Capturing complexity in clinician case-mix: classification system development using GP and physician associate data.

Background: There are limited case-mix classification systems for primary care settings which are applicable when considering the optimal clinical skill mix to provide services. Aim: To develop a case-mix classification system (CMCS) and test its impact on analyses of patient outcomes by clinician type, using example data from physician associates' (PAs) and GPs' consultations with same-day appointment patients. Design & setting: Secondary analysis of controlled observational data from six general practices employing PAs and six matched practices not employing PAs in England. Method: Routinely-collected patient consultation records (PA n = 932, GP n = 1154) were used to design the CMCS (combining problem codes, disease register data, and free text); to describe the case-mix; and to assess impact of statistical adjustment for the CMCS on comparison of outcomes of consultations with PAs and with GPs. Results: A CMCS was developed by extending a system that only classified 18.6% (213/1147) of the presenting problems in this study's data. The CMCS differentiated the presenting patient's level of need or complexity as: acute, chronic, minor problem or symptom, prevention, or process of care, applied hierarchically. Combination of patient and consultation-level measures resulted in a higher classification of acuity and complexity for 639 (30.6%) of patient cases in this sample than if using consultation level alone. The CMCS was a key adjustment in modelling the study's main outcome measure, that is rate of repeat consultation. Conclusion: This CMCS assisted in classifying the differences in case-mix between professions, thereby allowing fairer assessment of the potential for role substitution and task shifting in primary care, but it requires further validation

Achievably-Efficient Enrollments Using High Tuition-High Aid in Public Higher Education

With public universities tuitions and state appropriations are determined as efficiently as possible (“quasi-efficiently”) to cover fixed costs, an opportunity arises to admit additional low-income students at marginal cost. Using this tuition-appropriation approach, an implementable form of pay-what-you-can-afford tuition policy (PWYCA) can realize fully-efficient enrollments. This construction can be extended to include a standard, often legal, constraint that state appropriations must be used to support reduced resident tuitions. When applied to budget, tuition, enrollment and appropriation data of colleges at Penn State University, this high tuition- high aid policy not only accommodates additional low-cost enrollments but also increases social welfare

Lenguaje tabú y traducción audiovisual: estudio descriptivo de la subtitulación al español de la serie Orange is the new black

La subtitulación del lenguaje tabú y ofensivo es un ámbito relativamente poco explorado que presenta ciertos desafíos para el traductor. Las reducidas dimensiones de la pantalla y las necesidades de sincronía con la imagen y una cómoda velocidad de lectura para el espectador obligan a los subtituladores a reducir (condensar) la extensión de los subtítulos, por lo que las palabras y las expresiones tabú son tendentes a eliminarse. Esta reducción ocasiona una pérdida de información sobre el personaje y priva al público extranjero de la oportunidad de conocer estos elementos lingüísticos tan vinculados a la cultura de origen de la producción audiovisual y su sistema de creencias y costumbres. Con el objeto de conocer las tendencias actuales entre los traductores profesionales, este Trabajo fin de máster emprende un estudio descriptivo de un corpus audiovisual compuesto por los subtítulos de tres episodios de la serie de Netflix Orange is the New Black, traducidos profesionalmente al castellano y emitidos en la plataforma oficial de Netflix. Tomando una actitud inductiva frente al lenguaje tabú y ofensivo, se analizaron 270 subtítulos con más de 300 palabras y expresiones tabú, a fin de identificar las estrategias traductológicas implementadas, la frecuencia de las mismas y el cambio que la traducción supuso en la carga tabú del texto meta. Los resultados señalan que, si bien algún grado de condensación es inevitable en la traducción audiovisual, el traductor experimentado puede minimizar las pérdidas de lenguaje tabú y ofensivo, conservando así información relevante sobre el personaje y trasladando al público espectador estos legítimos elementos lingüísticos tan respresentativos de la lengua y la cultura de origen, en el interés de una experiencia audiovisual más completa.Subtitling of taboo and offensive language is a virtually unexplored aspect of both the translation and the audiovisual communication fields. The spatial and temporal limitations imposed on subtitles due to the physical constraints of the screen and the need to provide spectators with a comfortable reading speed oblige subtitlers to reduce or condense the length of subtitles by discarding words that are not deemed vital to understanding. Habitually, taboo and offensive words and expressions are among the first candidates to be jettisoned in order to save space, which can entail a loss of information that might have told viewers about a character’s personality, background and emotional state and, at the very least, deprives foreign audiences of exposure to these elements of language which are intimately tied to the source culture and its traditions and belief system. The following is a descriptive study of an audiovisual corpus comprised of three complete episodes from the first, second and third seasons of the Netflix Original series Orange is the New Black, professionally translated into Castilian Spanish and officially aired on the Netflix website. Taking an inductive approach to the taboo and offensive language in the corpus, the researchers analyzed 270 subtitles with over 300 taboo terms and words in order to identify the frequency of the translation strategies used in the transfer from source to target languages and then compared the taboo/offensive load of the subtitles between the source and the target texts to observe the changes in this load. The conclusions reached would suggest that, although some condensation is inevitable in subtitling, skilled translators can minimize the loss of these legitimate and generally colorful language elements, providing viewers with additional and often necessary character and narrative information and allowing them the chance to explore these linguistic features of the source language and its culture in the interests of a richer and more complete viewing experience

Bootstrap Exploration of the Duration of Surface Electromyography Sampling in Relation to the Precision of Exposure Estimation

Objectives: This study examined the effect of sampling duration, in units of work cycles, on the precision of estimates of exposure to forceful exertion obtained with surface electromyography (EMG). Methods: Recordings of the activity of the flexor digitorum superficialis, extensor digitorum, and upper trapezius muscles over 30 consecutive work cycles were obtained for a random sample of 25 manufacturing workers, each of whom was performing a unique production task representing a portion of the whole job. The mean root-meansquare amplitude and the 10th, 50th, and 90th percentiles of the distribution function of the amplitude probability were calculated for each cycle. Bootstrap analyses were used to examine the precision of the summary measures as the sampling duration increased incrementally from 1 to 30 work cycles. Precision was estimated by calculating the coefficient of variation (CV) of the bootstrap distributions at each sampling duration increment. Results: The average minimum sampling duration for a bootstrap distribution CV of 15% ranged from 2.0 (SD 1.5) cycles to 7.5 (SD 9.6) cycles, depending on muscle and summary measure. For a 5% CV, the average minimum sampling duration ranged from 11.9 (SD 9.0) to 20.9 (SD 10.5) cycles. Conclusions: The results suggest that sampling as few as three work cycles was sufficient to obtain a bootstrap distribution CV of 15% for some of the muscles and summary measures examined in this study. While limited to machine-paced, cyclic manufacturing work, these results will assist the development of exposure assessment strategies in future epidemiologic studies of physical risk factors and musculoskeletal disorders