Could Distance be a Proxy for Severity-of-Illness? A Comparison of Hospital Costs in Distant and Local Patients.

We test the hypothesis that hospital costs, after adjusting for DRG mix, are higher in distant patients than in local patients. Data were obtained from the Washington State Commission Hospital Abstract Reporting System (CHARS) and included all patients discharged from 15 metropolitan hospitals in the state of Washington during fiscal year 1987 (N = 181,072)

BIMA and Keck Imaging of the Radio Ring PKS 1830-211

We discuss BIMA (Berkeley Illinois Maryland Association) data and present new high quality optical and near-IR Keck images of the bright radio ring PKS 1830-211. Applying a powerful new deconvolution algorithm we have been able to identify both images of the radio source. In addition we recover an extended source in the optical, consistent with the expected location of the lensing galaxy. The source counterparts are very red, I-K=7, suggesting strong Galactic absorption with additional absorption by the lensing galaxy at z=0.885, and consistent with the detection of high redshift molecules in the lens.Comment: To be published in the ASP Conference Proceedings, 'Highly Redshifted Radio Lines', Greenbank, W

Atherosclerotic carotid plaque composition: a 3T and 7T MRI-histology correlation study

Background and Purpose Carotid artery atherosclerotic plaque composition may influence plaque stability and risk of thromboembolic events, and non-invasive plaque imaging may therefore permit risk stratification for clinical management. Plaque composition was compared using non-invasive in-vivo (3T) and ex-vivo (7T) MRI and histopathological examination. Methods Thirty three endarterectomy cross sections, from 13 patients, were studied. The datasets consisted of in-vivo 3T MRI, ex-vivo 7T MRI and histopathology. Semi-automated segmentation methods were used to measure areas of different plaque components. Bland- Altman plots and mean difference with 95% confidence interval were carried out. Results There was general quantitative agreement between areas derived from semi-automated segmentation of MRI data and histology measurements. The mean differences and 95% confidence bounds in the relative to total plaque area between 3T versus Histology were: fibrous tissue 4.99 % (-4.56 to 14.56), lipid-rich/necrotic core (LR/NC) with haemorrhage - 1.81% (-14.11 to 10.48), LR/NC without haemorrhage -2.43% (-13.04 to 8.17), and calcification -3.18% (-11.55 to 5.18). The mean differences and 95% confidence bounds in the relative to total plaque area between 7T and histology were: fibrous tissue 3.17 % (-3.17 to 9.52), LR/NC with haemorrhage -0.55% (-9.06 to 7.95), LR/NC without haemorrhage - 12.62% (-19.8 to -5.45), and calcification -2.43% (-9.97 to 4.73). Conclusions This study provides evidence that semi-automated segmentation of 3T/7T MRI techniques can help to determine atherosclerotic plaque composition. In particular, the high resolution of ex-vivo 7T data was able to highlight greater detail in the atherosclerotic plaque composition. High field MRI may therefore have advantages for in vivo carotid plaque MR imaging

Concentration of Physician Services Across Insurers and Effects on Quality: Early Evidence From Medicare Advantage.

BackgroundA growing proportion of Medicare beneficiaries is covered by private insurers through Medicare Advantage, yet little is known about how these plans are structured in terms of relationships with physicians and implications for quality of care.ObjectiveThe objective of this study was to assess whether greater physician concentration of services across insurers was associated with higher quality in Medicare Advantage (MA), overall and particularly among MA insurers serving a high proportion of vulnerable enrollees.Research designA retrospective cohort design with regression analysis.Data sourcesThe primary dataset was 2014 MA encounter records submitted by insurers to the Centers for Medicare and Medicaid Services, covering 600,329 physicians across 119 insurers. These data were merged with Centers for Medicare and Medicaid Services data on MA contract quality rating as well as physician characteristics in the Medicare Data on Provider Practice and Specialty file.MeasuresTwo measures were generated to capture the concentration of physician services across insurers: the percentage of a physician's Medicare services which was through MA (MA penetration); and the percentage of a physician's MA services with a specific insurer (insurer share of MA services).ResultsGreater MA penetration and insurer share of MA services were each associated with higher MA plan quality. The relationship between insurer share and quality was stronger in contracts with a relatively high percentage of disabled enrollees.ConclusionGreater physician concentration of services across MA insurers was associated with a higher quality of care overall and especially among vulnerable enrollees

The redshift of the gravitationally lensed radio source PKS1830-211

We report on the spectroscopic identification and the long awaited redshift measurement of the heavily obscured, gravitationally lensed radio source PKS 1830-211, which was first observed as a radio Einstein ring. The NE component of the doubly imaged core is identified, in our infrared spectrum covering the wavelength range 1.5-2.5 microns, as an impressively reddened quasar at z=2.507. Our redshift measurement, together with the recently measured time delay (Lovell et al.), means that we are a step closer to determining the Hubble constant from this lens. Converting the time delay into the Hubble constant by using existing models leads to high values for the Hubble constant. Since the lensing galaxy lies very close to the center of the lensed ring, improving the error bars on the Hubble constant will require not only a more precise time delay measurement, but also very precise astrometry of the whole system.Comment: 11 pages, 2 figures, Accepted ApJ

Aerodynamic Effects of High Turbulence Intensity on a Variable-Speed Power-Turbine Blade With Large Incidence and Reynolds Number Variations

