The impact of liability for malpractice on the optimal reimbursement schemes for health services

We analyze the impact of liability risks for malpractice on the optimal reimbursement schemes for hospitals. In our model, the hospital decides upon two unobservable efforts, a cost reduction effort and a quality improvement effort. We assume that the total effort is positive even without monetary incentives due to some intrinsic motivation, but that motivation is biased towards quality. In our basic model without liability risks, we then find that either a fee-for-service system (FFS) or a fixed-fee prospective payment system (PPS) is optimal, but mixed systems are strictly inferior. With liability risks, mixed systems are in general optimal, and the variable part of costs that should be borne by the hospital is increasing in the degree of the liability risk. This may at least partially explain why countries like Germany where liability risks are low compared to the US have been more reluctant in switching from FFS to PPSprincipal-agent-theory, multi-task, health care, hospital compensation schemes, liability law

Entwicklung der Altersdemenz seit 2000

nicht vorhande

A Schr¨odinger-Poisson-Boltzmann system applied to the charge carrier transport in strained silicon

In this paper, a kinetic modeling of the electron transport inside a strained-silicon device structure is established. The reduced conduction band energy of a strained layer gives rise to a potential well structure, which may have a varying bottom energy. Electrons are introduced into the well by remote antimony doping, where they form a two-dimensional electron gas. Quantum-mechanical aspects are treated by using a self-consistent Schr¨odinger-Poisson block (subband model). To account for the transport properties of the strained-silicon device structure, an adapted semi-classical formulation of the Boltzmann transport equation is applied. This approach allows us to consistently include the relevant scattering mechanisms. The resulting coupled Schr¨odinger-Poisson-Boltzmann system is used for a phononlimited mobility estimate

Организационно-техническое обеспечение эксплуатации резервуара вертикального стального типа РВС на примере объекта в Ленинградской области

В работе рассмотрены вопросы организационно-технического обеспечения эксплуатации резервуара вертикального стального типа РВС на примере объекта в Ленинградской обл. Приведен расчет конструкции резервуара РВС-2000 м3 для хранения нефти и нефтепродуктов. Выполнены гидравлический расчет трубопровода и выполнена проверка всасывающей способности насоса. Произведен подбор резервуарного оборудования.The paper considers the issues of organizational and technical support for the operation of a vertical steel tank of the RVS type on the example of an object in the Leningrad region. The design of the RVS-2000 m3 tank for the storage of oil and petroleum products is calculated. The hydraulic calculation of the pipeline was performed and the suction capacity of the pump was checked. The selection of tank equipment was made

The unnoticed however spectacular dispersal of the neophyte Rubus armeniacus in urban areas – the example of Braunschweig

Intra-urban woodlands are not a popular topic for investigations due to their floristic and ecological heterogeneity as well as to their mixture of planted, running wild and indigenous species which are difficult to unravel. It seems too complicated to place them within the conventional system of plant communities and they are somewhat like the urchins within the woodlands and shrubberies. Rubus armeniacus, the Himalayan [precisely: Armenian] blackberry, originates from the Caucasus region and was introduced to Germany first in 1837. For a long time the species was the most frequently grown bramble in our gardens and in some regions it is still like this. Running wild plants established quite unnoticed shrubberies of different plot sizes. Actually publicity is increasingly interested in the spreading of neophytes whereas the assessment changes remarkably. The heavy discussions sometimes may take xenophobic attributes. To generate an authoritative basis distribution, habitats and establishing of Rubus armeniacus were investigated within the city of Braunschweig. Besides this possible vectors of dispersal and the potential suppression of indigenous species were in the focus of our investigations. Within the area of Braunschweig (192 km²) 1,703 locations with stands of Rubus armeniacus where documented during winter 2017. The area covered by Rubus armeniacus was at least 104,589 m². 175 of the locations are plantings, 464 are juvenescences near plantings (distance < 15 m), whereas 1,064 locations are not near to plantings. This results in a rejuvenation index (Verjüngungswert) of 72.6 % as well as in a value of spreading (Ausbreitungswert) of 69.6 % in Braunschweig. Random remapping in summer 2017 showed that 90 % of the stands have been covered by the investigations during the winter 2017. The mapping shows a clear accumulation of stands with Rubus armeniacus along railways and with allotments. Within intensively maintained gardens of detached houses Rubus armeniacus was found only seldomly. The association of the species was determined by 23 relevés. The species composition is very heterogeneous: Of the 70 accessory species only Urtica dioica and Galium aparine reach medium constancy. At the edges of the bramble stands and in their neighbourhood only trivial ruderal species and trivial grassland species have been found. A punctual suppression of such species by Rubus armeniacus seems not to be critical. Furthermore a control measure in the district of Lüneburg was evaluated. It shows that a singly cut directly at the soil surface is not sufficient to repress a stand of Rubus armeniacus. Depositing the chopped shoots at edges of woods speeds up the spreading of the species in the open landscape. A suppression of Rubus armeniacus will be successful only by long lasting maintenance. The costs however will not be within a reasonable correlation to its success. The probability is high that Rubus armeniacus will not be eliminated from our flora, especially because you can still buy it as a garden plant

