Do Health Care Providers Quality Discriminate? Empirical Evidence from Primary Care Outpatient Clinics

There has been minimal attention paid to the mechanisms of hospital quality oversight that are currently in place. Accordingly this study will analyze the system of hospital quality regulation in the US. The Social Security Act as amended in 1965 gave the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) "deeming" power for Medicare quality requirements. There are numerous reasons why JCAHO's oversight strategy may be ineffective. The primary reason is the dual role of JCAHO as a regulator and advocate. In conclusion, JCAHO surveys do provide an incentive to hospitals to improve processes of care for the period leading up to an inspection and that incentive gets eliminated after the inspection occurs. JCAHO has announced a change from the scheduled survey to an unannounced strategy. The objective of this change is to provide an incentive to maintain a level of readiness. This may not occur if hospitals are motivated to minimize the overall cost of JCAHO compliance.

An Efficient Interpolation Technique for Jump Proposals in Reversible-Jump Markov Chain Monte Carlo Calculations

Selection among alternative theoretical models given an observed data set is an important challenge in many areas of physics and astronomy. Reversible-jump Markov chain Monte Carlo (RJMCMC) is an extremely powerful technique for performing Bayesian model selection, but it suffers from a fundamental difficulty: it requires jumps between model parameter spaces, but cannot efficiently explore both parameter spaces at once. Thus, a naive jump between parameter spaces is unlikely to be accepted in the MCMC algorithm and convergence is correspondingly slow. Here we demonstrate an interpolation technique that uses samples from single-model MCMCs to propose inter-model jumps from an approximation to the single-model posterior of the target parameter space. The interpolation technique, based on a kD-tree data structure, is adaptive and efficient in modest dimensionality. We show that our technique leads to improved convergence over naive jumps in an RJMCMC, and compare it to other proposals in the literature to improve the convergence of RJMCMCs. We also demonstrate the use of the same interpolation technique as a way to construct efficient "global" proposal distributions for single-model MCMCs without prior knowledge of the structure of the posterior distribution, and discuss improvements that permit the method to be used in higher-dimensional spaces efficiently.Comment: Minor revision to match published versio

Vernacular theories of everyday (in)security : the disruptive potential of non-elite knowledge

Citizens increasingly occupy a central role in the policy rhetoric of British National Security Strategies (NSS) and yet the technocratic methods by which risks and threats are assessed and prioritised do not consider the views and experiences of diverse publics. Equally, security studies in both ‘traditional’ and ‘critical’ guises has privileged analysis of elites over the political subject of threat and (in)security. Contributing to the recent ‘vernacular’ and ‘everyday’ turns, this article draws on extensive critical focus group research carried out in 2012 across six British cities in order to investigate: 1) which issues citizens find threatening and how they know, construct, and narrate 'security threats'; and 2) the extent to which citizens are aware of, engage with, and/or refuse government efforts to foster vigilance and suspicion in public spaces. Instead of making generalisations about what particular ‘types’ of citizens think, however, we develop a ‘disruptive’ approach inspired by the work of Jacques Rancière. While many of the views, anecdotes, and stories reproduce the police order in Rancière’s terms, it is also possible to identify political discourses that disrupt dominant understandings of threat and (in)security, repoliticise the grounds on which national security agendas are authorised, and reveal actually existing alternatives to cultures of suspicion and unease

Practical experiences in concurrent, collaborative ontology building using Collaborative Protégé

Creation of an ontology according to some common plan is best accomplished collaboratively. This is sometimes contradicted by the distribution of the ontology’s developers. An obvious solution therefore is to build collaboration into ontology development tools. Such support necessarily includes both the technical means to perform editing operations upon an ontology, but also support for the communication that makes collaboration such a vital part of much ontology development. To investigate the distributed, collaborative ontology engineering process and the corresponding capabilities of the Collaborative Protege 3 (CP) tool, members of the OntoGenesis network came together and enriched the Ontology of Biomedical Investigations (OBI) with new content. The communications and interactions of the participants with each other, directly or through the tool, were tracked and analyzed. Our initial analysis of the degree to which this new tool fulfills the practical requirements of collaborative ontology engineering suggests the approach is promising. We present some observations and recommendations for CP based upon this experience

A hydrodynamic limit for chemotaxis in a given heterogeneous environment

In this paper, the first equation within a class of well-known chemotaxis systems is derived as a hydrodynamic limit from a stochastic interacting many particle system on the lattice. The cells are assumed to interact with attractive chemical molecules on a finite number of lattice sites, but they only directly interact among themselves on the same lattice site. The chemical environment is assumed to be stationary with a slowly varying mean, which results in a non-trivial macroscopic chemotaxis equation for the cells. Methodologically, the limiting procedure and its proofs are based on results by Koukkous (Stoch. Process. Appl. 84, 297–312, cite.​Kou99) and Kipnis and Landim (Scaling limits of interacting particle systems, cite.​KL99). Numerical simulations extend and illustrate the theoretical findings

Intertwining semisimple characters for p-adic classical groups

Let be an orthogonal, symplectic or unitary group over a non-archimedean local field of odd residual characteristic. This paper concerns the study of the “wild part” of an irreducible smooth representation of , encoded in its “semisimple character”. We prove two fundamental results concerning them, which are crucial steps toward a complete classification of the cuspidal representations of . First we introduce a geometric combinatorial condition under which we prove an “intertwining implies conjugacy” theorem for semisimple characters, both in and in the ambient general linear group. Second, we prove a Skolem–Noether theorem for the action of on its Lie algebra; more precisely, two semisimple elements of the Lie algebra of which have the same characteristic polynomial must be conjugate under an element of if there are corresponding semisimple strata which are intertwined by an element of