All Payer Hospital Regulations

Introduction: An all-payer system is a price setting system where rates of payment for healthcare services have not been negotiated between a hospital or health system or a payer but instead by a third party organization, such as Maryland’s Health Services Cost Review Commission (HSCRC), who sets most hospital rates that all payers agree to honor. All payer hospitals focus is on legislative principles in an effort to control costs. Methods: The methodology for this study was a literature review compiled with overview of All-payer hospital systems and its utilization in a hospital setting. All articles prior to 2000 were eliminated from the search. Twenty-eight references were examined and concluded to have mitigated the inclusion parameters along with benefits and disadvantages of the system. Results: Since 1976 Maryland has successfully kept hospital costs under control using an all-payer system. Additionally, improvements in length of stay and other health measures have improved. While an all payer system works for Maryland that has a large population in urban areas, other states may not see an improvement if they are larger or more rural. Even with lower controlled rates, Maryland still ranks less favorably in per capita health spending and regional variations than other states. Discussion/Conclusion: The majority of states are not utilizing the benefits of all payer systems. Implementation can improve healthcare in the US by impeding escalating costs, distinguishing fair payment systems, and increasing the access to care. This research study did not extensively compare other nations all payer systems to Maryland or how it could be implemented in the US. The all payer system has practical implications in the US healthcare system. If programs to cut spending are implemented too quickly, national healthcare could be compromised

Large Scale Structures a Gradient Lines: the case of the Trkal Flow

A specific asymptotic expansion at large Reynolds numbers (R)for the long wavelength perturbation of a non stationary anisotropic helical solution of the force less Navier-Stokes equations (Trkal solutions) is effectively constructed of the Beltrami type terms through multi scaling analysis. The asymptotic procedure is proved to be valid for one specific value of the scaling parameter,namely for the square root of the Reynolds number (R).As a result large scale structures arise as gradient lines of the energy determined by the initial conditions for two anisotropic Beltrami flows of the same helicity.The same intitial conditions determine the boundaries of the vortex-velocity tubes, containing both streamlines and vortex linesComment: 27 pages, 2 figure

The Qualitative and Quantitative Effects of Patient Centered Medical Home in the Veterans Health Administration

Since the 1990’s, the Veteran’s Health Administration (VHA) has implemented a system of primary care that has been considered some of the best care that can be offered (Klein, 2011). The Patient Center Medical Home (PCMH) Model, also called “Patient Aligned Care Team” (PACT) in the VHA, has been coordinating and integrating services which ensure optimal health outcomes at an acceptable value (Bidassie, Davies, Stark, & Boushon, 2014). PACT was created in 2010, building on 20 years of the VHA transforming from a loosely based system of inpatient services to a provider of outpatient primary care for veterans. From 2010 until 2011, their primary care staff levels decreased from 2.3 Full Time Equivalents (FTE) to 3.0 FTE, and in there was a reduction in face to face encounters as it was increased telephone consultations and electronic messaging (Trivedi et al., 2011). The VHA meets all five core functions under the PACT system, notably with the Peer to Peer toolkit, which permits the PCP to coordinate care with multiple specialists, and allows the exchange of electronic health records, which meets the requirements for accessible services, comprehensive care, patient centered, and coordination of care with one system (Luck, 2014). Quality metrics are hard to come by because most PCPs under the pact program see quality metrics to be a hindrance to the spirit of the PACT program, because responding to the performance metrics consume time and resources, and these quality metrics do not take into account the spirt of PCMH (Kansagara et al, 2014). The purpose of this research was to analyze the effects of PACT on the VHA to determine expenditures and the overall outcome of patient care

Volatility of Linear and Nonlinear Time Series

Previous studies indicate that nonlinear properties of Gaussian time series with long-range correlations, $u_i$, can be detected and quantified by studying the correlations in the magnitude series $|u_i|$, i.e., the ``volatility''. However, the origin for this empirical observation still remains unclear, and the exact relation between the correlations in $u_i$ and the correlations in $|u_i|$ is still unknown. Here we find analytical relations between the scaling exponent of linear series $u_i$ and its magnitude series $|u_i|$. Moreover, we find that nonlinear time series exhibit stronger (or the same) correlations in the magnitude time series compared to linear time series with the same two-point correlations. Based on these results we propose a simple model that generates multifractal time series by explicitly inserting long range correlations in the magnitude series; the nonlinear multifractal time series is generated by multiplying a long-range correlated time series (that represents the magnitude series) with uncorrelated time series [that represents the sign series $sgn(u_i)$]. Our results of magnitude series correlations may help to identify linear and nonlinear processes in experimental records.Comment: 7 pages, 5 figure

High-Resolution Mapping and Successful Ablation of Purkinje Ectopy–Triggered Ventricular Fibrillation Storm

Catheter ablation is recognized as a central therapeutic option in treating patients with drug-refractory, scar-related monomorphic ventricular tachycardia (VT). Catheter ablation also has a role in selected cases of polymorphic VT (PMVT) and/or ventricular fibrillation (VF). Rarely, premature ventricular contractions (PVCs) originating from the Purkinje network can induce PMVT/VF. Although not completely elucidated, the electrophysiologic mechanisms behind this lethal arrhythmia have generally been thought to be related to abnormal automaticity and triggered activity. Ablation of the triggering PVCs can prevent VF recurrence and is potentially lifesavin

Does Tropical Forest Fragmentation Increase Long-Term Variability of Butterfly Communities?

