Word of Mouth and Physician Referrals Still Drive Health Care Provider Choice

Examines how consumers choose physicians, specialists, or medical facilities, including the use of physician referrals, word-of-mouth recommendations, health plan information, and the Internet. Explores implications for consumer-directed health care

Designing Effective Health Care Quality Transparency Initiatives

Profiles two well-designed healthcare quality transparency initiatives from California and Massachusetts. Examines key design and implementation elements, including provider engagement, reliable data, consumer-friendliness, and feedback to providers

Coordinated design of coding and modulation systems

The joint optimization of the coding and modulation systems employed in telemetry systems was investigated. Emphasis was placed on formulating inner and outer coding standards used by the Goddard Spaceflight Center. Convolutional codes were found that are nearly optimum for use with Viterbi decoding in the inner coding of concatenated coding systems. A convolutional code, the unit-memory code, was discovered and is ideal for inner system usage because of its byte-oriented structure. Simulations of sequential decoding on the deep-space channel were carried out to compare directly various convolutional codes that are proposed for use in deep-space systems

Evolution of the Dark Matter Distribution at the Galactic Center

Annihilation radiation from neutralino dark matter at the Galactic center (GC) would be greatly enhanced if the dark matter were strongly clustered around the supermassive black hole (SBH). The existence of a dark-matter "spike" is made plausible by the observed, steeply-rising stellar density near the GC SBH. Here the time-dependent equations describing gravitational interaction of the dark matter particles with the stars are solved. Scattering of dark matter particles by stars would substantially lower the dark matter density near the GC SBH over 10^10 yr, due both to kinetic heating, and to capture of dark matter particles by the SBH. This result suggests that enhancements in the dark matter density around a SBH would be modest whether or not the host galaxy had experienced the scouring effects of a binary SBH.Comment: 5 pages, 3 figures. Submitted to Physical Review Letter

A photometric and kinematic study of the stars and interstellar medium in the central two kpc of NGC 3379

HST images of NGC 3379 show that the V and I luminosity profiles in the inner 13 arcsec of this E1 galaxy are represented by two different components: a stellar bulge following a Sersic Law with exponent n = 2.36, and a central core (r < 0.7 arcsec) with a characteristic "cuspy" profile. Subtraction of the underlying stellar component represented by the fitted Sersic profile revealed the presence of a small (r ~ 105 pc) dust disk of about 150 solar masses, oriented at PA = 125 degrees and inclined ~ 77 degrees with respect to the line of sight. The same absorption structure is detected in the color-index (V-I) image. The stellar rotation in the inner 20 arcsec is well represented by a parametric planar disk model, inclined ~ 26 degrees relative to the plane of the sky, and apparent major axis along PA ~ 67 degrees. The gas velocity curves in the inner 5 arcsec show a steep gradient, indicating that the gas rotates much faster than the stars, although in the same direction. The velocity field of the gaseous system, however, is not consistent with the simple model of Keplerian rotation sustained by the large (7 x 10E9 solar masses within a radius of ~ 90 pc) central mass implied by the maximum velocity observed, but the available data precludes a more detailed analysis.Comment: 23 pages, LaTeX(aaspp4.sty), 9 figures included. Figs. 1 and 5 are colour plates. Accepted for publication in The Astrophysical Journal (part 1

Interfaces of Steam Electric Power Plants with Aquatic Ecosystems

Growth and reproduction may be stimulated by increased temperature in the cooling system and thermal plume during seasons when ambient water temperature is less than optimum, but growth, reproduction and survival are reduced when the elevated temperatures become excessive. Some fish species congregate in the warm thermal plumes during cold seasons but are excluded from this living space by temperatures above their preference in the summer. However, the warm refuge provided by a thermal plume in cold seasons can be a death trap if a power plant shuts down suddenly and exposes the fish to cold shock exceeding their lower thermal tolerance limits. Each of the factors tend to affect different segments of the biota. For example, impingement involves primarily juvenile and adult life stages of fish and species of large invertebrates; pumped entrainment affects are restricted to the smaller planktonic forms that include egg and larval stages of fish; and chemical and thermal discharges may affect all segments of the biota but in ways that vary dramatically among segments, species or even life stages of a species

Can Standard Cosmological Models Explain the Observed Abell Cluster Bulk Flow?

