, Sex-Biased Expression, and Lineage-Specific Genes in the Drosophila melanogaster group

Here, we provide revised gene models for D. ananassae, D. yakuba, and D. simulans, which include UTRs and empirically verified intron-exon boundaries, as well as ortholog groups identified using a fuzzy reciprocal-best-hit blast comparison. Using these revised annotations, we perform differential expression testing using the cufflinks suite to provide a broad overview of differential expression between reproductive tissues and the carcass. We identify thousands of genes that are differentially expressed across tissues in D. yakuba and D. simulans, with roughly 60% agreement in expression patterns of orthologs in D. yakuba and D. simulans. We identify several cases of putative polycistronic transcripts, pointing to a combination of transcriptional read-through in the genome as well as putative gene fusion and fission events across taxa. We furthermore identify hundreds of lineage specific genes in each species with no blast hits among transcripts of any other Drosophila species, which are candidates for neofunctionalized proteins and a potential source of genetic novelty.Comment: Revised manuscript, also available online preprint at G3: Genes, Genomes, Genetics. Gene models, ortholog calls, and tissue specific expression results are available at http://github.com/ThorntonLab/GFF or the UCSC browser on the Thornton Lab public track hub at http://genome.ucsc.ed