Market Reform in New Jersey and Quality of Care: A Cautionary Tale

As more than 40 states face present and projected deficits in their health care budgets, some legislatures are considering market-based reforms to control rising health care costs. This continues a trend begun in the 1990s that emphasized market competition over state regulation and mandates. However, little is known about the impact of many market-based reforms on quality of care. This Issue Brief evaluates the effect of one reform—the deregulation of hospital reimbursement rates in New Jersey—on one important outcome of care—mortality from acute myocardial infarction (heart attack). The findings serve as a reminder that cost-constraining reforms may reduce the quality of care, particularly for uninsured and other vulnerable populations

COMPTEL observations of the Virgo blazars 3C 273 and 3C 279

We report the main MeV properties (detections, light curves, spectra) of the Virgo blazars 3C 273 and 3C 279 which were derived from a consistent analysis of all COMPTEL Virgo observations between 1991 and 1997

COMPTEL observations of the blazars 3C 454.3 and CTA 102

We have analyzed the two blazars of 3C 454.3 and CTA 102 using all available COMPTEL data from 1991 to 1999. In the 10–30 MeV band, emission from the general direction of the sources is found at the 4σ-level, being consistent with contributions from both sources. Below 10 MeV only 3C 454.3 is significantly detected, with the strongest evidence (5.6 σ) in the 3–10 MeV band. Significant flux variability is not observed for both sources, while a low emission is seen most of the years in the 3–10 MeV light curve for 3C 454.3. Its time-averaged MeV spectrum suggests a power maximum between 3 to 10 MeV

Analytic Approaches for Causal Inference with Complex Multi-Component Interventions

Estimating the causal effects of complex, multi-component health interventions is a task with many challenges in measurement and methodology. This presentation profiles the methods being used as part of the PCORI-funded Project Achieve, a national study to estimate the comparative effectiveness of heterogeneous care transition programs designed to help hospitalized patients and their caregivers navigate care delivery systems effectively and return back to the community with optimal health and wellbeing

Automated, high accuracy classification of Parkinsonian disorders: a pattern recognition approach

Progressive supranuclear palsy (PSP), multiple system atrophy (MSA) and idiopathic Parkinson’s disease (IPD) can be clinically indistinguishable, especially in the early stages, despite distinct patterns of molecular pathology. Structural neuroimaging holds promise for providing objective biomarkers for discriminating these diseases at the single subject level but all studies to date have reported incomplete separation of disease groups. In this study, we employed multi-class pattern recognition to assess the value of anatomical patterns derived from a widely available structural neuroimaging sequence for automated classification of these disorders. To achieve this, 17 patients with PSP, 14 with IPD and 19 with MSA were scanned using structural MRI along with 19 healthy controls (HCs). An advanced probabilistic pattern recognition approach was employed to evaluate the diagnostic value of several pre-defined anatomical patterns for discriminating the disorders, including: (i) a subcortical motor network; (ii) each of its component regions and (iii) the whole brain. All disease groups could be discriminated simultaneously with high accuracy using the subcortical motor network. The region providing the most accurate predictions overall was the midbrain/brainstem, which discriminated all disease groups from one another and from HCs. The subcortical network also produced more accurate predictions than the whole brain and all of its constituent regions. PSP was accurately predicted from the midbrain/brainstem, cerebellum and all basal ganglia compartments; MSA from the midbrain/brainstem and cerebellum and IPD from the midbrain/brainstem only. This study demonstrates that automated analysis of structural MRI can accurately predict diagnosis in individual patients with Parkinsonian disorders, and identifies distinct patterns of regional atrophy particularly useful for this process

COMPTEL upper limits for Seyfert galaxies

The gamma‐ray emission of Seyfert galaxies has fallen far short of pre‐GRO expectations. No single object of this class has been detected by either COMPTEL or EGRET, and OSSE has detected only a fraction of the Seyferts expected. To derive a more stringent upper limit to the emission from these objects in the energy ranges 0.75 to 1 and 1 to 3 MeV, we have summed a large number of COMPTEL observations acquired during Phase 1 of the GRO mission. From a total of 47 observations of 23 individual X‐ray selected Seyfert galaxies, we derive preliminary upper limits of 8×10−8 photons/(cm2 s keV) in the 0.75‐1 MeV band and 1×10−8 photons/(cm2 s keV) in the 1‐3 MeV band

X- and gamma-ray observations of the 15 November 1991 Solar Flare

This work expands the current understanding of the 15 November 1991 Solar Flare. The flare was a well observed event in radio to gamma-rays and is the first flare to be extensively studied with the benefit of detailed soft and hard X-ray images. In this work, we add data from all four instruments on the Compton Gamma Ray Observatory. Using these data we determined that the accelerated electron spectrum above 170 keV is best fit with a power law with a spectral index of −4.6, while the accelerated proton spectrum above 0.6 MeV is fit with a power law of spectral index −4.5. From this we computed lower limits for the energy content of these particles of∼1023 ergs (electrons) and ∼1027 ergs (ions above 0.6 MeV). These particles do not have enough energy to produce the white-light emission observed from this event. We computed a time constant of 26+20−15 s for the 2.223 MeV neutron capture line, which is consistent at the 2σ level with the lowest values of ∼70 s found for other flares. The mechanism for this short capture time may be better understood after analyses of high energy EGRET data that show potential evidence for pion emission near ∼100 MeV

MeV measurements of γ-ray bursts by CGRO-COMPTEL: Revised catalog

The imaging COMPTEL telescope has accumulated 0.1–30 MeV spectra, time-histories, and positions of more than forty γ-ray bursts within its ∼3 sr field of view in the eight years since its launch. CGRO-COMPTEL measures in both imaging “telescope” and single detector “burst spectroscopy” mode. In an ongoing collaboration with BACODINE/GCN, bursts are imaged automatically, with localizations relayed to a global network of multiwavelength observers in near real time (∼10 minutes). We have updated our burst search procedure in two ways: 1) using more sensitive search algorithms; and 2) using data from more detectors. The first are double change-point algorithms. With these we can find regions of significant excess flux with no assumptions on the wide range of burst time-scales (e.g., rise-times or decay-times) or intensities, and only one adjustable parameter (the time-averaged count-rate of the detectors). This makes it simpler to combine information on burst time-histories from the larger effective area (but cruder time bins) burst spectroscopy detectors, and hence better pinpoint the best times for imaging each burst. We report the eight bursts detected during 1998–1999