As políticas públicas e o enfoque no agressor para o desmonte da violência intrafamiliar contra crianças e adolescentes

Este estudo teve como enfoque o panorama da Violência Intrafamiliar contra Crianças e Adolescentes e a intervenção proporcionada pelas políticas públicas no atendimento ao agressor. A metodologia utilizada foi a pesquisa bibliográfica. Denunciar aos órgãos competentes a ocorrência de casos de violência intrafamiliar dos quais se tenha conhecimento é muito importante, pois, pela denúncia, as leis que garantem os direitos fundamentais às crianças e aos adolescentes se farão cumprir, punindo adequadamente os agressores e livrando as vítimas de sofrimentos profundos. Contudo, entendeu-se que pensar o combate da violência intrafamiliar contra crianças e adolescentes, apenas fortalecendo o aparato judicial e prisional contra o indivíduo infrator, é um grande equívoco. A execução penal não se esgota na perspectiva punitiva, e sim, deve-se preocupar ainda com o sujeito que cometeu o ato delituoso e fazê-lo refletir sobre a sua conduta, adotando medidas educativas e acompanhamento social e psicológico de todos os membros da família. Os profissionais, que trabalham na área da infância e juventude, devem discutir intensamente tal problemática e atuar interdisciplinarmente juntos aos envolvidos que necessitam de atendimentos e de prevenção desse fenômeno.

Data from an Observational Study

Introduction Effective management and development of new treatment strategies for response fluctuations in advanced Parkinson’s disease (PD) largely depends on clinical rating instruments such as the PD home diary. The Parkinson’s kinetigraph (PKG) measures movement accelerations and analyzes the spectral power of the low frequencies of the accelerometer data. New algorithms convert each hour of continuous PKG data into one of the three motor categories used in the PD home diary, namely motor Off state and On state with and without dyskinesia. Objective To compare quantitative motor state assessment in fluctuating PD patients using the PKG with motor state ratings from PD home diaries. Methods Observational cohort study on 24 in-patients with documented motor fluctuations who completed diaries by rating motor Off, On without dyskinesia, On with dyskinesia, and asleep for every hour for 5 consecutive days. Simultaneously collected PKG data (recorded between 6 am and 10 pm) were analyzed and calibrated to the patient’s individual thresholds for Off and dyskinetic state by novel algorithms classifying the continuous accelerometer data into these motor states for every hour between 6 am and 10 pm. Results From a total of 2,040 hours, 1,752 hours (87.4%) were available for analyses from calibrated PKG data (7.5% sleeping time and 5.1% unclassified motor state time were excluded from analyses). Distributions of total motor state hours per day measured by PKG showed moderate-to-strong correlation to those assessed by diaries for the different motor states (Pearson’s correlations coefficients: 0.404–0.658), but inter-rating method agreements on the single- hour-level were only low-to-moderate (Cohen’s κ: 0.215–0.324). Conclusion The PKG has been shown to capture motor fluctuations in patients with advanced PD. The limited correlation of hour-to-hour diary and PKG recordings should be addressed in further studies