The effects of high inlet turbulence intensity on the aerodynamic performance of a variable speed power turbine blade are examined over large incidence and Reynolds number ranges. These results are compared to previous measurements made in a low turbulence environment. Both high and low turbulence studies were conducted in the NASA Glenn Research Center Transonic Turbine Blade Cascade Facility. The purpose of the low inlet turbulence study was to examine the transitional flow effects that are anticipated at cruise Reynolds numbers. The current study extends this to LPT-relevant turbulence levels while perhaps sacrificing transitional flow effects. Assessing the effects of turbulence at these large incidence and Reynolds number variations complements the existing database. Downstream total pressure and exit angle data were acquired for 10 incidence angles ranging from +15.8deg to 51.0deg. For each incidence angle, data were obtained at five flow conditions with the exit Reynolds number ranging from 2.1210(exp 5) to 2.1210(exp 6) and at a design exit Mach number of 0.72. In order to achieve the lowest Reynolds number, the exit Mach number was reduced to 0.35 due to facility constraints. The inlet turbulence intensity, Tu, was measured using a single-wire hotwire located 0.415 axial-chord upstream of the blade row. The inlet turbulence levels ranged from 8 to 15 percent for the current study. Tu measurements were also made farther upstream so that turbulence decay rates could be calculated as needed for computational inlet boundary conditions. Downstream flow field measurements were obtained using a pneumatic five-hole pitch/yaw probe located in a survey plane 7 percent axial chord aft of the blade trailing edge and covering three blade passages. Blade and endwall static pressures were acquired for each flow condition as well. The blade loading data show that the suction surface separation that was evident at many of the low Tu conditions has been eliminated. At the extreme positive and negative incidence angles, the data show substantial differences in the exit flow field. These differences are attributable to both the higher inlet Tu directly and to the thinner inlet endwall boundary layer that the turbulence grid imposes

Aerodynamic Investigation of Incidence Angle Effects in a Large Scale Transonic Turbine Cascade

Aerodynamic measurements showing the effects of large incidence angle variations on an HPT turbine blade set are presented. Measurements were made in NASA's Transonic Turbine Blade Cascade Facility which has been used in previous studies to acquire detailed aerodynamic and heat transfer measurements for CFD code validation. The current study supports the development of variable-speed power turbine (VSPT) speed-change technology for the NASA Large Civil Tilt Rotor (LCTR) vehicle. In order to maintain acceptable main rotor propulsive efficiency, the VSPT operates over a nearly 50 percent speed range from takeoff to altitude cruise. This results in 50 deg or more variations in VSPT blade incidence angles. The cascade facility has the ability to operate over a wide range of Reynolds numbers and Mach numbers, but had to be modified in order to accommodate the negative incidence angle variation required by the LCTR VSPT operation. Using existing blade geometry with previously acquired aerodynamic data, the tunnel was re-baselined and the new incidence angle range was exercised. Midspan exit total pressure and flow angle measurements were obtained at seven inlet flow angles. For each inlet angle, data were obtained at five flow conditions with inlet Reynolds numbers varying from 6.8310 (exp 5) to 0.8510(exp 5) and two isentropic exit Mach numbers of 0.74 and 0.34. The midspan flowfield measurements were acquired using a three-hole pneumatic probe located in a survey plane 8.6 percent axial chord downstream of the blade trailing edge plane and covering three blade passages. Blade and endwall static pressure distributions were also acquired for each flow condition

BVRIJK light curves and radial velocity curves for selected Magellanic Cloud Cepheids

We present high precision and well sampled BVRIJK light curves and radial velocity curves for a sample of five Cepheids in the SMC. In addition we present radial velocity curves for three Cepheids in the LMC. The low metallicity (Fe/H ~ -0.7) SMC stars have been selected for use in a Baade-Wesselink type analysis to constrain the metallicity effect on the Cepheid Period-Luminosity relation. The stars have periods of around 15 days so they are similar to the Cepheids observed by the Extragalactic Distance Scale Key Project on the Hubble Space Telescope. We show that the stars are representative of the SMC Cepheid population at that period and thus will provide a good sample for the proposed analysis. The actual Baade-Wesselink analysis are presented in a companion paper.Comment: Accepted for publication in A&A, 23 pages, 10 figures, data tables will be made available electronically from the CD

Aerodynamic Measurements of a Variable-Speed Power-Turbine Blade Section in a Transonic Turbine Cascade at Low Inlet Turbulence

Aerodynamic measurements obtained in a transonic linear cascade were used to assess the impact of large incidence angle and Reynolds number variations on the 3-D flow field and midspan loss and turning of a 2-D section of a variable-speed power-turbine (VSPT) rotor blade. Steady-state data were obtained for ten incidence angles ranging from +15.8 deg to 51.0 deg. At each angle, data were acquired at five flow conditions with the exit Reynolds number (based on axial chord) varying over an order-of-magnitude from 2.1210(exp 5) to 2.1210(exp 6). Data were obtained at the design exit Mach number of 0.72 and at a reduced exit Mach number of 0.35 as required to achieve the lowest Reynolds number. Midspan total-pressure and exit flow angle data were acquired using a five-hole pitch/yaw probe surveyed on a plane located 7.0 percent axial chord downstream of the blade trailing edge plane. The survey spanned three blade passages. Additionally, three-dimensional half-span flow fields were examined with additional probe survey data acquired at 26 span locations for two key incidence angles of +5.8 deg and 36.7 deg. Survey data near the endwall were acquired with a three-hole boundary-layer probe. The data were integrated to determine average exit total-pressure and flow angle as functions of incidence and flow conditions. The data set also includes blade static pressures measured on four spanwise planes and endwall static pressures. Tests were conducted in the NASA Glenn Transonic Turbine Blade Cascade Facility. The measurements reflect strong secondary flows associated with the high aerodynamic loading levels at large positive incidence angles and an increase in loss levels with decreasing Reynolds number. The secondary flows decrease with negative incidence as the blade becomes unloaded. Transitional flow is admitted in this low inlet turbulence dataset, making it a challenging CFD test case. The dataset will be used to advance understanding of the aerodynamic challenges associated with maintaining efficient power turbine operation over a wide shaft-speed range. de