Information Disclosure and the Equivalence of Prospective Payment and Cost Reimbursement

A health care provider chooses unobservable service-quality and cost-reduction efforts. The efforts produce quality and cost efficiency. An insurer observes quality and cost, and chooses how to disclose this information to consumers. The insurer also decides how to pay the provider. In prospective payment, the insurer fully discloses quality, and sets a prospective payment price. In cost reimbursement, the insurer discloses a value index, a weighted average of quality and cost efficiency, and pays a margin above cost. The first-best quality and cost efforts can be implemented by prospective payment and by cost reimbursement. Cost reimbursement with value index eliminates dumping and cream skimming. Prospective payment with quality index eliminates cream skimming

Debridement with high speed burr reduce more colonies of Staphylococcus aureus in chronic osteomyelitis of rabbit’s tibia compare to debridement with curettage

Background: Chronic osteomyelitis has been a difficult problem for the patient and for the treating physician. Chronic osteomyelitis is defined by most authors as osteomyelitis with symptoms that have been present for more than 1 month. Chronic osteomyelitis also defined by an infected dead bone within compromise soft tissue. An aggressive debridement and specific antibiotic treatment is first choice for chronic osteomyelitis. The purpose of this study was to assess the reduction in the number of colonies of Staphylococcus aureus after debridement with a high speed burr compared to debridement with curettage.Methods: This study is an experimental study was designed using a randomized post-test only group design. A total of 42 rabbits inoculated his right tibia with 0.1 ml Staphylococcus aureus 107 CFU / ml, and then inserted with K-wire intramedullary. Two weeks after inoculation, chronic osteomyelitis occurs, grade 3 and 4 radiologically. Then 10 rabbits were sacrificed without debridement, colonies of germs counted as control, 16 rabbits was performed debridement with curettage and 16 rabbits was performed debridement with high speed burr. Three weeks after debridement, 32 rabbits was sacrificed and counted for final germs colonies.Results: The results obtained from debridement with high speed burr and debridement with curettage, number of colonies of Staphylococcus aureus is less than the number of control’s colonies, with a value of p = 0.006 (p <0.05), debridement with a high speed burr also decrease the number of colonies of Staphylococcus aureus compared to debridement with curettage, with p = 0.023 (p<0.05), odds ratio of 9.000 (CI=95%). This is shows that this difference is statistically significant.Conclusions: The data showed that debridement with a high speed burr more likely to decrease the number of colonies of germs that can be recommended as a method of debridement for chronic osteomyelitis

Assessment of Extracts from Red Yeast Rice for Herb-Drug Interaction by in-vitro and in-vivo assays

Red yeast rice (RYR) is made by fermenting the yeast Monascus purpureus over rice. It is a source of natural red food colorants, a food garnish and a traditional medication. Results of the current study demonstrated that polar fractions of the RYR preparations contained herbal-drug interaction activity, which if left unremoved, enhanced P-glycoprotein activity and inhibited the major drug metabolizing cytochromes P450, i,e, CYP 1A2, 2C9 and 3A4. The data from Caco-2 cell absorption and animal model studies further demonstrated that the pharmacokinetic modulation effect by RYR preparations containing the polar fractions (“untreated” preparation) was greater than that from RYR preparations with the polar fractions removed (“treated” preparation). The data indicates a potential for herb-drug interactions to be present in RYR commonly sold as nutritional supplements when the polar fractions are not removed and this should be taken into consideration when RYR is consumed with medications, including verapamil

Incentives for motivated experts in a partnership

A Principal has a set of projects, each having different benefit potentials, and each requiring a basic technology from one of two experts and time inputs from both experts. Experts enjoy motivation utilities from production, but have private information of their own motivation preferences and project potentials. Technology and time-input choices are experts’ private decisions. Experts form a Partnership, which designs a sharing rule and a gatekeeping protocol to determine experts’ priority on technology choice. Using a linear cost-share contract that lets experts make minimum profits, the Principal implements the first best by delegating all decisions to the Partnership.Accepted manuscrip

Multi-field Inflation with a Random Potential

Motivated by the possibility of inflation in the cosmic landscape, which may be approximated by a complicated potential, we study the density perturbations in multi-field inflation with a random potential. The random potential causes the inflaton to undergo a Brownian motion with a drift in the D-dimensional field space. To quantify such an effect, we employ a stochastic approach to evaluate the two-point and three-point functions of primordial perturbations. We find that in the weakly random scenario the resulting power spectrum resembles that of the single field slow-roll case, with up to 2% more red tilt. The strongly random scenario, leads to rich phenomenologies, such as primordial fluctuations in the power spectrum on all angular scales. Such features may already be hiding in the error bars of observed CMB TT (as well as TE and EE) power spectrum and can be detected or falsified with more data coming in the future. The tensor power spectrum itself is free of fluctuations and the tensor to scalar ratio is enhanced. In addition a large negative running of the power spectral index is possible. Non-Gaussianity is generically suppressed by the growth of adiabatic perturbations on super-horizon scales, but can possibly be enhanced by resonant effects or arise from the entropic perturbations during the onset of (p)reheating. The formalism developed in this paper can be applied to a wide class of multi-field inflation models including, e.g. the N-flation scenario.Comment: More clarifications and references adde