Habitat fragmentation is a major driver of biodiversity loss. Yet, the overall effects of fragmentation on biodiversity may be obscured by differences in responses among species. These opposing responses to fragmentation may be manifest in higher variability in species richness and abundance (termed hyperdynamism), and in predictable changes in community composition. We tested whether forest fragmentation causes long-term hyperdynamism in butterfly communities, a taxon that naturally displays large variations in species richness and community composition. Using a dataset from an experimentally fragmented landscape in the central Amazon that spanned 11 years, we evaluated the effect of fragmentation on changes in species richness and community composition through time. Overall, adjusted species richness (adjusted for survey duration) did not differ between fragmented forest and intact forest. However, spatial and temporal variation of adjusted species richness was significantly higher in fragmented forests relative to intact forest. This variation was associated with changes in butterfly community composition, specifically lower proportions of understory shade species and higher proportions of edge species in fragmented forest. Analysis of rarefied species richness, estimated using indices of butterfly abundance, showed no differences between fragmented and intact forest plots in spatial or temporal variation. These results do not contradict the results from adjusted species richness, but rather suggest that higher variability in butterfly adjusted species richness may be explained by changes in butterfly abundance. Combined, these results indicate that butterfly communities in fragmented tropical forests are more variable than in intact forest, and that the natural variability of butterflies was not a buffer against the effects of fragmentation on community dynamics

Aerosol nucleation over oceans and the role of galactic cosmic rays

International audienceWe investigate formation of sulfate aerosol in the marine troposphere from neutral and charged nucleation of H2SO4 and H2O. A box model of neutral and charged aerosol processes is run on a grid covering the oceans. Input data are taken from a model of galactic cosmic rays in the atmosphere, and from global chemistry and transport models. We find a weak aerosol production over the tropical oceans in the lower and middle troposphere, and a stronger production at higher latitudes, most notably downwind of industrial regions. The highest aerosol production, however, occurs in the upper troposphere, in particular in the tropics. This finding supports the proposition by which non-sea salt marine boundary layer aerosol in tropical regions does not form in situ, but nucleates in the upper troposphere from convectively lifted and cloud processed boundary layer air rich in aerosol precursor gases, from where it descends in subsiding air masses compensating convection. Convection of boundary layer air also appears to drive the formation of condensation nuclei in the tropical upper troposphere which maintains the stratospheric aerosol layer in the absence of volcanic activity. Neutral nucleation contributes only marginally to aerosol production in our simulations. This highlights the importance of charged binary and of ternary nucleation involving ammonia for aerosol formation. In clean marine regions however, ammonia concentrations seem too low to support ternary nucleation, making binary nucleation from ions a likely pathway for sulfate aerosol formation. On the other hand, our analysis indicates that the variation of ionization by galactic cosmic rays over the decadal solar cycle does not entail a response in aerosol production and cloud cover via the second indirect aerosol effect that would explain observed variations in global cloud cover. We estimate that the variation in radiative forcing resulting from a response of clouds to the change in galactic cosmic ray ionization and subsequent aerosol production over the decadal solar cycle is smaller than the concurrent variation of total solar irradiance

Minority Hole Mobility in n+ GaAs

The minority hole diffusivity, or equivalently the hole mobility, was measured in n+GaAs with the zero‐field time‐of‐flight technique. The minority hole mobility was measured for the donor doping range of 1.3×1017 cm−3 to 1.8×1018 cm−3 and was found to vary from 235 to 295 cm2/V s. At the lower doping level, the minority hole mobility is comparable to the corresponding majority hole mobility, but at 1.8×1018 cm−3 the minority hole mobility was 30% higher than the majority carrier hole mobility. These results have important implications for the design of devices such as solar cells and pnp‐heterojunction bipolar transistors

Static Loads Testing of a High Aspect Ratio Tow-Steered Wingbox

Static loads testing was performed on a 39-foot, high-aspect-ratio wingbox comprising carbon fiber tow-steered wing skins that were tailored for aircraft fuel efficiency under aeroelastic loads. The test article was designated the Passive Aeroelastic Tailored (PAT) wing. To date, the PAT wing, which has an aspect ratio of 13.5, is the largest wingbox designed and built to employ variably oriented carbon fibers along the span of the wing. During testing, distributed point loads were applied to the wingbox to simulate both -1g and 2.5g maneuver loads. To determine the wingboxs flexural axis location, individual point loads were applied. The global response of the wing (displacement and rotation measurements) showed similar trends compared to the finite element model predictions, though discrepancies of up to 17% were observed when comparing actual values between model and test. It was concluded that the boundary conditions and nonstructural features of the wingbox were the likely cause of the inconsistencies. The local response of the wingbox (strain measurements), which was much less affected by factors unrelated to tow-steering, exhibited good agreement with the model predictions, validating the modelling techniques employed for tow-steered composites

Shape complexity and fractality of fracture surfaces of swelled isotactic polypropylene with supercritical carbon dioxide

We have investigated the fractal characteristics and shape complexity of the fracture surfaces of swelled isotactic polypropylene Y1600 in supercritical carbon dioxide fluid through the consideration of the statistics of the islands in binary SEM images. The distributions of area $A$, perimeter $L$, and shape complexity $C$ follow power laws $p(A)\sim A^{-(\mu_A+1)}$, $p(L)\sim L^{-(\mu_L+1)}$, and $p(C)\sim C^{-(\nu+1)}$, with the scaling ranges spanning over two decades. The perimeter and shape complexity scale respectively as $L\sim A^{D/2}$ and $C\sim A^q$ in two scaling regions delimited by $A\approx 10^3$. The fractal dimension and shape complexity increase when the temperature decreases. In addition, the relationships among different power-law scaling exponents $\mu_A$, $\mu_B$, $\nu$, $D$, and $q$ have been derived analytically, assuming that $A$, $L$, and $C$ follow power-law distributions.Comment: RevTex, 6 pages including 7 eps figure