Lauer \& Postman (LP) observe that all Abell clusters with redshifts less than 15,000\kms\ appear to be participating in a bulk flow of 689 km s$^{-1}$ with respect to the Cosmic Microwave Background. We find this result difficult to reconcile with all popular models for large-scale structure formation that assume Gaussian initial conditions. This conclusion is based on Monte-Carlo realizations of the LP data, drawn from large Particle-Mesh $N$-body simulations. We have taken special care to treat properly the longest-wavelength components of the power spectra. Bulk flows with amplitude as large as that reported by LP are not uncommon in the Monte-Carlo datasets. However, the $\chi^2$ of the observed bulk flow, taking into account the anisotropy of the error ellipsoid, is much more difficult to match in the simulations. The models examined are ruled out at confidence levels between 94\% and 98\%. Any model that has {\it intrinsic} flows of less than 480\kms\ on the scales probed by LP scales can be ruled out at a similar level.Comment: Submitted to ApJ. 31 pages of uuencoded compressed postscript (810 kbytes); figures included. Also available via anonymous ftp to eku.ias.edu in /pub/strauss/warpfire/warpfire.ps.

An integrated study of earth resources in the State of California based on ERTS-1 and supporting aircraft data

There are no author-identified significant results in this report

The Stellar Kinematic Fields of NGC 3379

We have measured the stellar kinematic profiles of NGC 3379 along four position angles using the MMT. The data extend 90" from the center, at essentially seeing-limited resolution out to 17". The mean velocities and dispersions have total errors better than 10 km/s (frequently better than 5 km/s) out to 55". We find very weak (3 km/s) rotation on the minor axis interior to 12", and no detectable rotation above 6 km/s from 12" to 50" or above 16 km/s out to 90" (95% confidence). However, a Fourier reconstruction of the mean velocity field from all 4 sampled PAs does indicate a 5 degree twist of the kinematic major axis, opposite to the known isophotal twist. The h_3 and h_4 parameters are small over the entire observed region. The azimuthally-averaged dispersion profile joins smoothly at large radii with the dispersions of planetary nebulae. Unexpectedly, we find sharp bends in the major-axis rotation curve, also visible (though less pronounced) on the diagonal position angles. The outermost bend coincides in position with other sharp kinematic features: an abrupt flattening of the dispersion profile, and local peaks in h_3 and h_4. All of these features are in a region where the surface brightness profile departs significantly from a de Vaucouleurs law. Features such as these are not generally known in ellipticals owing to a lack of data at comparable resolution; however, very similar behavior is seen the kinematics of the edge-on S0 NGC 3115. We discuss the suggestion that NGC 3379 could be a misclassified S0; preliminary results from dynamical modeling indicate that it may be a flattened, weakly triaxial system seen in an orientation that makes it appear round.Comment: 31 pages incl. 4 tables, Latex, AASTeX v4.0, with 17 eps figures. To appear in The Astronomical Journal, February 199

An Empirical Study of Scoring Methods for the Conover Driving Attitude Inventory

The measurement of driving attitudes has followed in the wake of various studies and statistical data indicating that improper attitudes are responsible for an unduly high percentage of accidents. Certain of these tests have limitations, one of which is an economical method of scoring. Conover (Conover, 1947) used a scoring method such that the values 0, 1, 2, 3, 4, are assigned respectively to the responses designated as; most displeasing, displeasing, indifferent, pleasing, and most pleasing, for the positive items, and to avoid negative scores the values 4, 3, 2, 1, 0, are assigned respectively to the same responses; most displeasing, displeasing, indifferent, pleasing, and very pleasing, on the negative items. Summing the positive items according to the values given and the negative items by the reverse scoring system, the score for an individual is obtained. The Conover Driving Attitude Inventory is designed to measure the attitudes of individuals toward factors shown to be important in safe driving. An individual\u27s attitude toward specific factors, as indicated by his response to the items of the scale may be considered to constitute his attitude toward safe driving in general. In other words it is a test of one\u27s reactions to everyday driving experiences while behind the wheel. One-hundred fifty items make up the scale, thirty-five of which are considered positive items, thirty negative, and the remaining eighty-five are considered as fillers