Multi-field Inflation with a Random Potential

Motivated by the possibility of inflation in the cosmic landscape, which may be approximated by a complicated potential, we study the density perturbations in multi-field inflation with a random potential. The random potential causes the inflaton to undergo a Brownian motion with a drift in the D-dimensional field space. To quantify such an effect, we employ a stochastic approach to evaluate the two-point and three-point functions of primordial perturbations. We find that in the weakly random scenario the resulting power spectrum resembles that of the single field slow-roll case, with up to 2% more red tilt. The strongly random scenario, leads to rich phenomenologies, such as primordial fluctuations in the power spectrum on all angular scales. Such features may already be hiding in the error bars of observed CMB TT (as well as TE and EE) power spectrum and can be detected or falsified with more data coming in the future. The tensor power spectrum itself is free of fluctuations and the tensor to scalar ratio is enhanced. In addition a large negative running of the power spectral index is possible. Non-Gaussianity is generically suppressed by the growth of adiabatic perturbations on super-horizon scales, but can possibly be enhanced by resonant effects or arise from the entropic perturbations during the onset of (p)reheating. The formalism developed in this paper can be applied to a wide class of multi-field inflation models including, e.g. the N-flation scenario.Comment: More clarifications and references adde

EVALUATION OF GUIDELINE DIRECTED MEDICAL THERAPY IN A PHARMACIST-LED HEART FAILURE CLINIC

Background: Guideline directed medical therapy (GDMT) for the treatment of heart failure with reduced ejection fraction (HFrEF) improves morbidity and mortality. According to the CHAMP-HF registry, only 15% of patients with HFrEF achieve target dosing. Published literature reports increased achievement of GDMT by 25-40% through a multidisciplinary approach. However, the pharmacists’ role on the impact of GDMT is not well described. The purpose of this study is to evaluate the impact that the CVD Ambulatory Care Pharmacy Clinic has on achievement of GDMT for patients with HFrEF. Methods: This is the interim analysis of an IRB approved retrospective cohort study. This study compares achievement of GDMT in HFrEF patients managed by the pharmacy clinic versus the control group. GDMT is defined as achievement of target dosing or maximum tolerated doses. Control group represents those not seen by CVD Pharmacy clinic. Inclusion criteria includes adult patients with EF ≤ 45%, hospitalization in the previous 12 months, followed by a cardiologist within the health system, and not on maximum tolerated doses of GDMT. The primary outcome is the number of patients on GDMT 12 months after the initial visit. Secondary outcomes include days from initial visit until GDMT, number of patients on moderate dosing of GDMT and change in EF after GDMT. Patients were enrolled from October 1, 2019 through September 30, 2020. Results: Achievement of GDMT at 12 months was 67.2% (39/58) in the intervention group compared to 16.2% (7/43) in the control (P \u3c0.001). Days to GDMT was a median of 95.5 [57-175.5] days and 143 [64-214] days for the intervention and control group respectively (P = 0.493). In the intervention group, 50% (29/58) of patients achieved moderate dosing at 12 months compared to 11.6% (5/43) in the control group (P\u3c0.001). Patients in the intervention group who had an echo after achieving GDMT had a median increase in EF of 12% [5-20] after GDMT achievement. For all patients who achieved GDMT, 32.6% (15/46) achieved target dosing of medications. Conclusion: The CVD Ambulatory Care Pharmacy Clinic was associated with higher rates of GDMT achievement compared to the control and a shorter time to GDMT achievement

History and citizenship : sinews of Europeanity in the Maltese experience

History is central to citizenship; but the discourse on belonging and identity is, perhaps increasingly, in a state of flux. So is the approach and "the methodology, as mobility and technologies change rapidly, with such means as IT, TV, cinema, museums, orality, locality and regionality competing with the more traditional archival sources of information confined to books and journals, and that in a seemingly unstoppable globalizing world.l Citizenship can hardly exist outside of a framework of trust, born of an internalization of legitimacy, but the nurturing of such a disposition can no longer depend on set norms or value-systems, other: perhaps than citizenship itself, and even this, as it is a-changing. Citizenship, however, presumes "a nationhood, some kind of affiliation to nationality or statehood, otherwise it would be no more than a travel document. To make fun of a sense of affinity and belonging, of being, of place, of time and context, is to be too smart by half, or to be simply, perhaps unconsciously, the product of an utterly colonized or globalised mind. Of course identity would presume some roots. Were it simpfy preserved in a jar, its water would have dried up a rong time ago. Like citizenship, identity is dynamic; it is not a goldfish. In not being static, however, it does not thereby cease to exist.peer-reviewe

Assessing and augmenting SCADA cyber security: a survey of techniques

SCADA systems monitor and control critical infrastructures of national importance such as power generation and distribution, water supply, transportation networks, and manufacturing facilities. The pervasiveness, miniaturisations and declining costs of internet connectivity have transformed these systems from strictly isolated to highly interconnected networks. The connectivity provides immense benefits such as reliability, scalability and remote connectivity, but at the same time exposes an otherwise isolated and secure system, to global cyber security threats. This inevitable transformation to highly connected systems thus necessitates effective security safeguards to be in place as any compromise or downtime of SCADA systems can have severe economic, safety and security ramifications. One way to ensure vital asset protection is to adopt a viewpoint similar to an attacker to determine weaknesses and loopholes in defences. Such mind sets help to identify and fix potential breaches before their exploitation. This paper surveys tools and techniques to uncover SCADA system vulnerabilities. A comprehensive review of the selected approaches is provided along with their applicability

New Rattus from New Guinea

3 p. ; 24 cm.Includes 1 bibliographical reference (p. [1])